A majority of discordant couples often separate due to the complexities associated with a HIV positive status including stigma, strained sex life, greater responsibilities and failed trust.
Discordant couples are those where one partner is HIV-infected and the other is not, where a couple is defined as two persons in an on-going sexual relationship and each of these persons is referred to as a “partner” in the relationship.
Leaving her marriage was the least of Jane Kariuki’s considerations after discovering that her husband of 15 years was HIV positive. Her husband, Simon Kariuki, acknowledges that his wife has been his source of strength in his journey living with HIV. Theirs is a story of patience, resilience and love, which has preserved their union despite Mr Kariuki’s HIV positive status. It is easy to see how happy they are together from how they talk about each other, their four children, the businesses they run together and the experiences they have been through as a discordant couple.
Getting tested and status disclosure
When Simon Kariuki was diagnosed with HIV in the year 2000, he made a bold decision that he will forever be grateful for. Mr Kariuki decided that his wife must also be tested for HIV and that she must know his status in order to plan the way forward with the right information. Fortunately for his wife Jane, her results turned negative, making them a discordant couple.
Mr Kariuki had been suffering from consistent colds and coughs and was at the hospital on a regular basis for almost two years. On this particular visit to the hospital, Mr Kariuki met a doctor friend who advised him to take a HIV test to rule it out as the cause of his illness. On receiving news of his positive HIV status, he knew that letting his wife know and encouraging her get tested too was the best thing to do.
“My husband informed me that he would like me to accompany him to the hospital to take a HIV test at the Voluntary Counselling and Testing (VCT) Centre. Being supportive, I agreed, knowing I was not the promiscuous type. I had also seen his appointment card, which required him to take a HIV test and therefore considered it a follow-up. I did not make a fuss about it,” recalls Mrs Kariuki. Little did she know that her husband already knew of his status and only sought to confirm her status as well as disclose his to her.
“The doctors had recommended that I stick to a healthy diet and adhere to my medication in order to safeguard my health. This was a drastic change and I figured that my wife should know my status, especially because I needed to be on a special diet and she had to understand why,” Mr Kariuki explains. “In addition, if we were going to start using condoms, it would be difficult to explain to my wife why things had to change,” he notes.
Mr Kariuki goes on to say that while it was difficult, he did not fear disclosing his status to his wife because keeping it a secret would not only expose her to the risk of HIV infection if she was negative, but it would also be difficult to adjust to the recommended lifestyle changes. Mr Kariuki was also aware of the possibility of rejection once his wife discovered his HIV status, but he was prepared for anything.
On accepting her husband’s status
Mrs Kariuki acknowledges that she had difficulty understanding why her husband was HIV positive while she was negative. However, she did not dwell much on laying blame on her husband. Given the little information available in those days regarding HIV, she could only picture her husband dying in the next few months; she felt sorry for him. She resolved to make maximum use of the few days they had together to show him her love. “I even passed by the market the same day we were tested to buy fresh fruits and vegetables so that I could start implementing the doctor’s instructions immediately,” she says. Mrs Kariuki has remained committed to taking care of her husband and in the process, made significant sacrifices to ensure that his health is well taken care of. Jane however admits that the counselling they received at the health facility played a significant role in her decision to stay with her husband despite his positive HIV status.
Challenges of a discordant couple
Jane and Simon Kariuki both agree that accepting the other partner’s status is a difficult undertaking. There is the feeling of betrayal on the side of the negative partner accompanied by many unanswered questions. On the other hand, the positive partner may feel guilty for putting his/her partner in this predicament. “It is difficult for such a union to thrive if there is no acceptance and understanding from each of the partner’s,” Mr Kariuki notes.
The issue of stigma also continues to affect discordant couples. As Mrs Kariuki notes, people in the community will always talk and this often gets to her, especially when people make mean remarks at social gatherings about people living with HIV. “There are many instances when my friends tell me what people in the community are saying about us. I have however learnt to ignore negative talk and focus on the positive,” she says. While she admits that it can be depressing, Mrs Kariuki has now learnt how to deal with hurtful remarks by using such situations as an avenue to educate ignorant members of the community on HIV.
Being discordant may also affect a couple’s sex life if there are trust issues.
Keeping the marital fire burning
Mr and Mrs Kariuki owe their union to the love they have for each other; noting that not many marriages between discordant couples survive. “If I did not love him, I would have left 15 years ago but I chose to stay despite his HIV status,” says Mrs Kariuki who also notes that her husband is very hardworking and supportive of her and children. “My wife has been extremely supportive, ensuring that I always take my medication, keep up with my appointments and eat healthy meals. She has never ill-treated me because of my condition and makes it her duty to make sure I am comfortable. I am even stronger than her and rarely fall sick so she is doing a good job,” says Mr Kariuki.
Support from their children has played a significant role in keeping their family together. “All our children know that I am HIV positive and this has ensured that they can understand why things are done in a certain way.” Mr Kariuki has made it his duty to educate his children on the importance of protecting themselves from HIV. “I recently took my last born son who is 15 years old for a HIV test before advising him that it was only by making the right decisions in life that he would be able to steer clear of HIV,” he says.
Mr Kariuki advises couples in similar situations to embrace and support each other because HIV is not a death sentence. He advises them to accept their status and work towards living positively. Positive partners should be careful not to infect their partners or others in the community and avoid alcohol as it affects self-control, adherence and may lead to irresponsible/poor decisions. Mrs Kariuki is of the view that as long as the positive partner has accepted his/her status, the other partner should provide the necessary support because they need all the love they can get.
CHS support for discordant couples
CHS supports discordant couples through continuous education on HIV, treatment adherence and psychosocial support. Through psychosocial support groups, members are taught about infection prevention, condom use, disclosure, alcohol and substance abuse and income generating activities. This has greatly improved relationships between spouses, enhanced adherence to treatment and promoted economic well-being of participants.
Through the CDC funded TEGEMEZA project, CHS currently supports 51 discordant couples support groups with 798 members across five counties in Central Kenya.