Twin Pandemics in Rural Uganda: Intimate Partner Violence and HIV
Intimate partner violence (IPV) not only violates a woman's rights to fundamental freedoms, it increases her risk for HIV and other STDs, negative reproductive health outcomes and reduced quality of life. Fatimah (not her real name), for instance, was sold into marriage when she was 15. Her husband, a 40-year-old polygamous man she had never met before their wedding day, routinely forced her into sex and physically beat her when she resisted. She quickly became pregnant, but due to her small size and inability to access health care, she had a difficult, prolonged labor, resulting in her baby's death and her own incontinence. This brought shame to the family, so Fatimah's aunt helped her travel to the district headquarters for medical treatment. On this visit she learned she was HIV positive. Despite having only just turned 16, Fatimah felt little hope for her life, and she represents one of the many women in Uganda affected by the twin pandemics of IPV and HIV and for whom the Safe Homes And Respect for Everyone (SHARE) Project was developed in 2005.
The SHARE Project is coordinated by a five-person team that operates under the auspices of Rakai Health Sciences Program in four regions of the southwestern Rakai District. SHARE aims to prevent IPV by transforming community attitudes about women's status in society and the acceptability of violence against women. SHARE uses multiple strategies to reach different types of people at all levels of society, including outreach, advocacy, health education, local activism and capacity building. Above all, SHARE's success weighs heavily on the commitment of approximately 50 resident volunteers throughout the operational areas. These men and women spearhead all project activities and serve as liaisons between SHARE staff and the community.
It is possible that the single largest challenge to our work has been the extent to which attitudes about women's subordinate status and the acceptability of IPV are normalized. Previous research from the setting indicated that 70 percent of men and 90 percent of women feel that partner violence is justifiable under certain circumstances (Koenig MA, Lutalo T, Zhao F, Nalugoda F, Wabwire-Mangen F, Kiwanuka N, Wagman J, Serwadda D, Wawer M, Gray R. Domestic violence in rural Uganda: evidence from a community-based study. Bull World Health Organ. 2003;81(1):53-60).
That more women condoned violence than men was not only surprising, but troubling. Throughout the first two years of the project, however, we've come to understand that women naturally harbor these beliefs, as they have learned nothing else throughout the course of their lives. Talking about women's rights and IPV during SHARE programming represented the first of this type of conversation for many, many girls and women. An alarming number of women had no idea that they had rights, let alone know what those rights were.
Fortunately, many women, as well as men, have been extremely receptive to the idea of change. In fact, they've seemed ready for it. Participation in SHARE activities has greatly increased over the course of the intervention, and community members are not only involving themselves, but initiating their own projects and community-based watch groups to keep each other in check. Although it is going to take a long time to realize large change, we feel positive about initiating this process of social transformation toward improved circumstances for women, men, girls, boys and the larger community.
Jennifer Wagman is the director of the Safe Homes and Respect for Everyone (SHARE) Project in Rakai, Uganda, and she works as a senior researcher programmer in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. She received her MHS in 1999 from the Bloomberg School's Department of International Health and is beginning the PhD Program in PFRH in the fall of 2008.
