When positive and negative come together

Twenty years ago, Hassan* and Amina* sat in a counsellor’s room, staring at their test results in disbelief. They were just about to get married and these results could alter their destiny forever.

While that day they were gripped with fear and trembling, today they can smile about it. They are proof that a HIV-negative person can marry a HIV-positive partner and live happily ever after.

It all began in 1995. Hassan’s girlfriend of four years had just died, leaving behind two young children. He was lonely and in need of a companion and the most suitable girl was his childhood friend, Amina. He was 25, while she was 20.

Hassan’s hormones were raging, but Amina would have nothing of sex before marriage. To put him off, she told Hassan that she would only have sex with him after taking a HIV test.

Not one to give up, he declared that they should take the test immediately. He had nothing to fear – or so he thought. So off they went to Liverpool VCT in Kilimani, Nairobi. None of them had taken the test before and neither was ready for what they were about to learn: they were discordant.

“It was a whirlwind of emotions. I was extremely scared. Was I going to die? Would Amina still love me? Would she leave me for another man?” such were the questions that plagued Hassan’s mind.

OVERWHELMING

Meanwhile, Amina felt confused. “Here was the man I loved. A man I had known all my life. A good man. The man I wanted to marry… but what was I to do with this bombshell? It was overwhelming,” she recalls.

“What helped us make a decision was the intensive counselling we got. I learnt that I could still marry him and remain HIV-free by taking certain measures, and so I did. It wasn’t easy, but the counselling helped to allay my fears and give me confidence to stay with Hassan despite our discordant status,” adds Amina.

They went on to get married in October that year and got kids who are now 19, 13 and 11 years old, all HIV-negative.

Jane* and John* faced a similar fate in 2010. They had been dating since 2008. When Jane fell pregnant and went to the ante-natal clinic, she was asked to bring her partner so that they could be tested for HIV. They were discordant.

“I had shied away from HIV tests before out of fear, but I did not expect to be HIV-positive. I could not believe it!” she shares.

John took it in with restraint. “What helped, perhaps, was the many HIV peer counselling training sessions I had been attending for a while. In one of those sessions, I had learnt about discordant couples and how they could live together, but I didn’t expect it could happen to me,” he recalls.

After counselling they decided they would go ahead and get married because they loved each other, their discordant status notwithstanding. They have been together five years since then and have two children, a son and a daughter, who are HIV-negative.

However, what Hassan and Amina, and Jane and John did doesn’t come easy. While there are an estimated 260, 000 discordant couples in Kenya, according to the Kenya Aids Indicator Survey 2012, there are no hard facts on how these couples came to be discordant.

However, Churchill Alumasa, the director of Discordant Couples of Kenya (DISCOK) speculates that a big number get married while they are already discordant because they do not test for HIV before marrying or co-habiting, while the others become

discordant after marriage due to infidelity.

There are no figures for couples who knew they were discordant before marriage and decided to get married anyway, but if the results of an informal survey done for this feature (please see sidebar) are anything to go by, it is not an easy decision to make.

OBVIOUS CHALLENGES

“There are no guarantees,” said Faith, a 33-year-old master’s student, “Condoms burst ... you are not 100 per cent safe. I’d only marry someone with HIV if there was a vaccine.”

Leonora Obara, a programme officer at Women Fighting AIDS in Kenya, who counsels couples who are discordant, knows that when people are faced with this dilemma, the big question is whether they should remain together. While they don’t tell such a couple whether to stay together or part ways, they give them the requisite information to help them make an informed decision.

“For a person without information, marrying someone with HIV is a great risk, a death sentence, even, but if you get proper counselling on the modes of transmission and prevention, on interventions like ARVs, condoms and how to get babies without the negative partner or the babies contracting HIV, there is nothing to stop you from getting married.” she says.

Nevertheless, this kind of relationship comes with obvious challenges. First being the sex and all the fears of infection that surround it.

“We have a normal sex life, sex a couple of days a week, but we have to use condoms every time. Amina doesn’t like it, but I wouldn’t dare have sex without one. I wouldn’t want to do anything to harm her because I love her so much. I can’t compromise,” Hassan says as Amina nods.

As for Jane and John, at the beginning, John suggested that they stop using condoms because they had been having unprotected sex for months before they discovered they were discordant and he had not gotten the virus. At first Jane agreed, but after a few sessions of unsheathed sex, she became uneasy.

'MIGHT BE INFECTED ONE DAY'

“Initially condoms were a challenge because we were not used to them, so we decided to do without them, but I thought to myself, if we continue like this, one day he might get infected and he will blame me forever.

Sex without a condom became a very tense affair and we could no longer enjoy it. We had to go back to using condoms to be on the safe side and since then we have never had unprotected sex. Sex is the same with or without a condom. It is just as fun,” reveals.

Alumasa says there really should be nothing to fear when you put condoms and ARVs in the picture.

“The challenge is if the infected partner is not taking his or her ARVs and if the partners are not using condoms consistently as happens with quite a number of discordant couples. But if you do things right there is nothing to fear.

“For instance, among the discordant couples we’ve monitored since 1995 when we started DISCOK, only seven per cent of the HIV-negative partners turned positive, mostly because of infidelity or risky sex usually when they want to have a child and don’t

know how to go about it without putting themselves at risk. But if the couples are closely monitored by professionals, get counselling and support and encouragement, they do really well and stay together for years.

It is easy to protect yourself from the risk you know than from the risk you don’t know,” he asserts.

LIKELIHOOD OF CHEATING

There is also the likelihood that one of the partners may cheat. Jane and John also grappled with infidelity after an incident John blames on alcohol. This led them to separate for six months in 2013, but they reconciled after being counselled and being taught how to communicate effectively and support each other better.

The other challenge is how to get children. For this, Dr Patrick Oyaro the director of KEMRI’s FACES, a HIV prevention and care programme, says that if it is the woman who is HIV-positive, sperms can be harvested from her partner for vaginal

insemination. She also has to wait until the ARVs have rendered her viral load undetectable and time sex so that it happens during ovulation.

“There is also a plan to roll out pre-exposure prophylaxis (PREP) for the uninfected partners because this will make it even safer for discordant couples to protect the negative partner while they are trying for a child,” Dr Oyaro explains.

Thirdly, there is fear of stigma from parents – if they find out, they might want to break the relationship up to “save” the negative partner.

While all these challenges and fears are real, you can marry a HIV-positive person, remain HIV-free and have a happy marriage if you both follow the recommended measures. (See side bar) 

“HIV should not keep you from the one you love. It is just a condition that can be managed,” Hassan says.

HOW TO HAVE A HAPPY MARRIAGE AS A DISCORDANT COUPLE

1. Condoms – They provide 99 per cent protection if worn well (to prevent bursting) and worn consistently. For a natural feel, there are thin but strong condoms that feel like skin and all sorts of condoms to enhance pleasure.

2. ARVS – When taken consistently, they suppress the virus in the infected partner so it is not easily transmissible. ARVs reduce the risk of transmission by 96 per cent. When combined with condoms the couple can be at ease. The infected partner is also put on Septrin to prevent infection.

3. Health monitoring – The HIV-negative partner should be tested for HIV every three months and the health status of the HIV-positive partner should be monitored regularly.

4. Good health habits – Observe a healthy balanced diet, take the recommended supplements and avoid stress. Learn how to cope with stressful situations.

5. Getting children – This should happen when your viral load is undetectable. Time sex to coincide with ovulation. There are plans to roll out pre-exposure prophylaxis (PREP) for the negative partner during the period when you are trying to conceive. Enrolling into a ‘prevention of mother to child’  programme while pregnant helps to keep your child HIV-free.

6. Peer support – Attend support group meetings with other discordant couples to share challenges, work them out and learn from and encourage each other.

7. Continuous counselling – Consult a counsellor conversant with discordant couple issues regularly to help you cope with any emerging challenges as they crop up. Talk, talk, talk about anything that bothers you and come to an amicable solution. Resolve to support each other as partners.

8. Don’t make status an issue – Don’t attack the positive partner or put him or her down based on his or her status.

9. Understand HIV – Learn everything you can about HIV. Keep abreast with new information. Learn the side effects of ARVs and how they may affect your partner’s mood. Learn how to beat the beast.

***

Would you marry a HIV-positive person?

ACHIENG, 31, VOLUNTEER SOCIAL WORKER, SINGLE

Yes. It doesn’t matter if your partner has HIV or not, what matters is if he gets you and if he is trustworthy. If he is the best match for me, I’d marry him regardless of his HIV status.

MAINA, 29, IT SPECIALIST, SINGLE

Yes, but only if she did not get the virus as a result of promiscuity.

JOHN, 29, JOURNALIST, DATING

No. I’m not ready to live with fear. I’d forever feel exposed to infection. What if the condom bursts? No.

NYAMBURA, 40, SALES MANAGER, SINGLE

I can’t. Why should I? Positive and negative cannot mix.

DORIS, 35, AGRICULTURAL CONSULTANT AND SINGLE MOTHER OF ONE

Yes, if it was someone I have known for a long time and if he was taking visible measures to protect me.

DUNCAN, 27, ADVERTISING CREATIVE, SINGLE

No. I don’t think people take their ARVs religiously and that would put me at risk.

KEVIN, 30, ENTREPRENEUR, DATING

No. I don’t want to use condoms all my life.

POLLY, 29, SCHOOL TEACHER, SINGLE

No. I‘d be too afraid every time we got intimate even with a condom.

KATHEU, 30, COMMUNICATIONS OFFICER, SINGLE

Yes. Why should I discriminate? If you are well-informed about HIV and you love your partner, his HIV status will not be an issue.

WILLIAM, 26, SINGLE

Yes. I’d only break up with a person if we had different values, not because of her HIV status. If our values are aligned and we love each other, why not?

DINAH, 30, PERSONAL ASSISTANT, DATING

No. Even if I was the one who was positive and my partner knew my status and was okay with it, it would be irresponsible to put them at risk. You can’t even get intimate without fear.