On Sexuality and Sexual Health

Do you consider yourself a sexual being?
Crépin Djemna who has been positive since 1998 responds with an emphatic ‘yes’. “Yes, As long as I have sexual desires and libidinous instincts and as long as I have sexual intercourse which I derive pleasure from; I think it is necessary to admit that I am a sexual being. Asunta Wangura affirms: “Of course I am a sexual being because I am a product of good sex and I practice the same”.

Chouchou explains further, “The HIV diagnosis or result generates more or less a transitory loss/disappearance of sexual feelings, a degradation of the body image, self esteem and difficulties in maintaining a satisfying, long-term relationships. Having experienced all these emotions and problems, knowing that I have some interest in sexual relations or intercourse, it is obvious that I am a sexual being” .

How can you describe your sexual life as a person living with HIV?
“The sexual life of a person living with HIV is not very free and does not always satisfy my desires - with regard to the choice of my partners as well as the manner of love making. There is also the constraint arising from the responsibility one must display in an endeavour to limit the risks of re-infection”, Djemna notes.
Wangura explains: “When first diagnosed, I considered sex dirty and blamed it for my fate. I suppressed this need for long until I could suppress it no more and openly declared I am a human being with sexual needs and feelings which need fulfilment without apologies to anyone. I decided I did not need to offer any explanations; it is my right, irrespective of my HIV status. So I lead a full sexual life.

	Crépin Djemna

The situation is even more difficult for women says Chouchou: “The sexual life of a PLWHA is very difficult especially for HIV positive women. It does not suit our desires. It makes one the object of a strict regulation which chooses those who are permitted to enjoy sexual acts and which partner they can be with.

What do you understand by responsible sexuality? In what ways can a PLWHA live a responsible sexual life?
“For me, responsible sexuality, is one in (the course of) which the risks of infection and re-infection are limited whether one’s partner is HIV positive or negative; this is sexuality that respects fidelity to one’s partner. On the other hand, one must not lose sight of the desire to have a child and the fact that a child requires a lot of attention” , Djemna observed.

According to Wangura, “Responsible sexuality involves not exposing yourself or your partner to sexually transmitted infections (STIs). Always, a consensus must be reached between the two parties and sex should be a component of a broader partnership or relationship - the icing on the cake”.

“I believe” says Chouchou that “responsible sexuality is one in which desire and pleasure are inscribed on true and genuine standards of good behaviour, bearing in mind the need to fight against HIV and other STIs, and avoid re-infection at all cost. I think that in all, fidelity is critical”.

Chouchou observed, “I once expressed interest in having a baby, in spite of my HIV status and I was criticized all around. The view is that a PLWHA should not think along those lines because having a baby involves sexual intercourse. And sure, I confirmed I would go the natural way of conception. So many reasons were given why I should not. I was firm that I was going on with my plan because it’s about my life and I have only one life to live”.

How do you ensure that you derive sexual satisfaction and pleasure from your sexual life and sexual relationships? What are the major challenges you face?
“I derive sexual satisfaction because it’s a subject I discuss openly with my partner without pretence or hypocrisy and so we have 50-50 share in the enjoyment. In any case, because this is what I want, I ensure that I get exactly what I want from intercourse. I am not there to please my partner neither is my partner there to please me… My challenge initially centred around the age gap between my partner and I. my partner is 11 years younger. But that has been resolved. Challenges are more from outsiders who feel we shouldn’t be that way”, says Wangura.

As far as Djemna is concerned, “the acceptance of one’s HIV status is a non-negotiable condition necessary to experience sexual satisfaction. To feel loved, understood, supported and accepted guarantees, to a certain extent, satisfaction and pleasure in life and sexual intercourse”.

“Imagine”, says Chouchou, “a scenario whereby a HIV positive woman is with a negative partner. Condoms appear to symbolize guilt. The partner is bound to entertain the fear that she will inflict him (with it)”.

Please describe in your own words what it means to “live positively” in the part of Africa that you live
“Living positively is in a way the acceptance of one’s status”, says Djemna. He adds, “It is a life in which one must overcome the prejudices that bring about stigmatization, rejection and discrimination; a life in which a person is self assertive and has self esteem. It means adapting to the environment to the extent that one experiences a pronounced ease in daily activities.”

Chouchou reiterates the point made by Djemna. She says : “Living positively is accepting your HIV status, accepting and loving yourself the way you are, developing self-assertiveness and self-esteem. Get rid of stigmatization, discrimination, prejudices and rejection. Adapt yourself to your environment. Develop your personality, abilities and potentials”.

Challenges and Strategies

What are the main challenges that you have encountered and how did you overcome them?
“The acceptance of PLWHA by the community and the ability to adapt to the environment are the major challenges we face” Djemna says. He adds: “To confront and successfully overcome these challenges requires profound awareness. One has to improve one’s psychological strength, acquire knowledge and develop skills in areas such as: self assertiveness and self esteem. There is need to take cognizance of the new life one is called to live and abide by the concepts and guidelines of this new life”.

Chouchou says, “stigmatization and discrimination by the community and non-acceptance by my family were some of the challenges that I faced. The other problem was adapting to my new life”. She advises, “accept yourself, find support from a close relative, then, maintain a good sense of humour and open yourself to new experiences. In short, be resilient”.

Programmes and Policies that Promote the Rights of PLWHA

What particular policies would be important to protect the sexual rights of PLWHA? Please indicate whether such policies are in place in your country
“I think it is important to have a policy that protects and respects the choices and sexual practices of each individual” says Djemna who is from Cameroon. “Unfortunately, in our country, certain choices and sexual practices are considered as deviant, others as illogical behaviours which are condemned. Moreover, a national legal and judicial framework to protect PLWHA in particular does not exist”, he adds.

Chouchou, also a Cameroonian observes, “In my country, to respond to the HIV pandemic, the government has set up a multi-sector policy. Unfortunately, the constant fact is that the individuals in charge of the implementation and management of programmes focus more on their personal interest than on the goals of the policy. The distribution of grants does not take into account the efficiency of existing structures or support groups but rather, human relationships. All these lead to mismanagement and misuse of allocated funds and, consequently, the failure of the policy”.

Chouchou continuing her argument further notes that the focus of HIV/AIDS programmes has shifted from a focus on providing prevention information to treatment access. She insists that “there is still a real need for information and sensitization in many localities in the rural areas. These sensitization activities are almost exempted from grants provided today. It is a question of taking account of local realities in the design and management of community action plans”.

Please provide any other information or experience you would like to share
Djemna explains that the systems that have been established to take care of PLWHA activities are good but “there is a real problem with implementation and follow up. Persons living with HIV and AIDS are not very involved in the formulation of policies and there is a very big gap between the policies and their implementation”.

Djemna further explains that while there are many actors in the HIV/AIDS work, , “the majority fight for HIV not against it. Funds mobilized for campaigns against AIDS have become a big public cake where everyone takes their share; the size depends on their power, influence and importance. In fact, AIDS itself causes less havoc and damage than the clash of interest around the financing of the programmes…”.