Introduction
Marriage is one of the most desired institutions
in Nigeria today. Young people, especially women,
dream about and yearn for the day they will walk
the aisle to the alter on the arms of the man
of their dreams; and with the hope of a happy,
serene and secure life ever after. But the
marriage bed can also become the death bed,
with more people (especially women) getting infected
with the human immuno- deficiency virus (HIV)
within the context of marriage. Thus, the marriage
institution is becoming a huge threat to public
health security. Yet, events that take place within
a marriage are usually relegated to the private;
firmly shut off from public scrutiny.
The situation is further complicated by the religious
and cultural injunctions that dictate and prescribe
acceptable modes of sexual behaviour especially
for women. Thus, women experience a diversity
of challenges which they must face and negotiate
within the constraints (or freedoms?) of their
individual cultures and traditions.
The paper acknowledges the need to promote and
document aspects of African cultures that protect
women’s right to healthy and pleasurable
sexuality within and outside marriage. It is also
important, the paper argues, to bring into the
open, and if need be peer through the keyhole
into even the most private of private spheres
to bring into the public health domain, sexuality
and gender issues in marriage that impinge on
women’s rights and increase their vulnerabilities.
This is especially necessary if policy and programming
is to effectively address the complex and diverse
factors that fuel the vulnerabilities of women
within the marriage context.
Marriage
Marriage is defined as the “socially recognised
acceptance by a community of the uniting of two
individuals in a permanent sexual and family relationship
as husband and wife. Their emotions and attentions
are focused on each other, but their roles and
relationship are expanded if and when children
come”. [2] While this paper recognises the
existence of various forms of unions, it will
focus on the heterosexual union.
Setting the Scene
HIV is accentuating the vulnerabilities of women.
“In sub-Saharan Africa, women represent
60% of those infected with HIV and 75% of those
infected are between the ages of 15 and 24…Worldwide,
80 percent of women newly infected with HIV are
practicing monogamy within a marriage or long-term
relationship. Sadly, their husbands and partners
are not…married women in sub-Saharan Africa
have one of the highest HIV prevalence rates…
Promoting abstinence or fidelity will not protect
them from HIV, since it is often their husbands
who infect them …[3] (Emphasis added.)
“…that the greatest risk of sexually
transmitted diseases (STDs) to women in Africa
is provided by their husbands and other unstable
partners has long been established”. [4]
“Contrary to the view of African women
as helpless victims, most women we spoke to saw
themselves as active participants in the search
for a way to protect themselves in sexual situations.
Nevertheless, their methods of sexual negotiation
are shaped by cultural and historical perceptions
of the bounds of the human body…Among some
groups… a woman can insist that a man use
a male condom, and she can withhold sex if he
refuses. Among other groups, a woman’s request
that her partner use a male condom is seen as
a challenge to his authority”. [5]
A Peculiar Silence
Sexuality issues are often shrouded in silence
and secrecy. The sexual relationship in marriage
which is considered sacrosanct is not only shrouded
in secrecy but often takes place behind firmly
locked, bolted doors and under cover of darkness.
Religious and cultural injunctions as well as
wise sayings abound that warn against the consequences
of discussing marital problems and issues with
a third party. Often, by the time a couple in
a marriage relationship discuss their problems
with a counsellor or religious leader, the issue
most probably has deteriorated to alarming proportions.
The silence deepens with the construction of
marriage as both inevitable and as a period of
relative safety and security as far as HIV is
concerned. This notion serves as a smokescreen
that successfully obscures the particular vulnerabilities
to infection arising within marriage situations.
A Peep into the Bedroom Space
Sexuality is an important and powerful force in
the human life cycle evincing strong and intense
emotions such as love and hate and inspiring the
expression of affection and care, giving, tenderness,
selflessness and ultimately allowing one person
entry into another’s most intimate of spaces
in the act of sexual intercourse. According to
Weeks and Hof, “… sexual expression,
especially the act of intercourse, is one of the
most vulnerable interactions that a couple undertakes.
The experience of lying nude …in the process
of giving and receiving pleasure is a most vulnerable
state. At no other ordinary time in the life of
a couple are they more vulnerable”. (Weeks
and Hof, 1987: 24-25. Emphasis added). [6]
This vulnerability is further heightened within
the context of marriage which comes with a signed
and sealed package of expectations usually dictated
by an individual’s or couple’s cultural
and religious social environment. Within this
ambiguous and complex setting, further complicated
by the esoterics of love, marriage ties, vows,
loyalty, and children; in addition to the often
quite rigid boundaries set by their familial,
cultural and religious affiliations and obligations,
women must make decisions (based on the knowledge
they have ) about what they perceive as theirs
and their children’s best interest. The
conflict of interest and tensions that characterise
this decision-making can be quite intense. Thus,
while the decisions that guarantee her safety
might appear quite obvious to an independent onlooker,
individual women’s action or inaction may
expose them to risks that may eventually cost
them their lives; further exposing the very children
they may have sought to protect.
The reality is that women constitute the higher
percentage of poor and are more implicated in
child-rearing and caring. Because they are often
dependent on men, this affects their ability to
negotiate on health and other issues. Even in
cases where they are not dependent on men and
have the capacity to be self-sufficient, they
are often no more empowered to negotiate safer
sex or demand fidelity from their spouse.
In the many African contexts, marriage often
involves not only the two individuals and their
children (as the definition implies) but their
extended family and even the clan and village.
Thus, though the marriage is undeniably between
two people, there is need to conform or to be
seen to conform to acceptable cultural and traditional
behaviours and norms. Refer to scenarios 1 &
2 below.
Scenario 1
“… Modupe, a young woman from Ibadan…discovered
that her husband was having sex with prostitutes.
She did everything within her power to make her
husband stop but to no avail… she decided
to stop having sex with him. Her husband reported
her to the elders of his family. Modupe was asked
to choose between divorce and satisfying her husband’s
sexual demands”.[7]
Scenario 2
Describing the pains encountered by women who
enter into multiethnic marriages in Nigeria in
a chapter of his book dealing with the negative
and destructive influence that relatives wield
on a marriage within a culture where “a
man is on the throne, sitting on a palace seat
that is made of women”[8], John Ibekwe
tells the story of Rachel. Rachel is a Nigerian
woman who entered into a marriage with Olu, from
another ethnic group. Rachel was enthusiastic
for her marriage to succeed and did all that was
necessary to learn the new recipes, the dance
and other aspects of her husband’s culture.
But barely one year into the marriage, she and
her husband decide to spend Christmas vacation
at his home town where he eventually leaves her
with his parents and returns to work in Abuja
at the end of his leave. Rachel begins to encounter
some resistance from her in-laws. Ibekwe writes
“the handwriting on the wall was becoming
visible. Rachel knew that prolonged argument would
bring more friction and worse still, a less favourable
disposition of the mother-in-law to her. She wrote
her husband…” Meanwhile, Olu’s
mother had sent relatives and friends to persuade
him to leave “…this alejo [stranger]
or Abuja wife and choose a new wife from the village.
In fact, she claimed that a new one had been prepared
for him to marry...”
Ibekwe, a medical doctor observes: “I
met Rachel a year later while investigating the
cause of a chronic cough… It was diagnosed
that she had pulmonary tuberculosis”.
Later diagnosed with HIV, the doctor says, “Her
tears were so heart-rending that I could not help
but inquire into her past life. It was then that
the above story came to light”. He
concludes: “Even when the couple is
determined to brave the storm, the immediate environment…society
will act in diverse ways to break that relationship”.
Many of the factors that have been documented
that heighten women’s vulnerability to HIV
within the context of marriage are a result of
the gendered power relations whereby men as household
heads and decision-makers are also in control
of sexual relationships. It is also true that
women within the existing socio-economic and power
structures are largely unable to refuse sex and
are unable to force their spouses to be faithful.
In most cases they cannot and sometimes do not
expect fidelity from their husbands. Culturally,
wives are expected to provide sex-on-demand, regardless
of their own feelings and needs. They are socialised
within a framework that says, if you refuse your
husband sex, you are pushing him into the ready
and waiting arms of other women who are more beautiful,
younger and available.
Not as Easy as A-B-C
The question is, how are these realities and women’s
vulnerabilities in specific situations reflected
or recognized in approaches such as the A –B-C
of HIV prevention which says Abstain,
Be faithful or use a Condom?
Within the context of marriage and some of the
scenarios painted above, a married woman has no
power to abstain. If she attempts this like Modupe
did, she is likely to be shown the door - forced
to choose between divorce and satisfying her
husband’s sexual demands.
Be faithful? She is not the unfaithful
one even though in some circumstances, the woman
could be the unfaithful partner. The truth is,
she does not have the power to stop the husband
from keeping mistresses or from marrying other
wives; as polygamy is still largely acceptable
for men. Condomise?
The condom domain is also controlled by the man.
The female condom, as ‘empowering’
a tool as it presents in the hands of women, is
still not as effectively marketed as the male
variety; and questions of availability and access
are still daunting issues within the context of
Africa.
Gender Dynamics in the Bedroom
Let us take a peep into the bedroom for the last
time. Mrs. J. suspects or knows that her husband
is having sexual intercourse with one or more
women besides her. She is afraid of contacting
HIV. Though she runs a local grocery store and
earns some income, the man is paying the house
rent and school fees for the children and paid
a heavy bride price during their traditional marriage
ceremonies. Besides, Mr. J is a well-respected
political and religious figure. In fact, she is
the envy of the women in the community.
She is in the bedroom with her husband of seven
years. The door is bolted and the lights are out
or dimmed. Their three children and other members
of the extended family are in adjacent rooms in
their small flatlet. She is worried and not really
interested in sexual intercourse. She has been
dreading the moment not knowing which way he will
react if she brings up the subject of his infidelity
(she has no proof anyway). She is in her flimsy
night wear or lying naked in bed and her husband,
a big man who has been especially nice to her
that evening has wrapped his arms around her naked
body in a bear hug; she can already feel the strength
of his fully erect penis. What does she do? (1)
jump out of bed with a warlike shout of “I
abstain”? Suddenly jump out of bed and grope
for the pack of condoms she bought from the local
patent medicine dealer (who had looked at her
in speechless wonder), and tell her husband “Eh
honey. Let me put this around your penis because
I suspect that you have been unfaithful”?
Or better still, she shoves the husband away,
turns on the light and reads a speech she has
prepared on the need for husbands to be faithful
to their wives.
Conclusion
Though marriage has been conceptualised as a strictly
private and confidential sphere, and a relatively
safe domain as far as HIV infection is concerned,
there is a need, with the increasing infections
taking place within the marriage institution,
to debate and bring into the open, the issues
and factors that increase vulnerability of both
men and women within marriage relationships. This
is in order to evolve more effective and workable
policies and programmes. There is need for more
engagement between researchers (especially those
involved in qualitative research) and practitioners
in the field of bio-medicine as well as those
in the social and behavioral sciences working
on sexuality and sexual health in order to enrich
and strengthen information, knowledge, programmes
and their implementation and bridge the gaping
disconnect between policy and lived realities.
Public health education programmes on HIV and
AIDS must be based on researched and lived realities
of the targeted populations.
References
1. Adapted from a presentation made at the 2nd
Annual Scientific Conference of the National Postgraduate
Medical College of Nigeria with the theme - Health
Security in the 21st Century: Challenges Facing
the Nigerian Health System – and held at
the Sheraton Lagos Hotel and Towers, 12 -13th
September 2006.
2. Westheimer R.K (2000) Encyclopedia of Sex.
New York: The Continuum International Publishing
Group, P. 172.
3. Helene Gayle, President and CEO CARE (September
6, 2006) Written Statement before the US House
Committee on Government Reform. Subcommittee hearing
on “HIV
Prevention: How Effective is the President’s
Emergency Plan for AIDS Relief (PEPFAR)?”.www.alertnet.org/thenews/newsdesk/N06171573.htm
(viewed on 08/09/06)
4. P.O. Ogunjiyigbe and E.O. Adeyemi (2005) “Women’s
Sexual Control Within Conjugal Union: Implications
for HIV/AIDS Infection and Control in a Metropolitan
City” in Demographic Research.
Vol 12, Article 2, P.10.
5. Ida Susser and Zena Stein (2004) “Culture,
Sexuality, and Women’s Agency in the Prevention
of HIV/AIDS in Southern Africa” in Ezekiel
Kalipeni et al. HIV/AIDS in Africa : Beyond
Epidemiology. Malden: Blackwell Publishers.
6. Gerald R. Weeks and Larry Hof (1987) Integrating
Sex and Marital Therapy, Brunner-Routledge,
London, pp.24-25.
7. C.O. Isiramen, “Women
in Nigeria: Religion, Culture and AIDS”
, International Humanist and Ethical Union,
www.iheu.org/node/979 (viewed 08-09-06)
8. Ibekwe J. (2002) “Influence of Relations
on Marriages” in To Live or to Die?
Ibadan: Spectrum Books Limited, pp 128 –
133.
