To tell or not to tell: The story of persons living with HIV

The depth of love in a relationship is once in a while put to test when partners are confronted with the reality of the vows and promises they made to each other when they were head-over-heels in love.

It is in such times that true commitment to the various parts of the popular vow – “For better, for worse, for richer, for poorer, in sickness and in health, to love and to cherish, till death do us part – comes to play.

For two Persons Living with HIV, Aku and Mansah (not real names), their  love test was on health and what would happen to their relationships if they disclosed their statuses to their partners or otherwise.

HIV/AIDS

HIV is an abbreviation for the Human Immunodeficiency Virus which causes the human body cells that fights infection to become vulnerable to other diseases.

According to Dr. Seth Duncan, a Ghanaian doctor based in the UK, the virus spreads mainly through bodily fluids such as blood, semen, vaginal and rectal fluids as well as breast milk of an infected person.

He said one of the main ways which have been known to spread the virus is through unprotected sex.

Unfortunately, there is no cure for the virus and persons who have it rely on antiretroviral drugs to live healthy lives.

HIV, if left untreated, could develop into acquired immunodeficiency syndrome (AIDS) which is the end stage of the disease, where one’s immune system is compromised and loses its resistance against any disease, he said.

Data

Global data from the UNAIDS shows that 38 million persons were living with HIV in 2019.  In Ghana, where the virus was first detected in 1986, current data from the Ghana AIDS Commission shows that over 340,000 persons were living with HIV in 2019.

Majority of them (64 per cent), numbering 219,986 were females with the rest being males.

Adults (15+ years) were 316,352 (92 per cent) while Children (0–14 years) constitute 25,955 (8per cent).

Per the Commission’s fact sheet, 20,068 people were newly infected with Adults (15+ years) being 17,096, representing 85 per cent of the figure; Youth (15–24 years), 5,613; males 1,205 and females 4,409, representing 79 per cent.

The number of annual AIDS-related deaths was pegged at 13,616 with those involving adults said to be 11,175. Estimated National HIV Prevalence for adult was 1.70 per cent and the National Prevalence was 2.0 per cent.

Data from the World Health Organisation (WHO) estimates that only 52 per cent of persons living with HIV/AIDS in Africa disclose their status with the remaining not disclosing due to varied reasons, including the stigma that comes with contracting the virus.

Indeed, the fear of the unknown reaction from family and friends after such disclosures has metaphorically become another virus which is silently hampering the fight against the HIV spread.

The lives of Aku and Mansah are living examples.

Aku’s story

The 26-year-old lady has been living with her current partner for the past four years, and they have a six-month-old baby girl.

She got infected at the age of 20 when she was living with her ex-boyfriend whom she suspects infected her.

According to Aku, the relationship, which lasted for a year, was not without the usual gossip from people that her partner was cheating, something she frequently ignored until it became necessary for her to test for HIV.

‘’I tested negative for the first time and after three months I started seeing body rashes so there was a church screening where I offered to be screened again to be sure that I was negative,” Aku narrated.

She tested positive and was victimised by the leader of the screening team.

‘’The woman accused me of knowing my status and deliberately not disclosing it. My pastor was there and I had no option than to confide in him because I was embarrassed and stigmatised,” she uttered.

According to her, starting counselling and the antiretroviral drugs, was the worst period in her life.

“If I wasn’t a tough woman, I would have committed suicide upon getting home from the supposed counselling session because I couldn’t bear the shame and the words from the counsellor,” Aku stated.

To prevent further emotional trauma, she broke up with her boyfriend, whom she believed gave her the virus, without disclosing her status to him.

Aku never gave up on her antiretroviral drugs or her love life, but the latter was unstable as her next relationship was short-lived after she disclosed her HIV status.

It is against this background that Aku has not disclosed her HIV status to her current partner.

After four years of being together, she has not been able to brace the courage to disclose her status to him because of the fear of losing him. With the antiretroviral drug suppressing the HIV virus, she feels her man is protected.

Although Aku wishes there is a ring to seal their marriage, she is not ready to reveal her deepest secret which she believes will compel her to divulge when they need to tie the knot.

For now, she wants to keep enjoying the company of her ‘baby daddy’ while keeping her secret.

Aku’s story is like that of many females out there living with HIV/AIDS.

Mansah’s version

Mansah’s story is the opposite of Aku’s. The 35-year-old mother of two who has been married for seven years with two girls, has disclosed her HIV status to her husband.

She was diagnosed during an antenatal routine check when she was pregnant with her second child. Within a week, a family doctor helped to break the news to her husband and for the past four years, they have lived happily.

 “I have a very supportive husband who trusts me,” she said.

Mansah’s husband periodically tests to know his status and has since remained negative. Their marriage, she believes, has already passed the test of time and would survive no matter the odds.

Counselling for Persons Living with HIV

Stephen Atta-Gyamfi works as a counsellor in one of the major hospitals in the country’s capital.

He has served as a counsellor for persons living with HIV/AIDS for almost ten years and recounts his experiences for the past years.

He says HIV/AIDS counselling has changed over the period.

Initially, persons who tested positive were required to go for counselling with relatives or spouses who are described as monitors to serve as a check and a support system.

These persons were supposed to serve as their support especially during the therapeutic sessions.

In September 2016, the government of Ghana adopted the WHO policy of “treat all” – which is the provision of antiretroviral treatment (ART) to all persons living with HIV (PLHIV) irrespective of their CD4 count, which was previously used as a cut-off to start treatment.

With the adoption of “treat all”, there is the need for a scale-up of not just preventive services and HIV testing, but also of availability of antiretroviral treatment (ART) and viral load testing with or without monitors.

This new policy, Mr Atta-Gyamfi believes, has in one way or the other,  not helped in the disclosure as currently any patient who tests positive and is enrolled to start taking the anti-retroviral drugs can only be encouraged to disclose his or her status to partner.

According to him, the number of people who involve their partners keeps dwindling as the years go by.

Unfortunately, the coronavirus (COVID-19) pandemic may have compounded matters as counselling services to encourage persons living with HIV/AIDS was temporarily withdrawn and yet to be fully restored.

This made it impossible for counsellors to have a oneon-one interaction with their clients and also impossible to track the disclosure of new clients.

Low awareness creation

The Ghana Aids Commission is yet to validate and publish the 2020 HIV/AIDS data, but a report by a non-governmental organisation, Friends of the Global Fight Against HIV/AIDS, Tuberculosis and Malaria, has predicted that HIV/AIDS cases were likely to go up due to the low education and attention that has shifted from the disease to fighting the Covid-19 pandemic.

Awareness creation, which has been a major factor in the fight against HIV/AIDS, could be increased to champion the awareness on the virus and encourage people to open up to prevent stigmatisation.

The introduction of witnesses during counselling for the start of the anti-retroviral drugs could have contributed to the reduction in cases, in the past.

In as much as Covid-19 requires attention because it is a pandemic, it is important that we do not neglect all other viruses and diseases which could go a long way to affect the people.

The disclosure of HIV/AIDS status as much as have many positive impacts is not without the negatives. Some have suffered discrimination, stigma, abandonment, domestic violence and others which have become a barrier for those who decide to disclose their status like that of Aku.

With the introduction of the anti-retroviral drugs that has made HIV/AIDS more of a chronic disease, it is pertinent that disclosure of status especially to partners is encouraged to reduce sexual risks and also reduce transmission of the virus.

Ghana is still striving to achieve the United Nations Programme on HIV/AIDS 90-90-90 target, which aims at ensuring that 90 percent of HIV/AIDS positive people know their status, 90 percent of those diagnosed are on treatment and 90 percent of those on treatment are virally suppressed.

We can have more Mansahs in our communities and help reduce the prevalence of HIV/AIDS or countless Akus and have our cases soaring unexpectedly.

The latter would thwart all the efforts of the government and its local and global partners over the years to reduce the spread of the virus.

By Adwoa Adobea-Owusu

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