Safe Sex Communication, Practices and Risks of Married Women to HIV/AIDS in the Evangelical Churches of Addis Ababa, Ethiopia By Aelaf Habte

Background Sub-Saharan African countries are places where more new HIV infection, AIDS death and number of people living with HIV is reside in. In 2010, about 68% of all people living with HIV resided in sub-Saharan Africa, even though it accounts only 12% of the global population. The majority of people living with HIV in this region are women: which means more devastation and load for them.

Ethiopia, one of the Sub-Saharan Countries, is estimated to have 1,216,908 million PLWHA in the year 2010 out of which, 717,669 are women. Addis Ababa region (the capital) has 210,306 number of PLWHA in 2010 having huge numbers of women living with HIV (124,609).

Around the world, women and children are vulnerable to many things that trouble their social, economical and health life. In the case of HIV as well, the population of women is at a great risk in acquiring and facing the virus.

The traditional assumption that goes behind marriages is that men and women are protected from all sorts of troubles when they are under the institution of marriage, especially HIV.

However, opposite to such an assumption, Many studies indicated that women who are married or are under a long term monogamous relationships are at a greater risk for HIV. Significant numbers of researches indicate that marriage is not a “safe place” in the pursuit of prevention from HIV and AIDS risks.

Married women are more in danger as low negotiation about safer sex, lack of communication and decision making, fear of partner violence, economic dependency, and failure to get an HIV test make them put them at risk. If married women are infected with the virus, a family cannot stand, the likelihood transmission of the virus from mother to child will be high, even worse generation will cease, development of a nations will be unthinkable.

General Objective The overall objective of the study was to examine the culture of communication about safe sex, the practice of safer sex and to assess the risks of married women in Addis Ababa Evangelical Churches.

Specific Objectives Examining the communication about and practices of safer sex behaviors among married women. Identify the reasons for practicing/ not practicing safer sex among married couples in Ethiopian context. Assess the risks of married women to HIV infection in the context of the Ethiopian Evangelical churches.

Methodology Study was done in Addis Ababa Evangelical Church Fellowship of Ethiopia (ECFE) is a fellowship of different denominations, which currently has 39 evangelical denominations as a member. From the 39 denominations, Ethiopian Kalehiwot church, Ethiopian Meserete Kristos church and Ethiopian Mekaneyesus church were chosen to be representatives of other evangelical churches in Addis Ababa making use of purposive sampling. This is because, they have large number of local churches and members in Addis Ababa.

Making use of simple random sampling, one local church that represents each denomination was chosen by giving an equal chance to each local church to take part. Representative participants of married women were selected from each local church by using Availability sampling in order to get as much participant as possible in a given short period.

The number of participants selected for the quantitative study was 150 married women from the three local congregations. The number of participants in the qualitative study was 8 Christian married women. Snow Ball method was used to choose HIV positive, married, and Christians women for the interview.

In this study, mixed method of data collection was used. The quantitative method was used by administering structured questionnaire. Furthermore, the questionnaire also included 8 Open ended Questions that ask for personal experiences of married women regarding safe sex practices, HIV testing and perception of spouses’ risk to HIV.

For the qualitative method, semi- structured interview questions were applied to support data collected through quantitative method.

Result More than 81% of the participants were from medium level economic class while, more than 28% accounted to have no occupation. 54.7% of the women were with non-functional literacy.

Communication About Safer Sex Of the total respondents, 52.1% claimed that they have no decision-making power over the practice of safe sex (condom use) in their marriage. It was found that, decision making power of women in marriage is predicted by age, occupation, educational status, and marital longevity. Lower educational and economic status showed less decision making and communication. Communication about sexual risks predicts the less likelihood of engaging in unsafe sex.

In contrast, 47.9% said they have the ability to decide regarding safe sex (using of condoms) in their marriage. Their reasons to initiate condoms include:-  desire to be free from HIV,  avoiding perceived risks and  prevention of pregnancy. This group indicated that, they insist on the using of condoms when they are doubting the faithfulness of their husbands.

HIV testing Only 13.7% of the married women have tested together with their partners while, more than 18% has never been tested at all. Reasons for this include:  Total ‘Trust’ in the marital institution.  Belief that married couples should not get an HIV test even though there is a doubt about each other's faithfulness. “It would be inappropriate to ask my husband to get tested.”

Practices of Safe sex Only 13.7 % of the participants practice safer sex and this is mainly to prevent pregnancy. This shows that only a small number of them has ever used or are practicing condoms as prevention from HIV and other STIs.

On the other hand, 86.3% do not practice safe sex. Reasons include :- o not being aware of risks, o perceived trust in the institution of marriage, misconceptions about condoms “Condoms are only for adulterers and for those outside of marriage.”

In the same way, data from the qualitative method indicated lack of communication about safe sex and perceived risks, prohibited the practice of safe sex and getting an HIV test. The study revealed that economic dependency is one of the reasons why married women could not negotiate about safe sex practices and insist on getting an HIV test with their risky husbands.

Conclusion It was found that married women do not communicate about and practice safer sex behaviors. In the Ethiopian Evangelical Christian married women context, different reasons were mentioned for not practicing safer sex as: marital longevity, lack of decision making about condom use, inflated trust in monogamous relationship, and both lower economic and educational status.

In addition, the study showed that married women are at risks of contracting the virus because they lack of decision-making, communication and resistance of unsafe sex in their marriage. Reasons for their powerlessness were uncovered to be, economic dependency, not being educated, and fear of violence e.t.c.

Recommendations Though, it is good that Evangelical churches in Africa are teaching the value of marriage & its sustainability, they must also acknowledge the existence of patriarchy and the risk of married women to HIV infection & work towards addressing it. One way of making women as decisive as men is by empowering them, building their capacities thereby making them economically independent by government bodies, faith based organizations and concerned nongovernmental organizations.

As women’s right, married women must as well be beneficiaries of prevention packages regarding HIV just as the other parts of the society. Thus, prevention efforts must go until grass root levels and address lower class married women and those who are economically dependent on their husbands.

Let’s Join Hands Towards the Prevention of Married women from HIV.