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I. SUMMARY

He used to force me to have sex with him. He would beat me and slap me when I refused. I never used a condom with him. . . . When I got pregnant I went for a medical check-up. When I gave birth, and the child had passed away, they told me I was HIV-positive. I cried. The doctor told me, “Wipe your tears, the whole world is sick.”

—Interview with Harriet Abwoli, Mulago, January 9, 2003.

Harriet Abwoli is just one of many women from diverse regions, ethnic groups, religious backgrounds, and economic classes in Uganda, whose experiences tell one story: that domestic violence has played a critical role in rendering them vulnerable to HIV infection. The human disaster of HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) has devastated the African continent, and disproportionately affects African women, who account for the majority of infected people in the sub-Saharan region.

The accounts in this report reveal that Ugandan women are becoming infected with HIV, and will eventually die of AIDS, because the state is failing to protect them from domestic violence. Domestic violence is a global phenomenon, and one of the leading causes of female injuries in almost every country in the world. For many women in Uganda, as in much of the world, domestic violence is not an isolated and aberrant act, but arises from and forms part of the context of their lives. Human Rights Watch interviewed Ugandan women who confront an environment that sustains unequal power relations, contend with persistent societal pressure to tolerate violence, and whose husbands and extended family routinely subject them to coercion and emotional abuse. Many women were victims of marital rape. Women were also powerless to protect themselves from infection and were unable to access HIV/AIDS services because their husbands physically attacked, threatened, and intimidated them, and did so with impunity. Although our interviews made clear that domestic violence was widespread, it is difficult to estimate the levels with accuracy, as government data are scarce. Despite a rhetorical commitment to women’s rights, the Ugandan government has failed in any meaningful way to criminalize, condemn, or prosecute violence against women in the home. To date, the Ugandan government has ignored the role of violence, and, in particular, unwanted sexual relations in marriage, in exposing women to HIV infection. Meanwhile, Ugandan women are dying.

Human Rights Watch interviews revealed that Ugandan women became vulnerable to HIV infection as a result of domestic violence in complex and intertwined ways. Most women saw domestic violence as innate to marriage, and viewed sex with their husbands as a marital obligation. Traditional attitudes that designate women as the physical property of their husbands deprived them of any authority over marital sexual relations. Customs such as the payment of “bride price” (payment made by a man to the family of a woman he wishes to marry), whereby a man essentially purchases his wife’s sexual favors and reproductive capacity, underscored men’s socially sanctioned entitlement to dictate the terms of sex, and to use force to do so. Violence, or the threat of violence, deprived women of bodily integrity by eliminating their ability to consent to sex, to negotiate safer sex, and to determine the number and spacing of their own children. In many cases, abandonment or eviction from the home held even greater terror for these economically dependent women, who, confronted by a hostile social environment, ignored their husbands’ adultery and acquiesced to their husbands’ demands for unprotected sex.

In an environment where the stigma of AIDS remains high, a fear of violence prevented many women from accessing HIV/AIDS information, from being tested for HIV infection, and from receiving HIV/AIDS treatment and counseling. Women attended HIV/AIDS clinics in secret, and were afraid to discuss HIV/AIDS with their husbands, even when they suspected that the men were HIV-positive and were the source of their own infection. Their in-laws evicted HIV-positive widows from their homes and stripped them of their property and means of support when they were at their most physically vulnerable. Their lack of economic autonomy hampered their capacity to escape abusive relationships, thereby exacerbating their vulnerability to violence and HIV infection.

Most of the women were in polygynous unions (marriage to a man with more than one wife). A number of these women were coerced into unprotected sex despite the heightened risks of HIV infection. Traditional practices such as widow inheritance (the “inheritance” by a man of his brother’s widow) exposed women to unprotected and unwanted sex with HIV-positive partners.

Uganda’s success in reducing HIV/AIDS prevalence has been globally acknowledged. Nevertheless, the government’s failure to identify and tackle the role of violence in the transmission of HIV to women is proving fatal to Ugandan women. Current approaches focusing on fidelity, abstinence, and condom use do not address the ways in which domestic violence inhibits women’s control over sexual matters in marriage, minimize the complex causal factors of violence, and incorrectly assume that women have equal decision-making power and status within their intimate relationships. The Uganda AIDS Commission has yet to incorporate violations of women’s rights, including domestic violence, in its HIV/AIDS programming.

To identify domestic violence as solely the product of custom and tradition simplifies a complex social problem. Spousal abuse is a result of, and reflects, prevailing economic, political, and social conditions. As a result, tackling domestic violence requires a strategy that goes beyond legal reform. However, laws proscribing domestic violence are essential to protect current victims of abuse, and to influence social mores. Uganda’s 1995 constitution has been rightly lauded for its gender-progressive provisions, and the government has made efforts to enhance women’s representation within its own structures. Nevertheless, representatives of nongovernmental organizations (NGOs) told Human Rights Watch that although Uganda is seen internationally as a progressive, pro-equality state, this image is belied by a close scrutiny of the laws and the realities faced by women at the grassroots level. The government has failed to pursue policies to eliminate violence against women, to provide women with equal protection of the law, to ensure women’s rights to the highest attainable standard of health, and, ultimately, to protect women’s rights to physical integrity, and to life.

Uganda has ratified international treaties requiring it to eliminate all forms of discrimination against women, including gender-based violence, and to act with due diligence to prevent, investigate, and punish acts of violence against women. Uganda’s constitution obliges the government to redress historical inequities and to provide women with equal rights in marriage and equal protection of the law. However, the government has failed to enact national legislation that provides for the effective prosecution and punishment of acts of violence against women. Inequitable divorce laws make it difficult for women legally to terminate their marriages. The government has yet to criminalize marital rape, which appears widespread. Draft legislation to regulate domestic relations and sexual offences has been pending since at least the early 1990s. (The “Kalema Commission” issued comprehensive findings on the laws of marriage, divorce, children and inheritance and some recommendations for their reform in 1965.) Women’s rights NGOs pressing for enactment of the draft laws have met with great resistance from numerous quarters of the government including the Office of the President. Although enactment would be an important step forward, none of the pending laws adequately address domestic violence. Plans for a specific domestic violence bill have been put forward, but the process has stalled.

A discriminatory legal framework is just one of the many obstacles that Ugandan women face in trying to escape abusive relationships. Women remain without adequate recourse to state protection whether through the police or the local courts, and contend with social stigma when attempting to prosecute their abusers. Biased officials, convoluted legal processes, and the imposition of official and unofficial “fees” hinder women at every step. The belief that domestic violence is a private concern that should not involve the state permeates all levels of the justice system, ensuring that perpetrators of domestic violence go largely unpunished. Women’s accounts revealed that government officials often responded to domestic violence charges by attempting to reconcile the parties and pressuring the women to return to abusive husbands. Few women had the resources or persistence to follow their complaints through to their conclusion. According to state prosecutors, only the most egregious domestic violence cases make it to prosecution. There are also serious failings in the collection of evidence, a lack of forensic resources in terms of equipment and personnel, and few viable alternatives such as shelters for battered women.

Domestic violence leading to a heightened risk of HIV transmission is a widespread phenomenon, and research similar to that reported here could have been conducted in any one of a number of countries. Obviously, not all Ugandan men abuse women, and domestic violence is just one of a number of factors that increase women’s vulnerability to HIV transmission. While the impact on women of the HIV/AIDS pandemic is at its most stark in sub-Saharan Africa, a similar trend is discernable on a global level, and the proportion of women infected with HIV is on the rise in high-income nations as well. Human Rights Watch chose to do this work in Uganda for a number of reasons, including high recorded rates of domestic violence, the existence of a developed and vibrant network of NGOs working on women’s rights, a coherent and well-established HIV/AIDS movement, and the involvement of a wide range of bilateral and multilateral donors who are contributing extensively to HIV/AIDS initiatives in Uganda.

This is a critical time for Uganda: interviews with Ugandan health officials revealed that the impressive decline in overall HIV/AIDS prevalence rates in Uganda is leveling off, and in some areas the number of people living with HIV/AIDS may even once again be on the increase. The same health officials acknowledged the dangers of complacency at this stage in the fight against HIV/AIDS. Donor commitment has been considerable, and the Global Fund to Fight AIDS, Tuberculosis and Malaria recently committed substantial resources to Uganda. However, the failure to address the very serious underlying and contributing issue of domestic violence may compromise Uganda’s continued success in the fight against HIV/AIDS. There is clearly an urgent need for the government to enact progressive, gender-specific, and effective domestic violence legislation, and to make women’s rights, health, and physical integrity a central focus of forthcoming strategies.

This report is based on more than 120 interviews conducted in Uganda in December 2002 and January 2003, and prior and subsequent research. The interviews took place in Kampala, Entebbe, Iganga, Luwero, Mulago, Pallisa, and Tororo districts. Human Rights Watch interviewed individual women and men from a variety of locations and diverse ethnic groups and subgroups including the Acholi, Abasamia, Baganda, Bakenyi, Basoga, Banyoro, Batoro, Banyankore, Banyarwanda, Iteso, and Jopadhola. We conducted additional interviews with government officials, including the prime minister, the minister of health, the minister of gender, labour and social development, and the minister of local government; United Nations (U.N.) representatives; representatives of NGOs working on HIV/AIDS; representatives of NGOs working on women’s rights; lawyers; legal aid providers; state prosecutors; health service providers; medical practitioners; traditional healers; academics; representatives of law review commissions; representatives of HIV/AIDS commissions; representatives of human rights commissions; donor government officials; police representatives; community and traditional leaders; and others.

The real names of women who provided accounts of their experiences with domestic violence and HIV/AIDS are not used in this report unless otherwise indicated. Other identifying information has also been withheld where necessary in order to protect their privacy.