Human Rights Watch interviewed HIV-positive women of various ages and ethnic groups to ascertain the role that violence had played in their vulnerability to infection. The personal accounts that follow illustrate the ways in which violence and crippling economic dependency infuse almost every sphere of women’s lives, robbing them of any authority over their own sex lives and denying them the ability to preserve their own health.121
A combination of factors heightens women’s vulnerability to HIV. Cultural perceptions of women’s sexual and reproductive obligations in marriage rob women of bodily autonomy, while unequal property rights, the payment of bride price, and women’s inability to take their children from the fathers’ homes render women unable to leave abusive relationships. In addition to coping with violence and disease, many women must also contend with the uncertain future their children face as children of parents with AIDS. As a result, many economically dependent women stay in high-risk, violent marriages. Widows also face imposing obstacles: many are stripped of their property and left to struggle to support themselves and their children while they are at their weakest. These factors and more combine with violence, or the threat of violence, to create an environment within which women are trapped into having unprotected sex with HIV-positive men and are unable to seek information or treatment on HIV infection and AIDS.
Poverty exacerbates the factors that determine women’s vulnerability to HIV infection. In an article on Uganda, molecular biologist Helen Epstein commented:
In the voices of women, this chapter provides an insight into the ways in which violence strips women of bodily autonomy, prevents them from safeguarding themselves from exposure to HIV infection, and forces them to go to great lengths to disguise their HIV-positive status. The chapter also reveals the links between certain traditional practices and women’s heightened risk of HIV infection and, ultimately, how economic dependency underpins women’s vulnerability to both domestic violence and HIV/AIDS.
Human Rights Watch interviewed women who confirmed that, in many instances, Ugandan men have absolute dominion over the terms of sexual relations with their spouses. Where the husband is HIV-positive, this dominion directly threatens women’s lives. In one such case, even the fact that he lay dying did not prevent Hadija Namaganda’s husband from punishing her. In 1994, Namaganda’s HIV-positive husband forced her to have unprotected sex with him until he became bedridden. He routinely beat her viciously, and, on one occasion, attacked her so violently that he bit off half of her left ear. Then, while he lay dying of AIDS too weak to beat her, he ordered his younger brother to beat her instead. Namaganda is now HIV-positive.123
Dr. Seggane Musisi, head of psychiatric consultation at Mulago Hospital, who has researched the factors that psychologically influence sexual behavior in Uganda, explained:
According to Ugandan HIV/AIDS service providers, the majority of their female clients become infected through unprotected heterosexual sex. TASO, which has seven centers countrywide providing care and support to people living with HIV/AIDS, has registered a cumulative total of just over 59,000 clients since its inception. Sixty-six percent of the clients served are female.125 Erasmus Ochwo, a counselor with TASO, told Human Rights Watch: “Most women actually come in having lost their partners. Almost 90 percent of these women get infected through unprotected heterosexual sex.”126 Dr. Sheila Ndyanabangi is in charge of mental health at the Ministry of Health, an office that also addresses general human rights issues. She highlighted male infidelity within marriage as a principal cause of HIV infection in women: “There is a high incidence of infection amongst faithful wives of errant husbands. The woman most at risk is a woman in a monogamous marriage.”127 Many of the women were powerless to resist sex with their husbands or to insist that philandering husbands stop having affairs or use condoms. For some, rape and battery had literally become part of the fabric of their daily lives.
Individual women, NGO representatives, and government officials all referred to the prevalence of the belief that wives have no right to deny their husbands sex. A women’s rights activist declared, “Men proceed under the common law assumption that saying ‘I do,’ means that you no longer have the right to say ‘I don’t.’”128 Human Rights Watch interviewed numerous women who felt obligated to have unprotected sex with their husbands, even those that were adulterous. Lydia Mbakile, a thirty-six-year-old HIV-positive widow, explained: “I think women should give their husbands sex. If you say ‘that is my husband’ you have to finish up [complete] the duties that he has delegated to you.”129
A number of government representatives stressed that married or cohabiting women appeared to be at a far greater risk of HIV infection than single women. Joyce Namulondo at the Uganda AIDS Commission concurred: “A woman properly married in the home is at a greater risk as far as HIV/AIDS is concerned, the reason being the power relations. . . . The single woman does not have a contract.”130
The fact that in some cases actual violence did not take place did not alter the coercive nature of these relationships. Women’s own belief that they had no authority over sex often made it unnecessary for husbands to rape unwilling wives. Masturah Tibegwya, a Munyankore, is forty-eight and lives in Luwero. She is on her second marriage, and first got married in 1966, at about the age of 16.131 Between the two marriages, she has had twelve children. She says that although her first husband was violent, he never had to force her to have sex because she knew her duty:
Joy Kobushingye, forty-five, told a similar story. Her first husband died of AIDS in 1992 and she tested HIV-positive the same year. She continued to have sex with him despite his extramarital affairs. “I still had sex with him even when he had other girlfriends. What do you do? Unless you intend to break [up] the marriage. That is not a strong reason to leave a home. . . . I don’t know about forcing. There is no negotiation. You know that you must.”
Many of the women were afraid to introduce the subject of prophylactic protection for fear of being beaten either for suspecting their husbands of having extramarital affairs, or because they might be accused of adultery themselves. When they did raise the subject of condom use, violence typically ensued. Margaret Namusisi, twenty-five, moved in with her husband when she was fourteen and he was forty. She explained why she continued to have unprotected sex with him despite her desire to stop having children: “There are times when I don’t feel like [sex] and tell him to use a condom, but he doesn’t want to. I’m on family planning. That causes disputes. When I tell him to use a condom he refuses. He accuses me of having other men. He goes away and doesn’t provide. So I have sex with him so that he can look after the children and won’t fight.”133
Sara Kisakye’s account of her relationship with her ex-husband is a vivid illustration of the powerlessness many women experienced as a result of violence. Kisakye, a thirty-one-year-old Muganda woman, left her husband in January 2002 as a result of his violence and extramarital affairs. She described how her husband would refuse to use condoms and how he would often beat her because she refused to have unprotected sex with him. She explained:
Many of the women interviewed by Human Rights Watch were unable to negotiate condom use even when their husbands had tested HIV-positive. Some of these women quoted husbands that had tested HIV-positive as saying that condoms were ineffective, or even that there was no reason for them to die alone. Khadija Nankwanga’s husband died of AIDS in 1995. Before he died, he repeatedly raped her and her three co-wives, one of whom died of AIDS soon after he passed away. Nankwanga, a forty-two-year-old Musoga, told Human Rights Watch: “In [HIV/AIDS] counseling they told us [the wives] about condoms but he didn’t want to use them because he didn’t want to leave us alive to remarry. . . . He promised to strangle us. He wasn’t violent but with that! There was not even any discussion.” 135
The inability to negotiate condom use is not only a concern with regard to potential HIV infection, but is also hazardous for HIV-positive women who face the danger of reinfection136 by their HIV-positive husbands. Joy Kobushingye’s current husband is also HIV-positive. Despite being aware of the danger of re-infection, Kobushingye feels that the greater danger is to stop having sex with her husband. “I don’t know what I can do about my re-infection. I don’t know if he would leave me if I asked us to stop having sex or use a condom. I have never tried it. I don’t want to try it.”137 Margaret Namusisi’s co-wife died of AIDS two years after she moved in, and now both she and her husband are HIV-positive. Her husband will not stop having sex with her despite the fact that they have received counseling on HIV reinfection. She told us, “Stopping sleeping with him is difficult. We have been taught about reinfection. I told him that we have to have sex once a month and use a condom but he refused.”138
Marital rape does not exist as a legal concept in Uganda, yet interviews with numerous women and service providers indicated that forced sex within marriage is rampant. 139 Thirty-four out of fifty women expressly confirmed that their husbands physically forced them to have sex against their will. Many others referred to verbal threats of eviction and abandonment if they refused to have sex. A recent study conducted in Rakai found a “strong association” between women’s perceptions of their male partner’s HIV risk and the risk of domestic violence: “Women who perceive their male partner to be at significant risk of HIV infection may be reluctant to engage in sexual relations with this partner; this resistance may be met, in turn, with physical violence or coercion into sex by the male partner.”140 The failure to criminalize forced sex in marriage perpetuates the belief that women have an obligation to submit to their husband’s sexual advances upon the terms that he dictates, and, furthermore, have no authority to negotiate condom use. The constant refrain in diverse regions and districts of Uganda was that “a man cannot rape his wife.” The following accounts demonstrate otherwise.
Ada Rose Luba, a twenty-seven-year-old Acholi woman, cried quietly when she told us how her HIV-positive husband would force her to have unprotected sex with him and would beat her with his “special stick” (the handle of a hoe). She told us, “He wanted to hit my head but I would hide under the bed so that he beat the other parts of the body.” 141 Grace Nabatanzi, a forty-two-year-old Muganda woman, told Human Rights Watch that her husband used to rape her when she refused to have sex with him because she was pregnant: “My first husband forced me to have sex with him . . . [usually] when I was expecting and didn’t want to have sex with him. When I was pregnant, I didn’t feel like sex. He interpreted it as infidelity. He would first threaten, then use force. He would rape me and I would vomit. He finally realized it was a problem. . . . It would be a woman’s duty [to have sex with her husband] if you have struck a compromise. But the man shouldn’t rape you.”142 None of the women interviewed complained to authorities about being raped. Amina Kabayondo, a forty-one-year-old Munyarwanda143 woman was just one such example: “We never used a condom in marriage. They weren’t very common. There were times he forced me to have sex. He would always do it if you refused. He would use force.”144
Jacqueline Nakitendedescribed how she had no place to turn to as her husband repeatedly raped her and her co-wife. Nakitende is a thirty-two-year-old Muslim widow whose second husband died of AIDS in approximately 1999. Nakitende tested HIV-positive in 2002 and her co-wife had begun to exhibit HIV-related symptoms. Nakitende had five children in all, the last four of whom were also HIV-positive. In her case, her husband liked to have forced, rather than consensual, sex. “That was a hard marriage. He beat me. There were times when he would want me to have sex with him even when I was on my period. Sometimes he forced me because he wanted to have forced sex.” She suspected that he beat her co-wife and had forced sex with her too because of reports that she would receive from the neighbors. She was unable to get help from the local court because her husband was in the army and they were afraid of him. The worst occurrence was when his rape of her resulted in a miscarriage. “The worst time?” she asked. “I was living in Rubaga and I was expecting. I lost my baby because of the force with which he raped me.” She found out that he was HIV-positive in 2000 when she was still pregnant because she found his test results in his briefcase. As a result of his violence, they never used condoms: “He wouldn’t use condoms. He would have beaten me. I’m his wife—why should we use condoms? I asked him to use a condom to space [out] our children and he refused.” She added, “I think it’s women’s duty to have sex with their husbands but not so often.”145
A number of women were not even aware of their husband’s illness until after his death. Some found out later that their husbands had been aware of their HIV-positive status and had been attending HIV/AIDS clinics secretly. Typically, the woman would either be advised to go for an HIV test by a relative or someone in the community, or would stumble across her late husband’s medical prescriptions.
In a few cases where their husbands had tested HIV-positive and were open about their status, women shared the same story: that the instances of forced sex increased, and their husbands would suddenly become insistent on not using a condom, even when they had used one previously. Most were unable to explain why. Esther Nanono, thirty-eight, is married with two children of her own and looks after her husband’s three children from other women. The mother of her husband’s last-born child died, and Nanono has come to realize that the woman displayed symptoms of HIV infection. She and her husband have both tested HIV-positive. Although Nanono is sure that her husband infected her, their counselors stressed that they should not try to allocate blame and so they have not discussed the issue. The counselors also advised that unprotected sex could lead to reinfection. Previously, her husband had agreed to the use of condoms for birth control but after he tested positive he started forcing her to have unprotected sex. She told us:
In 1997, when Rebecca Samanya’s husband found out he was HIV-positive, he killed himself, but not before he raped her one last time. Samanya, a Muganda, is thirty-six. She was the first of three wives, all of whom are HIV-positive. Her husband also had a girlfriend who was HIV-positive. Samanya’s husband would force her to have sex so that she could bear children. “He would say that I have two kids so he should have more. . . . I had sex with him. If I was in the home what would I do? I tried to tell him I don’t want to but he would fight. . . . He used to force me to have sex through our marriage. His aunt [a nurse] told us to use condoms. He refused. I tried to persuade him but he refused. He beat me because I didn’t want to have sex with him. He broke my finger.” She recalled the night he died: “It was a while since we had sex because he was at my co-wife’s place. He came back and spent the night. He had come with his poison. I laid my bed down on the floor. He raped me and afterwards left the house and poisoned himself.” Samanya found out she was HIV-positive when she had a miscarriage. Her in-laws blamed her for her husband’s death and threw her out of the marital home. She now lives alone and supports herself as a gardener.147
Barbara Nassozi’s marriage reflects the brutal sexual violence that some women endure within their own homes. Nassozi, who is Munyankore,lives in Nabulagala. She “married” her first husband, a twenty-year-old neighbor, when she was eleven. She remembers him clamping a strong smelling rag over her face and waking up in his house, where he locked her up for many months as he raped her. She was the second of three wives, had her first child when she was thirteen, and her second at fifteen. She finally left because of his mistreatment. She is HIV-positive.
Lack of Authority over Number and Spacing of Children
Many of the women explained that their husbands often forced them to have unprotected sex in order to have children. Unable to dissuade their husbands from having extramarital affairs, these women became highly vulnerable to HIV infection. Berna Alupo,149 a Muteso, is a thirty-year-old widow whose husband died of AIDS in 1997. She was the first of two wives. Alupo, who tested HIV-positive in 2000, started living with a man who was also HIV-positive. Despite her fear of reinfection, he forced her to have unprotected sex because he wanted to have a child.
My boyfriend wanted me to have a child. I wanted to use condoms so we don’t reinfect. . . . I am now five months pregnant. You know when you are in the house you are in the house alone. He said nobody would hear me. He forced me to have sex with him. That’s how I got pregnant. I wanted to separate because I started hating him.150
There was a time when I gave birth every other year and I had to go to the family planning counselor. . . . I couldn’t tell [my husband] about condoms. I only used injections. . . . If I told him about condoms, he would leave. You know men, they don’t want you to stop giving birth. He was in medicine, he would say that contraceptives can injure your health. I don’t know if he was tested for HIV, and we’ve never discussed it.
Despite the efforts of service providers, many women were unable to access HIV/AIDS information and treatment because of domestic violence. NGOs providing care and support to people living with HIV/AIDS and other service providers like traditional healer Mutebi Musa Takamalirawo, told Human Rights Watch that many women come to see them secretly.153 Women explained how they were afraid to discuss HIV/AIDS with husbands who were clearly unwell, how a fear of violence prevented them from openly attending HIV/AIDS sensitization programs, and how, despite feeling unwell themselves, they were unable to go for HIV testing or were too scared to pick up the results.
Alice Namagembe tested HIV-positive in 1996. She has never revealed her HIV-positive status to her husband. She explained: “I am married but I came alone [for testing]. I never informed him. He said, ‘if I know you’re positive I’m going to kill you.’ We used to quarrel. He beat me. I never talked about it. Once he asked how I got a job at TASO and I said a friend helped me.” Her fear of her husband prevented her from having her children tested: “I get scared that [the children] will tell him they were injected. I can’t even test the children because he’ll be angry and ask why.” 154
Lucy Akurut is a thirty-one-year-old Muteso woman working with an HIV/AIDS NGO. Both she and her husband are HIV-positive. She has three children, all of whom are losing weight and suffering from rashes. She was convinced her husband infected her: “He was HIV-positive when we got married. His last girlfriend died of AIDS. I only found out a year after we married. We didn’t use a condom. . . . Sometimes when I don’t feel like sex he forces me to have sex with him. He grabs me and beats me. We used to use a condom one-and-a-half years ago. Now he refuses. He becomes cruel when I ask why.” Akurut explained why she felt compelled to conceal her test results despite her husband’s own HIV-positive status: “I got tested in April 1999. . . . I went to get tested. I didn’t tell him. The type of person he is scared me. I had no idea how to approach him. I was scared to tell him I was HIV-positive.”155
Women who were experiencing symptoms were also unable to access testing and information centers because they had no money to travel, or to pay for care, and were too afraid to ask abusive husbands for funds. Rebecca Semanya told us: “I got counseling after he had died. I wanted to go before but I didn’t have the means. I wouldn’t ask him. He would [fight].” Meanwhile, her husband hid his medicine for herpes zoster (“shingles”)157 in the bar where he worked.158
Representatives from the medical community revealed that women used the opportunity of prenatal care to test for HIV.159 Dr. Musisi explained: “They are captive audiences at the antenatal clinic where men don’t go. That’s where we test them [for HIV]. Women can go to antenatal clinics because it is a matter of pride for men to have children.”160 Dr. Hafsa Lukwata is a general practitioner and works with the Association of Uganda Women Medical Doctors (AUWMD). She confirmed that women were using the prenatal care for HIV testing, but cautioned that because of this, some women were being prevented from attending at all: “Men have refused women to go for antenatal. For prevention of MTCT (mother-to-child transmission) we are testing for HIV. Men are warning women not to go to the antenatal clinic or, if so, not to take the test. Once I was doing a pap smear. Women don’t know how we test for HIV. I told her I was going to take a sample of her cervical mucus. She warned me not to test for HIV. Without hesitating.”161
Despite the fact that many women who survive husbands who have died of AIDS are ostracized by their communities and in-laws, a few of the women we spoke to insisted on using their real names because they were proud to be living openly with HIV. Erasmus Ochwo’s experiences as a TASO counselor provided him with numerous examples of widows whose mental and physical health benefited from finally having unrestricted access to HIV/AIDS services:
People associate AIDS with immorality. Men break down from the stigma very quickly. Women give men support. After the man dies there seems to be relief. The burden of care is gone and the women get to grips with reality very quickly. It is around then that they come for testing and come to TASO. Then they learn to live positively. The woman is also freed from the blame from her husband and his relatives. She reaches mental serenity when she learns that she does not need to be blamed. She becomes psychologically healthier.169
Women who form part of a discordant couple—a relationship where both partners have tested and one partner is HIV-positive and one partner is HIV-negative—experienced high levels of violence irrespective of whether they were HIV-positive or negative. The AIDS Information Centre (AIC) told us that about 11 percent of their couples that tested were discordant. They found that when men were HIV-positive and women were HIV-negative, the couples tended to stay together. However, when the woman was HIV-positive and the man HIV-negative, the woman was often abandoned.170 Erasmus Ochwo of TASO concurred: “If the man is HIV-negative and the woman is HIV-positive, chances are that the man will chase the woman away.”171
Human Rights Watch received disturbing reports that health workers were seeing a high incidence of forced sex in discordant couples where the man tested HIV-positive.172 Grace Ssebbanja-Namwanje, an AIC counselor working with discordant couples, told Human Rights Watch: “Where a man is HIV-positive there is always a lot of violence. Men say that the woman cannot deny them sex. They ask ‘how can you deny me sex when you are in my house?’”173
The AIC officers who spoke to Human Rights Watch attributed much of the violence to the man’s lack of understanding as to why discordancy would persist. However, some counselors presented a darker rationale for the violence. While Sebbanja-Namwanje told us simply that “men don’t want to die alone,”174 Robbinah Ssebbowa Ssempebwa at Action Aid-Uganda Uganda noted, “If both of you are sick it is difficult to prove responsibility.”175
As distinct from women in discordant relationships whose husbands had tested HIV-negative, women whose husbands had never been for testing, or had also tested HIV-positive, reported that they were experiencing violence because of their own HIV-positive status. Musisi told us, “Women are battered and killed when husbands or boyfriends find out that they have AIDS.” 176 Janet Nangobi, who heads a branch of a local NGO for women living with HIV/AIDS recalled: “In 1988, I lost a member who was a young HIV-positive widow. She didn’t tell her boyfriend. When he found out he strangled her.”177 HIV-positive women whose husbands were also infected hid their status, explaining that they were fearful of being accused of adultery and being blamed for the illness. Masturah Tibegwya described her secret visits to TASO, saying: “I’m scared of telling him that I went for a test. . . . I want them to counsel me first until I believe it. . . . I’m scared that he’ll think I was cheating on him. He might kill me and I want to live.” 178
In another case, Anna Isikoti,179 forty-three, said that both she and her husband were HIV-positive, but that he would not accept his status. Three of her co-wives died of AIDS, and her current co-wife was also HIV-positive. Her husband also had three girlfriends that died. At the time of the interview, Anna had begun to suspect that her youngest child might be HIV-positive. She told Human Rights Watch that although he had been violent before, the violence increased after she tested HIV-positive.
When I told my husband he started mistreating me. He spread the story stating that I was to blame for infecting him. Yet I have never gone outside for sex. He even mistreats my children. . . . He believes that I have bewitched him. The violence started mostly when I discovered my HIV status. There was some before but it increased sharply when I found out my HIV status. He used to beat me with a stick, kicking, slapping. I don’t hear properly because of slaps. In 1997 after I disclosed [my status] he beat me until my eyes bled. He kicked me. I ended up in the hospital here. My mother came to look after me.180
The context of polygamy has a lot to do with not just . . . violence, but the threat of violence. It is legally and socially accepted that a man can have many partners. This leads to both abandonment and violence because the fact that men can access other women means that women are more accepting of violence.
- Meenu Vadera, executive director, Action Aid-Uganda, Kampala, December 11, 2002.
Human Rights Watch’s interviews revealed tangible connections between polygyny and violence, not only because women became more accepting of violence in their fear that they may lose their husband’s economic support, but because polygyny was itself a source of tension. Mabirizi Busulwa, a community volunteer with an NGO working on domestic violence, was also a previous perpetrator of domestic violence. At thirty-nine, he had married two wives under customary law. He explained how tension arose as a result of his polygynous marriages: “I used to divide the nights in shifts. When I spent two nights with one wife then the other wife would be angry. I battered the first wife. . . . She said ‘you go to the other wife and then want me to cook for you.’ So to protect myself I used power.” 181
Human Rights Watch interviewed a number of HIV-positive women in polygynous unions who experienced forced unprotected sex. Busulwa’s wife, Robina Namutebi, told Human Rights Watch that problems between them only began when her husband married a second wife ten years into their marriage. In addition to abandoning the family for three years, her husband began to beat her, and to force her to have sex. She says that the forced sex went hand-in-hand with the violence, and that the last of her three children were conceived through rape. 182
Despite their trepidation that their husbands were openly having sex with other women, a fear of violence and abandonment compelled many women to remain in a sexual relationship with polygynous husbands. Dr. Musisi explained: “Men are culturally, economically, and educationally better. Their numbers are fewer. Therefore women have to accept being many to one man. Men have become almost priceless.”183 Namutebi was aware that this made her vulnerable to infection, particularly as her husband sometimes spurned condoms. She explained: “At times he decides [to use a condom] by himself, but it’s not for me to tell him. . . . He will not support me if I decide not to have sex with him.” 184 Crying, Namutebi told us that although she worried about HIV infection, her husband ignored her concerns.
Dr. Musisi argued that polygynous unions may in fact be safer for women’s health: “Men in polygamous relationships tend to stay more loyal and have less HIV spreading than monogamous relationships where men are hiding unofficial women. Also, when there is a fight they go to their girlfriends. In polygamous unions, they just move to the other wife.”185 However, many of the women in polygynous unions revealed that their husbands were nevertheless having extramarital affairs. Additionally, irrespective of who first becomes infected, when men are having unprotected sex (forced or otherwise) with multiple partners, the risk of HIV transmission is heightened for all parties.
Many HIV-positive women in polygynous marriages told Human Rights Watch that their co-wives were also subjected to forced sex and that one or more of them had also been infected. Namusisi told us, “[my] co-wives are dying one by one.”186 In another case, Magdalene Namatovu, a forty-six-year-old widow, told Human Rights Watch that most of her seven co-wives had died of AIDS. Namatovu, who was HIV-positive herself, was convinced that her husband infected her, as he was her sole intimate relationship.187 The cases that follow further demonstrate the ways in which polygyny and high risks of HIV infection coincide.
Jane Akinyi, a forty-eight-year-old Jopadhola woman, was the first of three wives. She told Human Rights Watch that her husband, who was violent to all three wives, died in 1990 of AIDS. They never used a condom, and all three wives tested HIV-positive. Akinyi took the last four of her children for testing and they were also HIV-positive. She worried that more of the children may be infected. Akinyi told Human Rights Watch that her husband used to rape her and thought this might explain the high infection rate. She said: “I don’t know how I can explain it. I don’t know whether the beating was out of love. It would usually happen when he demanded sexual intercourse and I said no. A week didn’t go by without my being beaten. . . . He forced me to have sex.” 188
Sules Kiliesa’s second husband, with whom she had two children, had three wives and fifteen other children. He died of AIDS in 1993. She says that she suspected he might have AIDS before he died and even went for an HIV test, but could not pick up the results because he might have beaten her. She and one of her co-wives tested HIV-positive after his death. She told Human Rights Watch that her husband used to beat and rape all three of his wives. “He beat me badly with a stool. . . . In 1992 he wanted me to have another child with him. I tried to refuse. He beat me and raped me. That is when I conceived the seventh child.” She knows that she was infected by her husband but does not know whether it was her husband or one of her co-wives that was first infected. “He wanted to blame me for his status. His other wives were blaming me. There was no other man. . . . His other wives, the second and third, were going with other men. They were younger than him.”189
The payment of bride price (also known as dowry) is a considerable obstacle for women attempting to leave abusive relationships. Said by some scholars to originally constitute a gesture of appreciation to the bride’s parents for their role in her upbringing and to reinforce relations between families, bride price historically did not carry any commercial implications. However, men now literally purchase their wives, and, as in a commercial transaction, the husband’s payment entitles him to full ownership rights over his acquisition.190 Masturah Tibegwya told us that her husband did not need to force her to have sex because: “The ancestors say this. They take you as property so if the man comes for sex you don’t say no.”191 Field research into domestic violence carried out in the districts of Iganga, Kabale, Kampala, and Kitgum, by Law and Advocacy for Women-Uganda found that 62 percent of the focus groups identified the payment of bride price as a major cause of domestic violence, as it encouraged men to beat wives who did not “measure up.”192
The payment of bride price demeans women’s status by encouraging men to conceive of their wives as chattel, and is a contributing factor to violence in the home. Ruth Mukooyo, a lawyer working with the Association of Uganda Women Lawyers (FIDA Uganda), whose four legal aid centers provide women with legal assistance, told us:
As property, many women have no authority within what is seen as the man’s home and do not even have the right to complain about their husbands’ risky sexual behavior. Pastor Wilberforce Owori of the Frontline AIDS Support Network in Tororo, recounted how he counseled a young man who beat his wife into a coma because she asked about his having sex with other women who might have HIV. He recalled: “Men don’t want women to mention if they are going out with women with HIV. Women have no authority. They are treated as property. He has paid the dowry, she is in his home.”196 The Ministry of Gender, Labour and Social Development has decried the practice, stating: “This practice undermines women’s dignity and welfare. . . . Forcing a woman to live under an intolerable and hostile family environment subjects her to servitude and slave-like conditions.”197
The practice of widow inheritance dictates that when a man dies, his brother is appointed to marry the widow. An old tradition, it was a way for men to take responsibility for their dead brother’s children and household. However, widow inheritance may also expose women to HIV infection, particularly when accompanied by violence. Jamila Nakitende recounted her ordeal after her husband died: “His brother tried to inherit me. I was living with my husband’s family. He tried to rape me. I fought with him and screamed and people came.”198 Zebia Itata199 is a thirty-six-year-old widow of the Itesot tribe whose husband died of AIDS in 1990. Itata has since tested HIV-positive. She explained what occurred after her husband’s death:
Women succumb to widow inheritance primarily as a result of economic vulnerability and the fact that they are often without property or any viable means of supporting their children. The practice can often result in the widow having sexual intercourse with an array of male in-laws. Ochwo told us,
In general, customary practice dictates that children are born into their paternal families, and tradition tends to favor paternal custody of children, save where the child is deemed to be young enough to require maternal care.202Women told Human Rights Watch that the fact that they did not have any custody rights over their children contributed to their inability to leave abusive relationships. Rhoda Nanyonjo is a twenty-five-year-old Musoga women whose four children range in age from five months to seventeen years. She told Human Rights Watch that despite her husband’s violence, extra marital affairs, and unwillingness to provide for the family, she was unable to leave him, saying, “I wanted to go but I couldn’t leave my children behind.” 203 This became an intractable problem for some women, who could not leave with their children, yet could not be sure that their husbands would care for them. Berna Alupo told us: “I couldn’t leave my husband because of my kids. I would leave them in a house with no food and they would suffer. I couldn’t take them to my parents to be a burden. So I stayed so I could work and look after my kids.”204
Susan Birabwa’s story illustrated this further. Birabwa is thirty and married with four children, whose ages range from eight to fourteen. She explained her reluctance to leave her violent marriage saying, “I would like to leave the man but fear to leave my kids.” She tried to move back to her parents in December 2001, but her husband would not let her take the children. Her eldest son told her that her husband tortured the children when he returned home drunk. She tried to take the children to her parents’ home, but her parents were unable to look after them so they told her to go back to her husband. He then abducted the children when they went to the well for water, and although she went to the police at Mulago, nothing happened. After a while she moved back home.205
Women and girls are commonly discriminated against in terms of access to education, employment, credit, health care, land and inheritance. With the downward trend of many African economies increasing the ranks of people in poverty, relationships with men . . . can serve as vital opportunities for financial and social security, or for satisfying material aspirations. . . . The combination of dependence and subordination can make it very difficult for girls and women to demand safer sex (even from their husbands) or to end relationships that carry the threat of infection.
—UNAIDS ‘AIDS epidemic update’ - December 2002
Although economic autonomy was not the sole factor limiting women’s capacity to leave abusive relationships, many of the women experienced poverty so severe that they had literally no option but to remain with husbands who routinely battered them. Their worth and social acceptance was found in marriage and children, making separation or divorce almost impossible. Although returning to their parents’ home was an option for a few women, some encountered male relatives who either did not wish them to return home or were unable to repay the bride price. Lack of education clearly contributes significantly to women’s economic dependency. The Rakai study found that women with secondary schooling experience had “significantly lower risks of violence.”206 Out of fifty women Human Rights Watch interviewed, only 21 had continued on to secondary school.
From its inception, Rose Kyolaba’s relationship with her husband was founded on economic necessity. Kyolaba is a thirty-one-year-old Muganda living in Mulago. She was the last of four wives. She told us that she had to move in with her husband because she was pregnant and could no longer live with her parents. Her husband was a neighbor of theirs who was paying her school fees. She said that the sex was not consensual because he gave her school fees for one term and then refused to pay more unless they had sex. Two of her co-wives died of AIDS in 1994 and 1995. Her husband died in 1997 of AIDS and now both she and her ten-year-old daughter are HIV-positive. Although their marriage was violent and she left him before he died, Kyolaba explained that she would submit to him because she depended on him economically. “He used to force me to have sex with him. He would threaten not to pay the rent or give me money for food.” 207
Economic dependency also prevents women from reporting abusive husbands to the proper authorities. Philip Wanyama, Chair of the LC1 in Mulago 3 Parish, Kawempe said: “In most cases women don’t want to go to the police because they feel if the law is applied the husband will be incarcerated and he is the husband, the breadwinner. We deal with minor cases of domestic violence. But even if it is major the women want it dealt with outside the police. . . . Women usually want us to mediate so the man can change his behavior. Otherwise there will be nobody to pay house rent.”208
Ruth Mukooyo of the FIDA legal aid project illustrated the dilemma saying: “Most people counsel for reconciliation. This is dangerous because someone could be killed. But [if you counsel against reconciliation] she asks you if you will support her [economically].” 209 Martha Nanjobe, director of the Uganda Law Society’s Legal Aid Project that delivers legal aid services to indigent women, men, and children, agreed: “The main problem is that women are not willing to pursue domestic violence particularly when they know it’s criminal. They come for us to ‘talk’ to the husband. We advise them to go to the police but they won’t. . . . A particular problem is if the husband is imprisoned and he’s the breadwinner.”210 As a result, organizations like FIDA refer women to income-generating projects so that they might at least find some way of sustaining themselves.211
Traditional healer Mutebi Musa Takamalirawo explained why he advised women to make every effort to remain in the home:
Human Rights Watch interviewed women who felt constrained to remain in relationships with HIV-positive men who beat and raped them because they feared being thrown out of the house or off the land, which their husbands typically owned outright. Zainab Gashumba, a forty-five-year-old Munyarwanda woman, got married under Muslim tradition in about 1974 at approximately the age of sixteen. Her husband died of AIDS in 2000. Gashumba was the second of four wives, and two of her co-wives died at about the same time as her husband. Gashumba, who tested HIV-positive, told Human Rights Watch that her husband would often threaten her with eviction. “My husband didn’t physically force me to have sex. But he would ask if it is my home. Even when he slept with other women I had to give in because he was the owner of the house.” Her fear of eviction prevented her from being tested for HIV, even when she suspected that her husband had AIDS. “I told him once that I heard of testing and he told [asked] me why should I check—that means there’s something I’m guilty of and that I should leave his house and go if I go for testing.” 216
In some cases, women’s fear of eviction was greater than their fear of violence. Lydia Mpachibi, thirty-five, was widowed in 1999 when her husband died of AIDS. She found out it was AIDS when she heard his relatives whispering: “This man has killed this girl also.” She was the third of three wives and the second wife also died of AIDS. She told Human Rights Watch that while her husband was alive she did not want to be tested for HIV or to try and obtain HIV/AIDS information because she was scared that he would evict her: “I wouldn’t dare because if I was HIV-positive he would say I brought the virus into the home. . . . I have seen very many women being chased away by their husbands. Many have been chased and beaten. I was scared of being thrown out. Beating, someone can beat you and he forgives you. I was scared of being thrown out.” 217
Nearly all of the women who had lost property after their husband’s death had been forcibly evicted from their homes by their husbands’ relatives. Mpachibi explained how her in-laws slowly deprived her of everything she had:
Sules Kiliesa told us that before her husband died he wrote a will that remained unsigned. In it, he declared that she was not his legal wife and should leave the home, and that “all the power [legal authority] was given to the sister [her sister-in-law].” His lawyer, who was also his brother-in-law, took everything: “Even property I had helped him obtain was taken.” She found no help anywhere, and pleaded with her in-laws to let her farm for food. “Relatives called me ‘the killer.’ I asked them for land to till to help maintain the children. They sent me to the family heir—the son of the eldest woman [oldest wife]. He beat me and told me he didn’t want to see me tilling his father’s land yet [when] I had killed his father.” Although the police helped her go to court, she had to stop cultivating the land. Her father told her that he would kill her if he saw her in his home. She now lives in a rental home with her children and scrabbles for survival, but is unable to look after all her children. “Two of my children are in the street because now I cannot meet their demands. My first girl had to get married at sixteen. The second boy left school at only nine.”219
In many cases, the husband’s relatives encouraged his violence against his wife by blaming his wife for his own HIV-positive status and accusing her of witchcraft or adultery. They used the same justification to steal her home and land. Jane Akinyi was certain that her husband infected her, particularly as all her co-wives are HIV-positive. Yet her in-laws blamed her for his death and chased her from their marital home. She explained:
The husband does not even have to be complicit for his relatives to strip his wife of her property. Josephine Opio-Apiyo,221 an HIV-positive Ateso widow, lost her husband to AIDS in 1991. His relatives parceled his property out before his death, leaving her with nothing. She explained: “I felt bad. They didn’t even know what we had. It contributed to his death because he felt bad. They used to call us ‘dead people moving.’ My mother felt bad. She knew what I was. I was a virgin [before meeting him]. I felt like committing suicide. Only the thought of the children stopped me.”222
Even the most supportive families discouraged women from complaining or reporting the theft of their property, either out of a sense of pride or because the family did not believe that she would achieve anything. Zebia Akware, an HIV-positive thirty-eight-year-old widow, was her husband’s only wife. Nevertheless, his relatives took his property immediately after he died. She described her family’s reaction: “My parents took me and my kids in. My brothers discouraged me [from complaining to the police or the LC]. They said they would look after the kids and that we didn’t need [the in-laws] money.”223 Sherry Simbo224 and her child both tested HIV-positive after her husband’s death from AIDS. She told us that although her husband had properties and cows in the village, “he didn’t write a will. His family, particularly the brothers, wanted the properties. They abused me so I left it for them. . . . I live with my mother and we sell a few things here and there. All the property, cows, and home things, are with his brothers.” Simbo has never tried to take legal action against her in-laws. “My family told me to forget about it and come back home,” she said.225
Human Rights Watch’s interviews revealed that survivors of domestic violence face a range of obstacles to obtaining and defending their property rights. Lack of economic autonomy and impediments in access to justice prevent women from contesting evictions by their husbands or hostile relatives. Without property ownership these women remain economically subordinate and are without the necessary resources to lay claim to, and establish, their property and other rights. When AIDS also affects these economically disadvantaged women, the inequities become particularly hazardous for them and for their children. Evelyn Edroma, head of legal and tribunals at the Uganda Human Rights Commission, explained: “Rural women don’t have their own voice. Even if a rural woman wants to challenge issues they have to confront family and it’s difficult for her to challenge them. Women’s real interests have not been taken into account. Most credit schemes are not favorable to rural women: for example, to get a loan, you need collateral. At the end of the day, to have a voice, you need economic independence.”226
The belief that a woman is her husband’s property to be disciplined at his will contributes both to a lack of reporting of spousal violence and to the failure of authorities to treat domestic violence cases as criminal offences. In a 1999/2000 study conducted in Apac and Mbale districts, the Coalition Against Gender Violence found that wife beating was considered a normal practice, and that both men and women interpreted wife beating to be an indication of spousal affection.229 The Coalition study also found that 46 percent of the respondents, the majority female, were of the view that domestic abuses such as wife beating should not be reported outside the family.230 Hope Tumushabe, a thirty-year-old HIV-positive Mchiga woman, admitted to Human Rights Watch that she never went to the police or LCs because she believed it to be shameful to complain about her husband raping her.231 Maureen Owor, a lawyer who previously worked in the Directorate of Public Prosecutions,232 told Human Rights Watch that it was rare to find a woman reporting domestic violence. “It was usually stranger rape. Never the spouse. There’s no culture of reporting domestic violence or marital rape.” 233
Women’s rights activists and government representatives were quick to stress that the problem applies across all societal levels. Jackie Asiimwe-Mwesige, coordinator for the Uganda Women's Network, described public reaction to former Vice President Kazibwe’s revelation that she had been a victim of domestic violence: “When the vice-president’s story came out and her husband claimed that he only slapped her twice, everyone said ‘that’s not violence.’ . . . Kazibwe was seen as a troublemaker. There was pity for her husband for having a ‘difficult wife.’ There was a definite backlash against women in politics.”234 Nevertheless, the vice-president’s revelations seem to have had some positive results, and representatives of the Human Rights Commission confirmed that reports of domestic violence went up as a result of the vice-president’s actions.235
According to Ugandan NGOs, domestic violence victims confront an environment that, at best, is indifferent to their suffering. Dipak Naker, co-director of Raising Voices, an NGO that is working to create and promote community-based approaches to preventing violence against women and children, emphasized: “We need to develop an opinion structure. Right now women are isolated. They need an infrastructure that condemns the violence. The government, the police, religious leaders, the media, and so on. All these people need to get on board to condemn the violence.”236
The Ugandan media has played a central role in highlighting government corruption and holding state officials accountable.237 Human Rights Watch encountered a mixed reaction, however, on the media’s role with regard to its depiction of domestic violence. While a few individuals praised the media for their exposure of domestic violence, some NGO representatives complained that the media treated spousal abuse as entertainment instead of helping to engender outrage. Jackie Asiimwe-Mwesige questioned: “If you shame corrupt officials that steal however much, why can’t you shame a man who has beaten his wife like she’s not a human being? We need to create public anger. Why will people cry when a child is beaten but not when a woman is beaten?”238 Jessica Saboni, a senior police superintendent, heads a small unit that plans and conducts human rights and gender training for police officers. She asserted that there was extensive discrimination on the part of the media. She argued: “With domestic violence against women it’s just one in a thousand cases. With violence against men it’s news.”239
121 For further information on intimate partner violence and health, see WHO, World Report on Violence and Health, (Geneva: WHO, 2002), chapter 4, [online], http:www5.who.int/violence_injury_prevention/download.cfm?id=0000000582 (retrieved June 2, 2003). For information on intimate partner violence in connection with voluntary counseling and testing, see Suzanne Maman et al, “HIV and Partner Violence: Implications for HIV Voluntary Counseling and Testing Programs in Dar es Salaam, Tanzania,” the Horizons Project, (implemented by the Population Council, the International Center for Research on Women, International HIV/AIDS Alliance Program for Appropriate Technology in Health, and the University of Alabama at Birmingham Tulane University), [online] http://www.popcouncil.org/pdfs/horizons/vctviolence.pdf (retrieved June 2, 2003).
122 Helen Epstein, “AIDS: The Lesson of Uganda,” p. 21.
123 Human Rights Watch interview with Hadija Namaganda, Iganga, January 11, 2003. As noted above, 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
124 Human Rights Watch interview with Dr. Seggane Musisi, Kampala, January 7, 2003.
125 The AIDS Support Organisation, [online], http://www.taso.co.ug/index.htm (retrieved March 31, 2003).
126 Human Rights Watch interview with Erasmus Ochwo, counselor, TASO, Tororo, December 17, 2002.
127 Human Rights Watch interview with Dr. Sheila Ndyanabangi, mental health program, Ministry of Health, Kampala, January 14, 2003. Helen Epstein wrote, “Indeed, those most at risk of HIV infection in Uganda now are married women who have sex only with their husbands.” See Helen Epstein, “AIDS: The Lesson Of Uganda,” p. 19.
128 Human Rights Watch interview with Jackie Asiimwe-Mwesige, coordinator, UWONET, December 14, 2002.
129 Human Rights Watch interview with Lydia Mbakile, Iganga, January 11, 2003.
130 Human Rights Watch interview with Joyce Namulondo, planning office, Uganda AIDS Commission, Kampala, January 16, 2003. A Ugandan government health survey conducted from 2000 to 2001, found that the “use of condoms among women with noncohabiting partners was high especially among those with secondary education (61%) and those in urban areas (58%).” STD/AIDS Control Programme, “HIV/AIDS Surveillance Report” (Kampala: Ministry of Health, 2002), p. 19.
131 Tibegwya was not sure of the precise year in which she got married, but knew that it occurred when the Kabaka, the king of the Baganda, went into exile. Date obtained from Reuters AlertNet [online], http://www.alertnet.org/ thefacts/countryprofiles/220795?version=1 (retrieved April 2, 2003).
132 Human Rights Watch interview with Masturah Tibegwya, Luwero, December 18, 2002.
133 Human Rights Watch interview with Margaret Namusisi, Iganga, January 11, 2003.
134 Human Rights Watch interview with Sara Kisakye, Naguru, January 15, 2003.
135 Human Rights Watch interview with Khadija Nankwanga, Iganga, January 11, 2003.
136 “Re-infection is a term used to describe a new or secondary infection by a virus that has already infected a person.” See Project Inform, “Re-Infection: Is It a Concern for People Living With HIV?,” The Body: An AIDS and HIV Information Resource, [online], http://www.thebody.com/pinf/jan03/reinfection.html (retrieved May 19, 2003). The possibility that a person living with HIV/AIDS could be reinfected with the same strain of HIV or infected with two strains at the same time has been a matter of controversy among AIDS experts for some time. In 2002, however, an influential editorial in the New England Journal of Medicine by Dr. Bruce Walker of Harvard University and the Massachusetts General Hospital reviewed available evidence and concluded that such reinfection was not only possible but convincingly documented in several cases. See Bruce Walker, “HIV-1 Superinfection—A Word of Caution," New England Journal of Medicine, vol. 347, no. 10, pp. 756-758, September 5, 2002. Even before this development, many AIDS education programs in developed and developing countries included warnings of the possibility of HIV reinfection.
137 Human Rights Watch interview with Joy Kobushingye, Mulago, January 9, 2003.
138 Human Rights Watch interview with Margaret Namusisi, Iganga, January 11, 2003.
139The risk of HIV infection in unprotected sex becomes heightened as a result of the vaginal lacerations and abrasions that often accompany sexual violence.
140 Michael A. Koenig et al, “Domestic Violence in Rural Uganda: evidence from a community-based study,” Bulletin of the World Health Organization 2003 81(1), p. 58, [online], http://www.who.int/bulletin/pdf/2003/bul-1-E-2003/81(1)53-60.pdf (retrieved April 7, 2003).
141 Human Rights Watch interview with Ada Rose Luba, Tororo, December 17, 2002.
142 Human Rights Watch interview with Grace Nabatanzi, Naguru, January 15, 2003.
143 Banyarwanda (pl. of Munyarwanda), one of the largest groups in Uganda, moved north from Rwanda for economic or political reasons. Speakers of Kinyarwanda, some Banyarwanda are found farming in regions of Uganda adjacent to Rwanda while others form part of the urban, salaried elite.
144 Human Rights Watch interview with Amina Kabayondo, Mulago, January 9, 2003.
145 Human Rights Watch interview with Jacqueline Nakitende, Naguru, January 15, 2003.
146 Human Rights Watch interview with Esther Nanono, Entebbe, December 13, 2002.
147 Human Rights Watch interview with Rebecca Samanya, Luwero, December 18, 2002.
148 Human Rights Watch interview with Barbara Nassozi, Nakulabye, January 15, 2003.
149 Real name used at her specific request.
150 Human Rights Watch interview with Berna Alupo, Pallisa, January 10, 2003.
151 In Uganda, prenatal clinics are referred to as “antenatal clinics,” and prenatal care as “antenatal care.”
152 Dr. Hitimana-Lukanika is the executive director of the AIDS Information Centre, established in February 1990 to provide anonymous, voluntary, and confidential HIV testing and counseling services. He confirmed that they do not require women to provide letters of approval from spouses at AIC centers. E-mail message from Dr. Hitimana-Lukanika to Human Rights Watch, May 28, 2003.
153 Human Rights Watch interview with Mutebi Musa Takamalirawo, Kawempe office, January 13, 2003.
154 Human Rights Watch interview with Alice Namagembe, Entebbe, December 13, 2002.
155 Human Rights Watch interview with Lucy Akurut, Pallisa, January 10, 2003.
156 Human Rights Watch interview with Barbara Nassozi, Nakulabye, January 15, 2003.
157 A common viral infection experienced by people living with HIV/AIDS.
158 Human Rights Watch interview with Rebecca Samanya, Luwero, December 18, 2002.
159 Professor Florence Mirembe, head of Obstetrics and Gynaecology at Mulago Hospital, confirmed that prenatal patients are provided with the option of being tested for HIV and that the tests are administered solely at the request of the patient. Human Rights Watch telephone interview with Professor Florence Mirembe, head, Obstetrics and Gynaecology, Mulago Hospital, May 28, 2003.
160 Human Rights Watch interview with Dr. Seggane Musisi, Kampala, January 7, 2003.
161 Human Rights Watch interview with Dr. Hafsa Lukwata, Association of Uganda Women Medical Doctors (AUWMD), Kampala, December 19, 2002.
162 Human Rights interview with Jane Nabulya, Pallisa, January 10, 2003.
163 According to the WHO Technical Consultation on Behalf of the UNFPA/UNICEF/WHO/UNAIDS Inter-Agency Task Team on Mother-to-Child Transmission of HIV held in Geneva in October 2000, the prevention of mother-to-child transmission of HIV should be included in the minimum standard package of care for HIV-positive women and their children. A joint UNAIDS/WHO press release outlined the policy on breastfeeding and nevirapine: “An HIV-infected women should receive counseling, which includes information about the risks and benefits of different infant feeding options, and specific guidance in selecting the option most likely to be suitable for her situation. The final decision should be the woman’s and she should be supported in her choice. For HIV-positive women who choose to breastfeed, exclusive breastfeeding is recommended for the first months of life, and should be discontinued when an alternative form of feeding becomes feasible.” See Joint UNAIDS/WHO Press Release, “Preventing Mother-to-Child Transmission: Technical Experts Recommend Use of Antiretroviral Regimens Beyond Pilot Projects,” Geneva, October 25, 2000, [online], http://www.who.int/reproductive- health/rtis/MTCT/documents/ press_release_arv_25_10_00/Press_ARV-25-10-00.en.html (retrieved June 3, 2003).
164 At a conference held in April of 2003, Dr. Phillipa Musoke the head of Makerere University’s Paediatrics Department and a pediatrician at Mulago Hospital reportedly stated: “In our society when a baby cries, the husband, aunties, uncle, and in-laws tell the mother to breastfeed it. There is no way she is going to tell them she cannot because she has HIV/AIDS. The nurses themselves keep shouting to the mother to breastfeed her baby when it cries. There are so many pressures on the HIV/AIDS positive mother.” See Lillian Nalumansi, “HIV mums pressured to breastfeed their babies,” The New Vision, April 21, 2003, [online], http://www.newvision.co.ug/detail.php? mainNewsCategoryId=9&newsCategoryId=34&newsId=129127 (retrieved May 19, 2003). A recent article in The Lancet quotes Francis Mmiro, chairman of the technical committee for the prevention of mother-to-child HIV transmission in Uganda, as stating that 61percent of the HIV-positive mothers who attended prenatal clinics at the National Referral Hospital, Mulago, choose to breastfeed even after being informed that HIV can be transmitted through breastfeeding. Saul Onyango, the medical officer in charge of prevention of mother-to-child HIV transmission, is quoted as estimating that as many as 80 percent of rural HIV-positive mothers choose to breastfeed. See Charles Wendo, “Most Ugandan HIV-positive mothers insist on breastfeeding,” The Lancet, vol. 358, August 25, 2001, [online], http://pdf.thelancet.com/pdfdownload?uid=llan.358.9282.news.17420.3&x=x.pdf (retrieved May 19, 2003). The MTCT-Plus Initiative, in which the mother and her family continue to receive antiretroviral treatment after delivery, is based at Columbia University’s Mailman School of Public Health and supported by a coalition of nine foundations. Dr. Peter Mugyenyi, director of the Joint Clinical Research Center in Uganda, expressed the view that if sufficiently funded, the program should be effective in decreasing mother-to-child transmission of HIV and should contribute significantly to the prevention of HIV transmission generally. Human Rights Watch telephone interview with Dr. Peter Mugyenyi, director, Joint Clinical Research Centre, Kampala, May 29, 2003, and e-mail from Dr. Mugyenyi to Human Rights Watch, June 2, 2003.
165 Emily Bass, “Is There a Role for Vaccines in Protecting Infants Against HIV in Breast Milk?,” International AIDS Vaccine Initiative Report: Women & AIDS Vaccines, vol. 5 no. 8, July-September 2001, [online], http://www.iavi.org/reports/259/breastfeeding.htm (retrieved May 20, 2003).
166 Bertil Lindblad, deputy director UNAIDS, Forty-Seventh Session of the Commission on the Status of Women, New York, March 5, 2003, [online], http://www.unaids.org/whatsnew/speeches/eng/47thcsw%5F050303% 5Fen.html (retrieved May 19, 2003).
167 Human Rights Watch interview with Sandra Kyagabe, counselor, NACWOLA, Kampala, December 19, 2002.
168 Human Rights Watch interview with Alice Namagembe, Entebbe, December 13, 2002.
169 Human Rights Watch interview with Erasmus Ochwo, TASO, Tororo, December 17, 2002.
170 Human Rights Watch interview with Josephine Kalule, program manager, AIDS Information Centre, Kampala, December 11, 2002.
171 Human Rights Watch interview with Erasmus Ochwo, TASO, Tororo, December 17, 2002
172 Human Rights Watch interviews with Dr. Lukanika-Hitimana director AIC, and Josephine Kalule, program manager, AIC, Kampala, December 11, 2002; Human Rights Watch interview with Grace Ssebbanja-Namwanje, counselor for discordant couples, AIC, Kampala, January 16, 2003.
173 Human Rights Watch interview with Josephine Kalule, program manager, AIC, December 11, 2002.
174 Human Rights Watch interview with Grace Ssebbanja-Namwanje, counselor, AIC, January 16, 2003.
175 Human Rights Watch interview with Robbinah Ssebbowa Ssempebwa, Action Aid, Kampala, December 16, 2002.
176 Human Rights Watch interview with Dr. Seggane Musisi, Kampala, January 7, 2003.
177 Human Rights Watch interview with Janet Nangobi, Iganga, January 11, 2003.
178 Human Rights Watch interview with Masturah Tibegwya, Luwero, December 18, 2002.
179 Real name used at her specific request.
180 Human Rights Watch interview with Anna Isikoti, Pallisa, January 10, 2003.
181 Human Rights Watch interview with Mabirizi Busulwa, Kampala, December 12, 2002.
182 Human Rights Watch interview with Robina Namutebi, Kampala, December 12, 2002.
183 Human Rights Watch interview with Dr. Seggane Musisi, Kampala, January 7, 2003.
184 Human Rights Watch interview with Robina Namutebi, Kampala, December 12, 2002
185 Human Rights Watch interview with Dr. Seggane Musisi, Kampala, January 7, 2003.
186 Human Rights Watch interview with Margaret Namusisi, Iganga, January 11, 2003.
187 Human Rights Watch interview with Magdalene Namatovu, Nakulabye, January 15, 2003.
188 Human Rights Watch interview with Jane Akinyi, Tororo, December 17, 2002.
189 Human Rights Watch interview with Sules Kiliesa, Tororo, December 16, 2002.
190 Kulsum Wakabi, “Bride Price and Domestic Violence: Briefing Paper,” (Kampala: the Mifumi Project/PROMPT, 2000), p. 3. “Many changes have occurred in the structure of society, thereby increasing the significance of bridal wealth in these communities. Migration to towns and cities, economic decline during the Amin and Obote II era meant that families were split and increasingly impoverished. All cultural values and norms that governed bride price gave way to economic interests in most parts of Uganda. . . . Bride price has, throughout the years become increasingly commercialized and abused.”
191 Human Rights Watch interview with Masturah Tibegwya, Luwero, December 18, 2002.
192 LAW-U, “Project Report on the Domestic Violence Study,” page 81.
193 Human Rights Watch interview with Amina Kabayondo, Mulago, January 9, 2003.
194 Human Rights Watch interview with Dr. Kasolo, executive director, Women and Children’s Crisis Centre, Kampala, December 11, 2002.
195 Human Rights Watch interview with Ruth Mukooyo, project coordinator, FIDA Legal Aid Project, Luwero, December 18, 2002.
196 Human Rights Watch interview with Pastor Wilberforce Owori, Tororo, December 16, 2002.
197 MGLSD, “Third Country Status Report,” p. 72.
198 Human Rights Watch interview with Jacqueline Nakitende, Naguru, January 15, 2003.
199 Real name used at her specific request.
200 Human Rights Watch interview with Zebia Itata, Tororo, December 17, 2002.
201 Human Rights Watch interview with Erasmus Ochwo, counselor, TASO, Tororo, December 17, 2002.
202 The laws governing child custody in Uganda are found in the constitution and the Children’s Statute. Article 31(4) of the constitution states, “It is the right and duty of parents to care for and bring up their children.” Article 31(5) states, “Children may not be separated from their families or the persons entitled to bring them up against the will of their families or of those persons, except in accordance with the law.” Section 5(1) provides that a child in Uganda has the right to live with his or her parents.
203 Human Rights Watch interview with Rhoda Nanyonjo, Kampala, December 12, 2002.
204 Human Rights interview with Berna Alupo, Pallisa, January 10, 2003.
205 Human Rights Watch interview with Susan Birabwa, Kampala, December 12, 2002.
206 Michael A. Koenig et al., “Domestic Violence in Rural Uganda: evidence from a community-based study,” p. 56.
207 Human Rights Watch interview with Rose Kyolaba, Mulago, January 9, 2003.
208 Human Rights Watch interview with Philip Wanyama, LC1 chair, Kampala, December 12, 2002.
209 Human Rights Watch interview with Ruth Mukooyo, project coordinator, FIDA Legal Aid Project, Luwero, December 18, 2002.
210 Human Rights Watch interview with Martha Nanjobe, executive director, Legal Aid Project, Kampala, January 8, 2003.
211 Human Rights Watch interview with Ruth Mukooyo, project coordinator, FIDA Legal Aid Project, Luwero, December 18, 2002.
212 Human Rights Watch interview with Mutebi Musa Takamalirawo, Kampala, January 13, 2003.
213 For an overview of women’s property rights violations in Kenya, see Human Rights Watch, Double Standards: Women’s Property Rights Violations in Kenya (New York: Human Rights Watch, 2003).
214 Elizabeth Eilor and Renee Giovarelli, “Land Sector Analysis: Gender/Family Issues and Land Rights Component,” Final Report, The Government of the Republic of Uganda, Grant No. PHRD/02/04, Rural Development Institute, February 2002, p. 21.
215 Human Rights Watch interview with Miria Matembe, minister of ethics and integrity, Kampala, January 13, 2003.
216 Human Rights Watch interview with Zainab Gashumba, Luwero, December 18, 2002.
217 Human Rights Watch interview with Lydia Mpachibi, Tororo, December 17, 2002.
219 Human Rights Watch interview with Sules Kiliesa, Tororo, December 16, 2002.
220 Human Rights Watch interview with Jane Akinyi, Tororo, December 17, 2002.
221 Real name used at her specific request.
222 Human Rights Watch interview with Josephine Opio-Apiyo, Entebbe, December 13, 2002.
223 Human Rights Watch interview with Zebia Akware, Tororo, December 16, 2002.
224 Real name used at her specific request.
225 Human Rights Watch interview with Sherry Simbo, Tororo, December 17, 2002.
226 Human Rights Watch interview with Evelyn Edroma, head legal and tribunals, Uganda Human Rights Commission, Kampala, January 16, 2003.
227 Human Rights Watch interview with Barbara Nassozi, Nakulabye, January 15, 2003.
228 Radhika Coomaraswamy, Report of the Special Rapporteur on violence against women, its causes and consequences, February 6, 1996, U.N. Doc E/CN.4/1996/53, para. 29.
229 The Coalition Against Gender Violence, “An Assessment of Gender Violence In Apac and Mbale Districts of Uganda,” p. 19.
230 The Coalition Against Gender Violence, “An Assessment of Gender Violence In Apac and Mbale Districts of Uganda,” p. 38.
231 Human Rights Watch interview with Hope Tumushabe, Tororo, December 17, 2002.
232 The Directorate of Public Prosecutions exists to prosecute all criminal cases in the country on behalf of the state.
233 Human Rights Watch interview with Maureen Owor, advocate, Owor & Co. Advocates, January 6, 2003.
234 Human Rights Watch interview with Jackie Asiimwe-Mwesige, coordinator, UWONET, Kampala, December 14, 2002.
235 Human Rights Watch interview with Evelyn Edroma, head legal and tribunals, and Nathan Byamukama, monitoring of treaties, Uganda Human Rights Commission, Kampala, January 16, 2003.
236 Human Rights Watch interview with Dipak Naker, co-director Raising Voices, Kampala, December 10, 2002.
237 Common Country Assessment, Uganda: Promise, Performance and Future Challenges, p. 32.
238 Human Rights Watch interview with Jackie Asiimwe-Mwesige, coordinator, UWONET, Kampala, December 14, 2002.
239 Human Rights Watch interview with Jessica Saboni, police senior superintendent, Kampala, December 19, 2002.