Source: allAfrica
Grace* raised her children in the cramped corridors of Kampala's slums where proximity and necessity make neighbours de facto family members. But everyone looked the other way when her husband started beating her.

She says the violence began soon after they were married. When she asked to work to raise money for their five children's school fees, he beat her. When she asked about his HIV status, he beat her. She never denied him sex, but still he beat her.

Grace was trapped by the need to secure the immediate survival of both her and her children. "I needed school fees for our children. I needed food. I wanted to work outside of the home but he refused me to work. I had no choice," Grace said.

The abuse Grace suffered has been normalised and reinforced through the centuries of global and local traditions of male dominance. But the historical inequality puts women at risk of a modern threat--HIV.

The ABC strategy of the 1980s focused on abstinence and being faithful, but did not address the complex cause and effect relationship between gender-based violence and HIV.

Vulnerability

Grace gave birth to five children and then following the birth of the couple's last child, Grace took her first HIV test. That was in 1997 and she was positive. In denial and for fear that it too would result in beatings, she kept her status secret.

He came home just before dawn most nights, saying that his shift as a taxi driver ran late. Grace says she always guessed he was out with any one of his multiple girlfriends. Although she shrugged his late nights off at the time, she feels confident that it was through one of these rendezvouses that he contracted HIV. In turn, she contracted the virus from him. "Definitely," Grace said.

The cultural acceptability for men to take multiple partners outside of the marital home and the expectation for women to engage in unprotected sex, regardless of his actions, puts wives at a particularly dangerous nexus.

Sammuel Lule is a community activist for SASA!, a Swahili word for "now" and an acronym for the organisation's steps against gender-based violence and HIV--start, awareness, support and action.

"Even if the man goes out of the house for one year or more, the day he comes back, he expects to have sex with his woman," Lule said. "She loses her voice. She cannot refuse. The husband always decides, even if he left the house for years. When he returns, she is expected to submit fully."

Afraid of beatings or worse, Grace never asked her husband about his status nor asked him to use a condom.

"He didn't tell me if he tested but I think he knew. He was always taking medicine. I would ask, 'Why are you taking so many pills? What could these be?' He ignored me and did not suggest safe sex. Now I know he knew his status and still forced sex with me," Grace said.

She was forced by her husband's secrecy into a secrecy of her own. She could not disclose her status without risking abuse. She could not seek treatment.

Setback

Stellah Namanya, a volunteer, says, "Often men do not have good health practices. He does not want to go to the clinic for testing," Namanya said. "[If] she tests and is positive, the husband blames the woman for bringing the HIV into the home. Then he acts against her. He refuses to provide for her and the children. He kicks her out of the house. He rapes her."

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Confined to the home under her husband's control and with five children to care for, Grace put her health on the back burner for both her and her children's security.

"I just kept quiet," Grace said. "I thought there would be violence. He would say I brought it here. He would have beaten me."

Refuge for Grace's health only came after her husband's death from an AIDS-related illness in 2000. She retested to confirm her status two months after his death.

Her husband left her a flooded home, debts and a life-threatening illness. Now she had to juggle single motherhood and unemployment without any professional skills. She struggled to find work and provide for her children

A dearth of time, money and emotional support kept Grace from seeking ARV treatment for eleven more years.

Although the HIV epidemic first wracked Uganda in the 1980s, the country lacked resources for abused women until 2008. Without communal support, Grace was left to face her husband's abuse and her diagnosis alone.

In 2008, ActionAid launched three pilot shelters for victims of gender-based violence. The first opened in Kampala in 2012. Today there are only 13 shelters operating nationwide.

The shelters' capacities pale in comparison to the estimated number of women in abusive relationships. But a culture of submission and a lack of awareness about the shelters keep women from seeking care. On June 7, Kampala's shelter housed only three women.

"Some people don't know their rights. Some know but don't know where to go. We try to sensitise them about what power they have, what legal rights they have and where they can go," Irene Ahimbisibwe, counsellor at the Action Aid Women Protection Centre, said.

The ActionAid shelters and SASA! work to break down cultural gender norms that subject women to abusive behaviour.

"There are some women who still have that belief that, for example, if her husband doesn't beat her, it means that the husband doesn't love her. So they also think that men should beat them," Namanya said.

SASA!'s prevention programmes and the limited shelter network offer little support to victims of abuse like Grace who have already contracted HIV.

After her husband's death, Grace was initially furious that he had given her HIV. Eleven years after his death, Grace turned to counsellors at The Aids Support Organisation (TASO).

TASO provided food and other basic necessities, affording Grace more time to focus on treatment and her ARVs. Slowly, she regained control of her health.

Despite the obstacles of widowhood, HIV, poverty and gender inequality, Grace is proud of the control she has claimed in her life.

She hasn't missed an ARV pill since starting treatment in 2011, works with a local NGO helping other widows from Aids find work and feels confident of her ability to negotiate safe sex.

"I'm not going back," Grace said. "Today I look forward."

* Name changed to protect victim's identity.

By Annie Brackemyre

• Africa
• Uganda