A Defining Moment: Gender-based Violence and HIV Prevention in Uganda
By Jennifer Kristin Clarke, MMASc. in Global Health Systems
I am currently finishing my 1-year MMASc. in Global Health Systems at Western. As part of this experience, I am currently in Uganda for an 8-week practicum placement. I am fortunate to have been placed for a research internship with the Rakai Health Sciences Program (RHSP), a program that is focused on improving health through research. This is an NGO that operates in a region that once had an extremely high HIV infection rate of 19.1% of the population over the age of 15 years (Nalugoda et al., 1997). The Rakai Health Sciences Program was founded in 1987 as a collaboration between Makerere University, Columbia University, John Hopkins University, the Division of Intramural Research at the National Institutes of Allergy & Infectious Diseases, and the International Centre for Excellence Research (ICER). Rakai continues to conduct research on HIV/STIs, non-communicable diseases, and reproductive health through community-based participatory research methods and field research. If you want to know more about the organization please visit https://www.rhsp.org/
On my first day at Rakai Health Sciences Program, I was given the chance to shadow a clinician working with women’s sexual health and HIV prevention. I learned about pre-exposure prophylaxis (PrEP), an oral pill taken once a day by individuals with a high risk of contracting HIV. I sat listening to the clinician discuss the medical options with several patients in Luganda--the local language. It was the fourth patient I observed that Monday morning that changed the directory of my research career and set the stage for my next research project.
I vividly remember this woman. She was in her thirties and walked into the office, handkerchief messily folded in her shaking hands, with a hollow look in her eyes. I immediately felt a sense of emotional connection with this patient and wanted to know more. I intently observed her interactions with the clinician as I watched this woman break down. Although I could not understand her language, I understood that something needed to be done to help her out of her situation. After the patient departed, I had a long conversation with the clinician who began by recounting the patient’s story in what she later referred to as “The life of an African woman.”
The patient had come into the RHSP clinic seeking an HIV prevention method because she was experiencing severe gender-based violence (GBV), particularly intimate partner violence (IPV). The particular details of the story belong to the woman who came into the clinic that day. It is her situation, and what did not happen after that will stick with me for the rest of my life. Following the woman’s departure that day, I had a longwinded conversation about general intimate partner violence in Uganda versus in Canada with the clinician. I shared my experience with past intimate partner violence to convey the climate of intimate partner violence in Canada. The clinician shared how the ‘norm’ for women in Uganda is the expectation to have sex with their husband anytime he wants, with this setting the stage in many cases of recurring marital rape. It was also shared that if a woman were to try and take action against a partner, it is very easy for their violent partner to bribe the police with ~300,000 Ugandan Shillings (currency) which is equivalent to 100 Canadian Dollars. A woman may have an option to travel and find one of the few lawyers willing to take on such cases, but then she must have the means also to pay the steep lawyer fees.
I remember asking in despair if there was anything we could do to help our previous patient. I inquired if there was any organization we could refer her to that could give her and her children aid and protection. At that moment, I could not fathom allowing anyone to go back to living under such severe intimate partner violence. The clinician calmly responded that “God will help her.” I took from this that there was no organization that could help, and that she must see many gender-based violence cases. I wondered what it felt like to be a clinician witnessing such violence, and knowing one’s patients in most cases had no choice but to return to their abusive partners.
I had not realized that my discussion with the clinician had continued through lunch and I had a long walk back up to the main building at Rakai. As I walked up the hill, I had a mix of emotions from anger towards the gender-based violence climate to helplessness as a woman. By the time I reached the top of the hill, I had a powerful desire to make a change. There was no way that I could ever ignore my experience in the clinic that day and continue with my life as if nothing had happened.
I remember lying in bed that night replaying the day in my head and searching for something that I, just one student with a strong desire for change, could do to help women across the world in similar gender-based violence situations. It was not until after a sleepless night that I thought about changing my research interests to focus on gender-based violence in Uganda and how that influences uptake and adherence to PrEP (HIV prevention method). I know I am only one student. I do not have the means to understand and provide the support every woman experiencing gender-based violence requires. However, I can publish research that not only raises awareness of the issue, but also elevates the voices of women facing gender-based violence every day. I am also excited that I can tie my passion for HIV research and prevention into my newfound purpose of building gender-based violence awareness and reduction.
It was soon after confirming that there is little research in the field, particularly in Eastern Africa, that I expressed interest in conducting research for my practicum placement. I met with the head of the gender-based violence team at Rakai who is going to help me engage in training as well as interview health workers and intimate partner violence survivors to help me conduct this research from a more informed perspective. Because I expressed an interest in publishing this research, I need a research proposal to undergo research ethics board approval both back in Canada and here in Uganda. I am interested in pursuing this research as a Ph.D. This brings me to my current challenge of needing to find a Canadian professor with the interest, infrastructure, and capacity to support this research.
References
Nalugoda, F., Wawer, M. J., Konde-Lule, J. K., Menon, R., Gray, R. H., Serwadda, D., Sewankambo, N. K., & Li, C. (1997). HIV infection in rural households, Rakai District,Uganda. Health Transition Review, 7, 127–140. http://www.jstor.org/stable/40652330
Photo by Jennifer Kristin Clarke
