The use of condoms within a marriage seems to continue to be surrounded by a lot of controversy and in some cases deliberately misleading misinformation. It would appear that there is a common belief (particularly among men) that the use of condoms does not belong in a marriage – under any circumstances whatsoever. Men who have multiple concurrent partners seem more prepared to use condoms in their sexual relationships outside of marriage, and yet would be unwilling to do so with their wives at home.
In the innumerable HIV and AIDS related meetings and workshops I have attended or spoken at over the years, the tendency is for the male participants to reject the idea that condoms can and should be used in marriages when necessary. Men have said categorically that they can not and would not use a condom with their wife. I have had men say angrily to my face that they think it is absolutely preposterous that I could even suggest that they use a condom with their wife at home!
The use of condoms has somehow been stigmatized to imply that condoms can or should only be used in illicit sex – or just in sex outside the marriage.
Women on the other hand, have always seemed more open to the idea of condom use in a marriage if it is deemed necessary. Most have however been reluctant to be the ones to initiate the idea, fearing rejection, rebuke and gender-based violence if they did so. Again the impression is that the majority of men will not accept the idea of condom use in a marriage, and even much less so if the suggestion to do so is mooted by their wife.
In the last couple of years of writing this column, I have received quite a number of correspondences from women whose male partners insist on unprotected sex even under circumstances where it should be known that this would place the women at high risk of HIV infection. When I have received such mail, I have time and again visited the topic of the consistent use of condoms in a married couple. I have pointed out that there are several circumstances under which it would be imperative and absolutely non-negotiable for condoms to be introduced in a marriage.
The most obvious of such circumstances is where there is discordance – that is where one member of a married couple is HIV positive and the other is negative. In such cases, it is imperative that sex between the two should always be with the protection of condoms. This is necessary in order to protect the HIV negative partner in the couple from being infected. The onus is therefore on the HIV positive partner to protect his or her partner from infection.
In the cases that have come to my attention, in practice and through this column, the difficulties seem to arise when the HIV positive partner is the man or husband. It would appear that some HIV positive men are in the habit of putting their HIV negative wives under pressure to have sex without condoms. Many reasons and excuses are advanced for this and all of them we have dealt with in previous articles.
For example, there are several stories told where some HIV positive men seem to insist that in order for their negative wives to show or prove their “love” for them, they must accept sex without condoms. Then there are those who insist on their wives to show their love by getting pregnant. To get pregnant there must be unprotected sex.
Sometimes, men have been known to deliberately misquote the science of HIV and AIDS in order to persuade or coerce their wives into sex without condoms. I have been told of men who tell their wives that the doctor has said that it is okay to do this because they are on ARV treatment and therefore they are not infectious.
(To be fair to the men, there has been at least one story that we have quoted on these pages in the past, of an HIV positive woman – from one of the health professions no less – who was deliberately misinforming her negative husband, in order to coerce him into having sex with her without a condom!)
The bottom line is this: In case of discordance, couples must have protected sex all the time – using the male condom or the female condom – in order to prevent transmission of the virus to the partner who is negative. With improving quality of counseling, this should not even be arising as a debatable issue. Where the negative partner feels that they are being put under undue pressure to have unprotected unsafe sex, they should access the counseling services, first on their own, and then together with their partner to receive more counseling.
The next set of circumstances under which condoms should be used consistently and correctly by a married couple is when both are HIV positive. In this case, it is necessary for the couple to protect each other because every time they have unprotected sex, they are exchanging virus – a process referred to as “re-infection”.
We often hear stories of men who say to their wives that since they are already infected, then there is no need to protect each other any further. The argument that is sometimes advanced is that if they remain faithful to each other, there is no more danger. This is not true. Every time an infected couple has unprotected sex there is viruses being exchanged and being added to the viruses that each already has. Because there are different strains and subtypes of the virus, this re-infection could even be with a strain of virus that is different from the one the person already has circulating in their blood and other body fluids.
Protected sex is essential even if both the people concerned are on ARVs. If for argument’s sake one partner’s virus develops resistance to the ARVs because of problems of poor adherence, they could then infect their sexual partner with this resistant strain. When this happens, no matter how adherent the second person is, they will have a strain that is resistant, and will not respond to the ARVs they have been taking with good adherence.
Thus condoms are a very essential part of the sexual lives of HIV infected people, whether they are both infected or not.
The next set of circumstances is rather difficult to convince most people about. Every married couple should use condoms if they do not know each other’s HIV status. The only true exception should ideally be situations where when the couple married they were both virgins, and since they got married they have remained absolutely faithful each to the other. In any other circumstances outside that, people should use condoms if they do not know their HIV status, or that of their partner in marriage, if they know their own to be negative.
For example, where two people get married who have both, or one of whom has, been sexually active before the marriage and without condoms, they should, in reality, always use condoms until they know both their HIV status to be negative.
Condoms do have a very important place in marriage, especially where there is HIV
The stark reality is that in a country like ours with its high HIV prevalence, in certain cities and towns, just about every fourth adult person is infected with HIV. Certain age groups have higher prevalence than others – including those at which most people get married. This is why it is imperative young couples contemplating marriage should have counseling and testing before they marry. (In actual fact they should know their status before they have unprotected sex – if they do this before they marry.)
The reason is not that they should call off the marriage if one is (or both are) found to have been infected with HIV. It is done just so that as they get married, they should be aware of their collective HIV status (negative, discordant or concordant), to enable them to handle sex in their marriage.
Unfortunate situations have arisen, where marriages have been called off because one or both partners have been found with HIV. It is unfortunate because it is not necessary for two people who love one another and would like to be married to be denied this union because of HIV. Two people can live together very lovingly and happily when one or both have HIV. All they need is some counseling about how to handle the sexual part of the union.
Couples who are discordant or concordant can have children too – provided that they attempt this under the guidance of an HIV practitioner. The practitioner can help them plan to have the pregnancy in such a way that the possibility of infection of the negative partner is minimized (in discordant couples). If both are positive and they feel that they would like to take the chance to bring a child into the world, they too can be helped to plan the pregnancy in such a way that repeated re-infection is minimised.
In all this, what is important to bear in mind is that the both members of the couple are absolutely truthful to each other, and that they share the knowledge, facts, counseling and all else.
As they share the truths, so they will share the myths, misconceptions and fears that will always come up when dealing with HIV. It does not do for one spouse to distort the truth and plainly lie to the other, just for the benefit of having unprotected sex.
When two people really love each other, the needs, wishes, protection and safety of the other should be paramount in everything they do – including sex.
This applies equally in couples where there is HIV. When malicious lies come in about there being no need to use a condom for this or that reason, then love has gone out the window.
Condoms do have a very important place in marriage, especially where there is HIV.