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Research |
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Haitian Women's Role in Sexual Decision-Making: The Gap Between AIDS Knowledge and Behavior ChangeII. Presentation of Findings |
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3. Women's Beliefs about Vulnerability and the Consequences of AIDS Just as the majority of women in Delmas and Savanne were aware of the role of sex in the transmission of AIDS, most also believed strongly in the vulnerability of people like themselves and expressed fear of the consequences of the disease for their families. Others, like the Delmas woman above who felt overwhelmed by many bits of information, were confused. Another Delmas participant, a woman with no factory experience, believed that people differ in their susceptibility to the HIV virus.
Although doubts lingered in the minds of a few, it was evident that for most women AIDS was not only a familiar illness, but one to be feared for reasons that emerged with consistency in all participant categories. The disease is worse than evil Women usually expressed their fear of AIDS in terms of inevitable death and the suffering it would cause the family. Many spoke of the economic costs when the breadwinner dies, the breakup of the family unit, poverty, destitution, ostracism, and even the spread of the disease to other family members. "The disease is worse than evil if it takes away a family member who used to help you financially," said a woman in Savanne with no income of her own. A Delmas street vendor and mother of three echoed her fear:
A 36-year-old woman factory worker may have been conscious of her own responsibilities when she said,
Participants focused particularly on the effect of AIDS on surviving children. Phrases such as "AIDS crushes families", "kids have no future", and "children in misery" were common. A Delmas woman with a husband and two children warned:
A woman factory worker in a "vivavek" relationship expressed the same concern differently when she argued that a woman with children should not continue to live with a man who has other partners, because:
Only one woman, a Delmas mother with secondary school education, spontaneously mentioned perinatal transmission as a consequence of AIDS for the family. This disease gives the family a bad reputation Although not a major theme, the possibility of social rejection as a consequence of AIDS arose several times. In all categories except the married ("maryé/plasé") women of Savanne, participants alluded to the stigma suffered by a person with AIDS. A Delmas factory worker said she feared AIDS because of what people would say afterward to her children. "I wouldn't like to die strangely and have my children go through misery later when people ostracize them and tell them that their mother died of AIDS." One group of "vivavek" women in Savanne was also concerned about the family's reputation in the community when a member develops AIDS. "If someone in your family has it and another person speaks to you," said a woman in this group, " he curses you." Yet, despite their concern for the family image, women rarely suggested that AIDS-infected members would not be received and cared for in their homes. For the most part, women across all groups had a realistic fear of the consequences of AIDS. It was not clear whether their failure to focus on risk to the unborn child represented acceptance of child mortality as a fact of life or a gap in their knowledge of HIV transmission, but other data indicated the latter. Their preoccupation with economic loss and social consequences for abandoned children exceeded by far their concern about having to care for the sick, a reminder perhaps of many women's dependency on others for survival. Women tended to hold similar views on the risk and consequences of AIDS, regardless of differences in characteristics such as age, education, marital status, and employment. You can recognize them When asked how one recognizes a person with AIDS, some women listed such classic signs as weight loss, diarrhea, fever, and sores, as well as more exaggerated and inaccurate criteria. Others countered that a diagnosis of AIDS must be confirmed by laboratory test or medical opinion, but some doubted the physician's willingness to tell the patient the test results. Comments like the following from a segment of the discussion in Savanne are typical of women's responses on this topic.
My husband is not fooling around out there Although women concurred strongly that "anyone can get AIDS," in each category there were some who felt they were exceptions to this rule. Many qualified their remarks with statements that people do not need to be afraid if they do not "fool around" ("viv deyo"), referring to the practice of sexual encounters outside the regular partnership. Remarks such as, "If a woman has confidence in herself ("fe respe") and the husband she is living with, she knows she will not contract the disease" and "if they can trust themselves, they will have no problem" illustrate their cautious optimism. The discussion often turned to personal testimony, with assertions of their own responsible behavior and sometimes also the fidelity of a husband or regular partner, but there was less conviction about the latter. Others based their confidence on religious belief. One such woman, a Protestant from Delmas, feared AIDS from hospital treatment but not sexual transmission:
Another Delmas woman also defended herself but with an edge of uncertainty about her husband's behavior. She explained at length that her decision to use condoms for family planning had nothing to do with fear of AIDS, since "he doesn't see ("viv ave") other women." As for herself, she assured the group that she "does not fool around ("mwen Fe respe mwen"). God will not let me contract AIDS unless I go around looking for it." Then, as if to allay an edge of doubt, she added, " Even if my husband is promiscuous, I would know if he were coming to give it (AIDS) to me. God will see to it that he does not transmit it to me." We are afraid Few women shared even the guarded confidence of some of the Delmas participants quoted above. In every category they spoke of the unpredictability of AIDS transmission with respect to several recurrent sub-themes: You can't tell who has it; you can't trust your partners; some people give AIDS to others on purpose; men won't listen; and, finally, if you refuse your partner, you only increase your risk, because he will find what he wants on the streets. Not surprisingly, the Savanne women in "vivavek" relationships added another dimension to the problem: dependency on men for economic support. Women in more stable relationships face the same problem, but the "vivavek" groups were the most outspoken in their expression of dependency and personal vulnerability. When asked directly, almost all admitted to being very afraid, as in the following dialogue:
A "vivavek" woman with five children and no steady income summarized the fears of other vulnerable women when she observed:
You never know who has it When asked if it is possible to recognize an infected person, women in all categories were quick to compare what they had seen or heard about the appearance of AIDS in its later stages. These sometimes vivid descriptions were accompanied by warnings to avoid sexual contact with such individuals. When prompted, however, most acknowledged the possibility that infected people who do not appear ill may also transmit the disease. Women readily volunteered such comments as, "When they first catch it they don't look like they are sick" and "The AIDS germ doesn't appear on you easily - you're eating, you're looking great, and you have the germ." "I consider it like a lottery," said a married woman from Delmas. "If you're lucky you won't get it, but if you have bad luck you will." The transcript does not reveal the kind of luck this woman believed might protect her from AIDS, but numerous comments from other women across all categories suggest that this kind of fatalism may reflect their painful awareness that one can never be sure of the HIV status of a sexual partner. The following segment from a "vivavek" group in Savanne illustrates the thinking of women in unstable relationships:
Married women in Savanne had similar misgivings. "There are men," one warned, "who deny they are seeing other women ("nan fi deyo"). When they contract the (AIDS) virus, you will not know they have it. It is only when they start having diarrhea that you know, and by then it is too late." Another woman in her group explained that "when the disease first penetrates the man's system, he may not know he has it. You as his wife won't know - you will contract it no matter what, because it doesn't appear full blown at first ("li pa vin ak fos"). You will always get the disease, because neither person knows. Similarly, a married woman in Delmas lamented, "Anyone can get AIDS. Even if we know everything we should do (to prevent it) we can get it. You never know who has AIDS." "I may be sleeping with ("mwen gen") two, three, or four men," said a single woman in Delmas, "and I don't know which among them has AIDS. I will catch it and transmit it to my 'husband'." The man goes out and his wife gets AIDS Driven by the realization that often they do not know with whom their partners are having sex, women were more vocal than men when it came to expressing fear. Not only is it impossible always to know who has AIDS, many women never know for certain whether their husbands or regular partners are visiting and contracting the disease from other women. A former woman factory worker, a married mother of three from Delmas, warned that René would probably "try to prove to Joujou that he is not involved with other women when he really is. With bad luck the woman he is seeing may have AIDS." Individually, many women volunteered that their own husbands were faithful to them, but the underlying consensus seemed to be that monogamous unions are rare. Women in all categories commented frequently that, married or not, men leave the house to have affairs with other women who may be infected. As a married Delmas woman put it, "The wife at home knows she is sleeping only with her husband and trusts him - so she gets AIDS." This comment prompted another woman in the group to add, "The man may be seeing another woman who is leading another life that she knows nothing about." Women often personalized the issue of trust, stating that they, themselves, did not engage in extramarital affairs but that they had misgivings about their men, as in the following comments of women in Savanne:
"We are afraid," said a married woman in Delmas, "because even if you want to live (monogamously) with men, they do not want to stay with one woman." Another married Delmas women in Delmas volunteered that, "for myself, I would not be afraid, but the person I am with is not seeing just me, so I will always have fears." Later the same woman added:
And a Delmas mother of five in a "vivavek" relationship, said,
The uncertainty that these and other women were expressing is an important element in their fear of AIDS. They have heard and taken seriously the public health messages warning of the dire consequences of promiscuous sex, but they lacked a clear sense of personal empowerment to act on their own behalf. If I had AIDS I would not die alone The question of intentional transmission arose often enough to suggest that it is a concern that may add to the Haitian woman's sense of vulnerability to AIDS. A married woman in Savanne told a story in which a man gave a woman a large sum of money for sex, then "told her to eat well and wait for death." This participant was illustrating a point that others also made: people with money are to be feared, because they not only are more likely to have AIDS, but they can afford to disseminate it more widely to women they encounter on the street. A married ("plasé") street vendor in the group supported this view when she commented that a man "may know that he is going to die and yet offer you as much as $200; if you like money, you may get AIDS." Why do some women feel a person would wish to infect others? The problem may be one more of disregard than of intention, but some of the women in Delmas saw it otherwise:
Women in both the "vivavek" groups also raised the issue of deliberate transmission. "When a person finds out that he has the disease (AIDS), he is happy to give it to the other person so the other can have it, too," said one. When the moderator asked the other "vivavek" group to comment on whether a healthy appearing person infected with AIDS can pass the virus on to others, the answer was definitely yes. One of these unmarried participants, a 25-year-old mother of four, elaborated on the overall affirmative response of the group as follows:
In Delmas, a woman factory worker gave her opinion that some men have no interest in AIDS prevention, because "they want to transmit it to you; they're malicious." Her negative views were echoed by another factory worker who advised others in her group to "beat" a man if he tries to infect her. Remarks such as these reveal undercurrents of anger, blame, and retribution with important implications for behavioral intervention that need to be explored. |
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