Síntesis de la evolución del tema hostal al nivel nacional y local.

6.2.1 Assessing the Risk; 'I never thought I would be infected with HIV'

The perception that women in marriage are safe from HIV infection was commonly shared by the women in my sample. The following comments offered by respondents capture their perception of risk to HIV infection:

‘...I have been married to my husband since I was fifteen and have been faithful to him. I

never knew that married women can contract the diseases.’ (Interviewee # 1)

‘They [health care provider] asked if I suspect myself for being infected, I told them I am

a married woman. From where would I bring the diseases? .... But the result showed

positive and I did not trust any of the words they were saying...’ (Interviewee # 30)

‘As a married woman I did not suspect. I never thought that I might be infected with the

disease... never (laugh) … how could I suspect?’ (Interviewee # 6)

‘I never suspected I could be infected. When she [health worker] asked to see my blood

[HIV test] ... I did not even hesitated to agree because I never thought I might have it in

180 The above comments of the respondents indicate their beliefs that being in stable relationships like marriage eliminates the risks of HIV infection. But what is more interesting is that some women chose to believe that they were safe from the risk of contracting HIV even in situations where they were suspicious that their husbands might be infected by the virus. For example Interviewee # 15, who reported that she was given to a husband by her mother at a very young age when her father passed away, said that:

‘...during the pregnancy examination [ANC] she [health workers] asked if I know about

AIDS, I said yes and added I never tested for HIV. She asked why not and I responded that I am a married woman ... that I never needed to take the testing... I agreed for the test and tested HIV positive...there were certain things that I could not foresee. My husband was sick for quite long time and I was very suspicious about the cause of his deteriorating health situation ... but it never occurred to me that I could get caught by the diseases through him... it is bad to be an illiterate woman.’ (Interviewee # 15)

Other respondents also shared reports of the extra marital affairs of their husbands. Interviewee # 28 a mother of two who had been married to her husband for nine years expressed her awareness about his extra marital affairs. She said:

‘I have heard from people that he is seeing another woman in the neighbourhood ... but I

tried to ignore it thinking that he will come to his own sense and stop seeing her.’

181 Despite knowing about her husband’s behaviour to which she had no control Interviewee # 28 said that she never thought that she could be infected and strongly believed that she was protected from HIV. In her own words;

‘… how was I supposed to think that I could be contracted the virus while sitting at

home... I thought it happens only to women who jump here and there [have multiple

sexual partners].’ (Interviewee # 28)

Interviewee # 1 also shared a similar story of low risk perception. She reported that her husband has already has a child with another woman but she forgave his act after he promised her he would not see the woman again. In spite of this, when Interviewee # 1 was offered an HIV test at the ANC, she reported that she resisted the offer by saying:

‘... I do not need to test for HIV because I do not suspect myself of being infected. I am a

married woman ...’ (Interviewee # 1)

6.2.2 Respondents Prior Consideration of HIV Testing

To understand prior knowledge and experience of the respondents in relation to HIV screening I asked whether they had ever considered HIV testing before their pregnancies. Only one respondent confirmed to me that she actually did have HIV testing before her pregnancy.

‘...five years ago I was tested for HIV. I was very sick and the doctors recommended me to do the testing but back then the result was negative...’ (Interviewee #6)

182 Among the women in my sample only four of them were in their first pregnancy when they underwent the screening for HIV. For the remaining women in my sample they had had prior experience of pregnancy and child birth even though I established from their responses that none of them had undergone HIV testing during their previous pregnancies. A respondent who said that she gave birth to her first daughter five years ago states that:

‘... they (the health providers) started the testing recently ... there was no such thing [HIV testing] before. But these days they do not allow you to leave easily at the ANC

without taking your blood for the test if you are pregnant ...’ (interviewee # 4)

Similar comment was made by another woman from Mekelle who was pregnant at the time of fieldwork and who declared that she is member of the ruling party.

‘... When I married my second husband I got pregnant immediately and I started my

pregnancy follow up [ANC] when I was already a two month pregnant woman and I

took the HIV test. Previously there was no HIV testing during pregnancy. The disease [HIV/AIDS] was found recently and woman used to give birth without knowing their HIV status and hence infect their children... But now the time is good. The government is educating women – a teachings that even ones father and mother would not teach you ...

So, No! I did not have HIV testing with my first child it is only with this one [touching

her stomach] ... time has changed.’ (Interviewee # 6)

The thinking that ‘because the disease started recently to spread and the need to test more women’ was also reflected by another woman from Mekelle during the interview:

183

‘When I gave birth to my other three children [13, 10, 7 years old] there was no such

‘testing’ thing. I have done all the monthly pregnancy follows ups [ANC] and gave birth

in hospital to all my children. There was no AIDS back then. It is nowadays that people are having it.... It is nowadays that we are hearing about testing for HIV during

pregnancy. There was no such thing before.’ (Interviewee #2)

6.2.3 The Process of Giving Informed Consent for Prenatal HIV Testing

Starting from the design stage of the interview questions, I was well aware of the problem of finding the direct meaning of the term ‘Informed Consent’ in Tigrigna (the local language). The word ‘fikadegna’ is the closest word in meaning to consent. It is inclined to mean not coerced, not forced or a volunteer without necessarily indicating awareness of available information and the capacity to understand the information given as well as the consequence of the decision to be made. Hence, throughout the data collection period I employed the word ‘fikadegna’ to connote informed consent cautiously and used different questions that related to it to avoid making assumptions about respondents’ understanding of the term.