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The Unseen Things: Women, Secrecy, and HIV in Northern Nigeria

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What do HIV-positive women in Nigeria face as they seek meaningful lives with a deeply discrediting disease? Kathryn A. Rhine uncovers the skillful ways women defuse concerns about their wellbeing and the ability to maintain their households. Rhine shows how this ethic of concealment involves masking their diagnosis, unfaithful husbands, and unsupportive families while displaying their beauty, generosity, and vitality. As Rhine observes, collusion with counselors and support group leaders to deflect stigma, secure respectability, and find love features prominently in the lives of ordinary women who hope for a brighter future as the HIV epidemic continues to expand.

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Introduction: Things Unseen

ePub

Introduction: Things Unseen

2. The Unseen Things

Hope is in the tender hands that hold you.

Hope is in the embrace of the loving.

Hope is in the flesh touching flesh

to remind us of our human selves.

Hope is in the gentle nod of recognition,

hope is in the limping body still pushing

against the pain, the discomfort, still

laughing from so deep down it feels

like the rush of alcohol in the head

the full abandonment of all fear.

Hope is in the freedom to say

I long to be touched by a lover,

I long to feel the rush of desire

satisfied; hope is to embrace hunger

and find comfort in the sharing of needs.

Hope is in the hands we grasp,

the prayers we whisper,

the Amen, the Amen, the Amen.

Kwame Dawes, Faith

IN THE SPRING of 2003, I met with a young, widowed woman named Mary in an HIV clinic in the middle-belt city of Jos, Nigeria.1 It was a difficult interview, filled with many tearful pauses as she recounted her relationship history. Apart from the physicians and counselors in the hospital, I was the only person who knew she was infected with HIV. Mary’s narrative jumped back and forth in time. It was hard to understand. She was anxious and interrupted at numerous points to ask questions: about America, about her health, about the tape recorder. As Mary grew comfortable with me, more personal questions followed: Did I have a boyfriend? When would I marry? I stammered through my answers. Yet another interruption: “Katie,” she said, “I want your advice.” Mary paused. She then asked, “Can I get married?” I did not know what to say.

 

1. First Loves

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1

First Loves

When I was a very young woman, men would compliment me a lot!” Amira, a married woman from Kano in her twenties, described to me:

When they said I was beautiful, I felt as if I was on top of the world. I felt so happy and proud among my friends. Then came my future husband, John. He kept on pursuing me … it was just a “boyfriend and girlfriend” routine. He would wait on the road outside my house to take me to school…. He was twenty-eight years old and I was a just a young girl. Let’s say around thirteen. He knew that lots of young guys were after me – younger than him. Good-looking guys! He dedicated a lot of time to me so that I would not escape from him. He would take me home after school. His car would be parked right at the school gate. I remember how my principal – who liked me so much – put me on suspension because of this. I was young and intelligent. She did not think John would allow me to focus on school. She thought I was too young for so much attention.

 

2. Twice Married

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2

Twice Married

Jummai was fifteen years old when she met the man she would eventually marry. Born in northern Nigeria, she spent her childhood in Cameroon. A mutual friend shared his photograph with Jummai, and she sent her picture to him in return. “Really,” she said, “at the time, I just wanted to see if he had any ‘defects,’ and then I would say yes. I always wanted to marry someone from far away.” This man traveled frequently to her city on business. When he first called on her, she liked him immediately. Jummai then introduced her boyfriend to her family. Next, he returned with his parents to ask Jummai’s parents for their approval. They consented to the marriage. His family presented them with an offering of kola nuts as a sign of their gratitude. After two months, they came back to Jummai’s home with a suitcase filled with cloth. His family gave these items to her relatives to announce the engagement. They set the wedding date. Soon after that, they brought Jummai’s kayan lefe (the groom’s gift to the bride).

 

3. Dilemmas of Disclosure

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3

Dilemmas of Disclosure

Over the past two decades, the number of HIV counseling and testing centers in medical sites across Nigeria has grown exponentially. Women also receive HIV tests when they seek prenatal care in hospitals. Because these services are routinely offered, many wives learn their status without their husbands’ knowledge. They must then decide if and how to disclose the results to them. Counselors often complained to me about the difficulties they had trying to persuade women to bring their husbands in for screening. I asked one administrator how she managed this challenge. She told me confidently:

Well, the number one thing that can be done to ease this issue is counseling. When women attend HIV counseling, it goes over very well. But, there is a different way you counsel a man because … well, personally, this is the way I do it: I will write a note to the husband. I will say that I would like to see him in the hospital because I have an important issue to discuss with him regarding the baby. So, the moment they see this note, they are very eager … that, “a medical personnel wants to see me! Let me go and know what is happening.” And, when the man comes, that will be the only opportunity that I have to even sit down and counsel him…. Specifically, I tell men, “Okay, when women come to the hospital to deliver the baby, they may need a blood transfusion. And, because HIV is so rampant now, we need to screen your blood.” If you just tell men directly that it is an HIV test, they will not like it. You will say that they need to know their blood group, the genotype, and so on. “Without this blood information,” we say, “your wife might get blood from somebody, and you will not know whether the person is HIV-positive.” They will say, “No! No! No! Madam, please test me so that I will know my status, just in case … so that you can prepare for the birth.”

 

4. Intimate Ethics

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4

Intimate Ethics

In 2006, I sat in a counseling office at an HIV clinic with Patience, a close friend and key informant. She had worked there for a year as a treatment support specialist. Her day-to-day activities consisted of escorting patients from the lab to the physician’s office to the pharmacy. Patience complained that the medical director had asked her to provide guidance on “living positively” to a distraught patient. They hoped Patience would share her personal experiences with her. Although some of the staff members knew she was HIV-positive, many of her clients did not. The hospital policies did not require her to disclose her status, and she resented being asked to do so.

Like many other patients, this young woman believed that her life was over. Patience confronted the client. She said, “Look at my face. Do you know if I am positive or negative?” The woman said she thought she was negative. She continued, “How do you know this?” The woman responded that it was because she was so fat. “In fact,” Patience countered, “I am positive … so you see, you can live healthy just like everyone, as long as you take your medicine every day.” The medical lesson was clear: if you adhere to your treatment regimen, you will remain healthy. However, Patience also imparted to her client a social lesson implicitly understood by all of the women in that clinic’s waiting room: beauty – displayed through a curvy, welldressed body and modest, yet self-assured, comportment – is deceptive.

 

5. Hope

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5

Hope

Because of global donors’ increasing investment in HIV treatment programs over the past decade, the number of support groups across the country has multiplied exponentially.1 In Kano city alone, there are at least seven, comprising several hundred HIV-positive men and women. On the wall of one of the offices where I conducted interviews, there was a framed document outlining the vision of the support group. In line with the expectations of these donors, it stated that their central mission was to “promote a self-sufficient society, the alleviation of poverty, and the reduction of stigma.” The nongovernmental organizations that sponsor support groups also assist them by serving as venues for programs that address “social care.”2 HIV-positive men and women may access resources, such as legal services, linkages to food support, and income-generating programs, primarily through enrollment and involvement in these groups. In addition, clinicians, public health workers, and researchers, like me, recruit people in these sites for different kinds of studies, interventions, and public events.3

 

Conclusion: Evidence and Substance

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Conclusion: Evidence and Substance

There is substance in the gathering

of bodies battered by this disease.

There is evidence in the quiet promise

we make to be here again next week.

There is substance in the sweet taste

of coconut water, the scent of morning.

There is evidence in the songs a slim man

sings, healing as the balm of warmed oil.

There is substance in the expletives shattering

our peace, the tears, the lament, the fear.

There is evidence in the hum of recognition,

the comfort of hands held tightly.

There is substance in the streets walked

to tell people to hope for tomorrow.

Kwame Dawes, Faith

Throughout this book, I have documented the centrality of hope in HIV-positive women’s narratives of their lives: for health and wellbeing; for love, marriage, and children; for education, work, and economic prosperity; and for security and longevity. Through an ethnographic lens, I have located these dreams in women’s lived realities. Their aspirations for the future surface in scenes of youthful trysts and romantic encounters; in marriage celebrations and fearful wedding nights; in violent encounters with abusive husbands and futile pleas for help from family members; in hidden pregnancies and joyous presentations of baby pictures; in elaborate beauty regimens and conspicuous displays of generosity to relatives, neighbors, and researchers; in successful entrepreneurial businesses and uncompensated, arduous household labor. These women’s steadfast faith – in God, in the virtue of family, in a meaningful life, in a cure for their disease – grounds these hopes as they face formidable daily struggles. Amid the changes ushered in by global initiatives centered on increasing access to HIV treatment and medical services in Nigeria, theirs is a story of continuity.

 

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