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HIV Transmission from Husbands to Wives in Cambodia: the Women's

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HIV Transmission from Husbands to Wives in Cambodia: the Women's Spousal Transmission of HIV in Cambodia HIV Transmission from Husbands to Wives in Cambodia: the Women’s Lived Experiences Young Ran Yang A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Washington 2012 Reading Committee: Frances Marcus. Lewis, Chair Daniel Kraushaar Mayumi, Willgerodt Program Authorized to Offer Degree: School of Nursing Spousal Transmission of HIV in Cambodia University of Washington Abstract HIV Transmission from Husbands to Wives in Cambodia: the Women’s Lived Experiences Young Ran Yang Chairperson of the Supervisory Committee: Professor, Frances Marcus. Lewis, Department of Family and Child Nursing, School of Nursing In spite of an impressive overall decline since 1997, HIV transmission among married women has emerged as a new threat in Cambodia. The purpose of this interpretive phenomenological investigation was to understand the culturally and socially embedded meanings and lived experience of Cambodian women whose HIV infected spouses transmitted HIV to their wife. The theoretical framework and assumptions of Heidegger phenomenology guided this inquiry. Fifteen married women, who were infected with HIV from their husbands, completed grade 12 or less, and were sexually active with their husbands, participated in the investigation. The women’s narratives revealed cultural beliefs and practices in marriage, as well as the experiences of discovering HIV and living with the virus. The overarching theme was The Loss of the Past, the Loss of the Future as a Life Journey of a Khmer woman before and after her HIV diagnosis. From the view of the woman as a person, women lost their sense of self in their past and were forsaken ones in their future. Analysis yielded four main themes: (a) Adhering to Traditional Khmer Family Values and Fulfilling the Role of a Khmer Wife; (b) Becoming a Person with HIV, (c) Undergoing Changes, and (d) Moving on with Life. The participants reported their lives had been focused on the adherence to cultural Khmer gender values since they were young girls. However, their husbands lived only for their own happiness, ignoring i Spousal Transmission of HIV in Cambodia their societal role of head of household, engaging in risky sex both within and outside the marriage. The women’s lives of faithfulness were rewarded with HIV infection. After learning of the HIV diagnosis, the women and their families underwent many changes including in their social relationships and economic consequences. In spite of enormous losses, the women had hope for their lives. Conclusion. The women’s lived experiences in becoming HIV positive from their spouse adds to our understanding of the gender, social, and cultural mechanisms by which HIV is transmitted within marriage. Study results provide suggestions for future needed research and programs that are culturally acceptable and potentially effective in curving intra-marriage HIV transmission. ii Spousal Transmission of HIV in Cambodia TABLE OF CONTENTS CHAPTER I : INTRODUCTION ............................................................................................................. 1 Statement of Problem ......................................................................................................................... 1 Purpose of Study ................................................................................................................................. 2 Background and Significance ............................................................................................................ 3 CHAPTER II: REVIEW OF LITERATURE .......................................................................................... 6 Cambodian Society ............................................................................................................................. 6 Women’s Status, Power, and Value in Cambodia ........................................................................... 7 Potential Factors Affecting HIV Transmission .............................................................................. 12 between Cambodian Women and their Spouses ............................................................................ 12 The State of Science .......................................................................................................................... 20 CHAPTER III: METHODOLOGY ........................................................................................................ 22 Philosophical Perspectives ................................................................................................................ 22 Phenomenology ......................................................................................................................... 22 Descriptive phenomenology ..................................................................................................... 22 Hermeneutic (Interpretive) Phenomenology .......................................................................... 24 Key Distinctions between Descriptive and Hermeneutic Phenomenology ........................... 27 Justification for the “Right” Approach................................................................................... 27 Personal Forestructures of the Investigator ........................................................................... 28 Methods and Procedure.................................................................................................................... 29 Sampling and Setting ................................................................................................................ 30 Recruitment and Enrollment Procedure ................................................................................ 31 Data Collection .......................................................................................................................... 33 Data Analysis ............................................................................................................................. 38 Trustworthiness ......................................................................................................................... 40 Protection of Human Subjects ................................................................................................. 43 iii Spousal Transmission of HIV in Cambodia Risks and Benefits ..................................................................................................................... 44 Summary .................................................................................................................................... 44 CHAPTER IV: RESULTS ....................................................................................................................... 46 Description of Sample Participants ......................................................................................... 46 Life Journey of a Khmer woman before and after her HIV Diagnosis ..................................... 50 Paradigm Case: Sonida ........................................................................................................... 51 Adhering to Traditional Khmer Family Values ....................................................................... 57 Being an asset to the household ............................................................................................... 58 Love does not matter in a marriage......................................................................................... 59 Living up to the family’s and community’s expectations ...................................................... 65 Fulfilling the Role of a Khmer Wife ......................................................................................... 69 Being the family caretaker ....................................................................................................... 71 Being the faithful and trusting life partner............................................................................. 73 Being an intimate partner in marriage ................................................................................... 77 Enduring the husband’s undesirable behavior ...................................................................... 91 Becoming a Person with HIV ................................................................................................. 109 Found to be HIV positive........................................................................................................ 110 Encountering HIV: accepting an unwelcome guest ............................................................. 118 Going Public: afraid of discrimination ................................................................................. 120 Undergoing Changes: Changed a lot! .................................................................................... 123 Tolerating emotional pain: Hopeless, hopeless ..................................................................... 124 Physically suffering ................................................................................................................. 132 Undergoing changes in interpersonal relationship: “The husband becomes a good partner” .................................................................................................................................................. 133 Undergoing changes in social relationships: being perceived as an infected object ......... 143 Suffering economic consequences: work one day, survive
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