August 2003 Vol. 15, No. 15(A) JUST DIE QUIETLY: DOMESTIC VIOLENCE AND WOMEN’S VULNERABILITY TO HIV IN UGANDA TABLE OF CONTENTS Map of Uganda .............................................................................................................................................1 I. SUMMARY..............................................................................................................................................2 II. RECOMMENDATIONS ........................................................................................................................5 To the Government of Uganda .................................................................................................................5 To Donors and Regional and International Organizations: ......................................................................6 III. BACKGROUND ....................................................................................................................................8 Uganda: Historical, Political, and Economic Context ..............................................................................9 The Legal System, Education, and Health..............................................................................................11 HIV/AIDS in Uganda .............................................................................................................................14 Domestic Violence in Uganda................................................................................................................16 Women’s Status in Uganda ....................................................................................................................18 IV. DOMESTIC VIOLENCE AND HIV/AIDS........................................................................................21 Lack of Bodily Autonomy......................................................................................................................22 Obstructed Access to HIV/AIDS Information and Treatment................................................................27 HIV Status ..............................................................................................................................................30 Polygyny.................................................................................................................................................32 Traditional Practices...............................................................................................................................33 Economic Dependence ...........................................................................................................................36 Limitations on Redress ...........................................................................................................................39 V. STATE RESPONSE .............................................................................................................................42 Shortcomings within the Legal Framework ...........................................................................................43 Constraints to Effective Prosecution ......................................................................................................53 Lack of Protective Services and Restricted Access to Health Services..................................................61 HIV/AIDS Services ................................................................................................................................62 HIV/AIDS Programming........................................................................................................................64 Dissemination of Information.................................................................................................................65 Ministry of Gender, Labour and Social Development............................................................................65 VI. UGANDA’S OBLIGATIONS UNDER INTERNATIONAL AND REGIONAL LAW....................67 VII. CONCLUSION ..................................................................................................................................72 APPENDIX: DECLARATION OF COMMITMENT OF THE U.N. GENERAL ASSEMBLY SPECIAL SESSION ON HIV/AIDS, JUNE 2001 ......................................................................................................73 ACKNOWLEDGMENTS ..........................................................................................................................76 MAP OF UGANDA Uganda, No. 3862 Rev. 4 © United Nations Cartographic Section, May 2003. I. SUMMARY He used to force me to have sex with him. He would beat me and slap me when I refused. I never used a condom with him. When I got pregnant I went for a medical check-up. When I gave birth, and the child had passed away, they told me I was HIV-positive. I cried. The doctor told me, “Wipe your tears, the whole world is sick.” ZInterview with Harriet Abwoli, Mulago, January 9, 2003. Harriet Abwoli is just one of many women from diverse regions, ethnic groups, religious backgrounds, and economic classes in Uganda, whose experiences tell one story: that domestic violence has played a critical role in rendering them vulnerable to HIV infection. The human disaster of HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) has devastated the African continent, and disproportionately affects African women, who account for the majority of infected people in the sub-Saharan region. The accounts in this report reveal that Ugandan women are becoming infected with HIV, and will eventually die of AIDS, because the state is failing to protect them from domestic violence. Domestic violence is a global phenomenon, and one of the leading causes of female injuries in almost every country in the world. For many women in Uganda, as in much of the world, domestic violence is not an isolated and aberrant act, but arises from and forms part of the context of their lives. Human Rights Watch interviewed Ugandan women who confront an environment that sustains unequal power relations, contend with persistent societal pressure to tolerate violence, and whose husbands and extended family routinely subject them to coercion and emotional abuse. Many women were victims of marital rape. Women were also powerless to protect themselves from infection and were unable to access HIV/AIDS services because their husbands physically attacked, threatened, and intimidated them, and did so with impunity. Although our interviews made clear that domestic violence was widespread, it is difficult to estimate the levels with accuracy, as government data are scarce. Despite a rhetorical commitment to women’s rights, the Ugandan government has failed in any meaningful way to criminalize, condemn, or prosecute violence against women in the home. To date, the Ugandan government has ignored the role of violence, and, in particular, unwanted sexual relations in marriage, in exposing women to HIV infection. Meanwhile, Ugandan women are dying. Human Rights Watch interviews revealed that Ugandan women became vulnerable to HIV infection as a result of domestic violence in complex and intertwined ways. Most women saw domestic violence as innate to marriage, and viewed sex with their husbands as a marital obligation. Traditional attitudes that designate women as the physical property of their husbands deprived them of any authority over marital sexual relations. Customs such as the payment of “bride price” (payment made by a man to the family of a woman he wishes to marry), whereby a man essentially purchases his wife’s sexual favors and reproductive capacity, underscored men’s socially sanctioned entitlement to dictate the terms of sex, and to use force to do so. Violence, or the threat of violence, deprived women of bodily integrity by eliminating their ability to consent to sex, to negotiate safer sex, and to determine the number and spacing of their own children. In many cases, abandonment or eviction from the home held even greater terror for these economically dependent women, who, confronted by a hostile social environment, ignored their husbands’ adultery and acquiesced to their husbands’ demands for unprotected sex. In an environment where the stigma of AIDS remains high, a fear of violence prevented many women from accessing HIV/AIDS information, from being tested for HIV infection, and from receiving HIV/AIDS treatment and counseling. Women attended HIV/AIDS clinics in secret, and were afraid to discuss HIV/AIDS with their husbands, even when they suspected that the men were HIV-positive and were the source of their own infection. Their in-laws evicted HIV-positive widows from their homes and stripped them of their property and means of support when they were at their most physically vulnerable. Their lack of economic autonomy hampered their capacity to escape abusive relationships, thereby exacerbating their vulnerability to violence and HIV infection. Human Rights Watch 2 August 2003, Vol. 15, No. 15(A) Most of the women were in polygynous unions (marriage to a man with more than one wife). A number of these women were coerced into unprotected sex despite the heightened risks of HIV infection. Traditional practices such as widow inheritance (the “inheritance” by a man of his brother’s widow) exposed women to unprotected and unwanted sex with HIV-positive partners. Uganda’s success in reducing HIV/AIDS prevalence has been globally acknowledged. Nevertheless, the government’s failure to identify and