An Excerpt from Saturday Is for Funerals

Cover Saturday Is For Funerals

I KNOW YOU STILL LOVE ME: SEXUAL TRANSMISSION
Chapter 2 from Saturday Is for Funerals

Divorces in Botswana are heard by the High Court; that is how seriously the country views marriage. By the time a marriage occurs, there will have been, at the very minimum, six family meetings, starting with those involving close family and progressing to those involving easily sixty or more extended family members. During the weeks, sometimes months, of family meetings and negotiations, small and big feasts are enjoyed, during which presents of bogadi cattle, firewood, and clothes are handed over to the bride’s family by the husband’s. By the time the couple says their Western-influenced “I do’s” before the marriage officer or Catholic priest or minister of religion, and an equally Western-style wedding party is held under white tents, all the customary aspects of the marriage process have been concluded. Parents, uncles, and aunts have given their advice, and the recurring message is simple: “Not two people but two families have just been joined in marriage, and nothing, not even death, is expected to end the relationship.” In fact, according to custom a deceased woman can remain married to a living man. So death does not, per se, end marriage under traditional law.

The marriage of Daisy and Kopano would have been no different. At the time of their wedding he was thirty-three and she was only twenty-two; he was a clerk and she was a nurse: two educated people setting out to start a family and promising that they would stick together “in sickness and in health.” Twenty-two and without a premarital child—a circumstance that was becoming a rarity in Botswana; Daisy’s face had been covered in white lace to signify this. There had been such hope!

Ten years on, though, they were in the High Court—in my courtroom— standing across from each other and without the presence of family and friends, having come to end the marriage. It had all started with joyous singing and extravagant feasting. Now it was ending, and in Kopano’s voice as he gave evidence in support of his case, there was not the usual acrimony that attends most divorces, but rather a sadness, perhaps even embarrassment.

“My wife has behaved in such a manner that it would be unreasonable to expect me to continue to live with her. My marriage has broken down irretrievably.”

The statement sounded rehearsed, as if he were afraid to move from his prepared script, lest he falter. His lawyer urged him to go on, to give examples of the unreasonable behavior he says his wife engaged in. His wife looked up at him from across the room, almost challenging him. She was a beautiful woman and she stood with poise and confidence. She was wearing maroon lipstick and when she pursed her lips, which she had a tendency to do, she seemed to be flirting or about to break into a smile.

The man faltered, grabbed the glass of water in front of him, and raised it to his mouth, only to put it down again without drinking. His hands were trembling.His lawyer was having no better time; she was fumbling with the papers in front of her.

The courtroom was quiet.

Others were waiting to have their turn and no doubt they were imagining themselves up there, publicly admitting that they had been unable to make their marriage work. No doubt many, in filing for divorce, had to go against the wishes of their family. “Ngwnaka itshoke”—My child, persevere—would have been the entreaty. That final walk into the High Court in Botswana would have taken immense courage. A few—not many, from the number of people in the gallery—may have brought a friend or relative for support.

What is more, when a marriage fails, it is a walk that is more often than not taken by women, not men. Botswana society will tolerate a man who, estranged from his wife, takes a public lover, but not the other way around. Such a wife must divorce if she wishes to find another companion. A husband seeking to end a marriage will not infrequently simply take up with another woman, forcing his wife to file for the divorce, citing his behavior as the reason—for divorce in Botswana is fault-based.

That Kopano was the one suing for divorce was creating interest, perhaps even sympathy, in the courtroom. Necks were craned to get a better view of the woman who was being divorced for unreasonable behavior. The majority of the people in court were women, and those waiting their turn had stories of abuse, child neglect, adultery, and other sorry tales, all allegedly committed by their husbands. A male story was of great interest, not least because it was rare.

“Can you give the court examples of your wife’s unreasonable behavior?” the lawyer asked again.

“She spends a lot of time away from our home. She disappears for weeks, without telling me where she has gone.”

The man paused, as if asking that he be excused from saying any more, but his lawyer urged him to go on. She was concerned that he had not placed sufficient grounds before the court for him to be granted divorce.

“She does not love me.”

In response to this, a smile played on the wife’s lips. Once again Kopano faltered. The story he finally told, in stops and starts, was that Daisy was in the habit of taking off for weeks on end, without bothering to tell him where she was.He complained that she was inconsiderate and irresponsible. She had taken lovers at various times during their marriage, and his attempts at rebuilding the marriage had failed. He wanted custody of their child, and did not ask that the mother contribute to his support. He also wanted their property to be divided between them. All this, he said, he and his wife had agreed to .He saw no reason for any arguments from his wife, as they had both agreed before the court hearing that she would not contest the divorce.

Indeed, according to court documents signed by the wife, she had agreed to all that her husband was asking for. It was therefore not necessary for her to address the court. Her attendance in court was not even required. She was determined to say her piece, though.

“There is nothing I can say,” she started. The court fell silent. She looked up at me, the judge, and her husband from where she was standing, without any trace of fear or embarrassment. When she started to speak, her voice was clear and confident, unlike that of her husband.

“I did not want a divorce. I was hoping that parents could meet.”

A sigh escaped Kopano.Weariness enveloped his face. He looked up at his lawyer, his eyes pleading for help.

“May I sit down?” he asked. He sat down and cast down his eyes.

Daisy was a healthy-looking, attractive woman. She was also, obviously, an assertive person, and once she started talking, it was impossible to get her to slow down.

“He is leaving me because I am HIV positive. He is afraid of me. He even locks his door at night as if he is afraid I will come in and give him HIV in his sleep. Our first child fell ill and died. It was a long and painful illness. But we stayed together during all that. The child died of AIDS. It was found out that I too had AIDS. After the child died, my husband was very sad. He wanted another child. He was negative, but he wanted another child. I did not want another child. I was afraid. But he wanted another child. He was very sad.”

Daisy paused and her voice faltered slightly before regaining its earlier clarity.

“I gave him the child. I gave him a second child. I was afraid to become pregnant again, but I did. Now I am afraid for this child. I want the child tested. He does not want the child tested.”

“My husband is negative. Now he is afraid. I can see his fear in his eyes. At night, when we have to go to bed, I see he is afraid. That is why I sometimes go away; to be with my friends. I drink some wine and I feel better, when I am with my friends. Sometimes I just go and sit with my mother. Day after day, I just sit with her. She doesn’t ask questions, and I feel better when I am with her.”

Kopano challenged his wife, “Why would I reject you now? I did not reject you when I first found out about your condition.”

Daisy cocked her head and shook it slightly, lips pursed before responding. “I even told the doctors, that you are now afraid of me. You are afraid that I will give you AIDS. I say we can use a condom. But you are possessed by fear now. But I do agree that the marriage has broken down. You can have your divorce.”

Daisy’s public admission that she was HIV positive left the gallery stunned; people sat straight or held tightly to the rails in front of them. After all, the husband had tried to protect her by avoiding the subject.

Even after her concession that the divorce could be granted, Daisy seemed to need to say more, so as the judge I invited the parties to a smaller room where they could have some privacy. After all, the main business of the court had been concluded, the divorce was granted, custody was given to Kopano, and the property—and there was not much—was divided as per their agreement.

“Have you had counseling?” I asked, once we were all seated.

“I have been to counseling, yes. He needs counseling too. But he thinks he can just run and hide away from my AIDS.”

Daisy and her now ex-husband were seated on the same two-seater couch. I thought it interesting that in choosing where to sit, they did not try to select seats as far away from each other as possible.

That would have been the sort of thing a warring and just-divorced couple would do. I suspected though, that Kopano, had he not been the one to sit down first, would have chosen another seat. He might have thought that he would be considered rude to get up and move to another seat once Daisy had planted herself next to him. He would have noticed too, that the office was not big enough to allow for much choice in seats. He clasped his hands together and stared at them. Daisy raised her head and looked around the office before being brought back by Kopano’s words.

“She says I am divorcing her because she has AIDS. That is not true. I stayed with her for a long time even after I knew . . .”

His voice trailed off. His body language suggested extreme fatigue.

A sad smile touched Daisy’s lips.

“He is right. When we first found out, he supported me. It was before you could get ARVs from government clinics. They were very expensive, and we had to buy them. I will not lie. He supported me. We bought the ARVs together. We told no one. We would hide as we bought them.

“First our baby was sick. Sick, sick! Have you ever a seen a child so thin he looks like a rope? I would lift that child and her shit would fly across my face. Judge, can you imagine that? I am sorry to use that language, but that is the honest truth. You have never seen a child that sick, dying a little bit every day. We took that child to many doctors, here and in South Africa. I remember a Zulu nurse telling me that only traditional doctors could help. She said, ‘My sister, only a sangoma can cure this child. What have you done to your ancestors, that this should befall your child?’

“Our families too, were begging us to go to a traditional doctor. They said the child was perhaps bewitched. Or perhaps she was the victim of dikgaba [when bad luck follows someone because he or she, or a parent, has done something wrong]. But the two of us, we knew that the child was sick with AIDS. At first we did not know, but then we were told. Am I lying?”

Kopano continued to look down. Daisy continued.

“We were close, during that time. But we were also tired and desperate. We had this secret, that I had AIDS. Those days, a child with AIDS just died. Right in front of your eyes, the child would turn into a listless rope, and the diarrhea! But I will be lying if I say this man did not support me. Remember that he was negative and I was positive and our child was sick. But now he wants to divorce me after all that!”

“But you would disappear for weeks.”

“But you knew where to find me. I would go and drink with friends. When I was with my friends, drinking and laughing, I would forget for a little while that I was sick. I could keep the image of my son from my mind. But when I came home, your face said it all. You were not talking to me.”

“How was I to know? You would go for days, leaving me with such a young child. You had lovers. I couldn’t take it anymore. I was patient for a long time.”

“I was sick, and you were beginning to reject me. Don’t deny that. You know I would sit with my mother. At first I did not tell her that I had AIDS. Then later, I did, and after that it was so peaceful to sit with her, not talking, but knowing that she supported me.”

“Don’t forget that you once told me you had another lover! You even told me his name!”

“But you knew I just said that to test you; to make you jealous. You knew.”

Kopano shook his head and signed, “Daisy, it’s over. This marriage is over.”

“I know you still love me. You will come back to me. You are just afraid.”

Kopano shook his bowed head and said nothing.

“I just wish you would agree that the child should be tested. Please.” Daisy’s voice was trembling a bit. Kopano looked up, as if the change in the voice had alarmed him.

“No, not now. If he gets ill, yes. But not now, please.” His voice was stronger than before. It was obvious that they were continuing a discussion they had had on many occasions.

“I can’t live through another sick child. It would kill me.”

“I will take care of this child. This child is okay. He is okay. I have been taking care of him anyway.”

“I have agreed to let you have the child. I pray to God that this child is okay.”

The couple’s story was a sad one, but Daisy was quite a character and while Kopano seemed to prefer silence, she could talk up a storm. By the time they left the office, having agreed to seek counselors and doctors, she had my staff, whose eyes had been teary during the meeting, smiling and on at least two occasions surrendering to bursts of laughter.

“Judge, let me tell you, my life has been sad. You don’t want your child to die like mine. I do not wish that on any one. All that flying shit . . . I tell you! Shit can be expensive, I tell you! You run out of disposable nappies and start using only cloth nappies and then you can’t keep up with changing the nappies and then shit flies everywhere.

I laugh now, because as we say in Setswana, Leso legolo ke ditshego [Even the greatest of calamities can induce laughter]. I laugh, but I was not laughing then. I am not laughing in my heart.

“And the lover I told him about, I was just making him jealous. But, of course I did have sex during these years when he was afraid of me. Being sick with AIDS is not medicine against wanting sex. I am still human! Let’s not be dishonest here. What was I to do? Can you imagine a man locking the door in your face? What did he expect? That I would rape him? I felt insulted and rejected. I became angry, so of course I had sex with someone else. Hey, I won’t say more. I used protection, of course, but I did. What was I to do? I was lonely and my child was dead and I had another one whose status I did not know. What was I to do? He would not even touch me. He wouldn’t hold me.

“I did not have a lawyer, but, Judge, I can tell you, this lawyer here was great. I was impossible. She was patient. She was like a mother and sister. She did a great job. She spent hours and hours with us, counseling us. I tell you, I could be impossible. Agreeing to things, then changing my mind. I know the marriage is over, but I am sad that AIDS brought us here.

“But I know he still loves me. Rra, you still love me. You will come back to me. I know. You are just afraid of AIDS. But I am happy you didn’t get it. That is why I am giving you our son. I know you will look after him. You are not sick, like me. But please, God, I hope he is okay.”

**************

Daisy and Kopano are a discordant couple with respect to HIV status. She is HIV infected and he is uninfected. This might seem highly unusual, but it is not. In Botswana, about 20 percent of all stable couples fit this situation, where one spouse or partner is HIV positive and the other is negative. In another 20 percent of couples, both partners are infected, leaving about 60 percent with both uninfected. It may appear that, among discordant couples, it is the woman who is more often infected. But this may be misleading and due to the process by which they are identified. Women are more likely to volunteer for testing and for research trials, and discordant couples are more likely to be identified when an HIV-positive woman is detected and asked if she would like to bring her spouse or male partner for testing as well. Recognizing that numerous people in stable relationships may be HIV positive, the government has now established procedures in many of the testing centers for couples to get tested together.

Obviously, when one partner is infected and the other is not, the positive partner got infected outside the marriage or relationship. In the case of Daisy, this could have happened because she was unfaithful and had sex outside the marriage with an HIV-positive man. It could also have happened during a relationship she had before she was married. As mentioned earlier, the time after infection until an adult develops the signs and symptoms of AIDS is prolonged and variable. We don’t know how long after the marriage Daisy and Kopano’s first child was born, but we assume it was before Daisy experienced any AIDS-like illness. However, we must also recognize the small possibility that she became infected as a result of her professional activities as a nurse. This is less likely, but possible.

Nurses and physicians sometimes take blood from HIV-positive patients. If they then accidentally stick themselves with a needle and syringe that contains HIV-positive blood, they are at risk of becoming
infected. If the skin is just nicked with the needle, the risk is not great. If the plunger goes in and the health care worker is injected with the contaminated blood, the risk is much higher. In any case, someone who is accidentally exposed to HIV-positive blood in this way should immediately begin taking the HAART drug regimen, and continue on the drugs for one month. If the health worker who receives the accidental needle stick starts taking the drugs within twelve hours after exposure, the risk that infection will occur is extremely low. Laboratory researchers who handle HIV to develop vaccines and drugs face this same risk of accidental exposure, and follow the same practice of postexposure prophylaxis if they get cut or stuck with an instrument that contains virus.

Presumably Daisy did not know she was infected when she got married, or when she had her first child, the one who died of AIDS. We are told that she first learned she was infected after her first child developed AIDS. Recognizing that the child could have gotten HIV only from her, she then got tested and realized she also was infected. If she had known she was infected, she probably would have taken drugs to reduce the risk that her child would get infected at the time of birth. It appears that the baby got sick with AIDS at a young age, before HAART therapy was generally available for children. As Daisy says, “Those days, a child with AIDS just died.” In Botswana, drug treatment to reduce maternal HIV transmission was available first, two or three years before HAART was widely available to treat clinical AIDS in adults. Treatment for children was not available until at least two or three years after it was available for adults. Even then, it was often available only in the cities, like Gaborone and Francistown.

The impression we have is that Kopano is afraid of becoming infected. This is a natural reaction, particularly when Daisy says they could still have sex if they used condoms, a suggestion he refuses. But then she states that he wanted to have another child. She did not want to, but she agreed to become pregnant again. Surely he must have known that getting her pregnant required them to avoid using condoms and would put him at risk of infection, unless it was done by artificial insemination. Did she receive chemoprophylaxis with AZT or other drugs to reduce the risk that the second baby would be infected? Was she on HAART for her own AIDS illness by then? If so, that would greatly reduce the chance that the second baby would be infected. We are told that they went together to a private physician to get antiretroviral drugs for her own AIDS illness before the drugs were available at government clinics. Kopano doesn’t want to get the second child tested for HIV unless the child gets sick. Daisy says that Kopano also needs counseling, and she is right. Daisy also admits that she had sex outside the marriage, after being rejected by Kopano. Did she use condoms in that situation? She said she used protection. If she did not, how could she avoid a pregnancy from the other man, as well as avoid putting him at risk of infection? Did he know she was HIV positive?

With the large number of discordant couples, and a yearning among many of them to have children, what are the options? If the woman is infected and the man is not, he has no risk if he donates sperm and she is impregnated by artificial insemination. It is impossible to eliminate all risk that the infant will become infected, but that risk can be as low as 1 or 2 percent if the pregnant woman is on HAART during the last four or five months of the pregnancy and she does not breastfeed after the baby is born. Having a cesarean section for delivery may reduce the risk to the baby even more. When the man is HIV positive and the woman is not, the situation is also difficult. He can donate sperm, which can then be washed. If this process works correctly, the sperm remain viable; the HIV is in the semen but not in the sperm itself. As an added precaution, the woman can also go on HAART for a month or so, mimicking the type of postexposure prophylaxis that might be followed for a needle stick or a case of rape.

Stigma and discrimination have been associated with HIV testing and disclosure of the infection in many different situations. This is perhaps less likely to be a dominant reaction in situations in Botswana now, during the current stage of the epidemic, when almost all people have a family member or friend who is infected. However, there is still the fear of exposure, and the fear and depression associated with the potential loss of a loved one. Even when patients have a sympathetic and supportive family, they may be reluctant to disclose the situation to others. They know that employers, for example, may be reluctant to retain HIV-positive employees, thinking that they will be less committed to their job, even though extensive evidence indicates that patients receiving adequate antiretroviral therapy usually continue to function just as well as they did before their illness.

In Botswana, the option of testing couples together may lead to opportunities for them to share in treatment and prevention strategies. These might include the use of drugs to reduce transmission in the case of discordant couples, and HAART treatment for both partners if both are positive. At a minimum, it includes shared counseling and education to help plan for family contingencies. Were couples training and counseling available for Daisy and Kopano at the time they realized the first baby was infected?

As rates of HIV infection got very high and the disease began to have an impact on most families, it was inevitable that stigma and discrimination would decrease. Testing to determine HIV infection gradually became more acceptable, especially when people began to realize that drug treatment could save their lives, and could allow those infected to lead productive lives. Perhaps these developments came too late to save the marriage of Daisy and Kopano.


From Saturday Is for Funerals by Unity Dow and Max Essex, published in May 2010 by Harvard University Press. Copyright © 2010 by the President and Fellows of Harvard College. Used by permission. All rights reserved.

About Martha S Henry

Martha Henry is the Director of Communications for the Harvard T.H. Chan School of Public Health AIDS Initiative.