The first patient of the day was a 50-year-old man – successful, robust, and in good spirits. He had come to the clinic at the Y.R. Gaitonde Centre for AIDS Research and Education Clinic (YRG CARE) in Chennai, India, to receive his antiretrovirals, as he had done since his diagnosis four years earlier. His wife, diagnosed with HIV shortly thereafter, had since died.
Today, the man had a surprise announcement for his two YRG staff counselors and Kartik Venkatesh ’06 MD/PhD. “I have brought a new wife with me. She does not know I have HIV.”
His request: that the staff break the news.
Before they had a chance to respond, the patient was introducing them to the young woman. Faded henna imprints from their wedding celebration were still visible on her hands and feet. It was she who broke the silence. “I chose to marry him, and yes, I knew he had HIV when I decided to marry him.”
She was the man’s niece. Still unwed at 18, she had been aware of her family’s growing concern that she might not marry or have children – both of paramount social and economic importance for women in India. Her uncle, recently widowed, had two small children to care for. And marrying within the family – an accepted practice in that part of the country – meant that her parents need not provide a dowry.
Although the man had not shared the news of his diagnosis with his family, they had deduced the truth from his weight loss and other symptoms, followed by his improved health after spending time away from their village.
“I was honored to marry my uncle,” the woman said.
Venkatesh didn’t know if she was speaking from the heart or on behalf of her husband and family.
He still doesn’t know.
Health disparities in the developing world are often framed in socioeconomic terms. But gender is often as potent a risk factor as poverty – and far more entrenched. Driven by cultural and social mores, gender disparities persist even amid growing prosperity. And in the world of HIV, behavioral factors and access to care – often very different for men and women – are matters of life and death.