You can learn about condoms, know that fidelity or abstinence can protect you from AIDS, but if your husband is HIV-positive, violent and wants sex, there is not a whole lot you can do.
HIV/AIDS is ravaging sub-Saharan Africa. It is one of only two regions -- the other being North Africa and the Middle East -- where more women are infected than men.
ILLUSTRATION: MOUNTAIN PEOPLE
The UN estimates that 29.4 million people in sub-Saharan Africa are HIV-positive. About 58 percent are women and girls.
It is not that African women sleep around. Subjugated in marriages where many have no economic or legal independence, infection is often unavoidable: if you have nowhere to go, having sex with your infected spouse is not a matter of choice.
HIV/AIDS has long been seen as a health issue, while domestic violence is classed as human rights. A new report by Human Rights Watch says that if governments are to fight HIV/AIDS, they must start seeing that the two go hand in hand.
"I was commonly the one who was beaten," Ugandan woman Sules Kiliesa told the report's author. "He would beat me to the point that he was too ashamed to take me to the doctor. He forced me to have sex and beat me if I refused.
"This went for every [wife]. Even when he was HIV-positive he still wanted sex. He refused to use a condom. He said he cannot eat sweets with the wrapper on," she said.
A combination of factors heighten vulnerability to HIV. Cultural perceptions of women's sexual and reproductive obligations, paying a bride price, unequal property and child rights can make it impossible to leave an abusive marriage.
Husbands may have several wives and lead promiscuous lives outside of their marriage. Women often see violence as innate to marriage, accepting it as part of their role as a wife.
"There is a high incidence of infection among faithful wives of errant husbands," Sheila Ndyanabangi, at Kampala's ministry of health, told Human Rights Watch.
Billboards advocating condom use, cheaper treatment or encouraging fidelity and abstinence -- all key to initiatives such as those proposed by US President George W. Bush -- have little impact on what happens inside an unhappy home.
Women cannot negotiate condom use, are unable to resist forced sex and without equal legal and economic rights have no chance of leaving -- where would they go, how would they live?
For report author Lisa Karanja, it is crucial that governments enact laws to prohibit discrimination against women. Land acts must provide for spousal co-ownership, widows must be able to inherit, marital rape must be recognized.
Women must be given a way out.
"It is crucial now that governments intervene," she said. "Using culture and tradition to allow women's violence to go on is now becoming fatal. You can't just brush this under the carpet anymore, it is killing women and creating orphans."
Karanja chose to write her report, called "Just Die Quietly," on Uganda, because it has often been held up as the continent's AIDS success story -- prevalence has dropped greatly in the past decade due to a courageous government campaign.
But if she could prove a link between domestic violence and HIV/AIDS in Uganda, Karanja said, the implications for the rest of the region would be frightening.
Neighboring Kenya has made far less headway in dealing with AIDS. An AIDS act has been pending for a year, and the lack of public debate has not helped reduce the stigma of a disease which kills around three Kenyans every five minutes.
"It is almost inevitable that those women are going to get infected, as long as their husbands stray and as long as they have no voice," said Judy Thongori, who chairs CREAW, a center for abused women in Nairobi.
Faced with unwanted sex with a husband who has HIV, a woman with no financial independence has two choices, Thongori said. She can either leave and starve today, or choose to stay with a roof over her head, putting off death for a few more years.
Karanja said that for a country like Kenya, where a new government says it is eager to change bad old habits, the time is ripe to address women's rights. If leaders truly want to tackle AIDS, domestic violence must be a priority.
While polygyny, male property rights, sex as a marital obligation, the payment of a bride price and the lack of rights over children remain customary in many African societies, it is time to stop hiding behind tradition.
"If tradition is subjugating and trying to harm someone, we have to change it," Karanja said. "We have to evolve, we have to be progressive."
Changing laws is only one part of the battle. Africa needs more shelters, more social education, more legal assistance for female victims of domestic violence. But a sound legal framework could provide the basis for those things to happen.
The frightening implications of HIV/AIDS for the African continent have been clear for some time, but Karanja said the enormity of the impending disaster for women is still unfolding.
In her report she quotes the UN secretary-general's envoy for HIV/AIDS in Africa, Stephen Lewis, who last year described the disaster as "annihilating a gender."
"The toll on women and girls is beyond human imagining," Lewis said.
"The practice of ignoring gender analysis has turned out to be lethal. For the African continent it means economic and social survival. For the women and girls of Africa, it's a matter of life and death."
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