Enwereji, E. E. (corresponding author)
College of Medicine
Abia State University
Uturu, Abia State, Nigeria
Phone:+2348036045884
E-mail: hersng@yahoo.com

Enwereji, K.O. (co-author)
College of Medicine
Nnamdi Azikiwe UniversityTeaching Hospital
Awka , Anambra State, Nigeria
E-mail: drkayman@justice.com

 

INTRODUCTION

One of Nigeria's greatest challenges is to discourage cultural practices that negatively affect the economic existence of HIV positive women. With Nigeria's high prevalence of HIV and AIDS, 5% of women attending antenatal care services (Federal Ministry of Health 2002 HIV and AIDS surveillance study) , economic empowerment of HIV positive women should be given high priority in the society. There is growing evidence that eliminating practices that discourage women's inheritance rights to family resources, especially those HIV positive, will mitigate negative economic consequences of HIV and AIDS, and reduce poverty [1,2]. This is necessary because women's lack of economic empowerment is the key factor in the spread of HIV and AIDS [3].

The problem is that traditionally, customs forbid women to own resources like land, and houses that would bring them at par with men economically [ 4], yet women's rights to inherit housing and land are enshrined under the international human rights laws to which many countries including Nigeria are signatories. The Nigerian legal system is a combination of Nigerian legislation, English law, customary law and judicial precedents [5]. Each of the legal systems determines the right of the woman. Under statutory marriage, women and children could have property rights but under customary law which is commonly practiced in Nigeria, women do not have the right to inherit family resources [6,7]. Usually, if a husband dies, the widow, her children and husband's property are inherited by brothers and/or other male relations of the deceased husband. Traditionally, a widow only escapes being inherited if she is too old and/or frail to be inherited [8-10].

In Abia State, property ownership is a source of security for means of livelihood and also a quick capital by which additional economic resources are acquired. It is this premise that encouraged men to exclude women, including widows and those HIV positive from access to and/or control of family resources [11-13]. Nowadays, the devastating effects of HIV/AIDS due to economic hardship requires that HIV positive women should be encouraged to own resources to enable them cope with their economic demands [14, 15]. This is necessary because the economic burdens of HIV and AIDS have reduced household income by 80%, food consumption by 15-30% and primary school enrolment by 20-40% [16,17]. Denying HIV positive women access to family resources because of stringent cultural practices could worsen their health conditions and chances of survival [18-20]. A good understanding of the health, economic and social needs of HIV positive women would encourage individuals to support economic empowerment of HIV positive women.

The custom of regarding married women as strangers who could leave when the marriage is estranged, contributes to the practice of denying them rights to family resources. The premise is that if women including those HIV positive are allowed access to family resources, that when their marriages are estranged, that they would probably take with them the acquired items (21-25).
The indigenous practice where the estate of a man who dies Intestate, would be inherited by his male children and/or relations rather than his female children has been described by [26-28] as a disadvantage to women's rights to resources. These authors favour the supreme court judgment (Mojekwu's judgment) that females should be encouraged to inherit family resources to minimize the economic hardship that most women are exposed to at the death of their breadwinners.
Family resources for this study refers to material goods in the family such as land, house, and other items that could generate funds.
The study aimed at noting the extent to which HIV positive women are allowed rights to family resources to enable them to generate finance to support themselves and avoid depending on others for assistance.

Study objectives are:
- to note the extent to which traditional rulers support economic empowerment of HIV positive
women
- to identify types of relationships HIV positive women encounter with family members
- to document factors that influence HIV positive women's rights to family resources.

Total sample of 98 HIV positive women in a network of people living with HIV/AIDS in Abia State was studied. Women in the network of people living with HIV/AIDS were used because of the difficulty in identifying HIV positive individuals in the society. Most individuals are reluctant for some reasons, to disclose their sero status. It was considered safer to study those who have openly declared their sero-status. Also 5 traditional rulers from the five communities where the PLWHA came from were interviewed. The traditional rulers were included in the study so as to authenticate the responses of the HIV positive women. Moreover, it was assumed that Traditional rulers as custodians of culture are veritable instruments capable of effecting changes that would positively influence HIV positive women's rights to family resources.

The study area is Abia State of Nigeria. Abia State is located in the South-eastern part of Nigeria and comprises 17 local government areas with Igbo as the common language. The population is over 3 million [2006 draft census report] with HIV prevalence rate of 3.6% [ABIA State HIV/AIDS status 2006].
In the indigenous customary set up, males are entitled to marrying many wives, have extra-marital sexual relationships, maintain family name, and also inherit family resources unlike females.

Two types of marriages, statutory and customary are practiced. Customary marriage is most popular and enforces women married under this law to practice exogamy (leaving their descendents to live with that of their husbands). There are two types of inheritance, patrilineal and matrilineal but the most common is patrilineal. Under both types of inheritance, custom upholds males as the sole owner of any property in the family, and that sons and not daughters should be the surviving heirs. However, under matrilineal systems, unlike patrilineal, daughters might have the right to inherit family resources only if they choose not to be married but rather remain in the family to procreate male issues that would bear the family name particularly, where such families do not have male issues. Where such daughters fail to have male issues, then, the family resources from the mother's side would be given to the nearest male kin relation.

Also, if a woman is wealthy as to buy landed property, it will be deemed that she bought the land for either the son or the husband and not for herself. Culturally, men's social statuses are assessed by the number of wives and children they have. The higher the number of wives and children, the higher men are socially rated. Traditionally, inheritance is based on the principle of primogeniture (the right of the first born to succession). Where a man marries more than one wife, the first son of each wife would be entitled to rights to inherit family resources. The extent of share each son gets depends on the age. The eldest gets a larger share than others. For occupation, main occupation of people in the communities is subsistence farming and staple food is 'garri', a product of cassava.

Data were collected with questionnaire, focus group discussion and interview guide. The questionnaire which contained open-ended and closed-ended questions was administered for those who cannot read and write, and self-administered for those who can read and write. Interview guide contained structured questions which were used to uncover some personal information that respondents were unwilling to release at group levels. This method was termed necessary because of the sensitive nature of the study.

Twelve focus group discussions comprising 7-9 HIV positive women were organized with the help of three trained Research Assistants. The questions in the focus group discussion contained structured questions and women were grouped according to their ages, marital status, types of marriage, and locale.

Key informant interview was used for the traditional rulers. The questions were made up of open-ended questions which explored the views of the traditional rulers on economic empowerment of women and others. For uniformity in the analysis, the key informant guide was administered because of disparity in the education of the traditional rulers.
Results of focus group discussions which were grouped according to themes were translated and transcribed by the three trained Research Assistants. Data were analyzed both qualitatively and quantitatively using Tables and percentages.

University Ethical Committee vetted and approved the study before its commencement. Following this approval, permission to conduct the study was obtained from the President of the network of people living positively with HIV/AIDS (PLWHA) as well as from the female members of the network in the State. Their respective approvals enabled the researcher to collect information from them uninhibited. The researchers also gave statements of confidentiality as well as briefs on the objectives of the study.
A request for permission to tape-record the session was made to participants and this was granted. In addition, a written permission to conduct the study was requested and obtained from the traditional rulers in the five communities studied.

Findings from the traditional rulers:
Five traditional rulers, all males, between the ages of 60 years and above were interviewed.

Traditional rulers' views on economic empowerment of HIV positive women
None of the five traditional rulers interviewed supported economic empowerment of women whether HIV positive or not. They held a common view that women would be obstinate if they are allowed to acquire more assets than men. The Traditional rulers emphasized that culturally, women are subordinates to men and that they should not acquire family resources in preference to men. Moreover, they stressed that women are visitors in the family and that they could abscond from the family at will and therefore should not be entrusted with family resources.

The majority of the traditional rulers felt that it would be outlawed for anyone to allow females to inherit family resources when there are males in the family to do so. Their belief was that men as breadwinners should be in possession of family resources so as to enable them to plan disbursement for the benefit of all family members.

In the words of these traditional rulers: it would be difficult for anyone to convince elders as decision makers , to allow women irrespective of their health or marital status, to inherit family resources, especially immovable ones like land, housing and others when there are men to do so.

Traditional ruler's knowledge of the health needs of HIV positive women:
Findings showed that the traditional rulers' overall knowledge of the health and nutritional needs of HIV positive women remained poor. Though the traditional rulers had a slight knowledge of modes of HIV infection, they were not aware that HIV positive women require special attention. For instance, the traditional rulers lacked the knowledge that HIV positive women need to eat balanced food, procure anti-retroviral drugs in other to cope with impacts of HIV and AIDS as well as seek treatment for opportunistic infections. The popular view of these rulers was that lazy women always fake sickness in other to avoid farming so as to depend on others for assistance. The rulers emphasized that women should engage in elaborate farming to produce enough food for their families' consumption.

The most intriguing findings in this section is that traditional rulers' lacked knowledge of those who are HIV positive in their respective communities. This finding suggests that most HIV positive women studied did not disclose their sero-status in the communities where they live. This lack of disclosure could be responsible for the traditional rulers' poor knowledge of basic needs of HIV positive women.

Traditional rulers' responses on factors that influence HIV positive women's rights to family resources:
Traditional rulers worried that individuals in the communities stress on practices that disallow women rights to resources more than other factors. Using the words of some of the traditional rulers:
'We feel bad that culture regards women as visitors in their matrimonial homes and therefore, are neither involved in family decisions nor entitled to family resources. Women are usually accused of being responsible for any death that occurs in the family, that is why a family 'will' is scarcely made in their favour and even when made, it is usually not implemented'.

Findings from HIV positive women:

Background information:
The average age of women studied is 22 years. About two-thirds of them, 64 (65.3%) are widowed, 20 (20.4%) are married while 14 (14.3%) are single. Out of those married, 8 (8.2%) of them are cohabiting with their husbands, while 12 (12.2%) of others are divorced and/or separated. From the number that are widowed, 48 (49%) of them were forced back to their natal homes, while 16 (16.3%) others were inherited by relations of their deceased husbands. For those that are single, 6 (6.1%) of them were about getting married while the rest were betrothed and had strong plans of getting married soon.

Out of the population of HIV positive women studied, only 16 (16.3%) had tertiary and secondary school education and are employed in some establishments while out of 82 (83.7%) who had primary school and non-formal education, 34 (34.7%) are self employed while the rest are mainly subsistent farmers. About 61 (62.2%) PLWHA complained of lack of financial assistance from relations. In all, 38 (38.8%) and 60 (61.2%) of the HIV positive women studied live in urban and rural areas respectively.

HIV positive women's responses on factors that affect rights to family resources:
The majority of the HIV positive women especially widows said they were deprived family resources because they were accused of playing key roles in the death of their husbands and/or other family members. As a result, they were subjected to some inhuman treatments such as stripping them, shaving of hairs including pubic hair, starving them, forcing them to cross coffins of those they are suspected to have killed as well as sleeping in the same room with such corpses. These treatments they said, were meted out to them to substantiate the allegations against them. Implications of these harsh treatments is that if during this period none of them died and/or fell sick, they would be vindicated, otherwise, they would be held responsible. In all, a total of 85 (86.7%) HIV positive women including widows said they were tortured and denied access to family resources.

Using the words of six of these women:

Our husbands' relations collected all our husbands' belongings on hearing of their death. They accused us of killing our husbands and as a result, brutalized us. Because of these accusations, they denied us support with our husbands' resources. Now some of our children have dropped out of school due to inability to pay their school fees.

When the women were asked whether those living in the urban areas also had similar experiences from their husbands' relations like those in the communities, a good number of the women responded in the affirmative. The women worried because they felt that the elders sanctioned whatever dehumanizing actions their husbands' relations meted to them. Using the words of five women:
The elders are not kindly disposed towards us. They support our brothers-in-law to maltreat us, If we ask for financial assistance, they would boo at us, insult and accuse us of also planning for their untimely death like we did in the case of our husbands. We are excluded from family decisions because we are regarded as visitors in our matrimonial homes. Moreover, when a family 'will' is made in our favour, the elders would discourage its implementation stressing that as visitors, we are not supposed to be heirs in the family.

The women complained that their greatest problem was how to raise money to procure anti-retroviral drugs, feed their children, and pay for their children's education.

Types of relationships HIV positive women enjoyed with family members:
Findings showed that a good number of HIV positive women especially the widowed had horrifying experiences like rejection, discrimination, beating, chastisement, lack of care and support with some family members which translated into interpersonal conflicts.

Four (4) of the women who were inherited narrated their experiences as thus:
'We are not happy because our brothers-in-law who inherited us insult, brutalize, stigmatize, and deny us financial assistance. Men are generally wicked. They purposely would not provide our needs. If we complain they will label us as bad and threaten to drive us out of the family or kill us.'
Further reports from three (3) widows state that:

'We have six children, yet our brothers-in-law took all our husbands' resources because we refused to be inherited barely one month after the death of our husbands. When we complained, we were chased out of our matrimonial homes.

Result from the quantitative data also show horrifying experiences HIV positive women had with family relations see Table 1.

From this Table, the highest experience HIV positive women 20 (20.4%) encountered from family members was intolerance.

Responses the women gave on reasons for family members' actions against them are contained in Table 2.

From the Table, the commonest reason 38 (38.8%) HIV positive women gave for their family members' action against them was demand for husbands' possessions. Further, the marital status of the women commonly chastised was explored. From the finding, respondents from all marital statuses were chastisements but the most commonly chastised were the widowed 48 (49%). Table 3 contains this.

From the Table, as high as 59 (60.2%) of the HIV positive women were chastised in all marital statuses.

Another important finding was that HIV positive women made a living by taking two types of risks. Firstly, 25 (25.5%) of them earned their livelihood by acting as hired labourers in the farm while as high as 54 (55.1%) at various periods had sex without a condom. These risks were more among women in the rural areas than those in urban areas. Table 4 contains details of their sexual practice.

The reasons the women had for engaging in unprotected sex was explored (see Table 5).

From the table, the highest reason 47 (87%) the women had for this awful practice was their male partners' dislike for condom use.

There were striking similarities between information given by the traditional rulers and the responses of the HIV positive women on factors that discourage HIV positive women's rights to family resources. The HIV positive women enumerated factors such as perceiving women as visitors in their families, seeing women as responsible for all deaths in the family, cultural rights for men to inherit property of the deceased including the widow, breadwinner role of men and others. On the other hand, the traditional rulers deliberately and carefully enumerated actions like cultural rights for men to inherit possessions of the deceased, perceiving women as visitors, subordinate role of women, seeing women as the cause of all deaths in the family, and others.

Also, a good number of the HIV positive women had horrifying experiences like beating, rejection, discrimination, chastisement and others from family members which resulted in denying them access to family resources. Based on this finding, it is safe to assume that HIV positive women studied arguably experienced domestic violence.
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A good number of the HIV positive women spoke at length about the difficulties and frustrations they had faced in the past or they anticipated having to overcome in future. One of the most frequently mentioned experiences was their lack of access to health care services. They worried that during episodes of sickness that neither the hospital authorities nor their family members assist them financially to receive prompt treatment rather, that they would be scolded for being sickly. The inability of family members and hospital authorities to financially assist HIV positive women to receive adequate treatment during health problems shows that HIV positive women were not provided with their health needs. This finding suggests lack of care and support for the HIV positive women. Findings on lack of care and support for HIV positive women agrees with that of (3, 6, 7) and is at variance with that of [12,14] which documented increased care and support for people living with HIV/AIDS. This finding presupposes that the family members of HIV positive women are not aware of their basic needs. It is not to be over emphasized that HIV positive women need finance to meet the demands of purchasing anti-retroviral drugs, eating balanced food, treating opportunistic infections, paying children's school fees and other family needs. Therefore HIV positive women should be allowed rights to family resources to enable them meet their health, financial and social needs. This will reduce the tendency of depending on others for assistance. Denying HIV positive women rights to family resources is at variance with the recommendations of (21, 22, 23) that supreme court ruling of Mojekwu to allow female's rights to inherit family resources be implemented.

In the present study, HIV positive women took two types of risks in order to earn their livelihood: acting as hired labourers in the farm, and having sex without condoms. The risks of acting as hired labourers could easily wear them down, reduce their immunity and further expose them to several infections especially opportunistic infections. Also, HIV positive women having sex without condoms increases actions that encourage HIV infection. The finding that HIV positive women engaged in unprotected sex agrees with that of [19, 20].

Although the traditional rulers had good knowledge of modes of HIV infection, their overall knowledge of health, financial and social needs of HIV positive women remained poor. They exhibited little or no concern for the welfare of HIV positive women. This is shown by the traditional rulers' attitude of linking constant illness and other life experiences of the HIV positive women with laziness and/or lack of zeal for the women to engage in elaborate farming to raise enough food for sustenance like others. This is also shown by their negative attitude of discouraging economic empowerment of women.

The findings of this research provide an introduction to problems HIV positive women encounter in their attempt to survive in the communities, as well as issues and concerns of stakeholders towards the wellbeing of HIV positive women and how these women cope with these problems. The most crucial need is the one the women identified themselves which is to create a society which will support their rights to access family resources to reduce their dependence on family members in their attempt to mitigate the demands of HIV infection. Therefore, encouraging policies that would promote inheritance rights of HIV positive women could reduce the risks they take to survive in the communities. If HIV positive women are continuously denied rights to possess family resources, government's efforts to reduce the impact of HIV and AIDS on women would yield no significant result unless the government with the support of traditional rulers enact policies that would discourage some cultural practices that negatively influence women's existence by denying them access to family resources.

It is therefore plausible to recommend that government and traditional rulers should discourage factors that dehumanize women, pauperize them and deny them access to family resources. This recommendation is necessary because only the government with the help of traditional rulers can make policies capable of changing social norms, customs, and other practices that negatively influence rights to possess material It is felt that since the traditional rulers decide what obtains in each community, that there is need to organize seminars and/or workshops to enlighten them on the benefits of empowering HIV positive women and allowing them access to family resources.

Many questions are generated by this study. Although this particular study was limited by the number of respondents, and the lack of generalization of result, there are clear indications that the concerns raised are as difficult as they are real. Marginalized groups of HIV infected women both in the rural and urban areas are perceived to have few resources and are at great risk of managing complex health problems including poverty. In addition, exploration of the experiences of HIV positive women in the communities would yield important information for HIV prevention.