“Clinical implications of HIV treatment and prevention for polygamous families in Kenya and Uganda: ‘My co-wife is the one who used to encourage me’”.

Johnson-Peretz J, Onyango A, Gutin S, et al. (2024). Journal of the International Association of Providers of AIDS Care (JIAPAC).

“I personally come from a polygamous family – we are two wives. I may be aware of my partner's status and in fact, we have all tested together the three of us, but this does not give me the leeway to monitor each one's movement and any of them may mess up [have an extra-marital affair] at any time. That is why I opted to use PrEP.” (24 y.o. female, (wife order unknown), Kenya)

“You find someone who is 15 or 16 years is already married as a third wife and they do not know the status of the husbands. When they come and tell you about it and you tell them about PrEP, they will say ‘I am willing to take that in order to protect myself.’” (46 y.o. female provider, Kenya)

Synopsis: Using 27 in-depth, semi-structured qualitative interviews with participants in two studies in rural Kenya and Uganda, we analysed challenges and opportunities that polygamous families presented in the diagnosis, treatment and prevention of HIV, and provider roles in improving HIV outcomes in these families. 
Key Findings: Overall, prevention methods seemed more justifiable to families where co-wives live far apart than when all members live in the same household. In treatment, diagnosis of one member did not always lead to disclosure to other members, creating an adverse home environment; but sometimes diagnosis of one wife led not only to diagnosis of the other, but also to greater household support. 
Recommendations: The complex families produced by polygamous marriage customs give rise to additional considerations for healthcare providers and public health messaging around HIV care. Cultural leaders such as imams and community elders can play a role in normalizing conversations about testing before marriage and discuss HIV treatment and prevention within polygamous families. They can persuade the community that it is the whole family's responsibility to protect one another and foster their health. Respected community leaders can also discuss HIV prevention and treatment with mothers-in-law so as to minimize or eliminate PrEP stigma towards their daughters-in-law.