KAMPALA, 14 March 2008 (IRIN) - Fatuma and Hamidu Kamugisha met 12 years ago as hotel employees in Tanzania's Victoria Lake-side town of Mwanza and sparks flew. The couple hooked up, married and then returned to Hamidu's native Uganda where they had four children.

Almost ten years later, however, Hamidu fell seriously ill and tested positive for HIV, although Fatuma tested negative for the disease.

"We had a very healthy sex life before I got TB," Hamidu told IRIN/PlusNews in the tiny one-room home he shares with his wife and children in the shanty town of Giza Giza in the Ugandan capital, Kampala. "In fact, just three days before I was taken ill with TB [tuberculosis] and hospitalised, we had made love."

When Hamidu fell ill, however, things changed. "I started on the TB medication and I can say for the eight months I was on the treatment I was too unwell to do anything with my wife. I was just too weak," he said.

In May 2005, three months after completing his TB drug regime, doctors prescribed Hamidu life-prolonging antiretroviral (ARV) medication.

"The change has been great. I fall ill less often and apart from a poor appetite and the occasional chest infection, I am as healthy as anyone else," he said. "I also quit smoking, which I believe has improved my health."

And although condom use with his wife was a difficult adjustment, the couple's sex life took an upward turn when his strength returned.

"We now use condoms all the time and our sex life is back to the way it was before the illness," Fatuma said.

Healthy libido

"It is well documented that when patients start on ARVs their sexual libido goes up," said Dr Charles Namisi, the medical coordinator of Reach Out Mbuya, a nongovernmental organisation providing counselling, livelihood support and food supplements to more than 2,800 clients affected by HIV/AIDS, including more than 100 discordant couples, where one partner is HIV-positive and the other negative.

"There is the fact that they are living longer and are healthier and also the 'second chance' effect, where they are energetic because they have been given a new lease on life," he said.

Reach Out Mbuya's senior counsellor Fredrick Katumba said, "When the HIV-positive person discovers their status and gets treatment, the love comes back, often stronger than before." He emphasised that a combination of ARVs and counselling were critical in keeping couples affected by HIV together.

A three year study into sexual behaviour and HIV transmission risks among people taking ARVs in rural Uganda, published at the 15th Conference on Retroviruses and Opportunistic Infections held in Boston in February, found ARVs significantly stimulated sex lives without increasing the likelihood of engaging in risky sex.

The study found that people on ARVs experienced an increase in sexual activity, as well as a better quality of life and a lower likelihood of depression.

"When we first thought I might have HIV, my wife was hesitant to tell me because I had already said I would kill myself if I were positive," Hamidu said. "But now that I'm healthy, I work as a builder and can support my family, so I no longer think such thoughts."

Through counselling and regular sessions with Reach Out Mbuya's discordant couples' club, Fatuma and Hamidu were able to work through the disharmony that plagued their marriage following Hamidu's diagnosis.

"We had a lot of misunderstandings before we got counselling," Fatuma said. "He had refused to use a condom, he said it brought him no pleasure and he would prefer to live like brother and sister. It was only when I threatened to go outside the marriage for sex that he agreed to wear one."

"Now we understand each other better and are able to communicate better; our children are even happier now that we don't fight so much," she said.

Risk reduction

Reach Out Mbuya's counselling sessions for couples affected by HIV place great emphasis on the consistent and correct use of condoms. The organisation's links with the Roman Catholic Church, which frowns upon condom use, mean its staff do not train people on how to use condoms, but refer clients to partner organisations that do.

According to Fatuma and Hamidu - who experienced a condom bursting during sex and then underwent months of anxiety waiting for Fatuma's HIV results - education on proper condom use was critical.

"We stress that they can have a normal sex life, but only as long as they take their drugs regularly and use a condom every time they have sex. It must become a habit," Reach Out Mbuya's Katumba said.

He said it was possible for discordant couples to have children, although a small risk of transmission remained.

The majority of the shanty town's residents are too poor to afford artificial insemination or other methods of safe conception, so clients are advised to try to conceive when their viral loads are undetectable and their CD4 counts [which measures the strength of the immune system] are high and, if they succeed, to enrol in a prevention of mother-to-child transmission programme.

"The risk of transmission to a partner or to a child is always there, but we make sure they know all the facts so they can make an informed decision - our job is not to tell them whether or not to have children," Katumba said.

The organisation discourages clients from alcohol abuse, which is a major factor leading to risky sexual behaviour, and emphasises the importance of adhering to ARVs and maintaining a healthy diet.

"We want the clients to remain healthy and continue to have a positive outlook on life, but at the same time we need to ensure that they are concerned about not infecting other people," Katumba said.

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