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African Journal of Reproductive Health, Vol. 15, No. 3, Sept, 2011, pp. 25-41 ORIGINAL RESEARCH ARTICLES What's Shame Got to Do With It? Forced Sex among Married or Steady Partners in Uganda Kathleen Cash Independent Scholar and Executive Director: Appalachian Institute for the Advancement of Women and Youth Code Number: rh11033 Abstract Research objectives were to understand the relationship between sexual, domestic and civil violence and the transmission of HIV/AIDS in Uganda. The focus of this paper is on forced marital sex within the context of Ugandan marital and steady partner relations. Qualitative unstructured interviews were conducted in focus group discussions and private in-depth interviews with 450 Ugandan men and women. Data analysis focused on patterns in respondents' experiences, interpretations and dialogue. Research findings illuminated how forced marital sex is induced by feelings of shame and could play a significant role in HIV/AIDS transmission. Findings suggest five interrelated reasons for forced marital sex: the absence of sexual pleasure, pregnancy, poverty, infidelity and alcohol use. Influencing the nature and extent of public and private conversations between spouses, men in drinking groups, family members and friends about the health and relational consequences of sexual violence is critical to changing normative beliefs and behavior. (Afr J Reprod Health 2011; 15[3]: 25-41). Résumé L' étude avait comme objectif de comprendre le rapport entre la violence sexuelle domestique et civile et la transmission du VIH/SIDA en Ouganda. L'accent est mis sur la violence sexuelle conjugale dans le contexte des rapports conjugaux et des partenaires en relations stables. Des interviews qualitatives non-structurées ont été menées à travers des discussions à groupe cible et des interviews en profondeur auprès des 450 Ougandais et Ougandaises. Les analyses des données ont concentré sur les tendances dans les expériences des enquêtés, les interprétations et le dialogues. Les résultats ont éclairé comment la violence sexuelle conjugale est provoquée par les sentiments de honte et peut jouer un rôle important dans la transmission du VIH/SIDA. Les résultats préconisent cinq raisons étroitement liées pour expliquer la violence sexuelle conjugale : le manque du plaisir sexuel, la grossesse, la pauvreté, l'infidélité et l'emploi de l'alcool. Pour modifier les croyances et le comportement normatifs, il est critique d'influencer la nature et l'étendue des conversations publiques et privées entre les époux, les hommes quand ils boivent ensemble, les membres de famille et les amis, sur les conséquences sanitaires et relationnelles. Key words: forced sex, Uganda, married, shame, sexual violence, HIV/AIDS Introduction Husband, now you despise me From Song of Lawino by Okot p'Bitek 1 Okot p'Bitek, a poet of Gulu, Uganda, wrote the song-poem, Song of Lawino, as a womanly and culturally provocative lament. In it, p' Bitek expresses a village woman's feelings toward her husband, Ocol. Lawino's lament is a castigation of Ocol as much as a plea for love because he has cultivated the ways of whites. Lawino's song inadvertently describes the attitudes of educated East Africans—discarding and disparaging 'the village' in their attempts to join their colonizers. Particularly compelling in this song-poem are the intimate feelings of a wife who represents the very things that her husband is trying to throw off. We hear how Ocol in his seeming arrogance and self importance transgresses against Lawino. In his mistreatment of Lawino, Ocol rejects what he believes to be inferior to acquire what he believes to be superior. However, it is Ocol himself who is colonized, not as much by the outward trappings of modernity, as by something much deeper in the human psyche: shame. What's shame got to do with it? Humans, individually and collectively, feel shame at the threat of or the anticipation of failure. Feelings of failure provoke internal discomfort: 'Who I am (we are) is being wronged' or 'Am I (Are we) being wronged because of this wrongness within me (us)'. 'Why am I (are we) being wronged?' and 'What have I (we) done to deserve this injustice?' Anticipated and experienced shame is relentlessly connected to our social fears because we live in the minds of 'others' without knowing it.2 Shame is lived contradiction. We are constantly negotiating these contradictions because our emotions are complicated by our dependence on others. However, while we live contradiction, we long for coherence. We want to set it 'right.' Shame, and inversely, pride, are ubiquitous emotions causing rupture as much as adding resilience to our social bonds. In rural communities, particularly those that are resource poor or highly stratified, public conversation can be a delicate matter. Public laundering of private matters is anathema because it exposes, as Lacan explains, the hidden text within everyone's sight.3 Social stigmatization can lead to social death. Small communities are ill-equipped for the emergence of the publicly shameful anomaly. While everyone might know everyone else's behind closed-doors business, these texts must be concealed from public expression of them. For example, someone with HIV/AIDS, if exposed, could bring disgrace to himself/herself and his/her family. No one wants this. These embarrassments open up underlying social fragilities to public scrutiny. Reaction to a person or a group who causes undue public shame is to blame, reject, stigmatize, silence, isolate, desert, cast out and, in rare cases, stone and kill. Most cultures have some history with this. The internal fragility of a marital bond is subjected to more stringent restraints exemplified in the myriad ways that familial and social rituals, structures and practices create master narratives to brace it against dissolution. Why? For the simple reason that this bond assures the continuation of family, tribe, ethnic group and culture. When this assurance is threatened, an intimate bond may rupture. In Uganda, a daughter or wife cannot inherit property; therefore, a family needs a son. When a man who does not have a son asks, Where will I rest my head when I die? or Who will bury me?, he is asserting that without a son, he has lost his identity, his position in the clan, his respect from ancestors, and connections to lineage and land. A Ugandan woman talks about this: My husband said, “My cattle are producing, but you are not producing. I am tired of feeding your anus.” He keeps money for drinking. I have six daughters. I can't divorce because my brothers have used my dowry. I was the only daughter in my family. When he gets angry he says to me, “You are producing only prostitutes. No one will remain to bury me.” Sometimes he refuses to buy food to cook and medicine for the children. I feel useless. I feel so much shame. A woman who only produces female children experiences abuse from her husband and mother-in-law because as a married woman, she is not living up to her social-familial obligation. This wife/daughter-in-law experiences failure in a paradox: she desires to be a 'good' married wife, but she is unable to produce a son so she achieves neither worthiness nor social acceptance. Her private plight is set against the public 'good'. Living this contradiction, her life becomes an unending humiliation. In this paper, forced sex and trajectories of shame are described within the context of Ugandan marital relations. Along with a consideration of the relationship of forced marital sex to the transmission of HIV/AIDS, broader emotional-relational issues and consequences are discussed and, where possible, presented from both male and female perspectives. The author refers to steady partner relationships as marital relationships in this paper although often these do not fulfill the Ugandan legal requirements or different ethnic customs of Ugandan marriage. The author hopes that readers understand that this is only one aspect of Ugandan marital and steady partner relations and hardly captures the convivial, warmhearted and loving relations between men and women in Uganda. Background In 2009, there were 33.3 million people living with HIV/AIDS worldwide. While sub-Saharan Africa has 14.7% of the world's population, 22.5 million people in this region are infected with HIV/AIDS, which is two-thirds of the world's total population infected with this disease. Of those infected, 58% are women aged 15 to 49. In the age range of 15 to 24, 75% of those infected are women. 4 The highest percentages of women infected with HIV/AIDS are found in sub-Saharan Africa. Why are so many women in this region infected? Research has highlighted multiple factors that contribute to women's vulnerability to contracting HIV/AIDS: concurrent partnering, absence of male circumcision, poverty, the low status of women, lack of condom use, prevalence of untreated STIs (sexually transmitted infections), early sexual initiation and certain cultural practices, such as widow inheritance (forced consanguine marriage to an infected man or woman) and the preference for male children, among other things. None of these factors alone can explain women's risks and rates of infection. One factor that is poorly understood, inadequately researched and infrequently referenced is the relationship between forced marital sex and the transmission of HIV/AIDS. In a global multi-country study, between 15% and 71% of married women reported physical or sexual abuse from a partner sometime in their lives.5 One study in Sierre Leone reported that 76.6% of female respondents experienced intimate partner violence and forced sexual intercourse.6 Women are most at risk of violence from an intimate partner than other perpetrators, while men are most at risk of violence from strangers or acquaintances rather than from intimates.7 This makes the consequences of violence for women and men quite different and highlights the significance of intimate partner violence and the transmission of HIV/AIDS for women. In a seminal paper on HIV and violence, Maman suggests three significant mechanisms, one being 'from forced or coercive sex with an infected partner'.8 For sure, women's sexual refusal leads to the possible transmission of HIV/AIDS. Women, for example, who perceive their partner at highest-risk for HIV/AIDS infection were three times more likely to experience forced sex than those whose partners were perceived as low risk.9 A study in Rakai, Uganda, showed an increased risk of HIV acquisition during pregnancy.10 Women's sexual refusal was also a common reason cited for domestic violence and assault. In a Uganda study, 70% of men and 90% of women interviewed felt that beating a wife was justifiable under some circumstances.11 Furthermore, women in a high-risk group for HIV/AIDS were four times more likely to experience violence than women in a low-risk group.12 There is a correlation between domestic violence and refusal to have sex without a condom.13 However, although directly associated with sexual coercion, HIV sero-positivity is not directly associated with physical violence.14 Alcohol consumption is also directly linked to HIV/AIDS transmission. Alcohol use with sex is commonplace in Uganda. The dis-inhibiting effects of alcohol mitigate shame contributing to a man's urge for immediate sex and the instigation of violence, particularly if a man has been denied something that he believes should rightfully be his. Alcohol use in intimate circumstances might not only be a catalyst for sexual violence, but also may significantly increase the likelihood of HIV transmission.15 One study in Uganda showed that HIV prevalence of Muslims who drank alcohol was similar to non-Muslims who drank alcohol. 16 It appears that under some circumstances, alcohol consumption might work against the benefits of male circumcision for the prevention of HIV/AIDS. Caldwell suggests the failure of behavioral interventions can often be explained by the failure to consider culture. Social and economic change made sub-Saharan Africans tragically unprepared for STIs and HIV/AIDS. For one thing, as Caldwell points out, a woman is not humiliated by it being known she had accepted money or a gift for sex as much as it being known that there was no offer.17 Sex maximizes economic gains for women. No self-respecting woman keeps relations with a man without material compensation for sexual access.18 Extending this paradigm to extreme social change as a consequence of the war in Northern Uganda, soldiers in IDP camps made sexual contact with girls (from author's research). Parents either encouraged or ignored these contacts. In the aftermath, a soldier humiliated a girl less from forced sexual initiation than from desertion. Loss of economic support was compounded by a girl's pregnancy or HIV infection. In other words, culture matters. What previously gave women sexual bargaining power can now lead to their death. Relational interactions are complex and contextually driven, and gender inequalities move in contradictory ways.19 Forced marital sex needs to be understood contextually as part of the meaning and significance of sexual refusal within relational interactions wherein violence is provoked and sustained. Given this, it is important to understand the pathways wherein forced sex and HIV/AIDS transmission might occur. Research In 2004, the author, together with 27 research assistants and 27 note-takers (9 of each at each site), conducted focus group discussions and qualitative in depth private interviews with 450 people at three sites: Kampala (Central Uganda), Kasese (Western Uganda) and Apac (Northern Uganda). The goal of this research was to understand experiences and interpretations of and the relationship between sexual, domestic and civil violence and the transmission of HIV/AIDS. Voluntary private individual interviews lasting from one to two hours were conducted over a span of two to three months at each site. Researchers and note takers were extensively trained in ethnographic interviewing techniques and shown how to follow an unstructured interview guide. Local organizations at each site offered venues and staff to support the training and selection of researchers and note takers. Researchers were trained to ask probing questions and use active listening techniques because the interviews were intended to be more like conversations than structured interviews. To capture the significance and meaning of violence, it was essential to capture respondents' experiences in their own words. Interviewers were trained to ask questions about actual verbal exchanges that occurred around a violent incident. The interviewers avoided questioning that was ideological, presumptive or judgmental. Respondents were a representative sample—youth, adults, farmers, traders and fishermen—of rural Kasese, rural Apac and a low-income area of urban Kampala. Approximately 45% of respondents were male and 55% were female. Twenty percent of respondents were youth between the ages of 15 and 22. The average age of women was 33, and the average of men was 30.5. Seventy-one percent were or had been married and 29.6% had never married. Most had attended primary school through P5 (primary 5) and P7. Approximately 20% were non-literate. Young, unmarried respondents had usually attended secondary school. Most respondents had no regular income; 75% were farmers. Other forms of employment were working in businesses or working as messengers, welders, students and health workers. Data was analyzed for culturally significant patterns not for the anomalous response. The data presented here is primarily (though not exclusively) reflective of rural communities in Kasese and Apac. Forced Sex in a Ugandan Marriage Of married respondents, approximately 70% of women and 66% of men in Apac and Kasese said they had experienced forced marital sex. However, interpretations of sexual pleasure and pain are culturally and contextually driven. A definitive line between forced and consensual sex is difficult to extract from experiential data. It is often a porous and fluctuating one. In customary Ugandan marriages, bride-wealth, gifts of cows, saucepans, alcohol and money are given to the wife's family. The gift of money, in particular, often involves lengthy negotiations. Respondents indicated that the purpose of these gifts was to strengthen the relationship between these families, show an appreciation for the daughter to her parents and to insure harmony, and as a sign of respect and appreciation between a man and a woman. Ordinarily after marriage a wife moves into her husband's village. She is surrounded by her husband's family—his mother, father, unmarried siblings, brothers and their wives. Sons inherit family property. Daughters move out. If a woman divorces, she must leave her children, once they are weaned, with her husband's family. Men and women often agree that a woman can never raise another woman's child—implying that if a woman divorces she is potentially subjecting her children to a miserable fate if they are raised by a stepmother: I cannot go and leave my children to suffer. Sex within the context of a Ugandan marriage is an investment because it is connected to land inheritance, primogeniture and generational continuity. Fertility and a male child are essential. If a wife fails to produce children, there is little recourse but divorce, abandonment or the acquisition of a second or co-wife. An expression commonly voiced by men and women during the interviews was a man can have as many women as he wants but a woman can only have one man. The application of this belief is unlikely because ordinarily any liaison with a woman (outside of a wife or steady partner) must be met with regular exchanges of money or gifts for sex. As one young man reported, his first girlfriend's first words were: I will give you my vagina. What will you give me? However, as another respondent commented, in times of scarcity women tend to reduce love. For many men, having as many women as they want is unaffordable (an obvious explanation) and sexually unattainable (a well-guarded secret). One man explained: My aunt said to make sure you satisfy a woman sexually so that she does not go in for other men. A woman concurred: My aunt told me sex is the most vital reason for marriage. Never turn your back on your husband. If the man is not served, he might die due to high sexual demands. She told me I should sleep with my legs open. I should satisfy him sexually by allowing him to play sex anytime he wants. So that's what I do. However, it is culturally legitimate for a woman to refuse sex under certain circumstances. During the interviews, researchers asked, When does 'no' mean 'no' and when does 'no' mean 'yes'? According to men and women, 'no' means 'no' when a woman is menstruating, when she is sick, for example with malaria, or immediately prior to or after childbirth. One man said, When she refuses sex, the first thing that comes to mind is that she is menstruating. So I have to touch her private parts and see whether I can feel the pad. The other thought is maybe she is sick. Under these circumstances, it is prohibitive for a man to have sex with his wife and acceptable for a wife to refuse her husband sex. Outside of these circumstances, a wife's sexual refusal of her husband is fraught with ambiguity. When 'no' really means 'no' is complicated by when 'no' sometimes means 'yes.' This man explained: To me, a woman's 'no' is always a 'yes'. Every woman has to say 'no' first. But later she admits. When she is trying to overlook me, then I have to force her to do it. Sex is the reason I married her. Both men and women spoke about women pretending to refuse sex or saying 'no' as a way of cultivating a husband's interest. Ordinarily a married woman is not supposed to ask for sex directly: I am not a prostitute...he would think I was a prostitute (said women) and only prostitutes ask for sex (said men). One man said: There is no single minute when a woman can say 'yes' immediately as you demand sex from her...you may say that she is a sex worker. Even though she gives it to you, she has to first refuse and then gives in. Men respondents stated that most women pretend that sex is against their will. An element of pretense, playful refusal or teasing is meant to encourage a husband as this woman reflected: Women may need sex but they are not open, unlike men. At times for women 'no' might mean 'yes'—this is how she feels inside. It is like she is testing you. Men agreed that being tested meant he had to prove himself: A woman says 'no' at the beginning. I penetrate her and she changes her mind; she starts to pick interest or change her mood. If you take her 'no', she thinks you are not manly enough. Respondents perceived differences between consensual or negotiated sex and forced sex in which there is no negotiation. One woman's advice was: Never say 'no' because then there is 'no' negotiation. However, the absence of negotiation does not necessarily mean the absence of pleasure, according to men, who said things like: At first she is dry and penetration is difficult. You harm her and she expresses pain but then she lubricates after some time. Similarly, women respondents said that even though they resisted sex and were forced, eventually they experienced pleasure: When my husband has sex against my will, I do not do it with morale. I leave everything to the man and I do not support him in the game. I give him an under-dose. But sometimes when I am forced into sex, I feel interested towards the end and the body responds. Some female respondents said that even though initially they refused sex and it was forced, they accepted it and at times felt pleasure because I realized that this is my husband. This knowledge disassociates forced sex from rape, which is done by a stranger. This view is compounded by a belief stated by men: Some women need to be forced because they cannot express their sexual need. Women voiced a similar opinion: Women cannot express sexual wants to their husband and pretend they don't want and yet they want. Then they have to be forced. Therefore, does a husband really not know when 'no' means 'NO' and 'no' means 'yes'? According to many respondents, the physical response of women is a clear indication that 'no' is 'NO': When I have forced sex, there is no time I can enjoy it. When I don't want it, I really mean it and there is no way he can bring me to the mood. I am dry. Some women fight back physically with chairs, pots and other implements. Other women talked about locking their legs (contrary to the aunt's advice to keep one's legs open). This man talked about fighting his wife until she opens her legs: I tell my wife that sexual intercourse is a major contract I have with her. I force my wife to have sex because she refuses to negotiate without any reason. I pull and twist her hands until she opens her legs for my sexual thirst. Women explained how they 'freeze' during forced sex to show no response: I never liked it because your desire is not there. Even he, himself, does not enjoy it. It becomes useless and he decides to leave me if he needs active sex playing. And yet in Uganda 'dry' sex or sex without lubrication is not a positive cultural value or considered sexually pleasing for either the man or the woman. Interviewers asked respondents about their experiences of pain during or after sexual intercourse. Pain, bleeding or wounds during intercourse were experienced by 60% of respondents. Of these, 51% said it was due to forced sex. Generally, most men said that when they force a woman to have sex they experience pain because of lack of vaginal fluids and too much friction. They said: I develop small wounds on my penis and I have pain when sex lasts too long or the woman is too dry. And: My penis is burning. Women said similar things: With forced sex, you have swelling of private parts, bleeding and severe pain. And: Forced sex is because there are no fluids...it is really painful. Two expectations set the stage for forced sex: the sexual rights of a man (that men can have many partners and women only one) along with the illegitimacy of a wife's sexual refusal (except for prescribed times). Ironically, the HIV/AIDS epidemic, by reducing the former, has reinforced the latter: If my wife refuses to have sex, I force her because she is violating my rights. I don't have a casual partner because I fear being infected and then infecting my wife. Whatever expectations and obligations surround marital sex, the emotional-relational reality is often otherwise. Social expectations set against intimate partner relations lay the groundwork for the shame of forced sex. This man expressed his shame: My wife does not enjoy—we both get cuts on the private parts resulting in pain. For unforced sex, she produces fluid. I look stupid for it is not her right to refuse sex. I feel rejected--that I do not satisfy her, that I do not know how to play sex. I feel despised, overlooked and I want to divorce. Likewise, this woman shared her shameful feelings: I can't go digging the next morning. Whether I am tired or not, he likes playing sex and sometimes I hate him for that. I don't want to tell him but I feel bad. I feel like vomiting. It's the same as rape. You can't be pleased. It is sex without consent. Primary Reasons for Forced Sex Research findings suggested five primary and interrelated reasons for forced sex in marriage: the absence of sexual pleasure, pregnancy, poverty, infidelity and alcohol consumption. Absence of Sexual Pleasure: In the literature on violence toward women there is little mention of women's need for sexual satisfaction, her frustrations when her husband is unable to fulfill her sexual needs and how the absence of sexual pleasure can lead to sexual violence. In the interviews, women spoke about the importance of sexual pleasure and their anger at its absence, the most vivid being women's frustration with male impotence: Sometimes he experiences impotence and I feel angry. I say, 'Do you think I am not a woman? Am I not nice sexually?' He does not please me during sex. In drinking groups, men explained how they counsel each other about fulfilling their wives' sexual needs saying things like: If your wife doesn't want to wash your clothes, try to see that you have satisfied your wife's sexual desire by making her reach an orgasm. But some men, such as this one, accused his wife of having too much desire: My penis softens. We fight because she thinks I have someone outside. I refuse sex because I am tired from fishing. She has too much desire. Behind sexual refusal or lack of desire is the lingering belief that one's partner has someone else: I feel useless. He does not want to play sex with me when he has fulfilled his desires with other women. I said, 'You don't want to play sex with me? Why did you bring me here? While impotence might signify male infidelity, this man stated that it just shows a lack of interest. Ironically, his lack of interest is cause for mistrust of his wife: My wife would do well to begin to trust me. Impotence in me has no special issue. It just comes when I am not interested. She thinks I am having sex outside. I am suspicious when my wife goes to do work without my permission. She pretends to be busy. I think my wife has love outside because of money and whenever there isn't enough sex exercise. In Uganda, impotence is believed caused by a curse from a disappointed or jealous partner. Impotence is thought to be induced by a wife trying to reduce her husband's philandering, for example, by putting something in his bed, food or tea (prescribed by a healer) to make him stay at home and love only her. Likewise, both men and women seek out remedies so they can go to a casual partner without their husband's or wife's interference. Respondents complained that their partner was sexually uninteresting and unresponsive. They sought out a casual partner although they, too, were less attentive to a steady partner: With my causal partner, you have sex many times and you show her many skills so you can win her but with an honest wife, you can just have sex with her once and you sleep without showing any skills. Of the married female respondents, approximately 26% said they had or currently had a casual partner. They offered the same justification as men for having one: I meet my casual partner and escape when my husband is not aware. My casual partner starts by playing with me and kissing me. But my husband only says 'turn to me' without love. With my causal partner, I will be smiling but not with my husband. Women friends also advocate to each other: If your husband has another partner, get one as well. A man may feel obligated to have sex with his wife or fearful that if he fails to have sex with his wife, she will go elsewhere. Coupled with this is the fear that a man's child might not be biologically his. Men told each other: If you abuse your wife by missing her sexual interest then if she gets pregnant, you should not blame her that this pregnancy is not yours. However, the absence of sexual pleasure can result in sexual refusal. This, in turn, can provoke a man to force his wife to have sex: Nowadays when I feel like having sex with my wife, she tells me that she does not have desire to do it. So there is a lot of pressure and I find myself forcing her to have it. She does not even show me the way. She even refuses to kiss me…hence I have to quench the thirst of my penis. Unfortunately, when a husband refuses sex, there is little recourse for his wife. Forced sex is a male prerogative as this woman states: Men are not forced into sex but they are good at forcing. When my husband wants sex and I do not want, he just forces me into a position for sex. He does it alone. Sex is painful. I get annoyed and feel disrespected. I wish it would end the moment it starts. When I am the one who wants sex, he is not in the mood. He ignores me saying I do not have the right to demand sex. I am interrupting his sleep. Pregnancy: Pregnancy is a legitimate reason for a woman to refuse sex; however, it puts enormous stress on marital relations. This man recounted: When my wife is pregnant, I am not at peace. When the pregnancy is almost six months, she does not want to see me for when she sees me she begins spitting and she says she feels like vomiting. So we separate our beds and I can't even touch her. Most of the duties like preparing meals are done by me. When I feel like having sex, I look for other means. She quarrels and asks where I have been. She keeps saying she is aware that I had sex out. Then I tell her that since she can't allow me to have it with her, I have to go outside to quench my thirst. Then she cries and wants to end. She cannot eat meals I have prepared for her and sleeps without eating. During pregnancy, my wife said she does not mind if I am imprisoned. Women confirmed these men's experiences: I did not want him to stay near me. He smelled bad and it made me vomit. We separated beds. I would write things for him to do. The child in my stomach made me behave like this. An expected period of sexual abstinence extends until a wife recovers from childbirth. With this, men feel shame as expressed by this man: After childbirth, I face a lot of problems with my wife. She says I am foolish and stupid. When I tell her she is smelly and dirty, she tells me that I am supposed to wash for her. I feel bad and become small and wish to slap her. I think of chasing her away but she is weak and I forgive her. Pregnancy is often a time when husbands seek out other partners--providing another woman with money and going elsewhere for sex: She begins arguing a lot so I increase going to have sex with other women. It's my only alternative. The last three months are months of war. My wife hates me very much. Men spoke about how cruel their wives were during pregnancy saying that she was lazy (not wanting to dig, wash clothes or care for the house) and rude. One man said: I want to fight her but I might hurt her. However some react violently to rejection as this woman described: I was pregnant. He slapped me because I refused to wash his clothes. While women expressed feelings ranging from distaste to hatred for their husbands during pregnancy, they were caught in a quandary knowing that their sexual refusal encouraged their husband to go elsewhere for sex: Pregnancy made me hate him. Although I did not want to share a bed with him, I did not want him to go to another woman. He said, 'I can't stay like this'. I said, 'If all children make you behave like this, then I will not produce because it makes you leave me.' During a second or later pregnancy, some husbands find a permanent second partner or co-wife: I married the second woman because the first woman would make me starve sexually during pregnancy. She never wanted to have sex. She complained of stomach pains after I had sex with her. I decided to marry another so when she is about to give birth, I shift to another one for sex. Women fear that a casual sexual contact her husband made when she is pregnant will turn into a permanent one: When I became pregnant with the third child, the problems started. He started sleeping out. When he comes back and I ask him where he slept, he shouts at me that he has a right to do anything he wants. He even refused to eat my food and bath and play sex with me. Alternatively, some men force their wives to have sex during pregnancy: During my wife's first pregnancy, she refused sex with me and this was the worst thing. I then had to force her to do it and we would do the act when she was crying. Women spoke openly about the pain of forced sex during pregnancy: Sometimes he forces me when I am pregnant. It is painful and afterwards I feel like beating him. You feel like you want revenge and blood comes out of your private parts. This woman expressed her ambivalence about having sex when she did not want it mixed with feelings of guilt about rejecting her husband: During pregnancy, I experienced sexual abuse. He forces me into sex saying I am his wife and therefore I have to serve him no matter what I am going through. During pregnancy, I became arrogant and rude. I do not care who I try to control. He had no other partner and needed sex badly. Nonetheless, forced sex during the latter months of pregnancy or after childbirth is customarily prohibited. Men fear parents, in-laws or neighbors finding out they forced their wife into sex during this prohibitive time. Not having a legal recognition of marriage can contribute to the frequency of forced sex and the unraveling of a relationship as this man described: My wife has no energy during pregnancy. Things are not easy for her. I am tired of forcing her to have sex. One time I threw her property out and told her to leave during the second pregnancy. I locked her out and brought a new woman for four days. I told her that I have not taken anything to her parents. I don't even know them. So I can't confine myself to her. Poverty: In rural areas men and women are expected to contribute to the household in different ways: I expect my husband to sell thing like goats, chickens and even produce millet, maize and cassava and simsim. If my husband doesn't meet these needs we quarrel. In many families the husband is expected to buy things for his household(s) and pay school fees for the children. Women are often expected to dig and take care of gardens, wash clothes, prepare food, sell things in the market and care for children and in-laws. Ordinarily, men control the household's cash flow. Many respondents said poverty contributes to quarreling: I am not able to meet my wife's demands like buying meat or salt during time of poverty. I become rude so that she stops demanding what she needs. Poverty or the inability to fulfill his family's and his wife's (or wives') needs weighs heavily on some men. This man said it is the loss of things his wife was used to that has caused problems between them: I became broke and my wife started initiating baseless quarrels. This happened when I desired sex. She said things like: 'I can't show you my thighs because you have not bought me fish or knickers or...' Before I became broke, she would ask for something and I would bring it and then, even if I am asleep, she would wake me up and touch my private parts especially my penis. When I realized she changed because of becoming poor, I started fucking her with force. She told her aunts about my sexual abuse. To explain why their marital relations broke down, men frequently used the phrase being undermined, which means being shamed. Men said that when they fail to meet their wife's financial needs, they become hostile to their wife. But in their words: The woman is really undermining the man. This man explained: Poverty contributes to abuse when they demand money or need to buy salt, clothing and medicine...then you as a man fail to meet their demands. Because of this shame, you end up exchanging bitter words and then there is abuse. If the woman thinks she is boss of the family, she undermines her husband. In some cases, a man may have money but he withholds it. This respondent explained what she did: When my husband has money, he does not want to give it to me. When he refuses to give me money, I say, 'icamo anywari'—no sex for that day or that week. I told him, 'You can now play sex with that money of yours.' In addition to sexual refusal, women commonly shame men when they do not provide by refusing to offer them food. As this woman related: When he does not meet my financial requirements, I do not give him food. I say to him, 'You cannot eat what you have not worked for.' Nevertheless, as this man stated, unlike a casual partner, a wife, regardless of economic hardship, is bound to her husband. Divorce is not a socially accepted option for a 'good' married woman: I get problems with my partners when I call them for sex and I don't provide either food or money. In times of scarcity, women reduce love. After I am broke, my partners want to look for other partners, but my wife persists. A casual partner is not obligated to have sex if the man does not provide. This respondent explained the shame he feels when his casual partner refuses him sex: With a casual when I meet them I go with fish or a bunch of 'matooke'. I have to. Whenever I don't provide meals, she threatens to leave me. She can't allow me to have sex with her. I feel ashamed before her. Since I have not fulfilled my duty to give her food, she can refuse sex. She looks big and strong and I feel tortured in my mind and say nothing but emotionally I am not myself. I can't get to sleep. I can't force her to have sex. In a marital relationship, however, when a husband is unable or unwilling to provide, sexual refusal can lead to forced sex: During the absence of basics like food, clothing, soap and other things...my wife starts disrespecting me. When I assign her work, she does not do it saying the soap is not enough for washing clothes but only enough for bathing. Then I force her to have sex. It is my responsibility to purchase everything for the household… Often a man's inability to provide is due to his infidelities. His support of another partner is usually an economic loss for his wife's household. Sexual refusal allows the wife to let her husband know his infidelities are causing her hardship. Unfortunately, he may resort to violence: Whenever my wife says 'no' to sex, her complaint is always that I have given her nothing. Our money is spent out with casual partners. Hence I believe that poverty contributes to this. Whenever a woman does not respect her husband, there is war between us. Undermining brings a lot of problems...since as a man, you can't be happy when a woman puts you under her control. I have to force her. If she runs away, I lock her out. Infidelity: Although poverty may ignite shame-provoking interactions, the underlying issue may be a partner's infidelities: When my wife refuses sex, I think she has learnt that I had sex outside. It's me to decide on having sex and her duty is to give in. There is much pressure being extended on me by my penis. I find myself forcing her. Yet a husband's infidelities are expected: Having a partner outside marriage is normal if the man can fully support the woman at home. What hurts me is that my husband is failing to support his family and now he puts another burden on us. Interview data revealed that infidelity led to more often to incidences of domestic violence than to sexual violence. Men sometimes erupt into extreme forms of violence and abuse when they suspect their wife has another man. Women warn each other: If you love outside, don't show him or he might kill you. This man told what he did when he suspected his wife was unfaithful: I met my wife standing with a man. She pretended she was fetching water. I greeted them. I wanted her to recognize me as I passed. I got a good stick. As soon as she reached home, I shouted at her asking what they were talking about. She told me that the man wanted her to get him a wife to marry. When I heard this, I started beating her seriously. The next morning she went to the clinic for treatment. I caught her red-handed. The main problem is undermining not poverty. Once a man sees his wife trying to overlook him, he has to make sure that his wife can realize that he is her husband. Questioning a husband's fidelity can lead to domestic violence. One woman shared her experience and feelings of shame: When my husband had love outside I asked him and he slapped me and said, 'Why do you ask me such questions! Shut up!' Then I told him if it is not true why do you slap me? He said, 'A wife cannot ask her husband about his love outside. You don't have control over! I can chase you away and bring this woman you are talking about.' I told him I am not going away. When he has money, he does not want me to know. I struggle on my own making brew. But men also fear that their wives might divorce them because of their infidelities. To remedy this, men seek out the services of healers: I planted herbs under my bed so that however much I have sex with other ladies, my wife says nothing. She can't think of divorcing me. I tied her to my house. This has let me do whatever I like. Behind the belief that a man is entitled to as many women as he wants is the subliminal fear that if a husband is unfaithful, his wife might be as well. Some men believe that it is not normal for a woman to have more than one partner, so a wife who takes a causal partner must be seeking revenge: It is not normal for a woman to have more than one husband. For revenge she went to the market and came back late when she was drunk. She was drinking with a former boyfriend though she said it was her brother. I think she is doing this because she thinks I have a casual partner. A man experiences great humiliation when his wife has a casual partner: My wife goes outside sexually. I sleep and when I wake up in the morning, my wife is gone to the garden. Many people have told me about her but I have not seen it. When I think my wife is having sex with other men, I feel like dying. This is a very great abuse. Men repeatedly said that a wife's infidelities are not normal and if a wife does this, the man can divorce her. Some men monitor their wives behavior closely, such as looking for the purchase of things that she would not have money for herself. Some women stated they are under constant surveillance: If I buy a dress, he asks me where I got the money. When he refuses to show up at home, I demand an explanation but he tells me that as a woman, I cannot ask for explanations. Men talked about catching their wives red-handed (a common expression when infidelity is discovered). If he catches her, he can legitimately divorce her and receive economic compensation because it is unlawful for a man to have sex with another man's wife. Though women said when they love somebody 'outside', they buy you clothes and money is given to you. When a wife is caught red-handed, both men and women agree on this: It brings shame to both of us. Women counsel each other about the dangers of having sex with another woman's husband: I tell my friends to be careful if you love someone else's husband. If a wife learns, she will beat you or burn you with boiling water. They say they will continue because their husband loves other women. Rumors about a wife's infidelity can cause violence. Men who travel rely on other people to keep tabs on their wives while they are away: When I reach the village, people tell me stories that my wife is going with other men. Some people try to break up marriages with rumors as this woman experienced: My husband was working far away. He came back and people told him I was loving someone. My husband divorced me. This brought me shame. People said he will come back but I waited in vain. This affected my life because my children are not with me. I really miss them. Men said they are pleased because their children resemble them or ashamed when their in-laws or others say the children do not resemble them. The implication is that his wife has been unfaithful to him. One woman stated: They say the child does not resemble the family. My husband is ashamed. An accusation and counter-accusation of infidelity and the potential for sexual violence is mitigated by fear that a wife will report her husband: I am tired and he wants to play sex. He accuses me of infidelity because once he saw a man in the compound. I say, 'What you have said is not good.' He say, 'I know why you are sleeping with the children. Come and settle it now. You see...I have left that woman.' Then he keeps quiet if I threaten to report him. Men said they assume their wife is unfaithful depending upon how often she refuses sex with him. Even with this assumption, a man may refrain from forced sex because he fears clan elders, in-laws or his parents might learn he forced his wife to have sex: If my wife refuses to have sex with me for no good reason, I can conclude that she has another man who has satisfied her sexually and she does not want more sex...so I will send her back to her parents. I do not force my wife. I do not want her to report that I forced her. Alcohol Consumption: The possibility of a man forcing his wife to have sex increases dramatically when he drinks alcohol. Approximately 65% of the men who had forced sex with their wives said alcohol use was a contributing factor. One woman commented: When he is drunk, he forces me into sex. He does not reach orgasm early but delays. He does it as if he is pumping a borehole. I fear people knowing that when he is drunk, I experience hell on earth. This man said: After alcohol, I feel sexually stronger. I have sex with my wife for many hours but we quarrel because she tells me that she is tired. I find myself forcing her into the act against her will. I feel this is violating her sexual rights but I married her for the purpose of satisfying my sexual needs. In addition, other factors contributing to forced marital sex—absence of sexual pleasure, pregnancy, poverty and infidelity—are further aggravated by alcohol use. First, respondents talked about the inability of men to satisfy their wives when they are drunk: When he is really drunk, my husband forces me to have sex but he does not satisfy me because he does it for a few minutes. Not surprising, impotence is related to alcohol consumption: I stopped drinking because of lack of sexual commitment. When I drink, if my wife wants to have sex, the penis does not erect. When I don't fulfill my wife's needs, we feel embarrassed. Second, men who drink also are more likely to ignore the customary prohibitions against sexual intercourse with one's wife: When he is drunk and I am menstruating, he forces me to have sex. The whole bed is full of blood. I showed him… This woman described how alcohol use led to forced sex after childbirth: Sex during the two weeks after childbirth is painful. He does it when he is drunk. It is against my will and happens after a long struggle. He says having sex during these weeks is a way of child spacing. During pregnancy, he has sex outside saying he doesn't feel comfortable having sex when I am pregnant. Sometimes I feel unwanted and treated like something that can never feel pain. He says I am pretending to be weak. It is not my intention to feel weak after childbirth. Third, alcohol consumption depletes money that should be spent on household needs. One woman explained: Money goes for drinking. I say, 'you spend money on drinking and yet we have to plant.' This has adverse effects for the men as well: I told her if she continues, I will beat her and chase her away because she feels I do not satisfy her needs. It is not normal for a person to love a different person from her husband. I think this had to do with overdrinking...my drinking was spending a lot of money that could be used for basic needs. Finally, alcohol contributes to infidelity, forced sex and domestic violence. Men said that when they are drunk, they must have sex immediately—without negotiation. Male respondents said things like: When I am so intoxicated, my mind is only sticking on having sexual intercourse. If I ask my wife to fulfill my sexual desires and she replies, 'The child is nursing', then I ask her to come with the child. Men are more likely to seek casual sex or have sex with whomever is available when using alcohol: If you drink where there are women, you tend to get a woman right away. But if you don't drink, I am not tempted for sex. I have sex normally when I don't drink but when I drink, I tend to force my wife and the process is rough and there is little enjoyment. Alcohol brings a lot of violence. You don't provide for your family and you fall in love with other women. A further consequence is that men who drink alcohol do not practice safe sex: Alcohol increases my risk because I don't remember to put on a condom. Yet I do have sex with people I don't know. When you are drunk, you forget about AIDS and just go in for unprotected sex. Sex takes on dire consequences when a man comes home to an angry wife after he has had sex at a trading center with a casual partner: My wife refuses sex when I come home late when I have a lot of alcohol. She complains because it means I have been fucking other women. When I disappoint her, it is because of things she has done to annoy me. I force her especially when she has annoyed me. Sometimes it is true. I may have played sex outside marriage and I feel I don't want more sex with her. Women as well spoke about their frustrations when their husband was unable to have sex with them because he had had sex with a woman at the trading center. The conundrum of relational failures may spiral into acts precipitated by anger and rage. Some men find relief from frustration by drinking alcohol with the intention of revenge: Before I say anything to her, I have to drink first. Then I come back and attack her. After drinking, I feel strong and fit to fight her. But when I am not drunk, I do nothing. Anger combined with alcohol results in rage directed at women: When I'm angry, I call my wife and talk to her about what she is doing. When she argues and assumes she is right, this increases my anger. I just keep quiet. We sleep and the next day I come back with a full tank of drink and hit her to make her believe that I am the head of the family and it's me who makes family decisions. When she is angry, she refuses me sex. Then I force her to have sex to show her my manhood. I even tell her the vagina is mine. Being intoxicated dis-inhibits behavior that would ordinarily cause embarrassment: When I am drunk, I feel very sharp (all shyness goes away). Then I am free to talk about sex with my wife. When drunk, I feel on such days that I satisfy my wife sexually…. I feel shy before her without alcohol. My problem is that when I am drunk everything becomes 'yes'. Decreasing inhibitions also frees men to force sex. Physical, relational and psychological injuries are inevitable as this woman stated: When my husband is drunk, I fight so that he does not penetrate me. I try to keep my vagina closed. So it is hard for him. I cannot produce fluids. Man takes a long time to penetrate. There is a lot of pain with a dry vagina and a lot of force needed to penetrate me. Eighty-six percent of male respondents reported drinking, saying that boozing is the only option if one is to have friends. Alcohol consumption is a means of socializing with other men and is essential to Ugandan culture. Discussion HIV is more readily transmitted when there is an opening in the vagina, anus or surface of the penis, such as an abrasion or sore that allows blood, semen or vaginal fluids infected by the HIV virus to be transmitted to the blood of an uninfected person. Because the anus does not produce its own lubrication, people who have anal intercourse are particularly vulnerable to HIV infection. Similarly the vaginal membrane, if not lubricated, suggests the same internal environment and consequences if not lubricated. Without lubrication the vaginal membrane is vulnerable to abrasion, tearing or minute capillary breakage during sex. As this respondent suggested, penetrative sex whether anal or vaginal (without lubrication) results in similar outcomes: A woman without enough water is not sweet. It feels like you are fucking an anus. There is too much penis pain due to increasing heat. You get wounds on the penis that put you in a poor condition. One can conclude that the epidemiology of HIV transmission among men and women might at times mirror the epidemiology of transmission between same sex male sex partners. Forced sex amidst an HIV/AIDS epidemic is a significant avenue for transmission of the disease particularly for women. As this man reflects: I think if I have sex with my wife when she is not willing, the act will be painful… something like rape. Findings from this research illuminated how forced marital sex, induced by feelings of shame, could play a significant role in HIV/AIDS transmission. Laden with contradictions between social expectations and private experiences, sexual refusal sets the stage for serious relational-emotional conundrums within Ugandan marriage. In Uganda, sexual pleasure between a man and woman is highly valued. There are cultural prohibitions against sexual contact at certain times, and if these prohibitions are ignored, men and women feel shame. Some men experience the contradiction between knowing they are not supposed to have sex with their wives during menstruation and doing so during this prohibitive time. Other men expressed the intense shame they feel during their wives' pregnancies when she does not want to be near him. How do feelings of shame lead to acts of sexual violence? From the interviews respondents (especially men) talked about being undermined or overlooked by his spouse and how the internalization of anger, shame and humiliation led to acts of sexual violence. Inability or unwillingness to fulfill economic and sexual obligations causes shame induced responses: When money is there, you are in a position to buy fish, paraffin and clothes and go with other partners. You can't see sexual denials, fighting or undermining in your family when there is money. Shaming another is an assertion of power. Acts of power express feelings that one has lost respect or lost what should rightfully be his or hers. Forced sex is an assertion of power as is sexual denial. As Foucault states: What makes power hold good, what makes it accepted, is simply the act that it doesn't weigh on us as a force that says no, but that it traverses and produces things, it induces pleasure, forms knowledge, produces discourse. It needs to be considered as a productive network which runs through the whole social body, much more than a negative instance whose function is repression. (61) 20 Forced sex together with sexual refusal weaves through a cultural logic that both Ugandan men and women participate in and perpetuate. A common scenario from a man's point of view is: A wife refuses to have sex with her husband. Therefore, he assumes she is having sex with someone else who can satisfy her economic and sexual needs better than him and is no longer interested in him sexually. He then feels that she has violated his sexual rights. This reasoning gives justification for forced sex. Reasons for forced sex are interrelated and difficult to disentangle, but alcohol use, in particular paves the way for the internalization of feelings of shame to dis-inhibition to acts of violence. When a husband arrives home drunk and demands sex from his wife and she is not receptive, this sets the stage for forced sex. Respondents frequently talked about how they could do things after drinking alcohol that they would not do without alcohol. Many respondents spoke about how a drunken husband can purposefully force his wife to have sex to take revenge on her. Alcohol allows him to set things 'right,' to relieve his shame. Sometimes because he is drunk, a husband is unable to perform sexually. This implies that he had sex at the drinking place. Unfortunately, unmarried women who stay at trading centers are sometimes infected with HIV. Perhaps some of these women have been chased away from her husband's household because her husband died of HIV/AIDS and she was blamed for his death. Women in trading centers brew beer and sometimes transact sex to survive. Men said that after drinking, they want sex badly and will have it with anyone available. One route of HIV transmission therefore is from a husband who had sex with an infected woman and then shortly thereafter might force his wife to have sex. Infectivity within the first weeks combined with forced sex increases the likelihood of HIV transmission. One study reported: Assuming no STDs for the index patient or the partner, an average man with acute HIV-1 infection in sub-Saharan Africa would, conservatively, infect 7% to 24% of female sex partners during the first two months of infection. In partnerships in which either partner had an STD, this rate could exceed 50%.21 Contrary to the social expectation that a woman should never refuse to have sex with her husband, women did refuse sex when they were pregnant, when she found out her husband was unfaithful, when her husband failed to provide economic necessities, when she was unfaithful, when he was drunk or when she was uninterested or tired. Beyond cultural prohibitions, a woman's recourse, and—to some extent—control, is exerted through sexual refusal. Women talked about refusing sex because they suspected their husband was infected. While aware of the risks of sexual refusal, they refuse possibly hoping to prevent transmission or perhaps because they are angry. In a similar vein, women fight back by freezing, locking their legs, fist fighting, hitting with household implements, biting or by running for help when their husbands try to force them to have sex. Regardless of the motives for or reactions to sexual refusal and forced sex, women and men hardly feel good about these interactions. Clearly, forced sex in a marital or steady relationship is one reason why women are so widely and disproportionately infected with HIV/AIDS in sub-Saharan Africa. Considering the significance of shame in these interactions, what kind of intervention might decrease forced marital sex? This research showed that ordinarily spouses do not talk about sex: When I force my wife to have sex, I get a lot of bruises on my penis and I feel pain. I don't know if she gets pain because I have not asked her and she doesn't tell me. One goal of an intervention to reduce forced marital sex would be to promote better communication between spouses about sex and sexuality. Respondents repeatedly mentioned how they feared that problems in their intimate life would become publicly known. If people knew about their fighting this would bring shame or our name will be spread or people will laugh at us. People will create shame us. Men and women feared that people learn about marital violence saying people are not supposed to know about forced sex outside. Others might disorganize us. They want to exploit your weakness. Respondents explained that violence might increase between couples whose marital problems were exposed: I do not want others in the community to know about my family and secrets concerning sexual intercourse in my home. This is confidential. This could create rumors and domestic violence. For this reason, while drinking groups of men spoke about women, they rarely spoke about their wife: We speak about sex with casual partners, but not about our wives...this would bring shame. Respondents agreed that men's drinking groups can facilitate (increase prospects for infidelity) or inhibit (decrease these prospects) with their drinking companions: When you are drinking with friends, everyone tells his experiences with different women...as a result we copy new methods of fucking from these stories. We encourage each other. Or alternatively, drinking groups of men warn each other: They say women who stay at the drinking place are not sexually to be trusted. They say avoid relations with them because you will be exposed to AIDS. On a positive note, respondents reported that neighbors, family and clan elders play a significant role in reconciling couples and preventing violence: I exchanged blows with my wife. She refused to have sex with me. I tried to force her and she bit my arm. This pained me and I hit her seriously. I took bride wealth so she has no right to bite me. In the morning we forgave each other before our elders. Improving and influencing the nature and extent of public and private conversations between spouses, men in drinking groups, family members and friends about sexual violence is critical to influencing normative beliefs and behavior in Uganda. An intervention must build on the cultural context of Ugandans' everyday lives and use existing social and organizational structures to influence what people say, who they talk to and how they talk regarding forced sex and its consequences to women and men's health and well-being. Conclusion* Women and men are bound culturally, relationally and emotionally. Gender dynamics are patterned and reflect a cultural sexual symmetry. The exclusion of one gender —be it women or men—is illogical when it comes to the prevention of HIV/AIDS or any disease or behavior where sex and sexuality are intrinsic to it. Women and men's interactions create and recreate meaning and value. These are the harnesses of culture: Sites of disempowerment are not just simple matters of human rights issues emerging from women's economic and sexual servitude. Rather, romance, hope, pleasure, need for…and abuse are interconnected sites through which agency is asserted and (dis)empowerment experienced. Circumstance, belief and gender dynamics of power and powerlessness set men and women up to complement and resist each other. Contradictions between social expectations and failed private longings set the stage for unmitigated shame. Violence is often shame's consequence. Toward the end of the Song of Lawino, Lawino, as Ocol's rejected wife, tells him: …I have only one request, Then Lawino goes on to express desire for her husband, Ocol: …Let me dance before you, These are not words of dissolution but of renewal. Like Lawino's, the words of Ugandans are filtered through a cultural lens of marital expectations and obligations that describe the bonds to which Ugandan women and men adhere. The invisible harnesses of culture weave through human interactions, creating and recreating repetitive narratives of shame. Fluctuating and changing, this is the narrative dynamic wherein forced sex occurs. Within this context, meaningful conversations might begin between and among married Ugandan men and women about forced sex and its consequences to relations and sexual health. However, outside this context, it is hardly likely. *The program, Education is a Conversation: I want to live! We want to live! Don't You?, was developed from this research and is based on narrative pedagogy or the use of cultural narratives to influence public and private conversations about gender-based violence and HIV/AIDS in Northern Uganda. For further information about this paper or program, please contact Kathleen Cash at cashkathy@gmail. com. Acknowledgements The author would like to express her appreciation to the sponsors, organizations, researchers and respondents who facilitated or participated in this study. The author was awarded a Fulbright HIV/AIDS Research Fellowship in 2004 that sponsored the research for this article. Raising Voices and the Center for Domestic Violence Prevention in Kampala hosted the author and facilitated research in Kampala. Good Hope Foundation in Kasese (Western Uganda) and Action Aid in Apac (Northern Uganda) hosted research in their respective venues. In addition, 54 researchers and note takers helped to conduct this research, and 450 women, men and youth participated in the interviews that led to this article and, ultimately, to an intervention based on this research. References
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