| Women in Southern Africa
Struggle Against HIV
Quick Facts
- Worldwide, there are now 17 million women and 18.7 million men between
the ages of 15 and 49 living with HIV/AIDS, mostly in developing countries.
- Young women now make up more than 60 percent of those 15-24 years
old who are HIV/AIDS positive. Globally, young women are 1.6 times more likely
to be living with HIV/AIDS than young men.
- Sub-Saharan Africa is the region most disastrously affected by the
HIV/AIDS epidemic — with 23 million adults now infected, 57 percent of them women.
Young women aged 15-24 are three times more likely to be infected than young
men.
- 77 percent of all HIV positive women live in sub-Saharan Africa.1
Some African countries are fighting back. UNAIDS reports that in Uganda, the
first African country to have subdued a major HIV/AIDS epidemic, prevalence has
fallen from 13 percent in the early 1990s to a level of 5-6 percent, and there
has been a sustained and significant decline of HIV prevalence among pregnant
women attending antenatal clincs.2
Three Allies Deliver Death: HIV, Poverty and Inequality
Twenty five years ago, early in the HIV/AIDS epidemic, women rarely figured
among the infected. As the pandemic exploded, it has become clear that women
are being infected and are dying because they are women.
As in other countries, many of Africa's leaders at first preferred avoidance
to recognition and action. But the pattern has begun to change. In June 2001,
Mozambique's Prime Minister, Dr. Pascoal Mocumbi — speaking out strongly in New
York at the UN General Assembly Special Session on AIDS (UNGASS) — warned that
the primary means by which AIDS is spread in sub-Saharan Africa is through risky
heterosexual sex. This goes beyond a health issue, he stressed, for "unlike
the communicable killer diseases we have encountered most often in the past,
HIV/AIDS is transmitted through the most intimate and private human relationships,
through sexual violence and commercial sex; it proliferates because of women's
poverty and inequality."
Mocumbi reported that in Mozambique the rate of infection among girls and
young women is twice that of boys their age, "not because the girls are
promiscuous, but because nearly three out of five are married by age 18, more
than 40 percent of them to much older, sexually experienced men, who may expose
their wives to HIV/AIDS. Abstinence is not an option for these child brides.
Those who try to negotiate condom use commonly face violence or rejection."
Prevention and Lack of Power
Continuing gender discrimination creates life-threatening dangers for Africa's
women. "There has rarely been a disease so rooted in the inequality between
the sexes," noted Stephen Lewis, U.N. Secretary-General Annan's Special
Envoy for HIV/AIDS in Africa. The entire continent needs to understand that "women
are truly the most vulnerable in this pandemic, that until there is a much greater
degree of gender equality women will always constitute the greatest number of
new infections." Lewis underscored "the degree of cultural oppression
that has to be overcome before we really manage to deal with the pandemic," as
he outlined the situation of millions of women who are effectively sexually subjugated
and forced into risky sex without condoms, "without the capacity to say
no, without the right to negotiate sexual relationships."
Double Jeopardy
Biology works against women, as the virus spreads more rapidly from male to
female than from female to male. For physiological reasons, women who have intercourse
with men are more vulnerable to HIV infection than their partners and are twice
as likely to be infected by their male partner as the reverse.
Nevertheless, the physiological reasons which place women in a more vulnerable
situation through heterosexual sex are not sufficient to account for the explosion
of HIV/AIDS in their ranks. It is gender inequality — which is based on the unequal
relations between men and women in society — that is the major driving force
in the pandemic.
Gender Dimensions of HIV
Gender inequality fuels the HIV/AIDS epidemic because it deprives women of
the ability to say no to risky practices, leads to coerced sex and sexual violence,
keeps women uninformed about prevention, puts them last in line for care and
life-saving treatment and imposes an overwhelming burden on them to care for
the sick and dying. When combined with poverty this means that women often have
little option other than to engage in unsafe sexual practices - in order to feed
their children or because they are economically unable to leave their husbands.
Ways in which this is manifest:
Saying no is not an option in many societies, where a culture of silence
surrounds sex and dictates that 'good' women are expected to be ignorant about
sex and passive in sexual interactions. This makes it difficult for women to
be informed about risk reduction, and more difficult, even if they are informed,
for women to pro-actively negotiate safer sex or the use of condoms. A study
in Zambia revealed that only 11 percent of the women interviewed believed that
a married woman could ask her husband to use a condom, even if she knew him to
have been unfaithful and infected.3
The widespread traditional expectation of virginity for unmarried girls
increases young women's risks of infection because it restricts their ability
to ask for information about sex, out of fear that they will be branded as sexually
active.
The strong norms of virginity and the culture of silence that surrounds
sex also make seeking information and accessing treatment for sexually transmitted
diseases dangerously stigmatizing for both adolescent and adult women.
Women can face a tragic set of circumstances when the male head of their household
dies: the husband's family often blames the widow as the source of the disease
and may refuse to accept her or her children into the family support system.
That stigma, coupled with fear, has even produced lynch mobs in communities,
when women are discovered to have the disease, or, as in the case of young South
African activist Gugu Dhlamini, courageously reveal their HIV status.
Women's economic dependency increases their vulnerability to HIV. Although
women are the primary producers of food across much of Africa, they rarely own
the land, have rights of inheritance or earn an income from their labor.
Their poverty and this economic dependence often make it impossible for women
to negotiate the terms of their relationships or remove themselves from relationships
that put them at risk. Women are frequently forced to endure high levels of domestic
violence within relationships, which both increases their chance of contracting
HIV/AIDS and deters them from seeking testing and treatment. With few opportunities
to earn paid livelihoods independent of men, women may turn to exchanging sex
for favors or are even forced into commercial sex, an occupation which places
them at enormous risk.
Violence against women is both a cause and a consequence of HIV/AIDS.
The World Health Organization research suggests that one in four women may experience
sexual violence by an intimate partner in her lifetime; the fear of partner violence
deters women from visiting clinics, joining treatment programs and adhering to
treatment regimens, because women are trying to hide their pills.
Periods of war or conflict exacerbate gender-based violence in horrifying
ways. In Rwanda, women who were raped in the 1994 genocide are now dying of AIDS,
so for them the genocide continues. Currently, in the Darfur region of Sudan,
human rights activists are convinced that rape is being used deliberately, as
a weapon of war.4
Women's access to and use of services and treatments is also affected
by the power imbalance that defines gender relations. Throughout southern Africa
only one eligible person in 25,000 is receiving drug treatment. Most of those
are educated men living in urban areas.5
Women are the first to take care of their sick partners, children and families
and to comfort the dying. They are the last to get lifesaving treatment. Yet
their critical role as the family caregiver is even greater when HIV/AIDS strikes.
Caring for an AIDS patient can increase their workload by one-third. A rural
woman interviewed in southern Africa estimated that it took 24 buckets of water
a day, fetched on foot (often from a significant distance) to care for a family
member dying of AIDS.6
In Africa most women only discover that they are HIV infected when
they are pregnant and visit prenatal clinics. The risk of mother to child transmission
is high, but women are often offered little to help them reduce the risks; which
might include anti-retroviral therapy, the more recently developed drug nevirapine,
advice to make informed decisions about the alternative dangers of breast-feeding
and of breast-milk substitutes and ongoing care, counseling and support. High
costs of drugs and medical services have meant that even if treatment is offered
it has, until now, been for only a brief period, to prevent infant infection,
thus leaving the mother to face the cruel prospect of her own death, and the
abandonment of her orphan children.
Action for Survival: Empowering Women
Leadership failures, cowardice, denial and avoidance have all contributed
to the exploding pandemic. Stephen Lewis, U.N. HIV/AIDS envoy, says: "For
20 years African leadership was largely silent, in denial... traumatized, paralyzed...
the Western world, which had the resources and knew how to deal with the pandemic...
contributed a negligible quantity of money to Africa. In the process 17 million
lives were lost and 25 million people were already infected. It is one of the
most astonishing moral lapses in post-war history."
Taking Action and Providing Resources
Lewis makes a powerful argument against helplessness and hopelessness: "We
know how to turn the disease around and we have the capacity at this moment to
prolong and improve the lives of millions and to prevent the infection from spreading
to other millions, and at the heart of it is largely the question of resources
which still isn't resolved. It can be done ... it is just a matter of fashioning
the will and the commitment to do it."
In April 2001 U.N. Secretary General Annan called for the establishment of
a Global Fund on AIDS and Health, estimating that a global campaign against the
epidemic needed $7-10 billion annually, over and above current spending,
for an effective response.
One reaction came in December 2001, when 18 of the world's leading economists,
sitting in the specially established "Commission on Macroeconomics and Health;
Investing in Health for Economic Development," chaired by Harvard Professor
Jeffrey D. Sachs, reported that massive investment in global health ($15.5 billion
annually), could save eight million lives a year and generate at least $360 billion
annually within 15 years. The report argued that there are very powerful links
between health, poverty reduction and economic growth.
Taking Action and Empowering Women
Policies that aim to erase the gender gap in education, improve women's access
to economic resources, increase women's political participation, protect women
from violence and enable them to achieve their rights to sexual and reproductive
health and self-determination are key to empowering women. And empowering women
is the key to challenging the pandemic. Women have developed a serious set of
blueprints for addressing inequality. Now governments need to implement the recommendations
laid out in such key documents as the Convention on the Elimination of All Forms
of Discrimination Against Women (CEDAW) and the Beijing Platform for Action.
These need to become the guiding frameworks in the development of all HIV/AIDS
prevention, treatment and care strategies.
What you can do:
1. Challenge your Congressional Representatives, Senators and the President
to adopt new standards for generous funding appropriations to the Global Fund.
2. Advocate U.S. policies for Africa that place women at the center of
planning and decision making about poverty eradication, debt cancellation, expansion
of education and health care.
3. Urge U.S. policy makers to adopt and implement a rights-based approach
to combating the epidemic, rather than only urging abstinence, and avoiding a
holistic approach to human rights and the provision of comprehensive reproductive
health services.
4. Maintain the pressure on U.S. corporations to avoid placing patents
and profits ahead of both women and men's need for truly affordable drugs. Encourage
research targeted to giving women the ability to protect themselves via women
initiated technology, such as female condoms and microbiocides.
5. Build direct connections and partnerships with African NGO's,
women's organizations and other sectors of civil society — you will find amazing
dedication, knowledge and courage. Such links can help strengthen the grass roots
pressures which have already made some cautious governments move beyond their
paralysis and failures of commitment to battle the pandemic. |
