Worse for women: AIDS exacerbates gender disparities

More than four years ago, Gugu Dlamini was stoned to death in KwaZulu-Natal, South Africa, after speaking out about her HIV-positive status. Despite commendable work by those concerned with the inter-relationship of gender and AIDS, things haven’t improved much for most African women today.

The HIV pandemic is a horror story of its own, but also has an extraordinary capacity to expose pre-existing inequalities and injustices in a glaring light. Issues of poverty, culture, sexuality, health provision, education, racism – AIDS gives us something new to say about all of it.

And so with gender, and specifically the extra price that girls and women are paying for the world’s lamentable response to the greatest cause of human suffering in our generation.

Women and HIV/AIDS

From an African perspective, HIV causes unacceptable hardship for all, but more so for women. It holds up to scrutiny the cultural, social, and economic inequalities that render females more susceptible, both to transmission and to the spin-off consequences of HIV/AIDS. If there is hope here, it is this: by improving domestic, legal and social conditions for women, and in particular by giving all women more say in how and when they will have sex, a dramatic change could be made in HIV prevalence.

Globally, half of all infected adults are women, but in Africa the proportion is higher, and rising.1 Teenage girls and young women in their twenties are five to seven times more likely to be infected with HIV than boys and young men of the same age.

Where the pandemic is spread mainly by heterosexual sex, as it is believed to be in sub-Saharan Africa, there are biological reasons why women are more susceptible, but that is only part of the story.

Cultural attitudes to women’s position play some part. Much of African tradition is protective of women and their pivotal role in the family, but some aspects have proven to be dangerous in the age of AIDS. In some places a single man in the clan is c e r e m o n i a l l y responsible for initiating all the young girls into sex, helping the wives of infertile men to conceive, and ‘cleansing’ widows through intercourse.

In a few places, good hospitality can include a man offering one of his wives to visitors for the night. Girls are often married so young that they aren’t capable of having sex without sustaining damage – and the age seems to get lower wherever poverty is most pronounced.

The withering effect of poverty overshadows and distorts everything. In a continent where 70% of the people ive on less than US$2 a day, no behaviour is ‘normal’ any more. As food security across Africa gets worse, girls are more easily coerced into sex to get food. Commercial sex workers are obliged to consent to dom. Many girls in Africa are brought up to believe that decisions about money, property and sex are not theirs.

It is not just in the relative risk of infection that women can get a raw deal, especially where extreme conditions undermine Africa’s normally strongly-held sense of fair play, respect, and social order.

Among two sick partners, the husband is more likely to control the money, so women have less access to  limited and costly health services. In caring for orphans, the burden falls hard on grandmothers. Should a wife survive her husband who has died of AIDS, his family may try to seize the family home, citing tradition. Amid violence and war, of which Africa has more than its share,women are raped as a weapon of fear and symbol of victory. When resources are scarce – in a food crisis, in displacement camps, where unemployment is high – the struggle to feed the family falls largely on mothers. If a child must be withdrawn from school due to lack of fees or to replace the labour of a lost adult, a daughter will usually be taken out before a son.

This threatens the continent’s future economic stability, because Africa is run on women’s unpaid, and often unregarded, labour. When a household suffers economic hardship, increasingly because of sickness and death due to AIDS, one study suggests that in more than three quarters of cases it is women who suffer the reversal.2

Make it real 

Solutions begin with frank discussion of the problems. Groups in rural African settings derive great advantage from grappling with the concept of transformed relationships between men and women, and are never short of ideas. Development workers tackling HIV/AIDS need to realise that men and women have different roles and needs, and that good interventions can most positively influence the health of both when they treat each as special.

Ultimately the most successful approaches to changing mind-sets seem to involve group work, helping women and men to identify the problems that lead to HIV prevalence, and resolving them in community. Where this also involves local leadership, such renewed thinking becomes binding on local social behaviour. This is an asset in African culture, empowering not just the individuals but society itself.

It is not enough to try to change this conditioning by re-educating women alone. It’s one thing to be taught it’s your legal right to stay in your home after your husband has died; quite another to be protected from the husband’s kin who want to throw you out. Girls don’t only need to be told schooling is their right; they need to be free to go to school.

Health interventions should be intelligently channelled to the part of the population that normally finds itself caring for the sick – usually women. Nor should we trick ourselves into believing that a technological solution to the spread of HIV among women – female condoms and microbicides – is anything but a short-term fix.

Ultimately the answer to our questions is a change in social perspectives that accords women proper respect,  and an assault on the aspects of poverty that have conspired to make life so miserable for so many.

The good news is that AIDS is forcing communities to re-evaluate the roles of men and women. Now  local leaders must get active and do something. Governments must give meaningful legal protection to women’s rights. Development work needs to be refocused to give meaning to talk of empowerment. And we have to make it real, because at the moment there are a lot more words than action at every level.

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