Saturday, May 6, 2006

Gender and its effects on the HIV / AIDS epidemic in Southern Africa

The HIV/AIDS empidemic in Southern Africa is one of biggest crisis that the continent is facing in the modern world. During my time studying abroad in South Africa, I learned a lot about the HIV/AIDS epidemic and about the cultural and social stigmas surrounding it. Coming from the US it seems like such a straight forward solution: education and safe sex. Pass out condoms and the problem will be solved.

The problem with this, however, is that it goes much deeper than just not having access to condoms or knowledge about the spread and prevention. While I was at UCT, I took a class on Gender and studied the part that gender rolls play in the spread of HIV. Today I was reading through my old papers and came across this one that I wrote about the topic. It is a little more formal than a typical blog post, but its pretty interesting so I thought I would share it.

Understanding The Transmission of HIV/AIDS
in Sub-Saharan Africa Through Gender

The HIV/AIDS epidemic is a problem of paramount proportions today in southern Africa. According to a fact sheet produced by UNAIDS and the World Health Organization (WHO) in 2005, Sub-Saharan Africa, which houses just over 10% of the world’s population, is home to over 60% of all people living with HIV- 25.8 million people. However, although both men and women are biologically affected in very similar ways by the disease, the epidemic seems to be affecting more women than men. In Zambia, for example, girls age 15-19 are 3.4 times more likely to test positive for HIV than their male counterparts, with this figure jumping to 3.7 for women aged 20-24 (Underwood, 2006).

Because southern African women have been targeted as high-risk group for HIV transmission, their education has been the predominate focus of many prevention campaigns in recent years (Lesetedi, 2005; Oriej, 2005). Unfortunately, while women are becoming more and more aware of the dangers of unprotected sexual relations, their sexual practices tend to remain high-risk and unchanged (Wood, 1997; Peacock, 2005).

Several factors influence the high rates of transmission to young women, chief among them are gender inequality, the prevalence of gender-based violence, and the patriarchal nature of African societies. In addition, poverty and lack of education play a significant role in the heightened vulnerability of women (Wodi, 2005; Eaton, 2003; Mill 2002; Oriel, 2005).

The gender dynamics in southern African societies gives almost sole control to men in sexual relationships. It is often taken as a fact, for example, that men need sex on a regular basis and that it is their right to get it when and how they want it (Ng’weshemi, 1997). Often times, the refusal of women to have sex on command results in violence and abuse. In interviews of pregnant teens in a township in Cape Town, South Africa, Katherine Woods and Rachel Jewkes found that “Repeatedly, the language of the girls’ narratives was of compulsion: `he made me’ , `he just pushed me and overcame me’ , `he forced himself onto me’ , `he did as he wanted with me’, `what could I do? (1997)’”

In an interview by Dean Peacock, South African men recount their views on women growing up in South Africa. Lee Buthelezi, remembers “I was socially brought up knowing that if you want to have sex with a girl and she doesn’t want, you just klap [hit] her two or three times and she will give you want you want…. We were brought up in a manner that women should be beaten in order to get what you want from them (2005).”

This hierarchy found within heterosexual relationships is characteristic of many relationships in southern Africa. It often leaves women completely unable to influence condom use, especially within marriage. As Judy Mille points out “Monogamous women who realize that their husbands have multiple sexual contacts are often powerless to protect themselves from HIV infection (2002).”

Several factors affect women’s inability to influence condom use. One reason is that there is a social stigma that associates condoms with prostitution, infidelity, filth and disease. However in a report published by UNAIDS, it was found that in 14 countries the most common reason for men to refuse to wear a condom was because it reduced sexual pleasure (UNAIDS, 2000). This attitude is putting the man’s right to sexual pleasure above the right of the woman to protect herself from HIV. Unfortunately, women can face being accused of unfaithfulness, being beaten or even being abandoned upon asking a male partner to use condoms (Ng’weshemi 1997). In interviews conducted by Judy Mille, she found that

“The men conceded that they would interpret a request from their wife or girlfriend to use a condom as an indication that she had a sexually transmitted disease and that they would be very upset about this situation. None of the men considered the possibility that the woman might be asking him to use a condom to protect herself from disease (2002).”

A further gender-issue in the transmission of HIV is the high value placed on fertility in many African societies. In many communities, a woman is not considered a full woman until she has born children, and her social status within the community is closely linked to her ability to produce children (Mille, 2002). This societal obligation can not only affect the woman, but can also affect her unborn children. For instance, an HIV positive woman may continue on with a pregnancy, knowing the risk of transmission to her child, just to fulfill her duty as a woman (Mille, 2002).

The great desire for children also negates the use of condoms as protection from HIV and other sexual transmitted diseases, even if the man in the relationship is having extramarital affairs. In instances of infertility, most men will take a new partner, ignoring that they could be the reason for the lack of children. When women are abandoned because of their inability to bear children, they can become desperate and engage in high-risk behavior in order to prove that they can get pregnant. Mill explains,

“[They] try to become pregnant with different men with the hope that they would be exonerated as the cause of infertility. Rene knowingly risked the exposure of her partner and her unborn child to the HIV virus in order to fulfill her need to have a child. She became pregnant after learning that she was HIV sero-positive, without consulting her boyfriend and without the knowledge of the physicians and nurses at the Fever’s Unit (2002).”

Additionally, postpartum sexual abstinence is a common custom in many African societies and may further lead to a heightened risk of HIV transmission to married women. During this period of abstinence, which according to Judy Mille averages 13.8 months, many men will stray to find other women to fulfill their sexual needs while their wives are nursing their new born child. Again, because condoms are largely not acceptable in a marriage, the husband’s increased sexual partners indirectly put his wife at a heightened risk for infection (Mille, 2002).

The poverty prevalent in many African societies also plays a large role in the transmission of HIV; however, this again is a gendered issue. It is not uncommon for women to seek out boyfriends or sexual relationships with men who will be able to support them financially. In a study done by Catherine MacPhail, she found that money was not only a factor, but was one of the driving forces for females to become involved in relationships (2001). This practice leads to women seeking out relationships with older men who will have the means to provide for them, but who will inevitably have a longer sexual history than a younger male will (Eaton, 2003). The exchange of financial support for a sexual relationship can place the women at the mercy of the man’s sexual desires and often leads to unprotected sex. However, as Eaton points out, “From the woman’s perspective, protection from possible future illness may be a lower priority than meeting immediate economic needs (Eaton, 2003).”

Although much of this paper has focused on women being at particular risk for HIV transmission, the dominant notion of masculinity in southern Africa (males as being dominant, sex-driven and risk-taking) is also causing men to put themselves at high risk for infection. For instance, many cultures expect men to have more than one sexual partner and therefore promote promiscuous behavior by men. According to Ng’weshemi, “Men may feel pressured to ‘prove their masculinity’ by being dominant and having many sexual partners; they may fear ridicule from their friends if they remain faithful to one woman (1997: 89).” Furthermore, because men see themselves as ‘risk-takers’ they are inclined to reject the use of condoms as “unmanly” or view sexually transmitted diseases as “no more than an inconvenience (Lesetedi, 2005).”

It is clear through this cursory gender analysis of the transmission of HIV that this is a very complex epidemic. Although much of the focus of preventative programs is on the education and empowerment of women, it remains a fact that men need to take a leading role in the struggle if significant progress is to be made at stifling the progression. The gender inequalities that pervade most African societies must be acknowledged and dealt with. As stressed by Dean Peacock’s interviewees, it is important to change the way men view women in order to stop high-risk sexual practices. In the interview, Regis Mtutu states that, “When that empowered young girl engages with this young man, he cannot engage, and all he can do is to resort to violence, sexism and so forth.” He continues that we need to “look at how we resocialize the young boy from that early age onwards (2005).”

Through education and resocializing of young men in African communities, as time goes on, women will gain more and more access to their human rights. As Mbuyiselo Botha, an interviewee of Dean Peacock’s, said, “In the oppression of men lies the oppression of women. And in the liberation of women lies the liberation of men.”

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