Gender and AIDS in Africa
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In June 2001, Mozambique’s Prime Minister, Dr. Pascoal Mocumbi, urging his fellow political leaders at the UN General Assembly Special Session on AIDS (UNGASS) to stop avoiding critical issues, underscored the need to recognize that the primary means by which AIDS is spread in Sub-Saharan Africa is risky heterosexual sex. This goes beyond a health issue, he indicated, 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.”
In Mozambique, he reported, the overall 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, 40% 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.
Power and prevention
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,” Stephen Lewis, UN Secretary-General Annan’s Special Envoy for HIV/AIDS in Africa, told a reporter at the end of 2001. 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.”
He 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 sex which is risky without condoms, “without the capacity to say no, without the right to negotiate sexual relationships.”
Women at risk—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. The virus has an easier time surviving in the vagina than on the surface of the penis; vaginal scrapes and cuts which occur during violent or coerced sex increase infection risks, and semen carries a heavier viral load than the fluids of the vagina.
Gender inequality is also fueling 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.
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 even 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% 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.
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. In 17 African countries surveys indicated that over half of the girls did not know any way of protecting themselves from HIV. HIV infection rates among young African women, aged 15-19, in some regions are five to six times higher than for young men.
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