Gender and AIDS in Africa
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The strong norms of virginity and the culture of silence that surrounds sex make seeking information and accessing treatment for sexually transmitted diseases highly stigmatizing both for 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 and may refuse to accept her or her children into the family support system. The law rarely allows the woman to inherit her husband’s land and property. 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. It may force them to endure high levels of domestic violence which both increases their chance of contracting HIV/AIDS and deters them from seeking testing and treatment.
With few opportunities to earn 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.
Women’s access to and use of services and treatments are also affected by the power imbalance that defines gender relations. A 1999 Tanzanian study showed that while men made the decision to seek voluntary counseling and testing independent of others, women felt compelled to discuss testing with their partners before accessing the service. Initial Africa-based surveys are revealing that when anti-retroviral therapies become available, men receive a larger percentage of the treatment due to discriminatory distribution by health facilities. 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 life saving treatment.
Women often only discover that they are HIV infected when they are pregnant and visit pre-natal 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, and counselling and support. Where treatment has been offered it has involved only a brief period, to prevent infant infection, leaving the mother to face the cruel prospect of her own death, and the abandonment of her orphan children.
Conflict situations, where rape is used as a weapon of war, are another horrific source of the spread of the pandemic, as the virus is spread through sexual violence. In Rwanda today, women who were raped in the genocide are now dying of AIDS. For them the genocide continues.
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