HIV & AIDS in Africa: The Female Face of the Pandemic. 2/12/10

You don’t ask the husband where he has been, or where he is going

Consultancy Africa Intelligence

In sub-Saharan Africa, women’s health and nutritional status is comparatively worse than that of men and also one of the lowest worldwide. The World Health Organization (WHO) reports that African women score the lowest rates in almost every health indicator category, and particularly with regard to HIV & AIDS. African women record the highest HIV & AIDS prevalence and maternal mortality rates. Nearly 90% of the world’s maternal transmission of HIV infections to newborns occurs in sub-Saharan Africa. According to UNAIDS, the region accounted for 67% of HIV infections globally in 2008. Women alone accounted for 60% of those estimated African HIV infections. Overall, 70 % of all women living with HIV & AIDS worldwide are in Africa. African women are the face of the HIV & AIDS pandemic worldwide.(2)

This CAI discussion paper explores the HIV & AIDS pandemic in African women – especially the causes of the disproportionate male and female basic health indicators and the need to develop appropriate and effective interventions that work towards the reduction of HIV & AIDS in African women. 

The drivers of the female HIV & AIDS pandemic

Socio-cultural, legal and economical factors contribute to female vulnerability to HIV & AIDS. Females are physiologically susceptible to heterosexual HIV transmission during unprotected sexual encounters. The extensive surface area of the mucous membrane in the vagina and on the cervix increases susceptibility to HIV infection through viral entry via tears and abrasions. This is particularly the case in younger women, whose vaginal lining is thinner, and most prone to abrasions.  In addition, semen deposited into the vaginal canal, which retains a high concentration of semen even some time after the intercourse, facilitates viral penetration over a longer time period.

- Mobility and Migration

Most of sub-Saharan Africa is poverty-stricken and/or has experienced social upheavals spurred both by economic downturns and by political instability and warfare. This leads to pervasive mobility rates and extensive migration. 

South Africa is the most common destination of an influx of migrants from poorer and war-torn African countries. People from predominantly rural areas relocate to greener city pastures.  South Africa’s Gauteng province especially is an urban hub and melting pot of diverse African cultures, characterised by migrant labourers. These migrant labourers work at menial jobs which do not afford them the means to relocate with their families. Therefore they generally leave their spouses behind, with both parties often entering into new sexual relationships for both psychological and material gain. This reinforces cultural norms that exacerbate female vulnerability to HIV & AIDS.

- Cultural expectations

Gender-based constrains also contribute to gendered economic disparities.  Gendered cultural expectations in particular reinforce the female face of HIV. The decision of whom to have sex with, for what purpose, when and how lies all too often exclusively with the male –regardless of marital status. In such male-dominated situations, women cannot negotiate safer sexual practices. For example, in Setswana culture a man who does not express his masculinity and sexual virility by having concurrent relationships is not perceived as a man. Society sanctions this and expects women to be submissive to their spouses. Lack of submission carries with it punishment, including permanent expulsion from the marital home, with devastating implications on lobola(3) and the custody of minor children. A complaint from a spouse slighted by the husband’s infidelity receives ridicule and comments such as:

- “Monna ga a bodiwe gore o tswa kae”
(You don’t ask the husband where he has been, or where he is going);
- "Monna ke poo ga e agilwe lesaka"
(A man is a bull which cannot be confined but must be let loose);
- "Monna ke thotse o a nama"
(A man is a seed which multiplies);
- "Monna ke selepe, o stamaya a rema, o a adimangwa"
(A man is an axe which must go about chopping, and therefore must be shared).

If the woman is caught transgressing her martial fidelity and is ‘lucky,’ she may be temporarily sent back to her family for conformity counseling (go laiwa) to be counseled on being a good wife, while the lover (the bull that broke into the kraal) is charged with trespassing and ordered to pay damages to the aggrieved male and his family for his indiscretion by customary law. Women in this context are in no position to negotiate safer sex even when they aware of their spouse’s infidelity. 

- Trans-generational/transactional sex

In addition to these gendered norms which contribute to the female face of the HIV pandemic in sub-Sahara, another driver of infection is trans-generational/transactional sex. Young females usually accept the advances of older males (sugar daddies) for financial and material gain. Such relationships bring gifts and money for the purchase of designer labels, cell phones and even better accommodation, often not only for the women herself, but also for her entire family. Women in such a scenario are in no position to negotiate safer sex.

The way forward in fighting the feminisation of the African HIV & AIDS epidemic

From a legal and government point of view there is a need to strengthen legal  frameworks and processes that promote women’s rights and eliminate gender inequality in the context of HIV & AIDS – particularly in relation to women’s property and inheritance rights, right to education, career and progression in the workforce. It is important that interventions facilitate a decisive strategy that secures women and girls rights to property and inheritance, as well as access to educational and employment opportunities.  

 Economic gender imbalances that are catalytic to the rise of the female-HIV gendered epidemic may be mitigated by interventions that empower women to be economically independent. Bursaries, scholarships, and internships empower girls to enter careers traditionally reserved for males. Facilitating an enabling, supportive environment that nurtures female business and agricultural ventures is another way. This is to motivate economic self reliance among African women. Incentives that foster female access to micro financing services and community-banking lending services to expand their business operations further empower women. To facilitate sustainability and harness female creativity for maximum potential, mentorship programmes and awards for women making inroads into this field could be used as an incentive.

Laws against gender discrimination, inequalities, violence and sexual coercion should be updated and enforced as part of national HIV & AIDS strategies, in order to reassert the human rights of women as a core part of universal human rights.  Interventions that seek a redress to century-old beliefs and unfavourable social norms that unfairly predispose females to contracting HIV must be identified, and appropriate measures developed to counteract them. The participation of female civil groups must be recognised as crucial. Gender imbalances within society must be addressed –especially in the fields of access to education, inheritance and property ownership rights. These imbalances disadvantage women economically. 

Culturally entrenched gender norms which increase women and girls’ vulnerability to HIV & AIDS need to be revised. Education and awareness programmes must encourage responsible sexual behaviour and discourage myths and misconceptions that fuel the spread of HIV & AIDS. Communities could be facilitated on gender inequalities and be incorporated into designing a comprehensive, step-by-step family and community-focused strategy of ending female gender inequities. This intervention should be designed and developed to accommodate the uniqueness of the target community i.e. it should be culturally sensitive to a specific community. The intervention must incorporate, right from conception, relevant stakeholders such as women groups, male groups, HIV & AIDS activists, traditional leadership, civil organisations and the government. The best people to determine the direction of the intervention are the members of the community themselves. For instance, the registration of a network of positive women living with HIV & AIDS in sub-Saharan Africa, and even in the broad African continent, may facilitate the mitigation of a range of issues that place women at risk of HIV transmission or prevent women from seeking timely access to preventive and treatment programmes, effective legal representation, gender-based human rights violations, and the promotion of sustainable HIV interventions.

Conclusion

Gender issues cannot be excluded in campaigns that seek to reduce the vulnerability of women to HIV infection. Gender relations and inequalities are core to the demographic disparities in HIV prevalence.  HIV & AIDS programmes must be balanced in their community services.  They must work towards a reduction in gender-based violence and coercion. Male norms and behaviours must be addressed. There is need for an increase in women’s legal protection. Finally, to reduce female economic dependence on males, there is a need for programmes that aim at facilitating an increase in girls’ and women’s access to educational opportunities, income, and productive resources. Most importantly, HIV & AIDS prevention, care and treatment activities must be addressed as gender inequalities.