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African Women Assert Themselves in Fight Against AIDS

Global commemoration of World AIDS Day on December 1, 2000, may have passed almost unnoticed in developed countries, especially in an America transfixed by the presidential election.


Women in KwaZulu-Natal, South Africa, attend instruction that will help empower them economically to assert themselves in their social relationships. (Benedict Carton/National Geographic)

But in developing countries in Sub-Saharan Africa where attending funerals of AIDS victims has become a weekend ritual, the commemoration was tragically ironic: To many people in southern Africa every day is AIDS Day.

With life expectancy rates for men and women dropping by as much as two decades (in Botswana it is now under 40), and economic development faltering, women are being particularly hard hit by the AIDS pandemic.

They shoulder the burden of care for the sick as well as orphaned children, and they represent the bulk of new infections.

Recent United Nations figures show that 55 percent of all adult infections in Africa are among females, compared with only 30 percent in Southeast Asia and 20 percent in Europe and America. HIV-positive teenage girls outnumber teenage boys by as much as 5 to 1 in southern Africa.

In South Africa, 25 percent of all women between age 20 to 29 are HIV-positive, and in some provinces, like KwaZulu-Natal, this rate is almost 40 percent.

Why are Women So Vulnerable to AIDS?

Researchers are exploring why women are so vulnerable to HIV/AIDS. And why they are four times more biologically susceptible to sexually transmitted infections, including HIV.

According to Dr. Quarraisha Abdool-Karim, the former director of South Africa’s national AIDS control program, “the imbalance of power between men and women and the perceived gender role of women are contributing factors to this excess vulnerability.”

In South Africa, where unemployment can be as high as 60 percent in some areas, a study of rural women by Abdool-Karim found that more than 70 percent were financially dependent on male partners. Some are forced to exchange sex for money or material favors, or to stay in risky relationships for economic survival.

In these circumstances, a woman’s ability to negotiate safer sex practices is limited.

According to a survey conducted by the Washington-based International Center for Research on Women, more than two-thirds of the women interviewed in southern Africa said they did not feel able to discuss safe sex practices with their partners, with one in five saying that she feared violence from her partner if she raised the issue of safe sex or no sex, because it would provoke suspicion of infidelity.

Biomedical Cure Not in Sight

Efforts to mitigate women’s vulnerability to HIV include the development of microbicides and the promotion and distribution of the female condom.

Yet with the announcement in August, 2000, that a clinical trial in Kenya of the use of the contraceptive agent nonoxyl-9 as a potential microbicide actually increased the study group’s chances of contracting HIV, and with trials of AIDS vaccines years away from producing concrete results, the search for biomedical preventive measures has not yet yielded viable results.

And the female condom, while enthusiastically received in pilot projects, is expensive and not widely available in most sub-Saharan Africa countries. (Zimbabwe is one exception. Women’s groups obtained more than 20,000 signatories to a petition to the government to obtain a contract with the Female Health Company, the sole manufacturer of the female condom, to distribute female condoms at low cost. While not universally accessible, and still relatively expensive, the female condom was, briefly, an option for some Zimbabwean women.)

Teaching Women to Protect Themselves

Many grassroots programs are searching for other ways to increase women’s capacity to protect themselves.

One such South African program, Thembelisha (a Zulu word meaning “New Hope, New Horizons”), seeks to empower unemployed young women in KwaZulu-Natal by providing them with self-employment opportunities: basic business skills, work experience with local businesses, and access to start-up loans.

An affiliate project, Phakama (“Rise Up”) conducts workshops for women and female high school students on sexual violence, teenage pregnancy, and HIV/AIDS.

Local programs like Phakama and its national counterpart, Stepping Stones, encourage young women to develop greater assertiveness (for example, by practicing role-plays about condom use). Such efforts increase the possibility that young women will exert more control over their sexual relationships, or even simply to seek treatment for a sexually transmitted infection.

Other programs in South Africa, like Planned Parenthood’s MAP (Men as Partners) work with young men to foster more constructive roles for themselves in sexual and reproductive health, and to examine and redefine harmful gender norms.

In a context where biomedical prevention and treatment for HIV/AIDS is limited, attempts to change behavior and attitudes are the only interventions that, for the moment, are possible.

Louise Vis recently returned to the United States from South Africa, where she worked extensively with grassroots organizations for HIV/AIDS prevention and care. She continues to conduct research and develop programs for women’s development and community health projects.

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More Information
According to the World Health Organization, since the onset of the HIV/AIDS epidemic 15 years ago, the virus has infected more than 47 million people in the world.

With more than 2.2 million deaths in 1998, HIV/AIDS has now become the fourth leading cause of mortality and its impact is going to increase.

Over 95 percent of all cases and 95 percent of AIDS deaths occur in the developing world, mostly among young adults and increasingly in women.

Just under 22 million people have died of AIDS since the beginning of the epidemic.

In South Africa, which has the world's highest total number of HIV/AIDS patients, the epidemic is projected to reduce the economic growth rate by 0.3-0.4 percent annually, resulting by the year 2010 in a gross domestic product (GDP) 17 percent lower than it would have been without AIDS and wiping U.S.$ 22 billion off the country's economy.

Source: World Health Organization