|African Women and AIDS: Scope, Impact and Response (UNESCO, 1999, 59 p.)|
by Lillian K. S. Chigwedere
(Psychologist Independent Consultant, Harare-Zimbabwe)
The June, 1998 UNAIDS report highlights the following issues
· Over two thirds of all people now living with HIV in the world live in Africa south of the Sahara desert
· Eighty five percent of the world's aids deaths have been in the Sub-saharan region.
· Right from the start of the epidemic, HIV has spread mostly through sex between men and women
· An estimated 87% of children living with HIV in the world are in Africa
· No cure for aids has yet been found.
The facts listed above immediately justify organising a workshop for the women co-ordinators of grassroots women's organisations, to share experiences on how best we can help to stop the spread of the HIV virus. Why women and not men? Some might ask. As you will see later in the presentation, women seem to be the more vulnerable group. The objective is to highlight some of the pertinent issues regarding HIV and women and to induce the reflection on the problem of HIV/AIDS in much broader terms than before. To help grassroots women protect themselves against HIV/AIDS and help to prevent its spread, it is imperative to have up to date information on these issues in order to transmit efficiently and effectively accurate and culturally appropriate messages to the target groups. The issues to be covered in this segment include:
· The extent and epidemiology of HIV infection in Africa
· Factors that make women, particularly in Africa more vulnerable to HIV virus
· Problems regarding sexuality between men and women, particularly in Africa
· Cultural and traditional constraints and practices - the challenge
· Reduction of risk of infection in women especially in Africa.
To be able to deal with a problem, one should understand not just the problem but the magnitude of the problem. We will look first at the problem as it affects us at individual, country, regional and global level. By analysing the problem this way, we will then know how to attack it and produce the appropriate tools to use to induce behaviour change.
First of all, we will note that it is not always necessary to have scientifically drawn statistics to see the magnitude of the problem and how it is indeed a pandemic. However, formal statistics can help us to appreciate not only the magnitude of the epidemic but also to begin to think of appropriate ways and means of fighting the HIV virus.
Globally, the data show that the HIV knows or recognises only one totem and that is "HUMAN" and that women are not spared at all. By 1994, women represented 40% of all new AIDS cases and 50% of all new infections were women aged between 15 and 29 (SAFAIDS & WHO 1995). Sources including UNAIDS say that by the year 2000 an estimated 14 million women will have been infected with HIV and about 4 million will have died of AIDS. The question is " why are women so vulnerable to HIV infection?" The answer may not be so simple. It is possible to list the various reasons. These include physiological, social and cultural, economic, sexual, and sheer ignorance.
Knowing one's body can help individuals gain insight into the risks of contracting the HIV infection.
What is it about the female physiology that facilitates the transmission of HIV infection in women?
· Larger mucosal surface area exposed to the virus
· Greater viral load present in semen compared to vaginal secretions
· Young girls have immature cervix and relatively low vaginal mucus production - this present less of a barrier to HIV
· Older women use various herbs and powders to make if difficult for penetration thus increasing both men's and women's pleasure from intercourse - this increases friction and the risk of lacerations is high
· Vaginal wall is not well lined with protective cells
· The cervix may be easily eroded
· Potential bleeding through tearing of the hymen.
Young women and teenagers constitute the group that is at most risk. Teenagers are a highly sexually active group and the percentage of young women pregnant or who have had their first child by age 19 is quite high in most countries. Most of these young women are impregnated by older men who are mostly promiscuous and infected. The reasons for younger women involvement with older men brings us to the second category facilitating factors i.e. social and cultural factors.
SOCIAL AND CULTURAL FACTORS
These range from rape to beliefs about sex and women in general.
· RAPE - this seems to be increasing at such an alarming rate. In many Sub Saharan countries it seems no day passes by without a report on rape or child abuse, e.g.
The causes of rape and child abuse are many. In the different parts of Africa, beliefs, traditions and cultures as well as perceptions regarding sex are central to societal norms and behaviours.
The following are some of the beliefs and practices that may result in either rape or child abuse in the Zimbabwean society:
· Traditional healers' prescription - to rid yourself of the HIV virus, you have to have intercourse with a girl under 10 years old.
· Man must regularly release semen to avoid ill health - the release may be effected through forced sex.
· The father of the groom should be the first one to have intercourse with his daughter in law in order to ensure that everything is OK before the son takes over.
· A father should have sexual intercourse with his daughter to appease the spirits.
All of the above are likely to involve coerced sex which increases the likelihood of micro lesions in the vaginal mucosae thereby creating entry points for the HIV virus. Other pertinent factors include:
· POLYGAMY - women are perceived as man's property, therefore a man can acquire as many as he wants or as his purse can afford to purchase.
· BARENHOOD VS MOTHERHOOD - no marriage is permitted to be childless hence sharing of wife with a nephew, uncle or brother is perceived as normal.
· INHERITANCE OF WIDOWS - belief that a woman is not complete without a man, she is only a property of her husband's family who has to be repossessed by another member of the family.
· PERCEPTION OF MANLINESS AND WOMANLINESS - the African society condones male sexual freedom while emphasising female virginity. Even young boys are encouraged to experiment with sex before marriage- they must be experienced yet girls must be virgins. If this practice is condoned note the relevance and implications to married women of the message "stick to one partner".
· ESAP - with the introduction of structural adjustment programmes in most of our countries, the poor are getting poorer thus putting many women and children at risk: many kids on the street risk being raped and sodomised.
· PROSTITUTION - this has become a means of survival for many women in our countries thereby risking their lives.
· SUGAR DADDIES - many young girls are enticed by older men into sexual intercourse in return for various material goodies.
· JOB SEARCH AND PROMOTION - many couples are forced to split in search of jobs or promotion - this migration promotes multiplicity of sexual partners thereby increasing the risk of HIV infection e.g. executives, drivers, soldiers, miners, farm workers, business women, etc.
· SEXUAL FAVOURS - many women (men too) are trading sex for a job or just job promotion.
· KNOWINGLY INFECTING - HIV positives are marrying in order to get someone to look after them when they become sick.
The norm is that sex is not something that you talk about, just get on with it. Women are supposed to be silent partners who have no say in the marital affairs let alone sex matters. Hence with this state of affairs, a woman cannot insist on condom use, if she does the result can be "guilty of mistrust or infidelity".
Multiplicity of partners
This practice is condoned in men and not in women, women silently accept this practice, challenging it is unwomanly.
Women may not be very knowledgeable about their bodies particularly the reproductive system, because of this ignorance they might fail to recognise any symptoms of STDs or be forced into unprotected sex.
Many women may be ignorant or may not very well understand the basic facts on HIV/AIDS that they unknowingly and unwittingly put themselves at risk of infection e.g. young girls and women may be talked into accepting sex without a condom because they are told by the men that if they do it standing the virus will not affect them, etc. The ignorance might also be linked to their strong belief in cultural and traditional practices. The portrait of a good African woman or (womanliness) and a good African man (manliness) according to Chigwedere, a well known Zimbabwean historian is as outlined below:
PORTRAIT OF A "GOOD WOMAN"
· Physical valour
(source: Chigwedere: The Abandoned Adolescents)
These values were taught and instilled in boys and girls from as early as six years of age. The question is: do these qualities of a good woman place a woman at risk of HIV infection or protect her? In what ways do they protect the woman? In what ways do they put her at risk?
CHALLENGE - Reduction of risk to HIV infection
Factors that put women at risk of infection seem to centre around the socialisation of woman as depicted in the above portrait. With a strong belief in these qualities that make a good African woman, and the African woman thoroughly socialised to accept and act in line with them, how best can we as people working with grassroots women help to empower them to make a difference in guarding their health and protecting themselves against HIV infection. With no cure in sight, what options do we have? These are questions to ponder seriously if we hope to design messages and tools that can effectively empower women to choose between sentencing themselves to death or to life.
It is true that old habits die hard and old patterns take long to break. It is also very true that nothing will ever change if no steps are taken to address the problem. Therefore the initial step to bring about change is awareness of and acceptance of patterns and behaviours that put women at risk. Therefore as we work through messages and tools of helping grassroots women to reduce risk of HIV infection, we must bear in mind an inevitable objective which is to touch a row nerve, "the belief system" in order to bring about meaningful change and appropriate behaviours.
True we can give many messages about how to avoid infection, but without the necessary tools to implement these messages, they will be like, if I may quote the Bible, 'seeds that fell on a rock that dried up and never generated'. So as we deliberate on messages and tools let us think seriously about the implications of the message that we give as well as the appropriate tools to make the seed germinate and bear fruit. One of the famous messages that has so far been widely used is " NO condom no sex". This is a very powerful message, but without first equipping women with appropriate skills to say and act it out, it is just as good as no message at all. The foundation to changing patterns is threefold, rights, boundaries and assertiveness. These are the issues that we shall discuss in the next session on messages and appropriate tools. For now let's start thinking: Realistically, Appropriately, Practically, Assertively; in short RAPA.
1. Chigwedere A. S., The abandoned adolescents
2. Goodman M.S. et Fallon B.C., Pattern changing for abused women
3. SAFAIDS and WHO; Facing the challenge of HIV/AIDS/STDS: a gender response
4. UNAIDS, Report on the global HIV/AIDS epidemic, June 1998
5. WHO-global Programme on AIDS: report of a meeting 8-10 February 1995
6. Zimbabwe women's Research Centre and Network, Zimbabwe women's voices