ADDING INJURY TO INSULT:
HOW THE OPPRESSION OF WOMEN
DRIVES THE AIDS EPIDEMIC IN AFRICA
Africa is facing a devastating crisis with respect to the AIDS epidemic, currently accounting for over 70% of the world's HIV-positive population. There are, of course, many factors that drive the explosive transmission of the Human Immunodeficiency Virus, but in the tangled web that is the epidemic in Africa, many of these issues share a common thread. The oppression of women in Africa can be considered the virus' cultural vector. Females are rendered powerless in African societies, and existing gender inequalities are largely responsible for the spread of the disease. Females' disadvantaged position in society is intrinsically linked to the subordination of women in their relationships with men. In order for progress to be made, an examination of gender relations and empowerment for women must take place. To be successful, AIDS campaigns must be built on the existing organizational skills of women, but must incorporate men as well. The blatantly skewed distribution of power in African patriarchal societies makes women extremely vulnerable but has dangerous implications for all.
To examine the forces that steer the epidemic down its course, the epidemiology of HIV and AIDS in Africa must first be considered. More than 80% of all HIV infections in Africa are acquired through heterosexual contact. This statistic is grossly out of balance with the 13% rate of infection through heterosexual contact in the United States. Vertical transmission from mother to child is the second most common route for the virus to take in Africa (Essex et al., 158). These rates are generally much higher than in the United States and Europe, where the use of a drug called neviropine has drastically reduced mother-to-child transmission. This disparity is a direct result of differences in the nations' wealth. African nations simply cannot afford to provide the drug to infected pregnant women. The continued transmission of HIV through contaminated blood during processes such as blood transfusions is another dismal consequence of poverty and inferior health services in many African countries. This method accounts for the third most important mode of transmission, one that has been virtually eradicated in many countries because the technology is available to prevent it (Essex et al., 159). Part of what makes the situation in Africa so devastating is that the primary roads the virus travels in Africa were shut down long ago in other countries. Much of the world's population already takes many of the roadblocks for granted. The transmission route of heterosexual contact is so heavily traveled in Africa that it demands an examination of sexual behavior.
Before we delve into the workings of intimate relationships, however, the fine points of gender inequality in the public sphere must be examined. These social conditions spill over into every aspect of life, tainting women's casual and sexual relationships with men. Women are systematically disadvantaged in African society. Male bias in the structures of society is reflected in day-to-day behavior, embedded in legislation, policy, political and religious ideologies, and cultural conventions (Baylies et al., 6). Examples of this trend abound. The Civil Code of the Empire of Ethiopia designates the husband as the head of the family and gives him the authority to administer household property. The husband is given the right to control and manage common property and to make all decisions regarding it. While the Code requires that the husband act judiciously and not alienate property without the consent of his wife, strong traditional and cultural beliefs discourage women from enforcing this requirement (African Region Findings). In Kenya, the Constitution permits the application of customary law to personal matters. The Constitution contains no provisions for gender as a basis for non-discrimination and consequently, even gender-biased practices are held as valid and constitutional. Women's access to economic resources in Kenya is largely defined by customary laws (African Region Findings). Inheritance is usually along the male lineage; women do not inherit family property. Not only do women have less access to income and possess much less wealth than their male counterparts, but they also contribute more hours of labor than men do (Baylies, et. al., 7).
In a village meeting held in rural Lushoto, Tanzania, in 1996, coordinated in response to AIDS, even two of the men present agreed that women take the heavier burden. "A man, if you need him, is always out," an elderly man spoke out, "whereas the woman is the one at home, taking care of cooking and all other household affairs. . . . We get up in the mornings and go about our business and don't concern ourselves with whether [the children] eat or not," he continued. "We leave it all to mama. We give orders, we are 'dictators' in the home" (Baylies et al., 191). Most of the men, however, did not share his capacity to see the situation in this way. One male maintains, "as a man you have so many things to attend to, and you rely on her to think of things like soap for washing" (Baylies et al., 190).
Women's limited opportunities also translate into reduced access to education. Their lower levels of literacy contribute to their more limited access to information about sexually transmitted diseases and HIV (Baylies et al., 6). Cultural conventions prevent them from asserting themselves in public, squelching any hope of improving their situation in this way. Since their work is confined to the domestic field, women's labor does not command market value, leaving them dependent on those members of the household who operate in the cash economy (Baylies et al., 7). Economic need often drives women to enter into prostitution. The selling of sex, many argue, is often the only choice African women have "between starvation and survival" (Essex et al., 538).
It is the link between women's position in wider society and position in sexual relations that is crucial to understanding their vulnerability to the virus. UNAIDS reported in 1999 that in sub-Saharan Africa 12 or 13 women are infected with the HIV virus for every 10 men (Russell 101). Women have characteristically been viewed as responsible for transmitting the virus. Prostitutes are blamed for spreading HIV to clients, and mothers are blamed for passing it to their children (Essex et al., 3). Females are thought to have a polluting influence and are treated as "vaginas or uteruses," "whores or mothers," and "vectors or vessels" as opposed to people (Essex et al., 3). Instead of regarding women as blameworthy for the severity of the AIDS epidemic in Africa, they should be more accurately perceived as occupying a cultural niche in which they are highly vulnerable to contracting the virus.
Since women are forced to relinquish the driver's seat to males in the public sphere, they certainly have no say in the nature and timing of their sexual activity in the private sphere, leaving the roads HIV travels open to traffic. Intimate relations revolve around the same "notions of personhood" that operate in the larger society (Baylies, et. al., 7). The outcomes of these gender ideologies take form as sexual practices. The foundation of these sexual understandings seems to be that women are expected to give but not receive pleasure. Sexual norms prescribe relative passivity for females, while according sexual decision making to men (Baylies et al., 7). Tolerance is expected for the greater sexual mobility of men. Female fidelity is usually viewed as necessary while male infidelity is consistent with the extension of the familial line (Essex et al., 534). The double standard expectation is that women will enter into a marriage as virgins but men will not. In patriarchal, sub-Saharan African cultures, marriage can be defined as a legally and socially sanctioned relationship between a man and a woman within which procreation takes place (Essex et al., 534). Women are not viewed as people capable of sexual pleasure but as the means by which to achieve an end. That end is the perpetuation of the family line. This prime value on marriage and motherhood presses young girls into risky, multiple-partner relationships long before they are psychologically or physically mature. Young women cannot refuse the sexual demands of older men nor bear the social stigma of being without a husband or children (Essex et al., 536). Women are powerless within their relationships and have too little power outside of them to abandon partners that put them at risk.
How, then, do these social and sexual patterns account for the severity of the AIDS epidemic in Africa? Many claim that male privilege is what drives the AIDS epidemic, even going so far as to call AIDS a form of mass femicide (Russell 100). Diane Russell bluntly states, "Those women who contract HIV/AIDS from their male partners because of their sexist attitudes and behavior, and/or because of their superior power and dominant status, are—when they die—victims of femicide" (102). There are many examples of manifestations of male domination that can be fatal for female partners.
Male refusal to use condoms is perhaps the most critical of these behaviors. Utilization of condoms is the one factor that would undoubtedly reduce transmission rates drastically. Women are not even allowed to ask, "Can we have sex?," so it is even more difficult to bring up condom use (Russell 103). However, if a woman does find the courage to ask her male partner to use a condom, not only will he almost certainly refuse, he is likely to beat her. "Talk to him about donning a rubber sheath and be prepared for accusations, abuse or abandonment," relates Johanna McGeary in TIME magazine. Her article also related the story of a nurse in Durban, who, coming home from an AIDS training class, suggested that her husband put on a condom. He proceeded to grab a pot and bang on it loudly, attracting all the neighbors. He pointed a knife at her and demanded: "Where was she between 4 p.m. and now? Why is she suddenly suggesting that? What has changed after 20 years that she wants a condom?"
One man, who had already infected his wife with HIV and was developing open herpes sores on his penis, objected to his wife's suggestion of using condoms, accusing her of having a boyfriend (Russell 103). Even educated men, aware of the AIDS risk, balk at the suggestion. McGeary heard the same answer come up again and again: "That question is nonnegotiable." Several myths account for the lack of condom use, even when they are distributed for no cost: your erection can't grow, free condoms must be too cheap to be safe, condoms fill up with germs, condoms from overseas bring the disease with them, condoms donated by foreign governments have holes in them so that Africans will die (McGeary). Some men simply decide they do not like the way condoms feel, and that is enough to decide the issue. When interviewed, one couple in Kanyama, Zambia, reported using condoms for contraception, but the husband started to complain that they were "burning" him and was not going to continue using them (Baylies et al., 98). The established trend is that women must risk infection to please men.
Women compromise their sexual safety to men's pleasure by even more drastic physical means. Throughout Southern Africa, many women practice "dry sex" to please their husbands. This involved drying out the vagina with soil mixed with baboon urine; some use detergents, salts, cotton, or shredded newspaper (Russell 102). Not only is dry sex reportedly very painful for women, it causes vaginal lacerations and suppresses the vagina's natural bacteria, both of which increase the likelihood of contracting the HIV virus when engaging in sex with an infected partner (Russell 103). Since women are already twice as likely to contract HIV from a single encounter than are men, this is extremely dangerous (McGeary). The decision to engage in dry sex can be made for economical reasons as well. The prostitute who dries out her vagina can charge more, 50 or 60 rands ($6.46 to $7.75), enough to pay a child's school fees or to eat for a week (McGeary). This is in contrast to the 20 rands ($2.84) she might receive otherwise. Since male economic privilege plays a major role in forcing women into prostitution, any AIDS deaths resulting from it can be considered femicide.
Economic disadvantage for females drives them to participate in other "dirty" deals. Teenage girls especially are easy prey for older, wealthier "sugar daddies," men who provide money and goods in exchange for sex (Essex et al., 536). Sex has been referred to as the "currency by which women and girls are expected to pay for life's opportunities, from a passing grade in school to a trading license" (Baylies et al., 7). Girls as young as ten and eleven in Tanzania have been reported as having sexual relations with men for chips, Coke, money for videos or transport to school (Baylies et al., 11). Sexual networking has dangerous implications for the spread of HIV, leaving many young women with much more than they bargained for.
Yet another expression of male dominance on which the virus thrives is the practice of female genital mutilation. This practice, which has roots in the patriarchal society, is defined by the World Health Organization as the removal of part or all of the external female genitalia and/or injury to the female genital organs for cultural or other nontherapeutic reasons (Russell 104). It is designed to cater to men's sexual preferences and reinforce their control over women. The tendency of mutilated genitals to bleed, especially during intercourse, puts women at high risk for contracting the virus, as does the repeated use of the crude instruments used to perform these operations. The tools are often used on a number of girls on the same occasion (Russell 105). This practice is imposed on millions of girls in Africa. It is an attack not only on their bodies but also on their womanhood, on their personhood, and on their ability to protect themselves from a deadly disease.
Tolerance of male promiscuity is a further social construction that strips away females' autonomy with fatal consequences. Men are accepted as sexually voracious by nature. "They are like that, and you can't do anything," says one girl in Lushoto (Baylies et al., 128). Many families' economic situations require that husbands are gone for months at a time in order to work, and they are certainly not expected to abstain from sexual activity during this time. Another Lushoto girl, married to a trader often away in Dar es Salaam, reports that she is afraid of her husband, worrying "he may infect me" (Baylies et al., 128). Her concern is absolutely justified. When a wife suspects that her husband has many partners outside the marriage, she is not entitled to refuse to engage in sex. "You are a wife, what can you do?" is the sad reality for most (Baylies et al., 128). Marriage is an institution of vulnerability for women in Africa with respect to HIV. In general, it is men who bring HIV into a marriage (Baylies et al., 11). Women can be infected, not through promiscuous activity on their own part, but as a consequence of being faithful to their husbands.
The prevalence of AIDS in Africa also transforms sexual assaulters into murderers. The problem of rape is especially highlighted in South Africa, where a woman is estimated to be five times more likely to be raped than a woman in the United States (Russell 106). It is an extremely rare event that a rape is reported at all; 75% are believed to remain unreported (Russell 107). The existence of rape gangs is also a serious problem in South Africa. The term for recreational gang rape is jackrolling, and it is considered a game, not a crime.
An analysis of gender relations in Africa provides insight into how and why HIV spreads so efficiently. The question now becomes what should be done with this knowledge to generate prevention strategies. It is obvious that women must become more empowered for the epidemic to be slowed with any significance. Russell claims that the first order of business requires educating people about the role played by male domination in the spread of HIV and AIDS, and that policies must then be developed to eliminate manifestations of patriarchy (109). It is clear that education should focus more on gender issues than the need to avoid risky sexual behavior. However, as has been demonstrated over and over, increased knowledge does not always translate into changed behavior. Baylies and Bujra investigate the potential of women's groups in campaigns of protection against HIV in Africa. They also point out that if economic dependence on men is a factor underlying women's vulnerability, greater economic security should serve to empower women. For this to occur, women would require higher levels of education. How men should be involved is another debatable issue. Male behaviors not only put their partners in danger, but themselves as well. Therefore, not only do men bear responsibility in this area, but it would be in their interest to assist in the process.
One thing is clear: if the AIDS epidemic is to become any less of a problem in Africa, women will have to be empowered. Though AIDS is certainly a virtually impossible fire to extinguish in any context, the patriarchal society and exploitation of women not only fuels the flames but turns a fire into an inferno. For millions of African women, this hell is the reality. Their inferior position in larger society renders them powerless in sexual relations. The manifestation of these social constructions emerges in sexual practices and behavior that not only allow HIV to transmit at alarming rates, but also are blatant violations of basic human rights. When African women are no longer denied these fundamental rights, a decrease in the severity of the epidemic will undoubtedly follow.
African Region Findings. The World Bank Group, No. 126, January 1999. http://www.worldbank.org/afr/findings/english/find126.htm April 29, 2002.
Baylies, Carolyn and Janet Burja. AIDS, Sexuality and Gender in Africa. NY: Routledge Taylor and Francis Group, 2000.
Essex, Max, Souleymane Mboup, Phyllis J. Kanki, and Mbowa R. Kalengayi, eds. AIDS in Africa. NY: Raven Press, 1994.
McGeary, Johanna. Death Stalks A Continent. Time Magazine, 2001. http://www.time.com/time/2001/aidsinafrica/cover.html April 29, 2002.
Russell, Diane E. H. and Roberta A. Harmes, eds. Femicide in Global Perspective. NY: Teachers College Press, 2001.