Gender inequality is fuelling the HIV/AIDS epidemic: it deprives women of the ability to say no to risky practices, leads to coerced sex and sexual violence, keeps women uniformed about prevention, puts them last in line for care and life-saving treatment, and imposes an overwhelming burden for the care of the sick and dying. These fundamental threats to women’s lives, health and well-being are critical human rights issues—when women’s rights are not promoted, protected and fulfilled, gender inequality is the dangerous result. Guaranteeing women’s human rights is an indispensable component of the international struggle to combat HIV/AIDS.” www.undp.org/unifem
Women are biologically and culturally more at risk and more vulnerable to HIV/AIDS than men. Although biological vulnerability can be reduced, through for example the use of condoms and better access to health care (for example for the treatment of STIs), the success of these measures is somewhat dependent on a socio-cultural environment in which women and their particular risks, vulnerabilities and responsibilities for social reproduction are considered and respected.
Biologically women are 2 to 4 time more likely than men to be infected by the HI Virus during heterosexual intercourse without a condom. This biologically susceptibility is further compounded by numerous socio-cultural practices, such as “dry” sex and gender inequalities such unequal access to health care (which reduces the likelihood of STIs being treated) and poorer nutritional status. Furthermore, the current gender dynamics in much of Africa means that women are unable to negotiate the terms for a sexual encounter and have little control over their husband’s activities—
“We see our husbands with wives of men who have died of AIDS. What can we do? If we say no to sex, they’ll say pack and go. If we do, where do we go to” (Participant in a study)?
These cultural gender dynamics are entrenched by economic systems of female dependency on males. This is demonstrated by the inability of commercial sex workers to negotiate safe sexual encounters without reducing the cost of their services.
Not only are women more likely to be infected and least able to access health care—they are also disproportionately burdened with caring for household members, meeting the financial needs of the family, stigmatisation and discrimination. This burden of care is being compounded by government and health department strategies for home-based care. This shifts the burden of cost of care from governments to households and the burden of care from health facilities to family members with limited knowledge and experience [Machipisa, 2001]. Within the household and family structure this shifting of responsibility for care is placed on women, who are often sick themselves [Benner, Chigudu 2001]. A study in Zimbabwe found that 76 percent of children removed from school to look after sick family members or orphans were girls [Machipisa]. In some societies, HIV positive women face greater stigmatisation, discrimination and rejection than men because women are perceived as carriers of the virus. Reports of women being deprived of familial support, beaten or thrown out of their homes if their status is revealed, even if their husbands were the sources of infection, have become common. The tragedy of Gugu Dlamini who was beaten to death in 2000 in KwaZulu-Natal, after she publicly disclosed her HIV status, is a reminder that women are particularly vulnerable to violence bred by people’s fear about HIV/AIDS.
However, women are not passive victims of a disease and the burden of care. There an increasing number of women’s ventures (for example WOFAK—Women Fighting AIDS in Kenya) that are empowering women and enabling them to manage the increasing burdens placed on them by the HIV/AIDS crisis.
Strategies aimed at alleviating the burden of care and vulnerability of women to HIV/AIDS obviously need to have women as the centre of their focus. Women need to be provided with information, knowledge, support groups, income generating opportunities and more equal access to health care and education. However, men cannot be excluded from the process. Gender-based social change will have only limited success if women alone are made aware of the issues. Women need to be empowered to challenge women’s subordinate position while men need to be empowered to assist women in meeting the burden of care and reducing their own and their partners’ risk of HIV infection.