Women and AIDS in South Africa: A Conflicted History Leads to a Dispiriting Present

Article excerpt

TEN YEARS AGO, when Prudence Mabele discovered she had HIV, she was told to abandon her studies. She was working towards her degree in analytical chemistry at a time when HIV was neither understood nor tolerated in South Africa. "There were a lot of problems then", she said. "They didn't understand a lot about AIDS, so they told me to leave what I was doing because I was going to infect staff and students. They thought if I was at the laboratory I would infect people."

In a decade when there was a dearth of knowledge about HIV transmission, there proved an abundance of opportunity for proactive leadership. Prudence joined 59 other HIV-positive women to form the Positive Women's Network (PWN); today it has 2,000 members throughout South Africa. In such a forum, women began to speak about issues that directly affected them, such as how to discuss their HIV status with a spouse or how to cope with stigma. They also taught each other skills like weaving that could help them generate income. In other words, South African women, finding their families and communities unwilling or unable to support them, learned to support themselves and each other.

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In South Africa, AIDS has disproportionately infected and affected women, who comprise the majority of participants in community organizations and care activities for the sick, and the majority of people infected with HIV/AIDS in the country. In May 2006, the Joint United Nations Programme on HIV/AIDS (UNAIDS) released the 2006 Report on the global AIDS epidemic, which states that women account for the bulk of the epidemic: 58 per cent of HIV-positive South Africans are women, or 3.1 million out of 5.5 million infected among adults aged 15 and over. A study conducted by the South African Department of Health in 2004 found that almost one in three pregnant mothers who received antenatal testing was HIV-positive. UNAIDS identified South Africa as the country with the highest number of women infected with HIV/AIDS in the world, almost double the number in India and over triple that in neighbouring Zimbabwe.

HIV infection among women worldwide has risen. While the infection rate among both men and women in sub-Saharan Africa in 1985 was roughly equal, UNAIDS estimates that today women comprise 59 per cent of adults living with HIV, (1) while among youth the gender imbalance is even more striking. Young women between the ages of 18 and 24 are three times more likely to be infected than men in the same age group. The changing demographic, or feminization, of AIDS is what made UN Secretary-General Kofi Annan declare recently that AIDS has "a woman's face", and UN Special Envoy for HIV/AIDS in Africa Stephen Lewis describe the loss of young women in sub-Saharan Africa as "a pandemic within a pandemic".

While many women have taken action to help counsel each other and prevent the further spread of AIDS, they find themselves combating both biological factors and entrenched social norms. During sexual intercourse, the statistical probability of infection for women is higher than men, since men carry a higher viral load or concentration of HIV in semen than is produced by the female's vaginal fluid.2 However, biology cannot explain entirely the gender nature of the epidemic, as the proportion of women infected with AIDS differs vastly between countries and cultures.

In countries where gender inequality is large, women are at particular risk for contracting the disease. One great failure of prevention efforts is that an option does not exist for women to independently prevent sexual transmission of the virus. The male condom is often not a realistic option for women who live in countries where families and communities are patriarchal, as in South Africa. It is also an especially contentious issue, particularly for married couples, as women have limited leverage and bargaining power; despite its obvious limitations, there is no other alternative prevention for them. …