Gender, Power, and Death

O f the approximately 40 million people in the world living with HIV, almost half are women. The AIDS pandemic has moved from a disease that afflicts primarily males to one that progressively victimizes females. Dr. Kathleen Cravero, deputy executive director of the United Nations Program on HIV/AIDS notes, “Increasingly the face of AIDS is young and female.” In Sub-Saharan Africa, just under 60 percent of HIV infected individuals are female. The number of women and girls contracting the disease is rising in every region of the world. 

There are two primary reasons for the dramatic increase in female HIV infections. To begin, a growing body of evidence indicates that women and girls are physiologically more vulnerable than men and boys to HIV infection through heterosexual intercourse, the primary method of transmission. This biological susceptibility is compounded by violence and discrimination perpetrated against socially, politically, and economically pow- erless females in the developing world. 

A recent United Nations report stated: “The fact that the balance of power in many relationships is tilted in favor of men can have life-or-death implications” for women. Nowhere is this more evident than in the context of marriage. A study by Human Rights Watch found that married women in Uganda have little sexual autonomy and are routinely abused by their husbands. An HIV-positive woman infected by her husband stated, “He used to force me to have sex with him after he became ill.” Dying of AIDS and too weak to beat his wife, the man ordered his brother to continue abusing her. 

Shelley Clark of the University of Chicago discovered that in some regions of Kenya and Zambia early marriage was equivalent to an AIDS death sentence for young girls. She found that 32.9 percent of married girls in Kenya were HIV-positive compared to 22.3 percent of unmarried girls. Comparable figures for Zambia were 27.3 and 16.5 percent. 

Clark offers three primary explanations for these counterintuitive findings. First, marriage ends condom use because couples desire children. Second, the frequency of intercourse increases dramatically with marriage. Third, because men need considerable time to save money for the “bride price” required by the girl’s family, husbands are typically five to ten years older than their wives. During this period a man will have numerous sexual partners and is more likely to become HIV-positive. 

Although single girls have more sexual encounters than married girls, their (single girls’) boyfriends had fewer sexual experiences than older males and were more likely to use condoms. Clark concluded that frequent unprotected sex (as in marriage) was a more critical factor in the likelihood of a girl contracting HIV than the number of one’s sexual partners. 

Thailand may well be the most shocking example of the gender, marriage, and AIDS relation. In the early 1990s the overwhelming majority of HIV transmissions in that Asian country occurred between prostitutes and their clients. Today, nearly half of all new infections are the wives of men who frequent prostitutes. A study of HIV-positive women in India found that 93 percent were married and 91 percent overall had only one sex partner—their husbands. In Mexico, one-third of HIV-positive females learn they are infected after their husbands are diagnosed with the disease. 

Many observers believe that the highly-touted ABC approach (Abstain, Be Faithful, and use Condoms) to preventing HIV will have limited success as long as girls and women remain subservient to males. Thoraya Obsaid of the United Nations Population Fund notes, “Abstinence is meaningless to women coerced into sex. Faithfulness offers little protection to wives whose husbands have several sex partners.... And condoms require the cooperation of men.” One commentator summarized the relation between gender and HIV in the developing world: “While men are driving the AIDS epidemic in large degree, women become the victims.” 

This victimization of females is especially tragic as it relates to AIDS orphans whose numbers are increasing rapidly across Africa, Asia, and the Carribean. In Zambia alone, a nation of about 11 million people, between 600,000 and one million children are AIDS orphans or live in households where one or both parents are infected. 

When a mother and/or father become ill as a consequence of AIDS, girls are much more likely than boys to be removed from school to provide care for the sick. Prolonged illness usually leads to financial problems and girls find employment as housemaids, child-care workers, and vendors in local markets.