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June 2006

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Women & AIDS in Africa

By Anna-louise Crago
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June 2006
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W ith the establishment of the Global Fund for AIDS, Tuberculosis and Malaria it is estimated that a million and a half people gained access to anti-retroviral treatment around the world. In sub-saharan Africa, this means that 11 percent of the 4,700,000 people infected are receiving treatment, though this is well below the goal of 3 million that the WHO had aimed for in 2005. 

Unfortunately, as with almost all advances in the fight against AIDS, this one is tragically compromised by women’s inequality. 

In Africa tests for HIV are now routinely offered to women as part of antenatal medical consultations. Between 5 and 8 percent of pregnant women in Africa have, as added incentive, the possibility of taking nevirapine if they are positive, thereby reducing the chance of transmitting the virus to the fetus by 53 percent. In Botswana pregnant women are automatically tested for HIV as part of antenatal care, unless they make clear their desire to opt-out. 

However, for many married women, the choice to get tested for HIV can be considered selfinculpatory, according to Foro Maimouna, president of the Association of Midwives of Burkina Faso and a midwife at a clinic for Sexually Transmitted Infections (STIs). If a woman is pregnant, since it is a routine test, there are fewer problems explaining it to her husband, says Maimouna. “However, if she went to get tested of her own volition, they will say she suspected herself of something, she knew she was guilty, or she was sleeping around. If she tests positive and her husband is also infected, they will say it is her fault. Here, it can degenerate to the point where women who test positive are beaten and thrown out of their homes.” 

A 2005 study looked at the links between revealing one’s HIV status and conjugal violence in the lives of women in a slum in Kenya. Following HIV testing, 42 percent of the women who tested positive and informed their partners of the results were victims of conjugal violence (compared to 16 percent of women who tested negative). Among the HIV positive women, 15 percent of them had their relationships end. 

A report published in 2005 by the International HIV-AIDS Alliance describes the case of an African support group for HIV-positive women, of whom many practiced prostitution. It was revealed that the majority of those who were sex workers had begun prostitution as a means of financial survival after being thrown out of their homes for testing HIV-positive. 

“I lived through the case of one of my aunts who tested positive,” Maimouna says. “Now her husband says, ‘Well, if she went to take the test it’s because she is recognizing her own guilt, she is admitting that she cheated.’ Many months later, he has begun to speak to her again. However, he still flat out refuses to get tested himself. 

“Look at my case. Every year all of the midwives test ourselves at the clinic. I show my results to my husband. He is happy. He says, ‘You are HIV-negative, then I am HIV-negative.’ I say ‘That’s not enough, you need to get tested.’ He refuses.” 

Linda, a peer educator in HIV and STI prevention, agrees. “It happens often that a woman comes to get tested and treated for an STI, but the husband refuses to and often, if he still has the STI, he ends up reinfecting her.” 

Maimouna continues, “We know it is with boyfriends and husbands that women are getting HIV. That goes for all women in Africa because there is not a single husband who wants to use condoms.” 

“If women now constitute the majority of people with HIV in sub-saharan Africa where transmission is primarily sexual, there are two reasons,” says Jodi Jacobson of the Centre for Health and Gender Equity. “The first is their greater biological vulnerability to HIV during unprotected heterosexual intercourse. The second is their inequality in all areas and the consequent difficulty of insisting on condoms.” 

A UNIFEM study in Zambia found that less than 25 percent of women said they could refuse sex with their husband even if he had been demonstrably unfaithful or was infected with HIV. According to WHO, in Zambia and Kenya young married women had a higher rate of HIV-infection than their non-married peers. 

The portrait is similar in South Africa where the rate of HIV prevalence is 21.5 percent. “In South Africa women are extremely vulnerable to HIV. Despite the rhetoric, their status has not changed in reality. The most vulnerable are the ones who cannot insist on condom use, primarily married women. Even sex workers who contract HIV usually contract it from their boyfriends or husbands,” according to Britta Rottman, a lawyer with the Sex Worker Education and Action Taskforce, an NGO based in Capetown, South Africa that defends the rights of sex workers. 

In South Africa a proposed new law could complicate the situation even more. If passed, an individual who knows they are positive and participates in high-risk behaviors could be punished by a prison term. “Women’s groups argue that such a law would unfairly punish women since they are the ones who know their status and since they are unable to insist on condom use. On top of this, in a context where many women are severely beaten and then thrown out into the street when they reveal their status, it becomes tantamount to criminalizing a self-defense mechanism,” says Rottman. “If the law passes, the other major effect will be that less people will go get tested, since you are guilty of nothing if you don’t know your status,” a phenomenon that, according to Rottman, will only increase the vulnerability of women and prevent many more from accessing treatment.   

Anna-Louise Crago recently returned from Niger where she researched material for this article.
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