HIV/AIDS prevention in developing countries: Examining the justification for putting gender inequality at the heart of prevention
policies. By Dr. Ignatius Gwanmesia Abstract This analysis provides objective arguments to counter the blame ideologies that indiscriminately posit women’s at-risk behaviour as central to the ineffectiveness of the anti-HIV/AIDS agenda. The fulcrum of the debate is that as victims of an institutionally gender-discriminatory society whose structural barriers is significantly compromising the global struggle against HIV/AIDS, addressing issues of genderinequalities, especially in developing countries will empower women to take responsibility for their health. Holistically, complimenting this ‘health’ approach with systematic sensitisation programmes should arguably let to enhance outcome in efforts to prevent the spread of HIV/AIDS.
Introduction Hitherto, the decline of infectious diseases especially amongst the marginalised sectors of our society was attributed primarily to medical advances and better sanitary living conditions. Mckeown, (1976). Indeed, structural barriers like unavailability of services or provider resistance were alien concepts. In today’s rather regimented, urbanised, increasingly segregated and more promiscuous society, those infectious diseases like malaria and smallpox have been replaced by equally lethal coronary disease, cancer, HIV/AIDS, mental illness and other pathologies. Prevalently, discourses on these so-called diseases of the affluent especially HIV/AIDS are presented as if they reflect the problems of a homogenised society; obscuring the reality of class and the impact of social inequality on health. To date, not just feminists but critical analysts perceive gender discrimination, especially in developing countries as significantly responsible for the ineffectiveness of initiatives to prevent the spread of the HIV/AIDS pandemic. Mutangura, (2002, p. 3); Human Rights Watch, (2003). Describing the lethality and impact of HIV/AIDS especially on women as “raging with a Darwinian ferocity in Sub Sahara Africa (SSA)”, Stephen 1
Lewis, (2004) further asserted that “gender inequality is what sustains and nurtures the virus”. Referring to the debilitating and gender-induced affliction of women from HIV/AIDS, Kofi Annan, (2002)’s observation about HIV/AIDS and SSA women was reiterated by Lewis, (2004) who stated that, “the saddest thing is that the pandemic increasingly has a women’s face; gender inequality in the face of AIDS is fatal.” While Payne, (2000, p.63) asserts that ‘there is no society in which men and women are equal”, or “a society that is not patriarchal”, Goldberg, (1977, p. 26); it is suggested that “The reason that AIDS has escalated into a pandemic is because inequality between women and men continues to be pervasive and persistent; there is a direct correlation between women's low status, the violation of their human rights and HIV transmission” Heyzer, (2001). As Lewis, (2002) observed, “The challenge of protecting women and girls from AIDS-related human rights abuses is enormous. The abuses are many and varied, including rape within and outside of marriage, other sexual violence and coercion often abetted by poverty, domestic violence, unequal property and inheritance rights, divorce laws that exacerbate women’s economic dependence on their husbands, and discriminatory barriers to education and health services.” The paradox about the blame ideologies in fighting HIV/AIDS is that while the gender gap is ever-widening with women being given tokenistic vestige of ‘equality’; and people engaging in sex more for recreation rather than procreation, society expects women to be responsible for their health. So to what extent will empowering women catalyse the prevention of HIV/AIDS? Africa is the stage and women the actors, let the play begin. My hypothesis is that, without addressing the narrowness of the political and medical models of changing lifestyle and individual behaviour without changing the social and economic structures that has disempowered women, the overall efforts to prevent the spread of HIV/AIDS epidemic will be futile.”
Definition “HIV (human immunodeficiency virus) is the retrovirus that may lead to AIDS (acquired immune deficiency syndrome). Ogden, (2004, p. 329). HIV damages the body’s defence (immune system), making it more vulnerable to the effects of opportunistic infections” Thomas and Pierson (1999, p. 169). Once HIV enters the body, it weakens the immune system so that the infected person can no longer fight off life-threatening illnesses such as tuberculosis or rare forms of pneumonia or meningitis- what are called opportunistic infections” Fitzsimons et al, (1995, p. 13). Gender inequality - theorised on power relationship, ‘Gender’ -the sexual differentiation of human beings as male or female becomes a social concern or “gender segregation when we ascribe particular social significance to these differences and allot roles accordingly so that they become a matter of social construction rather than biological determination.” Burr, (1995, p. 12). In gender inequality, the disproportional power dynamics between the male and female human beings is perceived as discriminatory and exploitative of the latter. Hooper and Dryden, (1994, p. 165).
Background. To date legal documents like; “the United Nation Declaration of Human Rights; Goal 3 of the Millennium Development Goals to promote gender equality and empower women; goal 6 which aims to combat HIV/AIDS” Mutangura, (2002, p. 2) and the specific 1979 ‘United Nation Convention on the Elimination of All forms of Discrimination against Women’ (CEDAW)” Mutangura, (2002, p. 3) have provided the framework for approaching the prevention of HIV/AIDS from a gender neutral perspective. Despite these, the experiences of women diagnosed as HIV/AIDs positive in accessing relevant services show that gender inequality is not 3
prioritised on most HIV/AIDS policy agendum. Kaye, (2004, p. 1); UNAIDS, (2004); CUSS, 2006, p. 16). In fact according to Human Right Watch, (2002) “gender inequality still constitutes the most significant constraint in the struggle to prevent the spread of the disease” For example in Sub Sahara Africa girls and women face numerous human rights abuses at all stages of life; “as children, violations of their childhood and their innocence; that have exposed them to sexual assault and sexual coercion; as adults, in long-term unions where decision-making authority over sex is too rarely theirs and where economic dependence and inequality under the law limit their options for redress; in widowhood where gender discrimination is the rule rather than the exception for inheritance and control of property; and in war and civil conflict where rape is used strategically as a weapon.” Attributing these right abuses predominantly to poverty and inherent cultural practices, Human Right Watch, (2002) pointed out that “thousands of women and, hundreds of thousands of girls, including many orphaned by AIDS or otherwise without parental care, suffer in virtual silence as governments fail to provide basic protections from sexual abuse that would lessen their vulnerability to HIV/AIDS.” It is the reality of these female’s circumstances; the visible lack of systematic remedial policies; the legal imperative to comply with relevant legislations; and the recognition of “the central role that women play in sustaining livelihoods and therefore the nations wellbeing” Mutangura, (2005, p.11) that make it imperative to put the addressing of gender inequality at the heart of HIV/AIDS prevention policies.
Sub Sahara Africa (SSA), Poverty and HIV/AIDS. My decision to focus but not limit this discourse solely to the visibly impoverished Sub Sahara Africa is because the “incidence and prevalence of the HIV/AIDS amongst women in SSA is more acute here than anywhere in the world” Kaye, (2004, p. 1); Michiels, (2001). Indeed “almost 14 million of the 18 million women living with HIV/AIDS worldwide live in sub-Saharan Africa.” Lobe, (2004). 4
Furthermore, as an indigene of SSA, my in-depth knowledge of the cultures and their marginalising impact on females gives me a privileged and in-depth knowledge of the female’s marginalised status. Supplementing this experience, studies amongst various populations by United Nation’s organisations in SSA are consensual that “as elsewhere in Africa where poverty-stricken female care-givers lack appropriate exit options out of abject deprivations, “women are at a greater danger of HIV infection because they lack agency to refuse high-risk sexual encounters” of http://www.comminit.com/en/node/220072/38. The overarching determinant
women’s dependency is consensually seen as poverty that leads to social exclusion. According to Kaye, (2004, p. 4), the problem with poverty in gender inequality discourses is that poverty seems to be a factor in every aspect of deprivation in developing countries; although not homogeneously. More so, the notion of poverty is a social construct; problematic to qualify as well as quantify. Poverty aside, to date the WHO, (2000) also attributes the failure to adequately address gender inequality in the prevention of HIV/AIDS partly in SSA to the “lack of systematic data on the relationship between HIV/AIDS and gender inequality” Yet, further, studies by the World Health Organisation (WHO) cited in Williams, (1997) posits gender inequality as “a central and an empirically and robust predictor of variations in morbidity and mortality of persons infected with HIV/AIDS.” Humanitarian gestures aside; and from a social as well as economic perspective, social economists see women as nurturers of the family (the foundation of society) and therefore the pillar that supports nations. CUSS, (2006, p. 4). With the ravages of HIV/AIDS exacerbating women’s already chronic deprivation, if the current trend of increasing HIV/AIDS female infection is not addressed, then gradually it is all the fabric of society that would be decimated. Thus, while there is still time, preventative policy initiatives need to prioritise the addressing of “institutional, social and economic constraints that limit women’s ability to cope with the epidemic” http://www.jendajournal.com/issue7/mutangura.html. Now which are the areas of significant concerns? Principally, most of the arguments in this discourse are theories from a human rights perspective.
Loss of inheritance rights In most poverty-ridden developing countries, women’s right to land and property is the primary step necessary to promote gender parity; the absence of which directly impacts on the women’s ability to meet household food needs through own production” FAO, (2004). Studies in subsistence SSA show that, “access to, ownership of, and control over property are fundamental determinants of secure livelihoods; providing a secure place to live, a site for economic and social activity, and collateral for credit and other resources and services essential to prevent and mitigate HIV/AIDS” Aliber et al (2004); Strickland 2(004). Yet prevalently in patriarchal Africa, the chronic gender inequality means that women, especially widows often are denied this basic resource that would have “allowed them to improve their chances of preventing infection or enhance their capacity to mitigate the consequences of HIV/AIDS” UNAIDS, (2004). Even where women are privileged to access land or actually work, there is consensus that their land control or wages respectively are significantly compromised. Strickland 2(004); Mutangura, (2002, p. 11) In fact radical feminist conceive the work environments even within subsistence environment as bastions of male power which will consistently act to promote the interest of men.” Alcock et el, (2000, p. 98). Comparing women’s inheritance rights in SSA to those of Western nation, the paradox is that while male next of kin are able to inherit the widows in SSA, the unequal property and inheritance laws deny AIDS widows the right to the deceased’s property. As observed by Fortmann, (2001), “women’s uncertain access to land credit and education denies then exposure to and control of new technologies that might help them out of the mire of poverty” Bearing in mind that these women, especially widows usually care for other children orphaned by HIV/AIDS, the unlawful appropriation of the property of AIDS widows and orphans by relatives or others in the “community” can be so marginalising that they sink into destitution. Studies have shown that “the absence of any systematic land inheritance right laws based of Western models is a significant causation of female dependency and the resolve to prostitute.” UNAIDS, (2004). FAO, (2004). For example in Lesotho, South Africa, Kenya, Tanzania and Malawi where the impacts of HIV/AIDS on land tenure systems have been studied, one major impact of the epidemic was identified to be “the increase in the vulnerability of women, children and poor households to dispossession by patrilineal kin on the death of male 6
household heads” Aliber et al, (2004), Strickland, (2004), FAO, 2004). The resulting life options which predominantly consist of selling or exchanging sex for money and other forms of child abuse heighten their risk of contracting HIV/AIDS. Similarly, UNAIDS, (2002, p. 190) points out that “Children’s deprivation when denied their inheritance rights is compounded by the paucity of options they have for legal recourse.” Expounding on the plight of these homeless children, Savenstedt et al., (2000) assert that most resort to life on the streets where most girls are preyed upon by paedophiles and traffickers; maximising their risk of contracting HIV/AIDS. The gender-biased obstacles for victims attempting to assert their rights to property or inheritance include, “fear of violent reprisal, sluggish bureaucracies and official indifference” UNAIDS, (2004). As such, these victims of dispossession lack recourse. The main recommendation emerging from the various studies is “the need to draw up and prioritise legislation that can protect the land rights of women and children in policies seeking to address HIV/AIDS. Aliber M, et al., (2004)
HIV/AIDS and prostitution. In Africa as in the rest of the developing world, it is suggested that, “AIDS has a woman’s face” http://www.jendajournal.com/issue7/mutangadura.html. In this seemingly gender-biased statement, women are not only synonymised with HIV/AIDS, they seem to be blamed for it. In fact, in Sub Sahara Africa, sex workers are the personification of HIV/AIDS despite the reality that prostitution can only persist if it satisfies the economic law of supply and demand; prostitution will not exist without the demand for recreational sex. According to Wilton, (1992, p.56), “prostitution is not primarily a moral issues but an economic one” derived principally from women’s lack of appropriate survival options. The resolve to prostitute has generally been explained by “women’s limited access to economic and social resources which renders them dependent on men to provide for them.” Fieldhouse, (2003, p. 8). The reality in the safeguarding of oneself against the potential infection with HIV/AIDS is that “women who use sex in exchange for gifts, money or services 7
have difficulty negotiating safer sex, as well as obtaining adequate health services” AIDS Infothek (2000, p. 24). According to WHO, (2000) “these women serve as an important source of HIV infections for their male clients, once infection is established.” According to the World Bank (2000), “the role of prostitutes in the sexual transmission of HIV in Africa is apparent from various studies.” For example in Africa, the highways serving the multi-national extractive industries have become red-light environments where; The development of prostitution to service truck drivers on transcontinental trade routes is one example of the ways in which travel interacted with sexual activity to further the transmission of HIV” Fieldhouse, ( 2003, p. 9) While not ignorant of the heighten risk involved in unsafe sex, especially in prostitution, the WHO, (2000) suggest that “women’s destitution and desperation to sustain themselves and their families in spite of the visible lack of basic resources in times of increasing demand on their nurturing services are directly correlated to the ramifications of gender inequality”. According to UNAIDS, (2004) it is the resulting dependency and the remedial lifestyle and practices that heightens women’s risk of contracting HIV/AIDS. Citing the powerlessness to enforce the use of protective measures like condoms to prevent infection, UNAIDS, (2004) argues that the power deferential between the man and woman deprives the latter of the right to enforced safe practice. In SSA where women are perceived and treated as the properties of their husbands; thanks to the dowry system “the power dynamics of heterosexuality make it difficult or impossible for women to protect themselves from HIV” Doyal et al., (2004 p. 3); Wilton, (19923, p. 61). While the logical empowering policy suggestion would be to initiate and implement policies that would reduce female dependencies; giving them the assertiveness to make safety and informed decisions in sexual matters, some analysts rather advocate “the education of men to reduce their risky lifestyles of multiple partners in addition to the use of condoms in high risk encounters.” Fieldhouse, (2003, p.10). Nevertheless, and bearing in mind that twothird of the world’s illiterates are women; WHO, (2000); that by being mostly economically dependent they are vulnerable and powerless, World Bank, (2000), any anti HIV/AIDS policy that is underpinned solely on employing women’s assertiveness to safeguard them against possible infection is bound to be futile. 8
Patriarchy, the African woman and HIV/AIDS My argument on patriarchy are theorised on the disproportionate and prevalently exploitative power dynamics between men and women in developing countries. Cognisant of the reality that global societies are essentially patriarchal, Goldberg, (1977, p. 26); there is plausible logic to infer that “the power deferential in heterosexuality makes it difficult or impossible for women to be assertive-enough to protect themselves from HIV/AIDS in sexual encounters” Doyal et al., (2004 p. 3); Wilton, (19923, p. 61). The reasons for this are not hard to locate since “two-third of the world illiterates are women; WHO, (2000); a situation that deprives them of the means to access independent lives. Their resulting dependency and destitution means that these women are compelled by circumstance rather than by choice into lifestyles and actions that heightens their risk of contracting HIV/AIDS. For example, where the use of condoms would have mitigated the spread of HIV, there is consensus that male dominance vis-a-vis women’s powerlessness or oppression means that women are subordinated into risky unprotected sex. Wilton, (1992, p. 61). As Awasum, (2006, p. 12) points out, in most Sub Saharan cultures, it is the norm rather than the exception for women who attempt to assert their preferences within a heterosexual relationship to be “socially ostracised, turned out by their partners or husbands, beaten up, raped or even killed for trying to refuse sex.” Studies carried out under the traditional gender relations in Botswana show that, “women take significant economic and psychological risks when they refuse to have sex or unprotected sex. By refusing sex or insisting on condom use women may be denied or thrown out of marriage and lose the privileged social status and financial security of married women” Lunga. (2002), http://www.comminit.com/en/node/220072/38. Within this context, until appropriate legislations are put into place to address these gender-discriminatory practices with a corresponding framework to enforce and monitor outcomes, the ramifications of these women’s HIV/AIDS plight will have far-reaching social, economic and political repercussions both within and beyond their indigenous states.
HIV/AIDS and the Virgin Myth. In those African cultures where there is the myth that sex with a virgin can either safeguard against HIV/AIDS infection or actually cure the disease, UNAIDS (2004) noted that not only are men increasingly raping girls, children are similarly being sexually abused. Studies suggest that, “these human right abuses are responsible for the comparatively high incidences of HIV/AIDS infection in South Africa.” Heyzer, (2002) Michiels, (2001). WHO, (2000). While most nations treat rapes as criminal offenses, until developing countries actually enforced punitive legislations to deter perpetrators, the economic and social cost to the general wellbeing of the respective nations could be catastrophic. Similar attention also needs to be paid to the practice of genital circumcision or mutilation. Apart from the fact that such practices invade the personal privacy of girls this non-medical interventions using rudimentary tools greatly expose women to infections. In fact, feminist as well as human rights campaigners including medical professional are consensual that female circumcisions heighten the risk of HIV/AIDS infection. For ‘rights’ reason and women’s dignity, the elimination of this practice must take pride of place on all HIV/AIDS gender-neutral policies.
Multiple sexual partnership and polygamy in HIV/AIDS infections. My experiences of Sub Saharan culture indicates that while women are supposed to be faithful to their spouse, the entrenched gender inequality allows men to either be polygamous in their marriage or have extra-marital affairs. While there is consensus that multiple sexual partnerships heighten the risk of HIV/AIDS infection, for the patriarchal African man, multiple sexual partnerships is synonymous with being macho. Discriminatorily and as typified in ‘Sharia laws’, female prostitution or female infidelity is not only perceived as deviant, it carries such stigma that can socially exclude ‘promiscuous’ women from proactive participation in most social and cultural activities. From a moral perspective, in SSA “there has always been an association between sickness and sin; the undeserving and the guilty.” Awasum, (2006, 7). 10
Consequently, women’s health within the context of HIV/AIDS prevention is not only a key concept of self and health, but is intrinsically connected with morals and responsibility. Thus prejudicially for women in SSA, being diagnosed as HIV/AIDS positive or being associated with promiscuity is synonymous with “badness”, “immorality” and “irresponsibility”. Compared to men, women diagnosed as HIV/AIDS positive are seen as having departed from the socially accepted behaviour worthy of the righteous and therefore undeserving of any sympathy. The label, stigma and negative symbolisms surrounding HIV/AIDS and involving women’s implicit image of the contagious, sexually deviant and irresponsible person are arguably significant constraints in the decisions to self-present for HIV/AIDS diagnosis or treatment. To encourage women, especially prostitutes to self-present for diagnosis, and therefore mitigate potential infection, relevant communities need to be educated against the prevailing prejudicial blame practice. More so, the myths of the macho man with multiple sex partners need to be discouraged. The problem with implementing preventative HIV/AIDS policy is that there are no implicit ways of either enforcing of monitoring what are virtually people’s private lives. Bearing in mind that gender inequality stands accused of exacerbating the spread of HIV/AIDS, dogmas that advocate abstinence are self-defeating since they collude to control the sex life of women. Even the customary ‘say no’ approach can never be effective in the economic and social circumstances where women are compelled by multiple deprivation rather than objective choice to succumb to risky sex lifestyles. For example, in Cameroon as elsewhere in patriarchal Sub Saharan Africa (SSA), studies carried out in Zambia showed that, “Less than a quarter of Zambian married women believe they can refuse sex with their husbands; only 11 percent said they could ask him to use condoms (UNAIDS 2000). This gender-induced compliance to unsafe sex with persons whose lifestyles makes them HIV/AIDS liability is directly or indirectly attributable to the ramifications of gender inequality. As earlier noted, in some African cultures, gender inequality or women’s powerlessness is evident in the practice of widow inheritance. Traditionally, widows are supposed to be inherited by the next of the kin for assimilation into the family after the death of the husband. Another major gender-based determinant in the spread of HIV/AIDs in SSA is the extent of sexual encounters between older men and adolescent girls. According to a literature review by Loewenson and Whiteside, (1997) “over 45 studies reviewed found that this is the norm, including a widespread transactional component.” These 11
reviewers further point out that “the greater the age difference between them, the greater the girls’ risk of infection, due to the power imbalance, and increase in unsafe behaviours, such as non-use of condoms and multiple partners for both the men and the girls (ibid.)
A Success-proven Model of Intervention The problem facing policy makers in addressing gender inequality concerns in HIV/AIDS is that, despite the awareness of the risk associate with ‘unsafe sex’, how can one convince maybe a mother of five children living in abject poverty; socialised into learned-helplessness; denied her inheritance and access to land or other means of empowerment; yet expected to care for her family and maybe additional orphans from her extended family not to prostitute? More so, having been born into a patriarchal culture of female subjugation, and subsequently socialised into learned helplessness, how can women in developing countries be suddenly expected to assert their human rights including condom use in sexual encounters? Age-wise how can a child sold into early arranged marriage be expected to subsequently become competent-enough to understand, let alone safeguard herself from HIV/AIDS when her older and multiple-partner wield limitless power over her? How can a predominantly illiterate female be expected to access relevant empowering information in a technologically alien environment? While these dilemmas may seem complex and difficult, addressing these gender concerns in the prevention of HIV/AIDS is not impossible. For example, where poverty or social exclusion is perceived as the root of women’s deprivation, the instinctive policy recommendation 12
is to advocate “the economic empowerment of women as one of the key strategies of reducing the rate of HIV/AIDS infections, amongst women and girls.” http://statehousekenya.go.ke/oafla/speeches/f-lady/june05/2005020601.htm. In fact, addressing delegates at the First Ladies round table on the economic empowerment of women and the fight against HIV/AIDS in Kigali, Rwanda in June 2005, Lucy Kibaki first lady of Kenya while citing various gender-focused studies undertaken in East Africa in the prevention of HIV/AIDS stated that - There is evidence that poverty and subsequent dependence on men has increased their vulnerability to HIV/AIDS. The empowerment of women, therefore, constitutes an integral aspect of the fight against HIV/AIDS.”
As a remedial suggestion, Mrs Kibaki, pleaded with relevant agencies
“to push for the formulation and implementation of policies, which can facilitate integration of women into mainstream economic processes; including improving access to education by girls, guaranteeing sexual and reproductive health rights, ensuring women's wealth and inheritance rights, increasing women's share in political and public office and redoubling efforts to combat violence against women and the girl child.”
While her recommendations seem very rational, with the potential to succeed, the concern will be how men who have hitherto dominated women would react to any challenge to their despotic or autocratic attitudes. In the Cameroons, research by the Centre Universitaire de Science de la Santé (CUSS, 2006, p.16) is indicative that, using the power of the all-powerful chiefs; the church and elders, all of whom are held with very high and unquestionable esteem, to educate men not only to respect women, but to dissuade them from polygamy and multiple sexual partners is significantly reducing both the prevalence and incidence of the HIV/AIDS in the country. This policy approach is informed by the fact that in most of SSA, “elders are traditional educators, teachers and purveyors of cultural values, ideals, and rituals; younger people are accustomed to viewing them as repositories of wisdom, guidance, and advice May, (2003). As in Cameroon, these assets could be utilised in developing effective gender-neutral interventions, as could the potential of using the all-powerful chiefs (men) to provide peer counselling and dogmatic advice to their 13
subjects on the respect of female and the practice of safe sex. Equally important, there is an urgent need for developing countries to take measures to empower women who dwell in rural areas as farmers. This can be done through the transformation of agriculture from low value-added primary production, to the production of less labour intensive; high value-added finished products that can compete in international markets. It is imperative that governments implement policies that will encourage agro-based industries and enable agriculture to go beyond the level of subsistence and to the market-place. This commercialisation of traditional farming will inject new dimensions into the profile of women, expose them to the world of commerce and improve their incomes. This is what Malaysia did with spectacular success where in addition to legalised land rights, the marketisation of surplus agricultural products enhanced women’s independent abilities to sustain themselves and relevant dependents. Not having to dependent on men, meant that women would not have to succumb to unsolicited and risky sexual encounters that hitherto heightened their risk of contracting HIV/AIDS. While preceding examples have been locally-based, at an international level, there is need for relevant agencies of the United Nations to initiate and enforce legislations that compel countries to safeguards women’s rights. As a precedent, in July 2001 the UN General Assembly held a Special Session on HIV/AIDS calling on States to “enact, strengthen or enforced as appropriate, legislation, regulations and other measures to eliminate all forms of discrimination, in multi-sectoral national strategies that address the stigma and gender dimensions of the HIV/AIDS epidemic”. May, (2003) Specifically, the declaration called for measures to be taken “to increase the capacities of women and adolescent girls to protect themselves from the risk of HIV infection, principally through the provision of healthcare services, including sexual and reproductive health, and through prevention education that promotes gender equality within a culturally gender-sensitive framework.” UNAIDS, (2001)
Appraisal While advocating the prioritisation of relevant gender-neutral policies in the fight against HIV/AIDS amongst women and girls may appear simple, a major constraint is the fact that the cultures, people and the operational framework of healthcare systems in the developing world and their respective needs are not homogeneous. Added to the identified lack of systematic data to inform policy, constructing appropriate and effective interventions are not only complex but problematic. Similarly, in our patriarchal world where the man stands to lose through female empowerment, relinquishing his perceived right to dominate women is bound to face resistance especially in SSA where the payment of dowry objectifies rather than humanise females. Indeed in prostitution, the man, the payer of the piper, the dictator will always feel entitled to dictate the tune. Cognisant of the reality that even in advanced Western societies, gender inequality is both institutional as well as inherent, then it will come as no surprise to suggest that in essentially patriarchal cultures of Africa, addressing gender inequality is both complex and problematic. For example, how do you tell a man who perceives his wife as his property by reason of having paid a dowry, not to use this ‘property’ as he so wishes? Similarly, how can women who have been born into a culture of dependency and subsequently socialised into self-helplessness be expected suddenly to become so empowered as to assert sexual preferences? In an HIV/AIDS gender investigation by the World Health Organisation,( 2000) in Sub Saharan Africa, it was observed that “women who attempt to assert their preferences within a heterosexual relationship may be socially ostracised, turned out by their partners or husbands, beaten up, raped or even killed for trying to refuse sex.” http://www.unhchr.ch/html/menu2/7/b/hivbpracism.doc. This practice is chronic in
cases of prostitution where by virtue of their dependency, sex workers are compelled to summit to male sexual preference as the only exit option from either starvation from abject poverty. Within this context, the gender-based anti HIV/AIDs campaign needs to be focused not essentially on empowering women, but conversely of educating their polygamous partners to respect women. Pertaining to the alleviation of poverty, the concern is that the concept of poverty is not just a social construct, it 15
homogeneity in its impact on the various female societies, constraints that
render it both complex and problematic to initiate and generalise gender neutral policy in the HIV/AIDS campaign.
Policy suggestion According to UNIFEM, (2005) policies to address gender inequality in the prevention of HIV/AIDS should be right-based, “embodying strategies that make clear links to violence against women, feminized poverty, security and women’s limited voice in decision-making.” From an empowerment and user-involvement perspective if gender neutral policies to combat HIV/AIDs are to be effective, it seem logical to suggest that they must be designed by women for women so they can address women’s specific needs and vulnerabilities. For example, in order for women to protect themselves from HIV and other sexually-transmitted diseases, they must have access to prevention methods—such as female condoms and microbicides— that give them control over their own sexual decisions. www.africaaction.org. In recommending relevant education, the United Nation Population Fund,(UNFPA) “studies in many countries have linked education especially at higher levels with increased AIDS awareness and knowledge, higher rates of condom use, and greater communication on HIV prevention among partners which can significantly reduce girls' vulnerability to HIV” http://www.unfpa.org/gender/index.htm. Additionally, education is the pathway to economic independence; a sure weapon for female empowerment. Similarly, any gender-neutral policies should be designed to reduce “violence; protect property and inheritance rights of women; ensuring their access to health care; investing more in female-controlled prevention technology, including microbicides and female condoms; and supporting programs designed to enhance access to education and economic opportunity.” Lobe, (2004) http://www.commondreams.org. Finally, any policy to put gender inequality at the heart of HIV/AIDS prevention must be informed by the nonnegotiable right of every human being to be perceived and treated as equals.
Conclusion In the attempt to elucidate the contentious and complex dimension of employing gender equality in the prevention of HIV/AIDs, preceding discourse has exposed the “lack of sex and age disaggregated data to enhance relevant analysis. Despite the awareness of the central role of women in securing livelihoods and in efforts to eradicate poverty within local communities in developing countries, Strickland, (2004) asserts that “this knowledge gap remains”. Consequently, Mutangura, (2002, p.11) proposed that if the prevention of HIV/AIDS is to be addressed from a genderneutral perspective, “such information about the gender division of labour and responsibility can help shape more effective and equitable policies.” Equally, there is need for robust evidence on the impact and effectiveness of mitigation intervention so that a systematic form of prioritisation can be developed and adapted for particular nations of the developing world. Similarly, rather than the ad hoc policies of the past, a systematic monitoring and evaluation of data will ensure that genderbased interventions actually make a difference in the lives and experiences of these women; providing a basis for adjusting intervention to make them more effective. In emphasising the imperative to put gender inequality at the heart of the HIV/AIDS prevention in Sub Sahara Africa, Stephen Lewis (2002) observed that “the practice of ignoring a gender analysis has turned out to be lethal. For the African continent, it means economic and social survival. For the women and girls of Africa, it's a matter of life or death.” The concern with gender inequality in addressing HIV/AIDS is not that nothing is being done, but that not enough is being done systematically, consistently and comprehensively.
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