Kigali: Whereas Africa has 10 per cent of the world’s population, about 70 per cent of HIV infections are found in Africa. Out of the 33 m people who were living with HIV in 2008, 22 were in Africa,with the hardest hit in Sub – Saharan Africa. Ugandan academic Dr David Tigawalana explains how and why this is the case.
Women more affected than men
There is increasing concern that Sub-Saharan Africa is the region where more women are infected by HIV than men. 60 per cent of people living with HIV infections in Africa are women. On average about eight out of every 100 Ugandan women are infected with HIV compared to five out of 100 Ugandan men. Among young men and women aged 15 to 24 years, for every one man, four women are infected with HIV. And moreover, women are more subjected to HIV stigma and discrimination. Vulnerability of women and girls to HIV infections cannot be explained by biological factors alone but gender inequalities that exist in African society.
Women more vulnerable
In Africa, the HIV virus that causes Aids, is transmitted through two major routes. The first, which accounts for 80 per cent of the cases, is through unprotected sex between men and women. This is followed by HIV transmission from mother to child during pregnancy, labour and breastfeeding, which is responsible for about 20 per cent of the cases.
It has been scientifically proved that the risk of HIV transmission during sex is greatest for anal sex, followed by vaginal sex and least for oral sex. During vaginal sex, which is commonly practiced in Africa, the chance of HIV transmission from a man to a woman is two to three times greater than transmission from a woman to a man. This is due to the biological make up of the female genital tract.
The female genital tract is made up of a larger exposed area. Semen has higher viral load than vaginal fluids and the semen stays longer in the female genital tract after acts of sex which increases the chances of HIV transmission. It has also been proved that the genital tract of young girls is immature and more prone to invasion by HIV.
Sexually transmitted infections, which increase the chances of HIV transmission and acquisition of HIV, can occur in women without being recognised. This increases the chances of HIV transmission and acquisition by women. Furthermore, women in some African cultures use herbs to tighten the vagina to remedy what they call “dry sex” which causes tears in the genital tract during sex and makes women more likely to transmit or acquire HIV. Lastly forced or coerced sex, which is common but rarely reported by women, increases the chances of HIV transmission.
The roles of gender in HIV/Aids
Gender refers to differences in social roles and relations between men and women. Gender roles are learned through socialisation and vary widely amongest cultures. Gender roles are also affected by age, class, race, ethnicity and religion, as well as geographical, economic and political environments. The gender dimensions that are relevant to HIV and Aids include economic, legal, cultural, religious, political and sexual status of women. Some of the gender inequalities do not only increase vulnerability of women to HIV and Aids but also become factors that fuel the spread of the epidemic.
There is a multitude of socio-cultural factors that increase vulnerability of women to HIV and Aids. The subordination of African women creates vulnerability to HIV infection through economic dependency, lack of assets, and lack of protection against abuse and exploitation. Most women in African societies are subjected to discrimination right from their youth and denied access to education and gainful employment. Women end up being engaged in subsistence farming or low paying jobs. Economic pressures lead women to engage in vices like sex work and transactional sex. In urban settings, cohabitation and temporary sexual relationships are common because women need support for items like house rent and feeding.
Also, social construction of masculinity and femininity renders women powerless to demand for their rights, including not questioning infidelity of their husbands. The patriarchal system in Africa affects women directly by legitimisation of male dominance.
Effects of culture
In many African cultures there is tolerance for multiple sexual partnerships, including extra-marital sex by men. Marriage and monogamous relationships do not protect women. Ironically, an unmarried woman will be more protected than a married one because of the unfaithfulness of men. There are common sayings such as, “Aids can meet you in the bedroom,” “In polygamous societies, a man can have many sexual partners but a woman has to be faithful to one,” “A woman who has been paid a bride-price for is even more vulnerable to HIV”.
Intergeneration sex is common in Africa. Young girls have sex with older men (sugar daddies), for money, gifts or status. Even culturally, women are found to marry men who are much older than them and more sexually experienced, thus exposing them to the risks of HIV. There is a danger of young women seeking sexual satisfaction outside marriage, thus exposing them to risks of HIV.
Sexual violence is also common, including rape and defilement. In some instances men who are infected with HIV believe that a virgin can "cleanse" them of HIV. A number of young girls have reported forceful initiation into sex by older sexual partners. Sexual violence can also occur at work places, even among educated women, during job hiring, promotion and to avoid dismissal. Fear of violence leads to acceptance of sex and lack of protection. Orphans and domestic workers are also sexually abused.
Women in Africa need protection and this can be done by addressing gender inequalities. Women need a fair share of treatment. We need to address the root cause of HIV transmission, protect the rights of girls and women and target activities that improve the status of girls and women by providing training, life skills and access to work. Education opportunities should be provided to girls to create awareness and increase HIV prevention methods, delay and have choice in marriage, improve the status of women in society and achievement of autonomy. Poverty among women should be addressed through including women in poverty eradication programmes. Lastly, governments should institute legislation to protect women’s rights, access to resources, fair allocation of treatment, address violence and abuse against women, enforce legislation against Female Genital Mutilation and other actions to address the low status of women.
Adapted from Sunday Monitor, September 19, 2010. The writer is an epidemiologist/ coordinator of HIV Prevention, Uganda Aids Commission
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