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Southern Africa: Gender and AIDS
AfricaFocus Bulletin
Dec 3, 2004 (041203)
(Reposted from sources cited below)
Editor's Note
"If we can stop the spread of HIV among women and girls in southern
Africa, we can turn the epidemic around. ... gender inequality
fuels HIV infection because many women and girls cannot negotiate
safer sex or turn down unwanted sex. ... HIV/AIDS deepens and
exacerbates women's poverty and inequality because it requires them
to do more domestic labour as they care for the sick, the dying and
the orphaned." - United Nations Secretary General's Task Force on
Women, Girls and HIV/AIDS in Southern Africa
This AfricaFocus Bulletin contains excerpts from this task force
report, released in July this year. While the report echoes the
same themes as the annual AIDS Epidemic Update from UNAIDS, it is
considerably more specific, laying out strategies and
recommendations for addressing six areas in which gender inequality
fuels the AIDS pandemic. The report stresses that it is time to
move beyond general awareness of gender issues to specific steps to
enable girls and women to defend their rights more effectively.
Another AfricaFocus Bulletin sent out today contains excerpts from
the UNAIDS Epidemic Update for 2004.
Additional resources on gender, AIDS, and violence against women
are available at http://www.genderandaids.org and
http://www.who.int/gender/violence/sixteendays/en
For previous AfricaFocus Bulletins on AIDS and other health issues,
visit http://www.africafocus.org/healthexp.php
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Facing the Future Together
Report of the United Nations Secretary-General's Task Force on
Women, Girls and HIV/AIDS in Southern Africa
[Excerpts only. The full text of the report is available at
http://www.genderandaids.org/modules.php?name=News&file=article&sid=432
]
Preface
... As early as the 1980s, development workers and gender activists
were beginning to recognise that HIV/AIDS would have especially
severe implications for women. By the middle of the decades, the
Society for Women and AIDS in Africa (SWAA) was beginning to
mobilise women in the fight against AIDS. By June 2001, it was
clear that women, particularly in Africa, were beginning to strain
under the pressure of high infection rates and increased workloads
due to AIDS. The United Nations General Assembly Special Session on
HIV/AIDS declared that "women and girls are disproportionately
affected by HIV/AIDS" and committed UN member states to a set of
actions to reduce the impact on women and girls, and promote and
protect their human rights.
A year later, at the Barcelona International AIDS Conference in
July 2002, Stephen Lewis, the United Nations Secretary General's
(UNSG) Special Envoy on HIV/AIDS in Africa said, "The toll on women
and girls is beyond human imagining; it presents Africa and the
world with a practical and moral challenge, which places gender at
the centre of the human condition. The practice of ignoring 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." It was a plea that went
largely unheard.
In January 2003, Mr. Lewis, accompanied by James Morris, Executive
Director of the World Food Programme and the UNSG's Special Envoy
for Humanitarian Needs in Southern Africa, visited Lesotho, Malawi,
Zambia and Zimbabwe in a joint effort to tackle the unprecedented
humanitarian crisis in southern Africa caused by the interlinkages
between HIV/AIDS, food insecurity and weakened government capacity.
Their mission report highlighted the impact of the crisis on the
women of southern Africa, stating that "very little is being done
to reduce women's risks, to protect them from sexual aggression and
violence, to ease their burdens or to support their coping and
caring efforts." The envoys recommended that an "immediate,
strongly led and broadly implemented joint effort to take action on
gender and HIV/AIDS must be initiated without delay. The effort
should feature leadership from the United Nations, the active
engagement of governments and substantially increased support to
civil society organisations, including remarkable grassroots
initiatives."
... The United Nations Secretary General immediately requested
UNICEF Executive Director Carol Bellamy to set up a Task Force to
respond to this recommendation.
A planning meeting in Johannesburg, South Africa, bringing together
global, regional and country level representatives from the United
Nations, resulted in Terms of Reference for the Task Force focusing
on six issues, within a broad gender framework:
- Prevention of HIV/AIDS among young women and girls
- Girls' education
- Violence against women and girls
- Property and inheritance rights of women and girls
- The role of women and girls in caring for those infected and
affected by HIV/AIDS
- Access to HIV/AIDS care and treatment for women and girls
It was agreed that the Task Force would focus on the nine countries
in southern Africa most severely affected by HIV/AIDS Botswana,
Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland,
Zambia and Zimbabwe. ...
Moving Forward
This report and its recommendations are rooted in the experiences
and insights of people grappling with these challenges on the
ground, supplemented by information from existing literature and
discussions with individuals working on human rights, gender and
development, and HIV/AIDS within and beyond the sub-region.
In most countries the visits have already catalysed increased
action on Task Force issues. It is hoped that the recommendations
and substance of this report continue to inspire accelerated
action.
Executive Summary
"I don't want to die before I'm 110 with great grandchildren. I
don't want to die before I turn 25. I refuse to sit down and watch
my generation fall to pieces. I am going to make a difference will
you?" Rumbidzai Grace Mushangi, 15, Zimbabwe
If we can stop the spread of HIV among women and girls in southern
Africa, we can turn the epidemic around. While HIV prevalence is
high among all sexually active women, girls and young women are
particularly affected - the vast majority of young people aged
15-24 living with HIV/AIDS in southern Africa are female. Even more
worrying, data shows that many young women are being infected
almost as soon as they start having sex.
The findings of the United Nations Secretary General's Task Force
on Women, Girls and HIV/AIDS in Southern Africa show that gender
inequality fuels HIV infection because many women and girls cannot
negotiate safer sex or turn down unwanted sex. The findings also
demonstrate that HIV/AIDS deepens and exacerbates women's poverty
and inequality because it requires them to do more domestic labour
as they care for the sick, the dying and the orphaned. Although the
problems are complex, the Task Force has identified key actions in
relation to its six focus issues, which can make an immediate
difference:
1. Prevention among Girls and Young Women
We must collapse the bridge of infection between older men and
younger women and girls. Many girls have sexual partners who are
five to ten years older than them, and these men are more likely to
be infected than boys and younger men. Relationships with older men
are also more likely to be premised on unequal power relations,
leaving girls vulnerable to abuse and exploitation.
[See brief excerpts below for more on this point. For more on
points 2 through 6, see the full Task Force report]
2. Girls' Education
We must protect female enrolment figures AIDS may be taking girls
out of school. Although gender parity has largely been achieved in
educational enrolment in southern Africa, we need more information
on the impact of the epidemic on the education of girls,
particularly orphans.
3. Violence against Women and Girls
We must protect girls and women from the direct and long-term risks
of HIV infection as a result of violence Girls and women who have
been sexually assaulted are at increased risk of HIV infection,
through direct transmission and because of the long-term effects of
sexual violence on risk-taking behaviour
4. Property and Inheritance Rights
We must protect the rights of women and girls to own and inherit
land
In Task Force countries there are but a handful of small
initiatives by determined organisations that provide women and
girls with legal education and advice or assistance to prevent
dispossession or restore taken property.
5. Women and Girls as Care Givers
We must put in place a Volunteer Charter articulating the rights
and responsibilities of women and men who provide care and support
to the sick and orphaned. Communities, families, governments and
development partners cannot continue to rely on 'women's
resilience' to provide safety nets for the sick and orphaned.
6. Access to Care and Treatment for Women and Girls
We must address gender norms, violence, stigma and discrimination
as potential barriers to women's access to care and treatment.
Although women may have greater access than men to anti-retroviral
treatment through public health systems, they may miss out on
treatment opportunities because of fear that their partners will
discover their HIV status.
Gaps in the Response
The report highlights a number of important gaps in the response by
governments, international agencies and civil society organisations
identified by the Task Force:
- Many people know what the gender-based challenges facing women
and girls are. However, the complexity of gender relations means
that many find it difficult to focus on what exactly to do.
- Although girls and women represent the bulk of new infections,
budgets, programmes, policies and human resource commitments do not
reflect this. Many interventions continue to be aimed at an
imaginary boy or man or a fictional gender-neutral public.
- Even organisations that are explicitly trying to address the
problems of women and girls find it difficult to deal with the root
causes of gender inequality. Because changes in gender relations
occur slowly, not enough funding or attention is given to
programmes that try to address the deeper connections between
gender and HIV/AIDS.
Strategies that Work
After twenty years of HIV/AIDS programming, and thirty years of
gender and development programming we know that applying the
following approaches can yield success:
- Challenging the social norms and values that contribute to the
lower social status of women and girls and condone violence against
them, e.g. through dramas and community-based educational
initiatives;
- Increasing the self-confidence and self-esteem of girls, e.g.
through life-skills and other school-based programmes in which they
are full participants;
- Strengthening the legal and policy frameworks that support
women's rights to economic independence (including the right to own
and inherit land and property) e.g. by restructuring justice
systems, enacting laws and training NGOs to popularise these laws;
- Ensuring access to health services and education, in particular
life skills and sexuality education for both boys and girls, e.g.
by training health workers and teachers on gender, and re-orienting
health and education systems so that they are flexible,
participatory and community-centred rather than bureaucratic and
hierarchical; and
- Empowering women and girls economically, e.g by providing them
with access to credit, and business, entrepreneurship and marketing
skills.
Strengthening the Response
There are actions that can be taken today, which will make a
significant difference. In order to expand the capacities of
communities and of those working on HIV/AIDS programmes to do what
is necessary to ensure the fulfilment of the rights of women and
girls, the following actions are necessary:
- We must expand the pool of gender experts. Despite the fact that
many gender frameworks have been developed, not enough people know
how to 'do gender' in other words, how to conduct a thorough
gender analysis of the situation and design responses tailored to
the different requirements of men, women, boys and girls. There is
an urgent need to make the language of gender more practical and
accessible to people at community and programme levels.
- We must address the fears and resistance that surround gender.
Some women's groups have argued that there has been little progress
towards gender equality in some spheres because an honest analysis
of power relations provokes discomfort or even active resistance on
the part of some men. As a result, those who occupy decision-making
positions in donor agencies, community-based organisations,
households, governments and NGOs do not prioritise initiatives that
seek to challenge the status quo.
- We must support and strengthen local women's movements and
organisations. Partnerships between governments, women's
organisations and community-based organisations are crucial.
- We must increase public awareness and debate about the
relationship between gender inequality and HIV/AIDS.
- We must address the causes of gender inequality, not only the
consequences. In the weeks, months and years following this report,
we must work with girls and women to thoroughly analyse their
situation using a human rights- and gender-based approach.
Together, we must devise strategies that fight HIV/AIDS and
simultaneously address gender inequality. We must take this task
seriously. To ensure success we must redirect existing resources
and mobilise significant additional funds. And we must make sure
these resources get to where they are most needed, to the women and
the girls in the cities, towns and villages of southern Africa.
1. Prevention among girls and young women
Moving Forward
"As a man, I know men's behavior must change, that we must raise
boys differently, to have any hope of eradicating H.I.V. and
preventing the emergence of another such scourge . To change
fundamentally how girls and boys learn to relate to each other and
how men treat girls and women is slow, painstaking work. But surely
our children's lives are worth the effort." - Pascoal Mocumbi,
former Prime Minister, Mozambique
The ABC [Abstinence, Being Faithful, Condom Use] approach will only
present viable options for girls if it is part of a multi-pronged
package of interventions that take into consideration the problems
girls and women face at the personal, household, family and
community levels. These interventions must aim to empower girls and
young women by building assertiveness and self-esteem, and through
the development of inter-personal communication and leadership
skills. Ensuring that girls and young women participate fully in
designing and implementing programmes is a prerequisite to success.
Breaking the Silence
Communication strategies and life skills education
There is a need for better controls on the development and use of
communication materials, to encourage a stronger emphasis on
content rather than on producing T-shirts, caps and rulers. The gap
between awareness of HIV/AIDS and the knowledge and skills involved
in preventing HIV transmission, is still too large to allow for any
wastage of resources.
Communication strategies that focus on creating an environment for
interpersonal dialogue and debate, and which provide a voice to
women and girls, are more effective than those that focus only on
education through messages. Real individual and social change will
only come about when people become truly engaged in talking about
HIV, gender inequality, sexuality, culture and social norms, and in
finding their own solutions to problems.
Schools are ideally placed to facilitate such communication through
comprehensive life-skills and sexuality education, particularly
considering high enrolment rates in the region. Communities too
must play a role but may need support if they are to revive and
improve on channels through which information was traditionally
provided to young people (e.g from aunts to nieces, or from uncles
to nephews). These community elders will require support to ensure
that the information they provide is accurate and based on gender
equality.
Services
For prevention to be effective, young women and men must also know
where to go to seek appropriate health services. It is essential
that health workers are trained to handle the questions, concerns
and health problems of young people, particularly girls, in
non-judgmental ways. Such training must be complemented by measures
to relieve the stress on health workers facing increasing workloads
and staff shortages. Furthermore, as more young women become
infected, the need to develop services aimed at HIV-positive young
people becomes more urgent.
Youth programmes that promote gender equality
In the southern African context of high levels of sexual violence
and a generalized HIV/AIDS epidemic, programmes must take seriously
the gender dynamics between young women and men. Dialogue between
young women and young men should be encouraged. This will help
ensure that young men are sensitised about respect, and learn to
distinguish between appropriate and inappropriate sexual behaviour,
and that young women are able to articulate what they want and
like, as well as what makes them uncomfortable. This dialogue
should serve to facilitate platonic friendships between boys and
girls, which is something the UNICEF regional study showed is
particularly difficult for them.
Young men often feel rejected by young women because they cannot
compete against older men who have disposable income. As one young
man in South Africa asked rhetorically during the country visit,
"I'm at the desk, she's at the desk, what can I offer her?" Both
girls and boys need to be encouraged to contemplate relationships
in which boys are not expected to provide economically and take the
sexual initiative, as this perpetuates gender inequality and the
'sugar daddy' phenomenon.
Ending Exploitative Relationships
Intergenerational sex is clearly a risk factor for girls, and
becomes one for young men and boys who may later marry or become
sexually involved with women who were infected early in their
sexual lives, as well as for the children these women bear.
Research has confirmed that intergenerational sex "has a pivotal
role in the persistence of major epidemics Breaking this link in
the pattern of transmission must become a central focus of HIV
prevention strategies." As Task Force member Unity Dow said, "we
need to collapse the bridge of intergenerational sex between our
girls and older men."
The challenge is to change sexual and gender norms through
advocacy, gender socialisation of young people and education, so
that sex between older men and younger women becomes less accepted.
At the same time, social and economic conditions should be created
that give choices to girls who may be economically reliant on older
men. In all this extreme care must be taken not to place the blame
on girls. The onus is on adults to stop engaging in potentially
exploitative relationships.
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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