The world over, women constitute nearly half of the population of people living with HIV. The trend is the same in sub-Saharan Africa where more than 57% of adults living with the infection are women - with heterosexual sex as the dominant mode of HIV transmission.
Additionally, the result of a number of variables, sub-Saharan Africa has a peculiar prevalent phenomenon where young women (aged between 15 and 24) are recording the highest rates of new infections. Why?
Africa is renowned for poverty. Not only is poverty feminised in Africa, but alongside it, Aids is feminised too. In Zimbabwe for example, a non-performing economy over a prolonged period has propelled poverty, which tends to impact women and girls more than it does their male counterparts.
Due to opportunity limitations that girls and women find themselves bound in, transactional sexual relationships become an important survival mechanism for bread and butter, a meal and some sustenance. This ‘survival’ sex is often inter-generational, taking place between a girl and an older man, who is more likely to be HIV-positive.
Shamefully in some instances, men have been known to purchase sex for as little as 25 cents and will pay $1 for 4 girls. In such instances, the man has the "leisure" and "pleasure" of taking four girls, one after the other, bedding them and paying them the said amount.
Due to the power dynamics that exist between women and men, women often find themselves in positions where they are unable to negotiate for safe sex. These power dynamics manifest on the domestic front as well in public places. On the domestic front, it is a taboo for a wife to negotiate for safe sex with a man to whom she is married.
A married woman’s health is highly compromised due to a culture of infidelity that is so prevalent in Africa. Due to this behavioural trait, married women are significantly placed at risk not just by the past behaviour of their spouses but even present and future behaviour, as males generally tend to have multiple concurrent partners.
If a woman feels unsafe, doesn’t trust her husband or maybe prefers to use protection as a barrier to pregnancy, culture, tradition and the institutionalisation of marriage do not permit her to suggest condom use. The expectation is that because a bride price was paid for her and she is his wife, she must not only provide sex on demand, but she must also meet his sexual needs in the form that he wants.
In addition to lack of power to refuse sex or to negotiate safe sex in their intimate relationships, education and the absence of awareness and information are further key determinants in the feminisation of Aids. School dropouts, inadequate information channels and access to lack of basic information on how to protect themselves further render women and girls unequipped. And when they do have unprotected intercourse, women face a greater risk of becoming infected than men.
Religion and culture have also taken a stake in the feminisation of the disease through dictates and prescriptions on the chastity of marriage and the sin of divorce. As a result, even when a woman’s health is compromised, religion coupled with socialisation compels her to remain in a relationship where she is unsafe. Some African religions also encourage and are hinged on polygamy and will allow a man to marry several wives. When this happens several women are having sexual intercourse with the same man, which perpetuates their vulnerability to infection.
Additionally, harmful cultural practices such as female genital mutilation and levirate marriages also come into the fore and are a cause for heightened vulnerability.
While women’s health and survival are jeopardised by Aids, the epidemic further increases the care role that women play in their communities. Apart from their own self-care, women are often the ones who have to take care of the sick, which leaves them with barely any time to earn or learn new skills.
This increase in domestic burdens is often passed onto the girls in the household, who in turn have to help their mothers, further exacerbating the cycle of poverty as girls end up staying home to help their mothers, which itself reduces education and economic opportunities. And when parents succumb to Aids and die, the girl orphans usually take over the parental role of their siblings and often end up in exploitative relationships, marrying early or resorting to "survival sex" to fend for their siblings
HIV/Aids prevalence in Africa has been said to be a manifestation of inequality with its spread deeply enshrined in patriarchal contexts that favour men. The hierarchical pendulum favours men and places them in dimensions where they enjoy greater economic, political, social and legal control and access in addition to the biological advantage of their physiology. While the odds are against women who comparatively possess less both in power and legal rights as well as less access to information, and fewer ways to earn a living. Patriarchy has defined and maintained a set of rules through which relationships are formulated, established and maintained. These rules of engagement are strictly, but very subtly and intentionally "made" in a way that contributes to the feminisation of the epidemic.
If the battle is to be won, and Aids is eradicated in this lifetime, then there is need for urgent transformation of the structural causes of inequality that render women vulnerable. There is need for advancement of women’s rights, social and economic inclusion and removal of obstacles that limit women’s access.