Reducing African Women’s Vulnerability to HIV/AIDS
by Salimata Niang
Every country in Africa is faced with HIV/AIDS, and the situation is all the more cause for concern because the main transmission route is heterosexual. The measures adopted to control the epidemic have not prevented its rapid spread.
The extreme vulnerability of women, particularly African women, to sexually transmitted infections (STI) and HIV/AIDS is well-known. In Senegal, as in other African countries, the ratio of the number of women infected to the number of men has changed rapidly: in 1986, one woman was infected for every six men (a ratio of six to one); in 1990, one woman was infected for every three men (three to one); in 1997, one woman was infected for every two men (two to one); and in 1999, between 12 and 13 women were infected for every ten men.
Also, the number of HIV-infected women is often underestimated. Although the virus reduces women’s fecundity by approximately 20%, pregnant women have always been used as a reference to measure the prevalence rate. So while the rate may be accurate for pregnant women, it does not reflect the situation of women in general.
For biological, socio-cultural and economic reasons, African women are most vulnerable to the disease. Biological vulnerability is common to all women; they carry a double handicap because they are the receptive sexual partner and have a large area of mucous membrane that is exposed during sexual relations. These factors put them at a considerable disadvantage, since the sperm of infected males has a far higher concentration of HIV than vaginal fluid. In addition, STIs such as trichomonosis and gonorrhoea may develop unnoticed or be poorly treated (or simply ignored). However, it has been demonstrated that the presence of STIs in women is responsible for a four-fold increase in the risk of HIV infection. Women’s biological vulnerability is exacerbated in adolescent girls, whose immature vaginal mucous membrane is damaged by sexual rites, and practices and violence such as rape, infibulation or forced marriage at a young age.
In the same connection African women frequently suffer from haemorrhagic complications during childbirth and require blood transfusions. In a situation of poverty where budgetary restrictions severely affect health and other social services, it is impossible to guarantee the screening of blood transfusions.
However, the decisive factor in the vulnerability of women is their social, cultural and economic condition. Rates of heterosexual HIV transmission in Africa are increased dramatically by the practice, lawful or otherwise, of taking several sexual partners. Some African women play an active role in this through official, clandestine or disguised prostitution, according to several researchers.
Associations aimed at mobilizing women in the response to AIDS have been set up across the continent. One example is the Society for Women and AIDS in Africa (SWAA), established in 1988 in Senegal by a group of African women concerned about the specific problems they faced as a result of the epidemic. SWAA is a pan-African organization with 30 national branches and provides a rallying point where women can be heard and address their own concerns about the disease. Besides education and care for women and children infected or affected by HIV/AIDS, the society focuses on access to antiretroviral drugs, especially as a means of preventing mother-to-child transmission. It also attempts to persuade African decision makers to become more involved and improve women’s access to education, condoms, antimicrobial drugs, and care and support.
It is well-known that women are the victims of gender inequality including lowered access to education and paid work, as well as to social and health facilities. African men’s relative access to social and economic resources keeps them in a dominant social position and gives them the opportunity to impose their views and determine women’s behaviour, particularly sexual.
Analysis of the African social and cultural context shows that women as a rule are victims. According to some researchers, women at risk of HIV/AIDS in Africa share one thing: their lack of “empowerment.” Researchers describe married women as passive victims because they risk contracting STIs or HIV from their husbands. Epidemiological studies in Senegal and Rwanda undertaken in 1991 show that women became infected after sexual contact with their immigrant husbands. When questioned, husbands admitted to several sexual partners while wives stated they had been monogamous. Women living alone or away from their husbands are at greatest risk: often, men treat them as casual sexual partners while they themselves frequently change sexual partners.
The same social, cultural and economic environment is responsible for adolescent girls and young women marrying at an early age or having sexual relations with older men, who are more likely to carry the virus. An epidemiological study has confirmed that older men are the primary cause of infection among adolescent girls and young women.
To sum up, men exercise authentic power over women who are usually in no position to exert control over their sexuality or fecundity. They may be helpless to protect their health, whether by persuading men to use a condom or by insisting they be faithful.
The Consequences of Infection for Women
One of the main consequences facing infected women of childbearing age is the transmission of HIV to their children, which occurs in 20% to 35% of cases. In addition, infection of African women at an early age and inadequate treatment are often responsible for premature deaths and an increase in the orphan population. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), some 13.2 million children worldwide—90% of whom live in Africa—have lost their mother and sometimes their father because of AIDS.
HIV/AIDS also undermines women’s traditional role as caregivers. Women are frequently responsible for young children or for their partner, who may also be infected. Even when they reach old age, women continue to care for children and ill relatives. With AIDS in Africa primarily affecting the 15-49 age group, grandmothers often find themselves caring for their grandchildren once their own children have died.
At the same time, the benefits of science have been slow in coming to Africa. For example, on the continent 90% people living with HIV or AIDS are not even aware they are infected. As a result, they take no precautions to prevent spreading HIV. Moreover, many countries lack a systematic referral system to provide HIV carriers with psychological and emotional support, and equally few have access to antiretroviral drugs. With lack of drugs and proper care, morbidity and mortality remain high among African patients. In contrast, in developed countries mortality has fallen by two-thirds due to new drugs, and care and support mechanisms.
In addition to the male condom, one form of protection that is available though not widespread is the female condom. It is a first step toward emancipating women and enabling them to protect themselves against both unwanted pregnancy and sexually transmitted infections. It is also suitable for HIV-negative women who are pregnant or breastfeeding but want protection against HIV infection and eventual mother-to-child transmission of the virus. Not only does the female condom strengthen protection against infection, it empowers women. As one user has said, “I showed the female condom to my husband and talked to him at length to persuade him to accept it…in any case, I would have used it without his knowledge.”
Voices from Africa no. 10