Women show a clear trend of being infected at an early stage, and certainly earlier than men (UNAIDS, 2007; Makonese, 2007). Studies have documented that the peak infection ages for women are between 21 and 40 years while, for men, infection starts to peak at later ages of 40-50 years. These figures for women are indicated by rates of HIV and AIDS-related chronic illness and antenatal attendance by women. Marriage for women in many African societies has not changed from being primarily about child-bearing and child-rearing. High HIV infection rates in adults who are at the peak of childbearing ages, in the context of high fertility rates and ineffective mother to child transmissions services, have resulted in high HIV rates for children in the 0-15 age group (Makonese, 2007).
Most of the people in a study conducted by Makonese, who were chronically ill during the period of the study, reported to have lost a child due to chronic illness or had a child
34 who was chronically ill during that time (Makonese, 2007). Despite increasing levels of awareness, prevention of mother to child transmission (PMTCT) programmes are reporting problems of adhering to recommended child-feeding practices that reduce vertical HIV transmission from the infected mother to the child, in large part due to cultural taboos around breastfeeding and child feeding practises.
HIV and AIDS challenges have been traditionally considered from a medical point of view. In this regard, Meena (1992) points out that HIV and AIDS research needs to adopt a theory of gender about the changes experienced by women and men who are affected, especially with reference to the reconstruction of sex and sexuality as a response to the HIV and AIDS problem. The analysis of the different perceptions and responsibilities for both men and women and the various culturally-constructed power relations between men and women is critical for effectively addressing the root causes of risky sexual behaviour (Purnima and Aggleton, 2001). While growing attention has been given to the position of women in the epidemic, less attention has been focused on men. A deeper understanding of gender is crucial, and one which sees gender as a set of structures created by, and affecting both, men and women (Purnima and Aggleton, 2001). Most studies have focussed on women as a vulnerable group, with only minimal reference to men, and yet men are a critical part of the story about HIV and AIDS in the southern Africa region (Mutangadura, 1999; UNWOMEN, 2002).
Gender refers to the social relations between men and women, usually asymmetrical divisions and attributes connoting relations of power, domination and rule (and normally with respect to sexual interactions). However, gender relations are historical, malleable and changeable, and are subject to alternation often through every day activities and practices. Concentrating on women only, in the end, is erroneous and misleading in making sense of HIV and AIDS and its gender dimensions and dynamics.
2.3.1 Women as bearers of the HIV and AIDS burden
Because of their reproductive roles and their place in broader society, African women suffer the greatest burden of HIV and AIDS. Poverty-stricken people generally focus
35 more on their daily survival than their health and are stymied by a crushing sense of powerlessness and hopelessness. As women fall sick and divert time to care for sick family members, their ability to produce food and manage natural resources in a sustainable way is diminished. Women are especially vulnerable to HIV infection for social, cultural and biological reasons. Women's survival and that of their households and communities specifically depends on access to and use of land and natural resources.
Where women are not entitled to land in the same way as men (as is normally the case in the prevailing patriarchal systems), documented research has shown that the living conditions of surviving widows and orphans are worse (Drimie, 2002).
Land inheritance patterns in particular have often disadvantaged widows in patrilineal systems (Seeley and Pringle, 2001; Muchopa and Mutangadura, 1999). In Uganda, women do not retain the lands of deceased husbands and, in Zimbabwe, male relatives often claim the land of the deceased husband. This has implications for increased inequalities along gender lines in local agrarian communities (Drimie, 2002). In certain cases the gendered division of labour (such as in Zimbabwe and Malawi) has changed, with some significance for women; for instance, women have entered into growing tobacco and cotton (often considered men’s crops) and women are assuming some control over large livestock including cattle. Insofar as traditional knowledge of managing and producing livestock has been a male prerogative, the loss of males through AIDS-related diseases has implications on the quality of management and production systems of livestock and the overall quality of life for women (Kwaramba, 1997).
2.3.2 HIV and AIDS and the feminisation of poverty
Meena (1992) argues that HIV and AIDS and poverty are inseparable and women are more likely to be vulnerable to the poverty dimensions of the pandemic (Nkurunziza and Rakodi, 2005). Most HIV and AIDS-affected women experience negative social- economic outcomes primarily because of existing social, cultural and legal institutions which put them in a disadvantaged position. Institutions regulating access to and control of resources and livelihood assets are in large part in favour of men. In terms of the sexual division of labour in the spheres of production and distribution of goods and
36 services, women constitute the majority of the informal labour force, while also occupying the lowest positions in the formal sector as semi-killed or unskilled employees.
At household level (that is, in a key sphere of social reproduction), women perform most of the domestic and reproductive tasks, including child- bearing and -rearing, food processing and care of the sick and spouses; generally, this entails most of the functions needed for the reproduction of human labour. Women’s responsibilities in carrying the main burden of caring for the sick (including HIV-infected household members) reduce their ability to engage in productive labour. They simply have decreasing amounts of time to earn cash income outside the home, often leading to a cycle of poverty and sickness.
Reproductive tasks are considered as a constraint on women’s participation in the formal and informal sectors of the economy. A study by Bryceson (2006) in Malawi has seen casual labour though as a source of income especially for women in poor households.
Field evidence suggests that the highly exploitative contractual terms which employers offer widens the gap between the haves and the have-nots, and has fuelled the risk of contracting HIV for most women involved in the study; they hence seek dependence on men (Bryceson, 2006). However, other writers like Veheijen (2011) dispute the transactional model of HIV risk for women. Her findings in Mudzi (in Malawi) reveal that, apart from economic benefits, there are self-providing (or financially independent) women who remain with risky partners due to cultural and other reasons, that is, other than direct financial benefits. For Veheijen (2011), even where there are material benefits, these relate to luxuries such as umbrellas and clothes rather than basic need support as alluded to in the transactional model. Many poor women are heads of households and they often head the poorest of households. Such women will often engage in commercial sexual transactions, sometimes as commercial sex workers. Most women are unable to sustain themselves in either formal or informal work; hence, in these instances, they are also less able to dictate the terms of sexual relationships and are more likely to engage in risky sexual behaviour.
37 Overall, there are many broader structures and processes which disadvantage women in the context of the pandemic and which contribute to the gendered quality of poverty.
These include female illiteracy, economic dependency, weak land ownership and access rights, marginalised and subordinated inclusion in labour markets, significant time spent in domestic activities and an inadequate supply of supportive social services. Responses to HIV and AIDS can only be successful if investments in prevention and care (which are often underpinned by agency-based behavioural explanations for the pandemic) are combined with recognition of the structural and patriarchal bases for the pandemic – this would entail systematic support for national poverty reduction and action to address the developmental impact of the epidemic. Without a marked reduction in poverty and sustained advances in human quality of life, HIV and AIDS will continue to impoverish individuals, households and communities as a whole but women more specifically.
Poverty alleviation will feed into the prevention of further infections. Improving women’s incomes also increases their power in all aspects of life, including control over sexuality.