To some extent HIV/Aids has become a gender issue, especially in the sub-Saharan region of Africa where the majority of infected persons are females (Ross & Deverell, 2004). As females in this region and other poorly developed regions usually have limited say in regard to their bodies, which are often used for sexual purposes by men without their consent, it is perceived by some to be a gendered disease.
2.17.1 Global trends in HIV/Aids as a Gender Issue
HIV, especially within the South African context can be conceptualized as a gender issue. The majority of preventative campaigns have been narrowly focused on the use of condoms and partner reduction (Ross & Deverell, 2004). The power dynamics that exist within relationships are not recognized as critical. Most heterosexual encounters are male dominated and this domination provides a context wherein the responsibility lies with the women to negotiate safe sex. Many women do not feel sufficiently empowered to assert their rights, needs or desires and, in fact many women are not permitted this freedom of expression by their partners. The imbalance of power between men and women within relationships is intensified by economic forces. The economic security and survival of many women is dependent on the support of their partners. Despite the fact that women are at greater risk than men of contracting HIV,
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the messages contained in prevention campaigns remain biased towards male concerns and power dynamics. HIV testing then has become a gender issue, which has attached to it the discourses of patriarchy and heterosexuality.
Baumeister, et al. (2001) argues that, gender refers to the societal beliefs, customs and practices that define masculine and feminine attributes and behaviour. In most societies, the rules governing sexual relationships differ for women and men, with men holding most of the power. This means that for many women, including married women, their male partner’s sexual behaviour is the most important HIV-risk factor.
The epidemic also has a disproportionate impact on women. Their socially defined roles as carers, wives, mothers and grandmothers means they bear the greatest part of the Aids-care burden. When death and illness lead to household or community impoverishment, women and girls are even more affected due to their low social status and lack of equal economic opportunities. The testing procedure itself is open to power dynamics that could serve to reinforce what some pundits liken to gender oppression, and it needs to be examined in this light. Physiologically women are more susceptible to the virus, particularly during heterosexual sex thanks to the exposure of vaginal fluid to infected semen (Levine & Ross, 2002 & Nel, 2003). In many parts of the world women have to use sex in exchange for money, accommodation or food.
This is called transactional sex and is common in Asia and sub-Saharan Africa. This sexual intercourse is usually with older men and almost always without a condom sometimes for very small amounts of money.
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2.17.2 Sub-Saharan Africa trends in HIV/Aids as a Gender Issue
In many parts of the world, both developed and developing, being married doesn’t protect a woman from HIV. According to Mashego (2004) many women don’t feel they have the right to ask their partner to wear a condom. The result could be forced sex or other forms of domestic violence. For many young girls in developing and war torn countries, violence is often their first taste of sex. In Sub-Saharan Africa civil war has led to women being raped as part of the spoils of war.
It is also true that babies are raped because some men believe that having sex with a child can either cure or rid them of the HIV virus. Young girls from poverty stricken homes are being forced onto the streets and sold into slavery (Kumarnayake & Watts, 2001). They have sex against their will, usually with older men who have had unprotected sex with many partners. Many HIV infected women in developing countries have difficulty accessing good quality health care and often they are looking after relatives with HIV as well. They have very little chance of gaining a good education or of financial independence through employment thus are forced into sex work. For instance, in Tanzania women spend fifty percent less time doing farm work while their husbands are ill with HIV. In Vietnam seventy five percent of all carers of people with HIV are women.
In developing countries such as those within sub-Saharan Africa, there’s a major stigma attached to women undergoing HIV tests (WHO, 2007).These women can face
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violence and death if the test proves positive and they disclose their status. Concrete action is needed to prevent violence against women and ensure access to basic education and employment rights for women and girls. Women’s increased HIV infection risk mirrors gender inequalities in the developing world. There are large social and economic gaps between women and men in for instance, Zimbabwe, and these inequalities have played a central role in the spread of HIV. Conservative attitudes towards female sexuality contrast with lenient ones towards the sexual activity of men, resulting in a situation where men often have multiple sexual partners and women have little authority to instigate condom use. Sexual abuse, rape and coercive sex are all common. As economies in developing countries deteriorate more women are turning to sex work as a means of survival.
According to Mngomezulu (2005) prevention campaigns that emphasize safe sex and abstinence often fail to take into account these realities, and are more applicable to the lives of men than those of women. Women are likely to be poorer and less educated than men, predisposing them to HIV infection and making it harder for them to access treatment, care and information.
2.17.3 South African trends in HIV/Aids as a Gender Issue
In South Africa almost every family has been touched by Aids, infected females out number males by as much as two to one in some age groups. Besides being the majority of those infected, women and girls are now bearing the brunt of the epidemic in other ways as well. It is women and girls who usually take care of sick people, and it
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is they who are the most likely to lose jobs, income and stop going to school because of family commitments (Boxford, 2000).
In South Africa Black female university students use transactional sex in exchange for money with which they buy thing, sometimes they pay for their studies in this way.
This phenomenon is called the Sugar Daddy phenomenon. At present in South Africa it is largely a Black female phenomenon – although white females have been known to use Sugar Daddies (an older man that pays for a females needs). At present, little research has been carried out on the phenomena and it is an interesting area for future research (Private Communication with Dr Kathryn Nel, 20.5.09).