CHAPTER 2: LITERATURE REVIEW 2.1 Introduction
2.7 Married women's vulnerability to HIV/AIDS
not culturally accepted as some men ended up killing their wives or sending them back to their homes (Modo, 2000: 448). Both Inyatsi and isidikiselo sexual practices resulted in the emergence of 'amavezandlebe' which is a name given to children born to married woman out of wedlock.
partner. Thus dryness and tightening may increase vulnerability and risk of HIV infection to both men and women (De Bryun, 1998:18).
Socio-demographic factors also add to the problem of vulnerability to HIV infection in terms of access to health services. Economic factors cause women to need a basic income to fend for their families. Some of the needs include shelter and food, and these expenses may deter women from embarking on protective health behaviours. Often their men leave and do not give them money to cater for these needs. Poverty and the need for survival; gender and the inability to negotiate specific and relational issue, drug related behaviour, multiple partners, beliefs that condoms are embarrassing and female condoms are not freely available and costly all cause women to have no control over sexual relations (De Bryun, 1998:18).
Even if women could negotiate condom use, it is culturally expected by the family and husband that the wife should bear a child sometime, as they are married.
Even if a man has multiple sexual partners, due to his need have a child the condom use is temporally stopped in order to have a child. As mentioned above, the Zulu ethnic group culturally expects married people to have children, which is a cultural expectation that further aggravates women's susceptibility to HIV/AIDS, as women cannot challenge their culture.
Experience shows that in some cultures the gender issue of masculinity condones male involvement in multiple sexual partnerships and aggression.
Lately, women also become involved in such practices but women are stigmatized so they do it privately while male involvement is accepted. Cultural practices may thus aggravate the physiological vulnerability of women. Violence against women is one other social factor that makes women vulnerable to HIV infection in the form of marriage rape and incest. Violence against women is sometimes condoned in society as media portray women as sex objects and victims of abuse (Lont, 1995:15). Violence against women is further aggravated by the ability of men to exercise violence, desert or chase their wives away.
Because of such male behaviour, which is accepted, women are placed in a vulnerable situation to HIV infection. "Sexual violence is an outlet for power and anger; it is also an expression of masculinity that depends on the submission of women" (Mager, 1999:24).
Mass media plans programmes that are in accordance with the societal values.
Though these programmes are usually gender biased, the planners are not aware of this bias as it is taken for granted that they should happen that way. For instance, women are portrayed as sex objects and as housewives so they are trivialized and become vulnerable to sexual abuse (Tuchman, Daniels and Benet, 1978:28).
Myths and misconceptions also play a role in that they cause people to deny the relevance of AIDS in their lives. People who believe in witchcraft do not attribute disease to viruses but believe that an enemy deliberately caused the disease. My experience in working in the Verbal Autopsy project shows that people believe that diseases like TB, AIDS and others, are due to the consumption of a poisonous herb or witchcraft. Myths have also resulted in sexual violence in the form of rapes. Men have raped young girls in the belief that sleeping with a virgin cleanses them of the HIV infection (Leclerc-Madlala, 2002: 15).
As well as misconceptions, women lack information and so have a poor understanding of their own bodies and the mechanisms of HIV/AIDS transmission. Gender issue causes men to be exposed to the media in the form of radio and newspapers but women hear about current events very late. One woman in Senegal said: "I don't need condoms because I'm not a prostitute" (De Bryun, 1998:16). Different to the reason why this woman is not using condoms, is the inability to use condoms because women in other communities cannot negotiate condom use with their husbands.
Women are also susceptible to infection as primary care givers. For instance, AIDS patients are not hospitalized for a long time but are discharged and continue to be ill at home. As primary caregivers, women are expected to take care of them, which brings them into direct contact with the patients' body fluids.
This is a health risk practice when it is done in ignorance of how HIV is
transmitted. Women usually give care without protecting themselves by wearing gloves which can result to them becoming infected with HIV.
A study done in the United States of America in 1996 showed that when women comprise an increasingly large number of AIDS cases (De Bryun, 1998: 16).
According to this study, the incidence of women with AIDS in 1996 was more than 3.6 times greater than it had been 10 years earlier in the USA. Most of these infections were, however, attributed to heterosexual transmission where women indulged in unprotected sex. Condom use depends on attitudes, beliefs, self- efficacy and the partner (De Bryun, 1998: 16). This means that even if female condoms were available, their widespread use is doubtful as men are still the decision-makers because of the power they possess in a relationship.
Structural factors place women at risk. For instance, while male condoms are freely available, their use depends on male acceptance. Female condoms are not freely available and where these are available they are expensive and are unaffordable. These condoms could give women a certain amount of control and power in a relationship, as they are inserted prior to sexual contact and cover a large part of the vagina with minimal chances of breaking. (De Bryun, 1998: 20).
There are reports indicating that married life is not always pleasant, resulting in women engaging in extramarital relationships. For instance, a study done by
Isiugo-Abanihe (1994) looked at extramarital relationships among men and women and their perceptions of HIV/AIDS. The results of his study claim that the
more educated people were, the more they sought outside relationships. This was demonstrated in both sexes. Another factor that was discovered was the
lack of emotional bonding between men and women, which resulted in low sexual satisfaction. This, in turn resulted in sexual satisfaction being sought outside the marital home (Isiugo-Abanihe, 1994: 119). These studies were done in Nigeria and elsewhere but no such studies have been done or documented in South Africa, KwaZulu-Natal.
The above literature review supports the fact that HIV/AIDS is still a global problem as it is escalating, and has grave impact to families, communities, and all sectors. It also shows that women are more vulnerable to HIV infection revealed by the larger numbers of infected women in comparison to men. The literature also displays factors that cause women's vulnerability. However, gaps in studies conducted support the significance of the study. For instance Lurie at al (2000: 443) strengthened the need to investigate the findings that women were found HIV positive while their migrant partners were negative.