2.3 Factors that Influence Young People’s Vulnerability to HIV Infection
2.3.1 Unequal Gender Norms
There is increasing recognition among researchers and practitioners that the epidemic affects women and men differently. As illustrated by the prevalence rates discussed in the section above, HIV infections tend to be negatively sewed against girls and young women. For example, a 2014 survey found that 13% of young women compared to 6% young men aged 15-24 were living with HIV (Lesotho Demographic Health Survey, 2014). As discussed in Chapter One, researchers have argued that one of the reasons for this disparity lies in the generally lower status of women in society and their subordination and restricted opportunities for them to control the circumstances which may expose them to risks (Harrison, Colvin, Kuo, Swartz, & Lurie, 2015). According to Tuyizera (2007), the experiences of womanhood and manhood are inseparable from the relations of power and domination. This means that within the relationships, women (who are less powerful) tend to lack the power and agency to negotiate their safety, including safer sexual practices, Specifically, according to Lewis (2008), in a patriarchal society, the male figure dictates important decisions in the family
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(and community), including whether or not to have children, when to have them, how many to have and how they are to be spaced. In relationships, women’s sexuality is placed under the control of men.
Letuka’s (2008) study on Gender, HIV and the Law in Lesotho found that gender inequality limits women’s autonomy over their own bodies and their ability to control their sexual and reproductive lives. Similarly, the Lesotho Modes of Transmission Report (2009) states that power imbalances between men and women, and in particular women’s lack of economic independence, tend to limit their access to services, including health, education and others. As argued in Chapter One, this means that gender inequality, and the resultant gender-based violence in communities and families, means that women have little power to choose when, with whom and how to engage in sex (Meyer-Weitz et al., 1998). Linked to this situation is Ahmed’s (2011) research on property and inheritance laws in which Lesotho found that women’s economic dependence on others influence their vulnerability to HIV, especially where these laws come into question resulting from the passing a male partner.
Ahmed contends that such property and inheritance laws are discriminatory and that they may both prolong economic dependence and restrict the ability of women living with HIV to seek care, support and treatment. As a result, many women are left unprotected and are exposed to HIV infection from their male partners. Men, on the other hand, are often influenced by societal pressures and prevailing masculinities that can make it difficult for them to adopt protective behaviours both for themselves and for their sexual partners (de Bruyn, 2000).
Explaining this gender influence, the UNAIDS Global Report (2013) suggests that as a result of gender inequality and harmful gender norms, the epidemic imposes a particular burden on women
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and girls. These norms limit women’s autonomy to access sexual and reproductive health services and, therefore promote unsafe sex. Moreover, while the effects of HIV and AIDS are, on the whole, disastrous for all sectors of the population, women carry a heavier burden of HIV infection in Lesotho, with more than 27 percent of women aged 15-49 infected, while 18 percent of men in the same age group are estimated to be living with HIV (National Action on women, girls and HIV and AIDS 2012 -2017). Further, women tend to carry the burden of care work in the family and community (Revised National Strategic Plan 2012/13-2015/16), but at the same time tend to be poorer, having little to no access to economic resources as compared to their male counterparts (Letuka, 2008).
In a policy document guiding the Lesotho Government on how best to respond to the escalating rates of HIV infections, Kimaryo, Okpaku, Shongwe and Feeney (2004) highlighted gender inequality as a major factor in increasing the spread of HIV. They argued that:
…. even when they have the necessary information and knowledge, women often lack the power to determine when and with whom to have sex, let alone to insist that their sexual partner uses a condom (Kimaryo et al., 2004, p.51).
Within this context in relationships, culturally women are expected to be submissive, unquestioning and respectful towards men. This gender imbalance hinders their ability to negotiate condom use and therefore, increases their vulnerability to HIV infection (Ngwenya, 2011). This is not to suggest that all women and girls are powerless in relationships. For example, research by Leclerc-Madlala (2014) suggests that in the context of gender equality policy framework and national discourse in South Africa, in asserting their equality, some young women have come to see sexual relationships with
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older men as a way to a better life, with the potential for marriage and security, something same-age partners are often not able to offer. While this may be empowering from their perspectives, the unequal power relations that exist within the relationships may mean that young women have less decision-making power in matters that relate to their sex lives and that they may, therefore, be vulnerable to the risk of HIV infection among other negative impacts. This study examined the ways in which unequal gender norms may play a role in the ways in which young people in Lesotho schools understand and respond to the HIV and AIDS interventions that they are exposed to through the curriculum.