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of AIDS-: Ten unavoidable choices for African leaders
Extracted from Pambazuka News 202
April 14, 2005
The HIV/AIDS epidemic
in Africa is exposing the deadly consequences of gender inequities,
writes CHINUA AKUKWE. Practical solutions are needed to a problem
that will only get worse if nothing is done.
The UNAIDS report on
the HIV/AIDS pandemic highlights the growing rates of infection
among women worldwide. Women now account for nearly 50% of all individuals
living with HIV/AIDS. However, in Africa, the situation is more
ominous. Almost 57% of all individuals living with HIV/AIDS in Africa
are women. For Africans ages 15-24 living with HIV/AIDS, women account
for 76% of all infections. In South Africa, Zambia and Zimbabwe,
young women ages 15-24 have rates of infection that are between
three and six times that of their male peers.
The so-called feminization
of AIDS appears to be in full swing in Africa. The key question
is whether African leaders and elite are ready to make hard choices
that would slow down the rate of infection among women. I briefly
review these choices. The key is to focus on practical solutions
to a problem that can only get worse if nothing is done.
are African leaders and governments ready to mount a comprehensive
and sustained information, education and communication campaign
against risk-behaving practices of men that put women at risk of
HIV infection? I am not aware of any African country that is currently
implementing a sustained, nationwide campaign against sugar daddies,
the use of large sums of money by male clients to encourage sex
workers to engage in unprotected sex, the rape of young girls by
school teachers, the molestation of young girls by family members
and the molestation of street children. African men who have disposable
income are at the root of sexual networking in various communities
that spread HIV, according to the UNAIDS.
are African leaders and governments ready to address cultural practices
that may put women at disadvantage in the fight against HIV/AIDS?
These practices include lack of proactive opportunities for women
to discuss sexual mores and risks with their husbands, cultural
expectations of subservience in sexual matters, the culture of wife
inheritance after widowhood, and, the lack of property rights for
widows or single women even when they have to take care of small
are African leaders and governments ready to invest for the long
term on female education? According to latest data from the World
Bank, 45% of women ages 15 and above in Sub-Sahara Africa are illiterate.
While 94% of boys are enrolled in primary schools only 81% of girls
are in school. For starters, primary and secondary school education
should be free in Africa to allow young people, including girls,
to have a head start in life.
It is also important
for African women to have increased access to university education,
especially those from poor families. However, to ensure quality
education for African women, African governments and rich nations
such as the United States and other Western democracies should provide
increased, targeted development assistance for Africa. Rich nations
and multilateral institutions such as the World Bank and the International
Monetary Fund should provide comprehensive debt relief for Africa
with a major condition that significant portions of the savings
from debt relief should go toward social welfare programs such as
the financing of education initiatives for girls and young women.
are African leaders and governments ready to create enabling environments
for empowering African women? Limited economic choices and opportunities
constrict the capacity of African women to negotiate safer personal
behaviours, including sexual relations. Although African women are
major sources of economic wealth in many rural parts of Africa,
these women have limited control over their generated income due
to cultural taboos and traditional practices. African governments
should end cultural practices that deny women the right to benefit
from their toil and labor. It is also important for African governments
to create micro-credit facilities for enterprising rural women so
that they could become stable, small-scale entrepreneurs and accumulate
disposable income. Women with disposable income are likely to make
better personal choices for themselves and their children.
can African leaders and governments create political space for women?
Unlike many official statistics that cite token numbers of national
ministers and top government officials that are women, I believe
that in order to fight AIDS, women must be in decision making organs
in local and state governments throughout Africa, and also have
leadership roles in key national government institutions such as
the ministries of finance, national planning and justice.
In addition, African
women should be in decision making positions in civil society, local
chambers of commerce and local youth organizations that directly
interface with the grassroots. It is important to state without
equivocation that female representation in national cabinets in
Africa should go beyond the obligatory "Ministry of Women
or Gender Affairs."
are African leaders and governments ready to create the necessary
legal climate and framework that protects women from discrimination
and lack of due process? UNAIDS estimates that more than 50% of
African countries do not have laws against discrimination of individuals
living with HIV/AIDS.
In Africa, according
to the UNAIDS, the fear of a HIV test by women, including pregnant
mothers, is the beginning of wisdom, since negative societal consequences
and an uncertain future may lie ahead if they test positive. For
women living with HIV/AIDS, the prospect of dealing with family,
community and government indifference and sometimes hostility, can
be insurmountable. Legal reforms on rape, sexual molestations, domestic
violence, favors-for-forced sexual relations, property rights, and
ownership of business are crucial in the fight against feminization
are African leaders and governments ready to invest in public health
services that are friendly and accessible to women? National spending
on public health services is low in Africa, about US$30 per capita,
according to the World Bank. Women face formidable challenges in
accessing public health services for conditions such as sexually
transmitted diseases and tuberculosis that are important facilitators
of HIV transmission. Privacy and confidentiality is rare in African
health institutions, according to the UNAIDS. Societal stigma is
common when women become linked to sexual transmitted diseases.
In addition, fear of violence may keep women from utilizing HIV
preventive services or even showing up for AIDS clinical care, according
to the UNAIDS. It is important for the international community to
support African nations that seek to implement female friendly health
systems and programs.
are African leaders ready to position gender issues as a major priority
of international development assistance? Declarations, statements
and formal speeches about gender issues must be coupled with specific
policy and program initiatives to end gender inequities in Africa.
African leaders, continent-wide institutions and the civil society
should make gender equity a cardinal feature of their relationship
with bilateral and multilateral agencies.
There is a tendency to
point to token appointments of women to prominent positions as celebratory
signs of progress on gender issues in Africa. While this is important,
the focus should be on hundreds of millions of African women who
toil away anonymously, unsung and uncelebrated despite their significant
contributions to the economy of the continent.
In particular, African
governments should make ending gender inequity a top priority of
their partnership with donor agencies. A good measure of serious
commitment is the proportion of resources requested by African governments
to deal with gender inequities in proposals sent to donor agencies.
National budgets should also reflect increased resources devoted
to ending gender inequities and creating income-generating opportunities
can African leaders lead the fight against sexual violence against
women. Official, societal and personal silence on sexual violence
against women is deafening in many parts of Africa. In particular,
perpetrators target female teenagers in some parts of Africa, thereby
potentially setting off a chain of events that may leave the young
women not only emotionally scarred for life but also the ever possible
risk and danger of HIV/AIDS.
To end sexual violence,
African governments would have to deny perpetrators of sexual violence,
political, economic, legal and social sanctuary. Zero legal tolerance
against sexual violence should be enforced and perpetrators subjected
to the long arm of the law. Women should be encouraged to come forward
with cases of sexual violence and the society should treat them
with compassion while the legal system runs its course.
African leaders and governments must win the battle against widespread
poverty in the continent. Poverty is a major reason why individuals,
including women, knowingly engage in high risk behaviors that facilitate
the spread of HIV. Feminization of HIV/AIDS is closely intertwined
with poverty and harsh living conditions.
African leaders and governments
should create opportunities for poor women to escape poverty through
sustainable macroeconomic policies that improve their vocational
skills, provide access to literacy programs, provide incentives
for self-employment and allow them to accumulate capital and properties.
Rich nations, including
the United States, should work closely with African leaders in this
regard. Comprehensive debt relief, increased access to trade for
African farmers and businesses, and comprehensive micro-credit programs
are also critical policy issues that rich nations can assist African
nations as part of a comprehensive fight against poverty.
Efforts to end the feminization of AIDS in Africa must be African-based
and African-implemented. For the African woman at the receiving
end of HIV/AIDS, the solution lies principally in changing societal
beliefs and practices within her family, community, country and
to gender inequities lies in the capacity of African governments
to confront societal beliefs and practices that wittingly or unwittingly
put women at risk of physical, emotional and mental harm. The HIV/AIDS
epidemic in Africa is exposing the deadly consequences of gender
inequities. As the toll of HIV/AIDS mounts in Africa and the epidemic
gradually assumes a feminine connotation, every policy maker in
Africa should work toward the end of all practices that prevent
African women from becoming full partners in the titanic struggle
ahead. Any serious advocate for comprehensive AIDS remedial efforts
in Africa cannot afford to watch from the sidelines the increasing
feminization of AIDS in the continent.
1. UNAIDS (2004). AIDS Epidemic Update: 2004. November. Geneva,
Switzerland: Author. Available at the UNAIDS website, www.unaids.org
This is the latest update on the global AIDS situation and is dedicated
to the feminization of AIDS. Data used in this article are available
in the PDF format of the update under the following sections and
pages: INTRODUCTION, pages 2-6; WOMEN and AIDS, pages 7, 9-17 dealing
on issues such as gender inequities, problems with accessing preventive
and clinical care, power imbalances, fear of violence, lack of property
rights, cultural taboo about discussing sexual mores and risks with
husbands; SUB-SAHARAN AFRICA, pages 19, 23, 24, 27, 28, 29 on issues
that affect women in Africa and how it impacts on the spread of
2. UNAIDS (2004). 2004
Report on the Global AIDS Epidemic. July. Geneva, Switzerland: Author.
Available at the UNAIDS website, www.unaids.org This document released
during the Bangkok AIDS conference in July 2004 contains series
of information on the epidemic. The PDF format includes an executive
summary that also discusses continued discrimination against women
and the lack of enabling legislation that outlaws stigma and discrimination
against individuals living with HIV/AIDS.
3. World Bank (2004).
African Development Indicators 2004. Washington, DC: Author. This
is widely considered the authoritative database on Africa-s
development. Data cited in this article are found in pages
320, 322, 323 on healthcare expenditure per capita, illiteracy levels
and primary school enrollment. The female economic situation in
Africa is shown in page 330 of the document.
4. Chinua Akukwe,
Melvin Foote (2001). HIV/AIDS in Africa: It is Time to End the Killing
Fields. Foreign Policy in Focus, April.
Akukwe is a member of the Board of Directors of the Constituency
for Africa, Washington, DC and an adjunct professor of public health
at the George Washington University, Washington, DC. He has written
extensively on HIV/AIDS and development issues in Africa.
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