AIDS and AFRICA a Gender Driven
By Earl Hadley, Editor of Gender Policy
The numbers are staggering. The pain is long term. The affect on society
is deep reaching. The word genocide can easily be made to fit this
tragedy. And gender exploitation lies at the center of the problem -
AIDS in Africa.
There are twenty five million Africans infected with the HIV virus.
1 This number is probably a
minimum, as doctors seldom write 'AIDS' as a cause of death, there is
only limited AIDS testing, and what testing is done, occurs on pregnant
women who represent a sub-section of the at-risk population. Of this
number, 2.4 million Africans died of AIDS last year, out of nearly
twelve million who have died since the crisis began.
2 There are twelve million
AIDS orphans on the continent, with Zimbabwe possessing the largest
number with three-quarters of a million, a number which increases by
60,000 a year. 3
Africa possesses two thirds of the world's HIV infected population, and
over eighty percent of AIDS related deaths. In many sub-Saharan
countries more than ten percent of the population has HIV, in southern
Africa this figure lies between fifteen and twenty-five percent. UNAIDS
provides the facts: "According to 1999 estimates, by the end of the year
33.6 million men, women and children were living with HIV or AIDS, and
16.3 million had already died from the disease. In 1999, there were 5.6
million new infections worldwide, of which 3.8 million were in
sub-Saharan Africa." 4
While the United Nations has suggested that three billion dollars are
needed for prevention and care services, the world community has
provided about five percent of this amount.
5 Industrialized countries
have turned a blind eye to this tragedy.
Along with a lack of international financing from the countries of the
Global North, sub-Saharan governments have failed to use their resources
to respond to this health crisis. Despite the fact that AIDS kills more
Africans than armed conflicts, heads of state seldom discuss the crisis,
much less provide financial support to the fight against HIV. The Boston
Globe states that "sub-Saharan countries spend about $160 million
fighting 4 million new AIDS cases per year, and most of that is foreign
aid, according to US government figures. By contrast, the United States
spends $880 million on just 44,000 new cases annually."
This level of spending becomes all the more criminal when it is clear
that many countries spend more on their military than on the fight
against AIDS. "By it's own figures the Zimbabwean government spends
seventy times the amount that goes to HIV programs on its support of the
war in the Congo-a conflict with no direct implications for Zimbabwe."
South African judge Edwin Cameron, who is HIV positive, observed at the
1999 XIII International AIDS Conference that: "I am here because I can
afford to pay for life itself." "Those of us who live affluent lives,
well attended with medical care and treatment, should not ask how
Germans or white South Africans could tolerate living in proximity to
moral evil. We do so ourselves today, in proximity to the impending
illness and death of many millions of people with AIDS."
UNAIDS writes that "Biological and social factors make women and girls
more vulnerable to AIDS than men, especially in adolescence and youth,
when in many places HIV infection in young women has been found to be
3-5 times higher than among boys. Violence -- or the threat of violence
-- against women increases their vulnerability to HIV and reduces their
ability to protect themselves against infection".9
Gender also plays a key role in the spread of HIV in three key areas:
sexual assault, culture and development.
The lack of control over sex, which many women experience, is nowhere
more apparent than in societies in the midst of conflict or with
uncontrollable crime problems. In countries with ten to twenty five
percent infection rates, presumably higher among young male rapists,
non-enforced laws and treaties concerning sexual violence do little to
prevent the spread of HIV.
Similarly, troops in Sierra Leone, Rwanda, and in the Congo have all
been accused of using rape as a weapon of war. With the last conflict
involving six other African nations (including Zimbabwe with its 25%
infection rate) it is easy to see how armed conflict and male sexual
violence are significant conduits for the spread of HIV throughout the
With an eye on African troops, the UN Security Council has sought to
mandate HIV tests for all troops participating in peacekeeping
operations - a move that has been resisted by African nations upon
concerns of privacy violations and discrimination against infected
peace-keepers. As the governments of developing countries receive a
relatively substantial stipend for the services of their armed forces,
there are clear economic reasons for this resistance as well.
The threat, however, is not just from HIV positive soldiers spreading
the virus where they are stationed, but also from the real possibility
that they will catch such while working internationally. Soldiers from
Nigeria and the Netherlands, among others, have already been diagnosed
as becoming HIV positive while serving internationally.
Despite their support for testing, the industrialized members of the
United Nations have been conspicuously quiet concerning the prosecution
of troops sent home for sexually assaulting women or organizing child
prostitution rings. The same holds true for discussions of banning
prostitution much less prosecuting soldiers who sleep with prostitutes.
Cultures of Masculinity
Many suggest that men are the primary cause of the AIDS epidemic. One
Reverend in the United States asserts that male promiscuity, in this
context, is akin to male violence. Given the fact that men have more
partners than women, generally control when and how sex is conducted and
are the driving force behind demand oriented prostitution, this
statement seems reasonable. 11
As a result of this perspective there has been a growing trend toward
analyzing and attempting to manipulate male values and identity as a
solution to the AIDS crisis. The goal has been to move away from a
masculinity that is tied directly to how many sexual partners one has,
toward one of protecting yourself and your family.
This type of examination, however, identifies only one part of the
problem, and ignores the poverty women face economically and
powerlessness in negotiating sexual intimacy. The two together make
women vulnerable to the unhealthy attitudes of men and should themselves
be the focus of anti-AIDS efforts. As is suggested in a Village Voice
article, such initiatives are successful: "boosting women's power
provides a proven bulwark against the virus. A Zambian study, for
example, found that women who finish school are four times more likely
to avoid HIV than women who drop out."
12 Similarly, arguments
concerning African culture miss the point.
There seems to be a never-ending debate on culture. African leaders get
defensive in discussing HIV out of fear of supporting racist caricatures
of hyper-sexual black men and sexual frenzied black women. At the same
time commentators, dancing the fine line between ignorance and racism,
politely suggest that African traditions support polygamy, and thereby
promiscuity, and thereby the spread of HIV. Both positions waste our
Sadly, men are socialized in very similar ways across the planet: to
view sexual contact with women as a sign of their manhood, the more
women - the more of a man you are. They are also taught that sex without
a condom is preferred. The poorer women are, the less educated, the
fewer rights they possess - the lower their ability to choose who they
sleep with - and subsequently the higher the rates of HIV infection.
There are of course some relevant cultural issues. Africa has not yet
had a prominent popular man's man come forward and discuss
HIV/AIDS as occurred in the United States with Magic Johnson. As a
result there exists a strong reluctance to discuss promiscuity and
sexually transmitted diseases. At the same time, contracting the
diseases is viewed as being the fault of the infected person, who is
usually ostracized and condemned, and at times physically attacked.
Similarly, the Catholic Church, which is very prominent in Africa, has
been quiet on the subject of HIV, terrified to say anything more than
"abstinence", and has not spoken up for the victims of AIDS and
But these are not African cultural differences, the same sorts of
responses have been observed in the United States and Europe. Similarly,
where there have been serious efforts by African leaders to combat AIDS,
significant reductions in the spread of the disease have occurred. As
Kurt Shillinger reports:
"President Yoweri Museveni
[of Uganda] was outspoken about HIV long before any of his counterparts,
and mobilized his government to treat AIDS as a concern for all
ministries and sectors. The country encourages people to have
confidential HIV tests prior to marriage and promotes community-based
care for those ailing from advancing AIDS. After reaching a peak in the
early 1990s, when as many as 36.6 percent of urban pregnant women tested
positive for HIV, Uganda has apparently reversed infection rates. By the
end of 1997, only 14.8 percent of women attending urban clinics had
In addition to these cultures of silence there are also cultural trends
in developing country that actively lead to higher rates of HIV
infection and the spread of such. In many countries, when a husband
dies, his spouse is expected to sleep with her brother in law as a form
of ritual cleaning, or to marry him. There is a high probability that
the husband has died of AIDS, that the wife is infected, in short time
that the brother in-law will also contract HIV and infect others.
Similarly, women have few property rights in many African countries and
upon the death of a husband, all land and finances go to the husband's
family. In theory this explains why the brother in-law becomes
responsible for his sister in-law and marries her, in practice women are
kicked out of the family, off of the land, and are forced to resort to
prostitution or dependency upon another male in order to survive.
Perhaps the most devastating cultural factor is a new one, strongly
related to the development process - namely the sugar daddy factor.
Unlike traditional polygamy, in Africa and elsewhere, where men - who
can financially and sexually support more than one wife - do so, sugar
daddies trade gifts, money, and promises to girls and young women for
sexual favors. There is no long-term financial commitment, nor any rules
offered by society in regards to the woman's rights, as is the case with
polygamy. This type of exploitation is a major problem, in fact one
study suggests that 60 percent of women are HIV-positive by the time
they are 25.14 While
culture is not the driving force behind the spread of HIV, it is clear
that African leaders and people must address and alter some key social
Development - The Answer?
With poverty leading to conflict, prostitution and the sugar daddy
syndrome, the solution should be obvious - development is the answer.
Sadly, this is not the case; all too often development has resulted in
the increased economic exploitation and impoverishment of women and
subsequently a reduction in their negotiating power in sexual
Development in most sub-Saharan African countries has meant one of three
prospects: 1) Mining for precious minerals/oil 2) Export of Crops 3)
Tourism. Concurrently there has been an increase in education, intensive
urban migration and the creation of an upper class of men who are able
to exploit poor women.
1) Across the continent, developing mines for the extraction of minerals
means the creation of sleeping facilities for the workers, who are
hundreds of miles away from their female partners or major cities in
which to meet new ones. Not surprisingly when you have men with money
and no women around, prostitution appears.
Concurrently, as many female partners are left in rural areas without
significant financial support, they often develop sugar-daddy
relationships with employed men in the region. This dynamic holds true
for urban migration as well. Women who remain in rural areas often seek
the services of sugar-daddies, men in new urban areas solicit
prostitutes, and women encountering labor market discrimination in urban
areas enter into prostitution/sugar daddy relationships. South Africa
serves as an excellent example:
The miners, who migrate from all over southern Africa, are barracked in
all-male hostels, in which a dozen or more men share rooms as small as
20-by-20 feet. Most can afford to visit their families no more than one
weekend every other month. With such separations from wives and
girlfriends commonplace, the sex trade flourishes -- and so does HIV.
Between 27 and 41 percent of miners around the town of Carletonville,
where the East Driefontein mine is located, are HIV-positive. So are
two-thirds of the women in so-called hot spots like Mogweba's squatter
2) Increasing the export of agricultural goods often directly hurts
women financially. They are no longer able to produce food for
consumption and are instead dependent upon the whims of their spouses
who sell crops to exporters and subsequently control the profits. This
has a two-fold effect of lowering a woman's ability to reject her
husband's infidelity, or unsafe sexual practices, and providing male
partners with the cash to engage in prostitution or sugar-daddy
interactions outside of the marriage.
3) While tourism can bring in substantial revenue for a country, it
inevitably also invites single males looking for 'a good time' or child
prostitution, and where there is demand - there is supply, with
prostitutes quickly becoming fixtures at major hotels and bars. Indeed,
East Africa was the primary spot for sex tourism in the 1980s
(South-Asia subsequently claiming this mantle as men attempted to avoid
East Africa, which had become equated with HIV).
Because large parts of Africa's population live in rural areas,
development efforts require sending doctors, engineers, teachers, tax
collectors, and civil service administrators into these areas. Labor
market discrimination ensures that the majority of these individuals are
men, while male dominated urban migration guarantees that most of the
rural residents are women.
In this context, it is easy to see how sex can be traded for
administrative or financial favors - for health services/in place of
taxes. In setting up systems in poor communities where health care,
education, clean water, and sanitation are fee driven, governments
invite exploitation and the spread of HIV to its civil servants and
rural areas. Sadly, this type of exploitation occurs too often and those
who should be most aware of HIV, and attempt to avoid such, are some of
its biggest victims. In Namibia, for example, after the military and
truck drivers - teachers have the highest rate of HIV infection in a
given employment category. 16
Clearly universal and free health care, education, and sanitation would
be an ideal, as well as utopian, solution in much of sub-Saharan Africa.
It is also easy to see how enforcing laws prohibiting prostitution could
damage one of the countries primary sources of income. Similarly,
requiring extraction companies to provide lodging for female partners
would place African countries at a competitive disadvantage relative to
other regions. These consequences, however, do not suggest that some of
these steps should not be taken - the benefits of saving a generation of
Africans may be more important that export revenue.
Regardless of how one calculates this cost-benefit analysis there are
other means of fighting HIV that result in no net loss to the economy.
One such example, while only addressing one of the ways AIDS is spread,
is implementing a diversity program that ensures that the majority of
civil servants in rural areas are women. Doing so would economically
empower the women who administer these programs, thereby lowering their
dependency upon men and exposure to unsafe sexual practices, and removes
sex from negotiations concerning government services.
High Charges of
We've identified that the economic empowerment of women needs to be
centered in the development process for any successful effort to combat
the spread of AIDS to occur. But what about the 25 million men, women,
and children who currently have HIV? While drugs that slow AIDS are
available and used in the industrialized world they are but legend and
the stuff of gods in sub-Saharan countries. The majority of people in
said nations have disposable annual incomes ranging from two hundred to
one thousand dollars (US), with most toward the bottom of this scale,
while the annual costs of HIV drugs average from five to fifteen
thousand dollars (US).
Of course these prices don't measure the cost to produce anti-AIDS
drugs, or even the research and advertising fees, but all of the above
in addition to a large profit - which economic theory suggests is
necessary to induce future innovations from firms. Given this logic, it
seems reasonable that countries joining the World Trade Organization (WTO)
would agree to respect the right of drug companies to be the sole
producers of medicines for a number of years. All the more sensible when
high tariffs, and bans of access to industrialized markets, are the
results of not doing so. But the trade off, for such an agreement, is
the abandonment of millions of lives.
As more men, women, and children have died of AIDS, activists in
developing countries have demanded the right to produce the drugs
themselves, at much lower costs, if companies will not cut what they
charge themselves. South Africa is debating doing the latter, but has
been reluctant to begin, as they have been threatened with trade
Brazil, like India, however, has had a grace period in which it can
ignore intellectual property rights, as part of its WTO agreement, and
it has used this time fully. The Brazilian government has produced
anti-AIDS drugs with the goal of providing care to all individuals with
AIDS, and the results are clear. The HIV death rate in Brazil was cut in
half in four years and hospital admissions for AIDS patients have fallen
by 80 percent. 17 In
the process, Brazil has also proved wrong pundits who stated a
developing country could not manage the logistics of distribution and
supervision. India has also produced a number of generic copies of anti
retro-viral drugs and is offering to sell them to African countries at a
cost well below the prices demanded by European and US firms. [India,
unlike Brazil, has not instituted a countrywide campaign against HIV and
as a result the disease continues to spread rapidly].
There are of course many critics. They state that many developing
countries have a much larger problem than Brazil, where only one percent
of its population was infected, and will therefore will be unable to
accurately dispense the drugs, which could result in the appearance of
new drug resistant strains of HIV.
Others suggest that if companies are forced to provide their drugs at
lower rates in one area then they will be forced to do so in others. And
indeed, many AIDS activists in the US and Europe have been calling for
cheaper medicine in these regions - it's not as though poor/working
class people in the Global North, without health insurance, have six
thousand dollars in annual disposable income for fighting the AIDS
Meanwhile, pharmaceutical companies are doing their best to maintain
whatever profits they can. It might be possible to have empathy for
their position if their goal was anything but profit. Sadly, this is not
the case. If these firms were attempting to balance profit and saving
millions of lives, they would be the strongest advocates for:
pricing for countries and communities with divergent economic status;
- tight restrictions
to prevent the re-sale of drugs; and
- government support when the sales price from
producing at cost is still too high for some countries.
Instead they have stood by and watched twelve million people die. They
have instead hid behind the notion of intellectual property rights and
suggestions that developing countries don't have the infrastructure to
distribute the medicine. Instead they have refused to provide medicine
to dying people - even in capital cities where the infrastructure is
clearly in place.
The United Nations has tried to serve as a negotiator between
pharmaceutical companies and those dying of AIDS, and has even convinced
major companies to reduce some of their fees by sixty to eighty percent.
The results, however, have not been impressive. Through this haggling
UNAIDS, for example, was able to gain a three dollar reduction in the
price of a particular drug for a pilot program, from the US price to
$6.20(US) a day. 18 At
over two thousand dollars a year, even with this reduction, the price of
life is well above the annual income of most Africans -- Brazil produces
the same drug for less than a tenth of the cost.
In addition to lowering prices to a level that the vast majority of the
dying can't afford, others have reduced the price on one type of drug
but not the ones that should accompany such and still others have
offered reduced prices but only in limited quantities.
19 Some companies have
offered to donate medicine for a limited time. This move, however, has
been viewed with suspicion as an attempt coerce governments into
purchasing drugs at their inflated prices, once the donations stop, and
it's citizens have grown accustomed to life saving medicine.
As developing countries are dependent upon industrialized ones for the
purchase of their exports, they are hesitant to anger their Northern
counterparts by violating 'international trade rules' such as
intellectual property rights - even when the goal is free market
capitalism. Most of these countries, however, have a clause in their WTO
agreements that allow them to copy drugs in cases of national emergency.
If pharmaceutical companies continue to place profit before millions of
lives, hopefully many more countries will begin to produce the medicines
The European Union has already called upon drug companies to end their
legal attack against South Africa's decision to import anti-AIDS drugs.
Similarly, during his second term in office, President Clinton issued an
Executive Order stating that the US would not legally challenge African
countries attempting to import anti-AIDS medicines. Recently in South
Africa, pharmaceutical companies agreed to drop their law-suits against
the government, while the two continue negotiating. It remains to be
seen whether this truce will last. As the US Executive Order was
instituted under intense protest from Republicans it is also unclear how
long it will remain in place. 20
Millions have died, millions more will die, and if the current situation
is not addressed these deaths will occur at a faster pace. Indeed, South
Asia has the necessary conditions for an AIDS explosion:
High levels of poverty
Violence against women
Trafficking in women
High levels of prostitution
Cultural prohibitions on land ownership by wives
Economic displacement being disproportionately borne by women
And an upper class of men who can exploit poor women
All too often, the debate concerning HIV/AIDS has circled around
cultural differences, when in fact; discussion should focus on cultural
similarities - the patriarchy. Only through empowering women and girls
economically will they have options besides prostitution and sugar
daddies. Similarly, only through providing education to girls and women,
will they feel empowered to fight for greater control over sexual
We must force international drug companies to put lives before high
levels of profit and demand that industrialized countries not take trade
action against nations that create generic copies of life saving
medicines. But the pharmaceutical companies are not solely to blame,
industrialized governments must provide funding to nations that can not
afford generic copies or lower priced patented versions.
Providing 150 million dollars (US) every year to 4 million new African
AIDS victims is a travesty. We have seen the level of resources provided
to combat a glimmer of this crisis in the industrialized world. African
women and men deserve the same response.
Bruce Japsen, "Abbott to Sell HIV Drugs at Cost in Africa Other
Countries May Want Cuts", Tribune 03/28/01.
Rachel Swarns, "AIDS Drug Battle Deepens in Africa", New York
Times , 03/08/01.
Wil Haygood, "Aids and The African", Boston Globe,
The Joint United Nations Programme on HIV/AIDS, Gender Is
Crucial Issue In Fight Against Aids, Says Head of UNAID, (UNAIDS.
Mark Schoofs, "The Deadly Gender Gap", Village Voice.
Kurt Shillinger, "AIDS and The African Denial", Boston Globe.
Mark Schoofs, "Africa Responds", Village Voice.11/17-23/99.
Mark Schoofs, "The International AIDS Conference Makes a
Commitment to Saving Third-World Lives", Village Voice. 08/19/00.
Mark Schoofs, "The Security Council Declares AIDS in Africa a
Threat to World Stability", Village Voice. 01/12-18/00
Kurt Shillinger, "The Outsider. Minister tries to shame officials
into action", Boston Globe. 10/13/99.
Mark Schoofs, ibid., 12/30/98
Kurt Shillinger, "Aids and The African Denial", Boston Globe.
Kurt Shillinger, "A Continents Crisis Aids and the African",
Boston Globe. 10/10/99. (The Pretoria-based Council for Scientific
and Industrial Research).
Mark Schoofs, "How HIV Caught Fire in South Africa", Village
Shillinger, ibid., 10/12/99.
Schoofs, ibid., 08/19/00.
Schoofs, ibid., 08/19/00.
Schoofs, "An American Pharmaceutical Giant Offers to Donate an
AIDS Drug to South Africa", Village Voice. 04/4-10/00.
Johanna McGeary, "Paying for AIDS Cocktails who should pick up
the tab for the Third World?", Time Special 2001.