Women suffer most in AIDS fight; Africa's losing battle takes its heaviest toll on females
By, Mary Katherine Keown, The Sudbury Star, June 13, 2007
She was 27 years old, a single mother of two young children, and had only days to live. Theresia, a former prostitute, was dying of AIDS.
She was frail, weak and had been sick for a long time. She went to the hospital and was tested for HIV. She tested positive, but was sent away without treatment, or pain medication, because she was not a suitable candidate for anti-retroviral treatment.
"It was disgusting," says Madeline Johnson, a Canadian CUSO co-operant working at Uhai Centre, about her visit to Theresia. "She had skeletal hands, and was a pile of ribs and tiny boobs. We prosecute people for allowing animals to live like that, with those kinds of problems. How is it OK to allow humans to live like that?" Uhai Centre is a frontline, Arusha, Tanzania-based agency that works with HIV-positive people, particularly women, orphans and vulnerable children.
Theresia was confined to a filthy foam mattress. She was unable to wear a skirt or pants because of genital infections, and could not speak because of severe thrush. She was given medications for her opportunistic infections, but died 10 days after the Uhai team visited her.
"When the five-year-old picked up the two-year-old and walked out of the room, I saw their future," Johnson says, close to tears.
"It was awful. I have no idea what's happened to those children or whether they're even eating."
HIV is indiscriminate, but in sub-Saharan Africa, and Tanzania in particular, it is an infection that targets women.
It was not always this way.
As in most other regions of the world, HIV initially infected more men than women, but because of the nature of African society, it has become an overwhelmingly feminized illness.
"From the beginning of the AIDS crisis in sub-Saharan Africa, the epicentre of the epidemic, the number of infected women has been growing more rapidly than that of infected men," writes Michael J. Kelly, a Zambia-based priest, in The Female Face of HIV and AIDS.
The article is used as part of an annual lecture delivered through Trocaire, the official overseas development agency of the Catholic church in Ireland.
"The widening gap between the numbers of infected women and men, especially in recent years, provides a dramatic illustration of the increasingly female face of the epidemic," Kelly says. "By the end of 2006, an estimated 59 per cent of infected adults in the region (sub-Saharan Africa) were women. For every 10 infected adult men, there were more than 14 infected adult women.
"This gender differential has arisen partly because HIV transmission in sub-Saharan Africa occurs mainly as a result of heterosexual activity, and partly because of the extensive gender inequality experienced in the region.
"In other regions of the world, where transmission occurs mainly through homosexual activity, injection drug use or commercial sex work, men are still more likely than women to be infected with HIV." There are several reasons HIV/AIDS has been feminized in sub-Saharan Africa, including the severe economic disparities that exist between the affluent and the poor. Nearly 60 per cent of Tanzanians live on less than US$2 per day, or US$730 annually, according to the 2006 UNAIDS Report on the global AIDS epidemic. This extreme poverty has been a major factor driving the HIV/AIDS epidemic in Tanzania.
The UNAIDS report indicates that, at the end of 2005, Tanzania had an HIV prevalence rate of approximately 6.5 per cent. Of those living with HIV/AIDS, approximately 55 per cent were women aged 15 and above, up from 52 per cent in 2003.
Traditional gender roles have contributed to the spread of HIV among women. AIDS impacts women differently than men, and poverty and violence make women more susceptible to HIV infection.
"Poverty makes women dependent on men," Johnson says. "Because of that, they must endure violence, including sexual violence. The thing is, in marriage, most men don't feel the need to use condoms. They feel entitled to sex.
"For example, Elizabeth, a client at the Uhai Centre, married out of economic necessity.
Her new husband beat her and her three children, who were severely malnourished. Uhai Centre finally intervened and sent the three oldest children to live in an orphanage. When Elizabeth and her youngest child were tested for HIV, they both tested positive."
Julius Sabuni, a lawyer, and the human rights and advocacy officer at the Eastern Africa National Networks of AIDS Service Organization (EANNASO), agrees with Johnson's assertions.
"Generally, women and children - particularly girl children - are most affected by HIV," Sabuni says. "Historically, women have borne the brunt of community social life. The gender inequalities that exist, and have existed for a long time, have made women carry the burden of day-to-day household chores and socio-economic life, in general.
"They are the ones who care for the sick when people fall sick due to HIV infection. Because the medical system cannot cater to HIV/AIDS patients adequately, most patients are cared for in their homes. It is women who care for the sick."
The virus also infects more women than men.
"Socio-economic factors (that contribute to risk of HIV infection) include the power to negotiate sex, which, of course men have and women lack, in our context," Sabuni explains. "It is the men who make the advances and it is the men who decide whether or not to put on a condom. Because of the economic power that men have and women lack, it is always men who decide."
In Tanzania, marriage has emerged over the last decade as a major risk factor for HIV infection.
"HIV is common among sex trade workers, but the prevalence rate has fallen," Sabuni explains. "The prevalence rate among married couples has risen. Ten years ago, sex workers used to die and were affected very much, but nowadays commercial sex workers are not as high-risk as married people."
Sabuni also attributes the high prevalence of HIV infection among women in sub-Saharan Africa, in part, to traditional practices, such as widow inheritance and spear sex.
While little scientific evidence exists to support this thesis, Sabuni points out that numerous studies have indicated these practices, particularly widow inheritance, put women at higher risk for infection.
"There are many cultural practices in Africa that are believed to contribute to HIV infection," Sabuni says. "There is the practice of widow inheritance in some communities in Tanzania, whereby you find a brother of the deceased husband inheriting the widow of his late brother, allegedly to take care of the family. The inheritor takes on all the responsibilities, including having children with the widow."
For many women, particularly low-income, rural-dwelling and/or poorly educated women, being inherited is not a choice; it is the only way they can continue to support their families.
"Women, particularly, have suffered the most when it comes to discrimination and HIV/AIDS," Sabuni asserts. "They have been denied inheritance. This is a violation of human rights - a number one violation of human rights. They have also been denied property after their husband has died."
Spear sex, although less common now than in the past, is still practiced by some tribes in Tanzania and is also believed to put women at elevated risk of HIV infection.
"There is a practice, which the Masai call 'spear sex,' in which women are shared among male members of the community," Sabuni says. "Men will go to a homestead and if the husband is not there, the visitor will stick a spear in the ground at the front of the house. He will go in and have sex with the woman, if they are of the same age group.
"The practice has existed for some time and now we are seeing its negative results."
Sabuni says that, while awareness-raising campaigns have made some progress in eradicating spear sex and widow inheritance, they continue among the Masai (a semi-nomadic tribe present in several eastern African countries) and in some other tribes, and contribute to the growing number of HIV infections in southern and eastern Africa.
Theresia was a former prostitute.
She died of AIDS, alone on a filthy mattress surrounded by the evidence of her impoverished life. The virus, however, did not target her - entirely - because of her lifestyle or her socio-economic class. Theresia's major risk factor was, simply, her gender.
Source: http://www.thesudburystar.com/webapp/sitepages/content.asp?contentid=568167&catname=Local+News&classif=
She was 27 years old, a single mother of two young children, and had only days to live. Theresia, a former prostitute, was dying of AIDS.
She was frail, weak and had been sick for a long time. She went to the hospital and was tested for HIV. She tested positive, but was sent away without treatment, or pain medication, because she was not a suitable candidate for anti-retroviral treatment.
"It was disgusting," says Madeline Johnson, a Canadian CUSO co-operant working at Uhai Centre, about her visit to Theresia. "She had skeletal hands, and was a pile of ribs and tiny boobs. We prosecute people for allowing animals to live like that, with those kinds of problems. How is it OK to allow humans to live like that?" Uhai Centre is a frontline, Arusha, Tanzania-based agency that works with HIV-positive people, particularly women, orphans and vulnerable children.
Theresia was confined to a filthy foam mattress. She was unable to wear a skirt or pants because of genital infections, and could not speak because of severe thrush. She was given medications for her opportunistic infections, but died 10 days after the Uhai team visited her.
"When the five-year-old picked up the two-year-old and walked out of the room, I saw their future," Johnson says, close to tears.
"It was awful. I have no idea what's happened to those children or whether they're even eating."
HIV is indiscriminate, but in sub-Saharan Africa, and Tanzania in particular, it is an infection that targets women.
It was not always this way.
As in most other regions of the world, HIV initially infected more men than women, but because of the nature of African society, it has become an overwhelmingly feminized illness.
"From the beginning of the AIDS crisis in sub-Saharan Africa, the epicentre of the epidemic, the number of infected women has been growing more rapidly than that of infected men," writes Michael J. Kelly, a Zambia-based priest, in The Female Face of HIV and AIDS.
The article is used as part of an annual lecture delivered through Trocaire, the official overseas development agency of the Catholic church in Ireland.
"The widening gap between the numbers of infected women and men, especially in recent years, provides a dramatic illustration of the increasingly female face of the epidemic," Kelly says. "By the end of 2006, an estimated 59 per cent of infected adults in the region (sub-Saharan Africa) were women. For every 10 infected adult men, there were more than 14 infected adult women.
"This gender differential has arisen partly because HIV transmission in sub-Saharan Africa occurs mainly as a result of heterosexual activity, and partly because of the extensive gender inequality experienced in the region.
"In other regions of the world, where transmission occurs mainly through homosexual activity, injection drug use or commercial sex work, men are still more likely than women to be infected with HIV." There are several reasons HIV/AIDS has been feminized in sub-Saharan Africa, including the severe economic disparities that exist between the affluent and the poor. Nearly 60 per cent of Tanzanians live on less than US$2 per day, or US$730 annually, according to the 2006 UNAIDS Report on the global AIDS epidemic. This extreme poverty has been a major factor driving the HIV/AIDS epidemic in Tanzania.
The UNAIDS report indicates that, at the end of 2005, Tanzania had an HIV prevalence rate of approximately 6.5 per cent. Of those living with HIV/AIDS, approximately 55 per cent were women aged 15 and above, up from 52 per cent in 2003.
Traditional gender roles have contributed to the spread of HIV among women. AIDS impacts women differently than men, and poverty and violence make women more susceptible to HIV infection.
"Poverty makes women dependent on men," Johnson says. "Because of that, they must endure violence, including sexual violence. The thing is, in marriage, most men don't feel the need to use condoms. They feel entitled to sex.
"For example, Elizabeth, a client at the Uhai Centre, married out of economic necessity.
Her new husband beat her and her three children, who were severely malnourished. Uhai Centre finally intervened and sent the three oldest children to live in an orphanage. When Elizabeth and her youngest child were tested for HIV, they both tested positive."
Julius Sabuni, a lawyer, and the human rights and advocacy officer at the Eastern Africa National Networks of AIDS Service Organization (EANNASO), agrees with Johnson's assertions.
"Generally, women and children - particularly girl children - are most affected by HIV," Sabuni says. "Historically, women have borne the brunt of community social life. The gender inequalities that exist, and have existed for a long time, have made women carry the burden of day-to-day household chores and socio-economic life, in general.
"They are the ones who care for the sick when people fall sick due to HIV infection. Because the medical system cannot cater to HIV/AIDS patients adequately, most patients are cared for in their homes. It is women who care for the sick."
The virus also infects more women than men.
"Socio-economic factors (that contribute to risk of HIV infection) include the power to negotiate sex, which, of course men have and women lack, in our context," Sabuni explains. "It is the men who make the advances and it is the men who decide whether or not to put on a condom. Because of the economic power that men have and women lack, it is always men who decide."
In Tanzania, marriage has emerged over the last decade as a major risk factor for HIV infection.
"HIV is common among sex trade workers, but the prevalence rate has fallen," Sabuni explains. "The prevalence rate among married couples has risen. Ten years ago, sex workers used to die and were affected very much, but nowadays commercial sex workers are not as high-risk as married people."
Sabuni also attributes the high prevalence of HIV infection among women in sub-Saharan Africa, in part, to traditional practices, such as widow inheritance and spear sex.
While little scientific evidence exists to support this thesis, Sabuni points out that numerous studies have indicated these practices, particularly widow inheritance, put women at higher risk for infection.
"There are many cultural practices in Africa that are believed to contribute to HIV infection," Sabuni says. "There is the practice of widow inheritance in some communities in Tanzania, whereby you find a brother of the deceased husband inheriting the widow of his late brother, allegedly to take care of the family. The inheritor takes on all the responsibilities, including having children with the widow."
For many women, particularly low-income, rural-dwelling and/or poorly educated women, being inherited is not a choice; it is the only way they can continue to support their families.
"Women, particularly, have suffered the most when it comes to discrimination and HIV/AIDS," Sabuni asserts. "They have been denied inheritance. This is a violation of human rights - a number one violation of human rights. They have also been denied property after their husband has died."
Spear sex, although less common now than in the past, is still practiced by some tribes in Tanzania and is also believed to put women at elevated risk of HIV infection.
"There is a practice, which the Masai call 'spear sex,' in which women are shared among male members of the community," Sabuni says. "Men will go to a homestead and if the husband is not there, the visitor will stick a spear in the ground at the front of the house. He will go in and have sex with the woman, if they are of the same age group.
"The practice has existed for some time and now we are seeing its negative results."
Sabuni says that, while awareness-raising campaigns have made some progress in eradicating spear sex and widow inheritance, they continue among the Masai (a semi-nomadic tribe present in several eastern African countries) and in some other tribes, and contribute to the growing number of HIV infections in southern and eastern Africa.
Theresia was a former prostitute.
She died of AIDS, alone on a filthy mattress surrounded by the evidence of her impoverished life. The virus, however, did not target her - entirely - because of her lifestyle or her socio-economic class. Theresia's major risk factor was, simply, her gender.
Source: http://www.thesudburystar.com/webapp/sitepages/content.asp?contentid=568167&catname=Local+News&classif=
posted by AIDS-Care-Watch at 11:51 am
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