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Southern Africa: Gender and AIDS

AfricaFocus Bulletin
Dec 3, 2004 (041203)
(Reposted from sources cited below)

Editor's Note

"If we can stop the spread of HIV among women and girls in southern Africa, we can turn the epidemic around. ... gender inequality fuels HIV infection because many women and girls cannot negotiate safer sex or turn down unwanted sex. ... HIV/AIDS deepens and exacerbates women's poverty and inequality because it requires them to do more domestic labour as they care for the sick, the dying and the orphaned." - United Nations Secretary General's Task Force on Women, Girls and HIV/AIDS in Southern Africa

This AfricaFocus Bulletin contains excerpts from this task force report, released in July this year. While the report echoes the same themes as the annual AIDS Epidemic Update from UNAIDS, it is considerably more specific, laying out strategies and recommendations for addressing six areas in which gender inequality fuels the AIDS pandemic. The report stresses that it is time to move beyond general awareness of gender issues to specific steps to enable girls and women to defend their rights more effectively.

Another AfricaFocus Bulletin sent out today contains excerpts from the UNAIDS Epidemic Update for 2004.

Additional resources on gender, AIDS, and violence against women are available at http://www.genderandaids.org and http://www.who.int/gender/violence/sixteendays/en

For previous AfricaFocus Bulletins on AIDS and other health issues, visit http://www.africafocus.org/healthexp.php

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

Facing the Future Together

Report of the United Nations Secretary-General's Task Force on Women, Girls and HIV/AIDS in Southern Africa

[Excerpts only. The full text of the report is available at http://www.genderandaids.org/modules.php?name=News&file=article&sid=432 ]

Preface

... As early as the 1980s, development workers and gender activists were beginning to recognise that HIV/AIDS would have especially severe implications for women. By the middle of the decades, the Society for Women and AIDS in Africa (SWAA) was beginning to mobilise women in the fight against AIDS. By June 2001, it was clear that women, particularly in Africa, were beginning to strain under the pressure of high infection rates and increased workloads due to AIDS. The United Nations General Assembly Special Session on HIV/AIDS declared that "women and girls are disproportionately affected by HIV/AIDS" and committed UN member states to a set of actions to reduce the impact on women and girls, and promote and protect their human rights.

A year later, at the Barcelona International AIDS Conference in July 2002, Stephen Lewis, the United Nations Secretary General's (UNSG) Special Envoy on HIV/AIDS in Africa said, "The toll on women and girls is beyond human imagining; it presents Africa and the world with a practical and moral challenge, which places gender at the centre of the human condition. The practice of ignoring gender analysis has turned out to be lethal For the African continent, it means economic and social survival. For the women and girls of Africa, it's a matter of life or death." It was a plea that went largely unheard.

In January 2003, Mr. Lewis, accompanied by James Morris, Executive Director of the World Food Programme and the UNSG's Special Envoy for Humanitarian Needs in Southern Africa, visited Lesotho, Malawi, Zambia and Zimbabwe in a joint effort to tackle the unprecedented humanitarian crisis in southern Africa caused by the interlinkages between HIV/AIDS, food insecurity and weakened government capacity. Their mission report highlighted the impact of the crisis on the women of southern Africa, stating that "very little is being done to reduce women's risks, to protect them from sexual aggression and violence, to ease their burdens or to support their coping and caring efforts." The envoys recommended that an "immediate, strongly led and broadly implemented joint effort to take action on gender and HIV/AIDS must be initiated without delay. The effort should feature leadership from the United Nations, the active engagement of governments and substantially increased support to civil society organisations, including remarkable grassroots initiatives."

... The United Nations Secretary General immediately requested UNICEF Executive Director Carol Bellamy to set up a Task Force to respond to this recommendation.

A planning meeting in Johannesburg, South Africa, bringing together global, regional and country level representatives from the United Nations, resulted in Terms of Reference for the Task Force focusing on six issues, within a broad gender framework:

  1. Prevention of HIV/AIDS among young women and girls
  2. Girls' education
  3. Violence against women and girls
  4. Property and inheritance rights of women and girls
  5. The role of women and girls in caring for those infected and affected by HIV/AIDS
  6. Access to HIV/AIDS care and treatment for women and girls

It was agreed that the Task Force would focus on the nine countries in southern Africa most severely affected by HIV/AIDS Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. ...

Moving Forward

This report and its recommendations are rooted in the experiences and insights of people grappling with these challenges on the ground, supplemented by information from existing literature and discussions with individuals working on human rights, gender and development, and HIV/AIDS within and beyond the sub-region.

In most countries the visits have already catalysed increased action on Task Force issues. It is hoped that the recommendations and substance of this report continue to inspire accelerated action.

Executive Summary

"I don't want to die before I'm 110 with great grandchildren. I don't want to die before I turn 25. I refuse to sit down and watch my generation fall to pieces. I am going to make a difference will you?" Rumbidzai Grace Mushangi, 15, Zimbabwe

If we can stop the spread of HIV among women and girls in southern Africa, we can turn the epidemic around. While HIV prevalence is high among all sexually active women, girls and young women are particularly affected - the vast majority of young people aged 15-24 living with HIV/AIDS in southern Africa are female. Even more worrying, data shows that many young women are being infected almost as soon as they start having sex.

The findings of the United Nations Secretary General's Task Force on Women, Girls and HIV/AIDS in Southern Africa show that gender inequality fuels HIV infection because many women and girls cannot negotiate safer sex or turn down unwanted sex. The findings also demonstrate that HIV/AIDS deepens and exacerbates women's poverty and inequality because it requires them to do more domestic labour as they care for the sick, the dying and the orphaned. Although the problems are complex, the Task Force has identified key actions in relation to its six focus issues, which can make an immediate difference:

1. Prevention among Girls and Young Women

We must collapse the bridge of infection between older men and younger women and girls. Many girls have sexual partners who are five to ten years older than them, and these men are more likely to be infected than boys and younger men. Relationships with older men are also more likely to be premised on unequal power relations, leaving girls vulnerable to abuse and exploitation.

[See brief excerpts below for more on this point. For more on points 2 through 6, see the full Task Force report]

2. Girls' Education

We must protect female enrolment figures AIDS may be taking girls out of school. Although gender parity has largely been achieved in educational enrolment in southern Africa, we need more information on the impact of the epidemic on the education of girls, particularly orphans.

3. Violence against Women and Girls

We must protect girls and women from the direct and long-term risks of HIV infection as a result of violence Girls and women who have been sexually assaulted are at increased risk of HIV infection, through direct transmission and because of the long-term effects of sexual violence on risk-taking behaviour

4. Property and Inheritance Rights

We must protect the rights of women and girls to own and inherit land

In Task Force countries there are but a handful of small initiatives by determined organisations that provide women and girls with legal education and advice or assistance to prevent dispossession or restore taken property.

5. Women and Girls as Care Givers

We must put in place a Volunteer Charter articulating the rights and responsibilities of women and men who provide care and support to the sick and orphaned. Communities, families, governments and development partners cannot continue to rely on 'women's resilience' to provide safety nets for the sick and orphaned.

6. Access to Care and Treatment for Women and Girls

We must address gender norms, violence, stigma and discrimination as potential barriers to women's access to care and treatment.

Although women may have greater access than men to anti-retroviral treatment through public health systems, they may miss out on treatment opportunities because of fear that their partners will discover their HIV status.

Gaps in the Response

The report highlights a number of important gaps in the response by governments, international agencies and civil society organisations identified by the Task Force:

  1. Many people know what the gender-based challenges facing women and girls are. However, the complexity of gender relations means that many find it difficult to focus on what exactly to do.
  2. Although girls and women represent the bulk of new infections, budgets, programmes, policies and human resource commitments do not reflect this. Many interventions continue to be aimed at an imaginary boy or man or a fictional gender-neutral public.
  3. Even organisations that are explicitly trying to address the problems of women and girls find it difficult to deal with the root causes of gender inequality. Because changes in gender relations occur slowly, not enough funding or attention is given to programmes that try to address the deeper connections between gender and HIV/AIDS.

Strategies that Work

After twenty years of HIV/AIDS programming, and thirty years of gender and development programming we know that applying the following approaches can yield success:

  • Challenging the social norms and values that contribute to the lower social status of women and girls and condone violence against them, e.g. through dramas and community-based educational initiatives;
  • Increasing the self-confidence and self-esteem of girls, e.g. through life-skills and other school-based programmes in which they are full participants;
  • Strengthening the legal and policy frameworks that support women's rights to economic independence (including the right to own and inherit land and property) e.g. by restructuring justice systems, enacting laws and training NGOs to popularise these laws;
  • Ensuring access to health services and education, in particular life skills and sexuality education for both boys and girls, e.g. by training health workers and teachers on gender, and re-orienting health and education systems so that they are flexible, participatory and community-centred rather than bureaucratic and hierarchical; and
  • Empowering women and girls economically, e.g by providing them with access to credit, and business, entrepreneurship and marketing skills.

Strengthening the Response

There are actions that can be taken today, which will make a significant difference. In order to expand the capacities of communities and of those working on HIV/AIDS programmes to do what is necessary to ensure the fulfilment of the rights of women and girls, the following actions are necessary:

  • We must expand the pool of gender experts. Despite the fact that many gender frameworks have been developed, not enough people know how to 'do gender' in other words, how to conduct a thorough gender analysis of the situation and design responses tailored to the different requirements of men, women, boys and girls. There is an urgent need to make the language of gender more practical and accessible to people at community and programme levels.
  • We must address the fears and resistance that surround gender. Some women's groups have argued that there has been little progress towards gender equality in some spheres because an honest analysis of power relations provokes discomfort or even active resistance on the part of some men. As a result, those who occupy decision-making positions in donor agencies, community-based organisations, households, governments and NGOs do not prioritise initiatives that seek to challenge the status quo.
  • We must support and strengthen local women's movements and organisations. Partnerships between governments, women's organisations and community-based organisations are crucial.
  • We must increase public awareness and debate about the relationship between gender inequality and HIV/AIDS.
  • We must address the causes of gender inequality, not only the consequences. In the weeks, months and years following this report, we must work with girls and women to thoroughly analyse their situation using a human rights- and gender-based approach. Together, we must devise strategies that fight HIV/AIDS and simultaneously address gender inequality. We must take this task seriously. To ensure success we must redirect existing resources and mobilise significant additional funds. And we must make sure these resources get to where they are most needed, to the women and the girls in the cities, towns and villages of southern Africa.


1. Prevention among girls and young women

Moving Forward

"As a man, I know men's behavior must change, that we must raise boys differently, to have any hope of eradicating H.I.V. and preventing the emergence of another such scourge . To change fundamentally how girls and boys learn to relate to each other and how men treat girls and women is slow, painstaking work. But surely our children's lives are worth the effort." - Pascoal Mocumbi, former Prime Minister, Mozambique

The ABC [Abstinence, Being Faithful, Condom Use] approach will only present viable options for girls if it is part of a multi-pronged package of interventions that take into consideration the problems girls and women face at the personal, household, family and community levels. These interventions must aim to empower girls and young women by building assertiveness and self-esteem, and through the development of inter-personal communication and leadership skills. Ensuring that girls and young women participate fully in designing and implementing programmes is a prerequisite to success.

Breaking the Silence

Communication strategies and life skills education
There is a need for better controls on the development and use of communication materials, to encourage a stronger emphasis on content rather than on producing T-shirts, caps and rulers. The gap between awareness of HIV/AIDS and the knowledge and skills involved in preventing HIV transmission, is still too large to allow for any wastage of resources.

Communication strategies that focus on creating an environment for interpersonal dialogue and debate, and which provide a voice to women and girls, are more effective than those that focus only on education through messages. Real individual and social change will only come about when people become truly engaged in talking about HIV, gender inequality, sexuality, culture and social norms, and in finding their own solutions to problems.

Schools are ideally placed to facilitate such communication through comprehensive life-skills and sexuality education, particularly considering high enrolment rates in the region. Communities too must play a role but may need support if they are to revive and improve on channels through which information was traditionally provided to young people (e.g from aunts to nieces, or from uncles to nephews). These community elders will require support to ensure that the information they provide is accurate and based on gender equality.

Services
For prevention to be effective, young women and men must also know where to go to seek appropriate health services. It is essential that health workers are trained to handle the questions, concerns and health problems of young people, particularly girls, in non-judgmental ways. Such training must be complemented by measures to relieve the stress on health workers facing increasing workloads and staff shortages. Furthermore, as more young women become infected, the need to develop services aimed at HIV-positive young people becomes more urgent.

Youth programmes that promote gender equality
In the southern African context of high levels of sexual violence and a generalized HIV/AIDS epidemic, programmes must take seriously the gender dynamics between young women and men. Dialogue between young women and young men should be encouraged. This will help ensure that young men are sensitised about respect, and learn to distinguish between appropriate and inappropriate sexual behaviour, and that young women are able to articulate what they want and like, as well as what makes them uncomfortable. This dialogue should serve to facilitate platonic friendships between boys and girls, which is something the UNICEF regional study showed is particularly difficult for them.

Young men often feel rejected by young women because they cannot compete against older men who have disposable income. As one young man in South Africa asked rhetorically during the country visit, "I'm at the desk, she's at the desk, what can I offer her?" Both girls and boys need to be encouraged to contemplate relationships in which boys are not expected to provide economically and take the sexual initiative, as this perpetuates gender inequality and the 'sugar daddy' phenomenon.

Ending Exploitative Relationships

Intergenerational sex is clearly a risk factor for girls, and becomes one for young men and boys who may later marry or become sexually involved with women who were infected early in their sexual lives, as well as for the children these women bear. Research has confirmed that intergenerational sex "has a pivotal role in the persistence of major epidemics Breaking this link in the pattern of transmission must become a central focus of HIV prevention strategies." As Task Force member Unity Dow said, "we need to collapse the bridge of intergenerational sex between our girls and older men."

The challenge is to change sexual and gender norms through advocacy, gender socialisation of young people and education, so that sex between older men and younger women becomes less accepted. At the same time, social and economic conditions should be created that give choices to girls who may be economically reliant on older men. In all this extreme care must be taken not to place the blame on girls. The onus is on adults to stop engaging in potentially exploitative relationships.


AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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