HIV/AIDS prevention in developing countries: Examining the justification for putting

gender inequality at the heart of prevention policies.

By Dr. Ignatius Gwanmesia

Abstract
This analysis provides objective arguments to counter the blame ideologies that
indiscriminately posit women’s at-risk behaviour as central to the ineffectiveness of
the anti-HIV/AIDS agenda. The fulcrum of the debate is that as victims of an
institutionally gender-discriminatory society whose structural barriers is significantly
compromising the global struggle against HIV/AIDS, addressing issues of gender-
inequalities, especially in developing countries will empower women to take
responsibility for their health. Holistically, complimenting this ‘health’ approach with
systematic sensitisation programmes should arguably let to enhance outcome in
efforts to prevent the spread of HIV/AIDS.

Introduction

Hitherto, the decline of infectious diseases especially amongst the marginalised

sectors of our society was attributed primarily to medical advances and better
sanitary living conditions. Mckeown, (1976). Indeed, structural barriers like
unavailability of services or provider resistance were alien concepts. In today’s rather
regimented, urbanised, increasingly segregated and more promiscuous society,
those infectious diseases like malaria and smallpox have been replaced by equally
lethal coronary disease, cancer, HIV/AIDS, mental illness and other pathologies.
Prevalently, discourses on these so-called diseases of the affluent especially
HIV/AIDS are presented as if they reflect the problems of a homogenised society;
obscuring the reality of class and the impact of social inequality on health. To date,
not just feminists but critical analysts perceive gender discrimination, especially in
developing countries as significantly responsible for the ineffectiveness of initiatives
to prevent the spread of the HIV/AIDS pandemic. Mutangura, (2002, p. 3); Human
Rights Watch, (2003). Describing the lethality and impact of HIV/AIDS especially on
women as “raging with a Darwinian ferocity in Sub Sahara Africa (SSA)”, Stephen

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Lewis, (2004) further asserted that “gender inequality is what sustains and nurtures
the virus”. Referring to the debilitating and gender-induced affliction of women from
HIV/AIDS, Kofi Annan, (2002)’s observation about HIV/AIDS and SSA women was
reiterated by Lewis, (2004) who stated that, “the saddest thing is that the pandemic
increasingly has a women’s face; gender inequality in the face of AIDS is fatal.”
While Payne, (2000, p.63) asserts that ‘there is no society in which men and women
are equal”, or “a society that is not patriarchal”, Goldberg, (1977, p. 26); it is
suggested that “The reason that AIDS has escalated into a pandemic is because
inequality between women and men continues to be pervasive and persistent; there
is a direct correlation between women's low status, the violation of their human rights
and HIV transmission” Heyzer, (2001). As Lewis, (2002) observed, “The challenge
of protecting women and girls from AIDS-related human rights abuses is enormous.
The abuses are many and varied, including rape within and outside of marriage,
other sexual violence and coercion often abetted by poverty, domestic violence,
unequal property and inheritance rights, divorce laws that exacerbate women’s
economic dependence on their husbands, and discriminatory barriers to education
and health services.”
The paradox about the blame ideologies in fighting HIV/AIDS is that while the gender
gap is ever-widening with women being given tokenistic vestige of ‘equality’; and
people engaging in sex more for recreation rather than procreation, society expects
women to be responsible for their health. So to what extent will empowering women
catalyse the prevention of HIV/AIDS? Africa is the stage and women the actors, let
the play begin. My hypothesis is that, without addressing the narrowness of the
political and medical models of changing lifestyle and individual behaviour without
changing the social and economic structures that has disempowered women, the
overall efforts to prevent the spread of HIV/AIDS epidemic will be futile.”

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 Definition

“HIV (human immunodeficiency virus) is the retrovirus that may lead to AIDS
(acquired immune deficiency syndrome). Ogden, (2004, p. 329). HIV damages the
body’s defence (immune system), making it more vulnerable to the effects of
opportunistic infections” Thomas and Pierson (1999, p. 169). Once HIV enters the
body, it weakens the immune system so that the infected person can no longer fight
off life-threatening illnesses such as tuberculosis or rare forms of pneumonia or
meningitis- what are called opportunistic infections” Fitzsimons et al, (1995, p. 13).

Gender inequality - theorised on power relationship, ‘Gender’ -the sexual

differentiation of human beings as male or female becomes a social concern or
“gender segregation when we ascribe particular social significance to these
differences and allot roles accordingly so that they become a matter of social
construction rather than biological determination.” Burr, (1995, p. 12). In gender
inequality, the disproportional power dynamics between the male and female human
beings is perceived as discriminatory and exploitative of the latter. Hooper and
Dryden, (1994, p. 165).

Background.

To date legal documents like;

- “the United Nation Declaration of Human Rights;
- Goal 3 of the Millennium Development Goals to promote gender equality and
empower women;
- goal 6 which aims to combat HIV/AIDS” Mutangura, (2002, p. 2) and
- the specific 1979 ‘United Nation Convention on the Elimination of All forms of
Discrimination against Women’ (CEDAW)” Mutangura, (2002, p. 3)
have provided the framework for approaching the prevention of HIV/AIDS from a
gender neutral perspective. Despite these, the experiences of women diagnosed as
HIV/AIDs positive in accessing relevant services show that gender inequality is not
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prioritised on most HIV/AIDS policy agendum. Kaye, (2004, p. 1); UNAIDS, (2004);
CUSS, 2006, p. 16). In fact according to Human Right Watch, (2002) “gender
inequality still constitutes the most significant constraint in the struggle to prevent
the spread of the disease” For example in Sub Sahara Africa girls and women face
numerous human rights abuses at all stages of life;
- “as children, violations of their childhood and their innocence; that have exposed
them to sexual assault and sexual coercion;
- as adults, in long-term unions where decision-making authority over sex is too
rarely theirs and where economic dependence and inequality under the law limit
their options for redress;
- in widowhood where gender discrimination is the rule rather than the exception
for inheritance and control of property;
- and in war and civil conflict where rape is used strategically as a weapon.”

Attributing these right abuses predominantly to poverty and inherent cultural

practices, Human Right Watch, (2002) pointed out that “thousands of women and,
hundreds of thousands of girls, including many orphaned by AIDS or otherwise
without parental care, suffer in virtual silence as governments fail to provide basic
protections from sexual abuse that would lessen their vulnerability to HIV/AIDS.” It
is the reality of these female’s circumstances; the visible lack of systematic remedial
policies; the legal imperative to comply with relevant legislations; and the recognition
of “the central role that women play in sustaining livelihoods and therefore the
nations wellbeing” Mutangura, (2005, p.11) that make it imperative to put the
addressing of gender inequality at the heart of HIV/AIDS prevention policies.

Sub Sahara Africa (SSA), Poverty and HIV/AIDS.

My decision to focus but not limit this discourse solely to the visibly impoverished
Sub Sahara Africa is because the “incidence and prevalence of the HIV/AIDS
amongst women in SSA is more acute here than anywhere in the world” Kaye,
(2004, p. 1); Michiels, (2001). Indeed “almost 14 million of the 18 million women
living with HIV/AIDS worldwide live in sub-Saharan Africa.” Lobe, (2004).
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Furthermore, as an indigene of SSA, my in-depth knowledge of the cultures and their
marginalising impact on females gives me a privileged and in-depth knowledge of
the female’s marginalised status. Supplementing this experience, studies amongst
various populations by United Nation’s organisations in SSA are consensual that “as
elsewhere in Africa where poverty-stricken female care-givers lack appropriate exit
options out of abject deprivations, “women are at a greater danger of HIV infection
because they lack agency to refuse high-risk sexual encounters”
http://www.comminit.com/en/node/220072/38. The overarching determinant of
women’s dependency is consensually seen as poverty that leads to social exclusion.
According to Kaye, (2004, p. 4), the problem with poverty in gender inequality
discourses is that poverty seems to be a factor in every aspect of deprivation in
developing countries; although not homogeneously. More so, the notion of poverty is
a social construct; problematic to qualify as well as quantify. Poverty aside, to date
the WHO, (2000) also attributes the failure to adequately address gender inequality
in the prevention of HIV/AIDS partly in SSA to the “lack of systematic data on the
relationship between HIV/AIDS and gender inequality” Yet, further, studies by the
World Health Organisation (WHO) cited in Williams, (1997) posits gender inequality
as “a central and an empirically and robust predictor of variations in morbidity and
mortality of persons infected with HIV/AIDS.” Humanitarian gestures aside; and from
a social as well as economic perspective, social economists see women as nurturers
of the family (the foundation of society) and therefore the pillar that supports nations.
CUSS, (2006, p. 4). With the ravages of HIV/AIDS exacerbating women’s already
chronic deprivation, if the current trend of increasing HIV/AIDS female infection is not
addressed, then gradually it is all the fabric of society that would be decimated.
Thus, while there is still time, preventative policy initiatives need to prioritise the
addressing of “institutional, social and economic constraints that limit women’s ability
to cope with the epidemic” http://www.jendajournal.com/issue7/mutangura.html. Now
which are the areas of significant concerns? Principally, most of the arguments in
this discourse are theories from a human rights perspective.

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 Loss of inheritance rights

In most poverty-ridden developing countries, women’s right to land and property is

the primary step necessary to promote gender parity; the absence of which directly
impacts on the women’s ability to meet household food needs through own
production” FAO, (2004). Studies in subsistence SSA show that, “access to,
ownership of, and control over property are fundamental determinants of secure
livelihoods; providing a secure place to live, a site for economic and social activity,
and collateral for credit and other resources and services essential to prevent and
mitigate HIV/AIDS” Aliber et al (2004); Strickland 2(004). Yet prevalently in
patriarchal Africa, the chronic gender inequality means that women, especially
widows often are denied this basic resource that would have “allowed them to
improve their chances of preventing infection or enhance their capacity to mitigate
the consequences of HIV/AIDS” UNAIDS, (2004). Even where women are privileged
to access land or actually work, there is consensus that their land control or wages
respectively are significantly compromised. Strickland 2(004); Mutangura, (2002, p.
11) In fact radical feminist conceive the work environments even within subsistence
environment as bastions of male power which will consistently act to promote the
interest of men.” Alcock et el, (2000, p. 98). Comparing women’s inheritance rights in
SSA to those of Western nation, the paradox is that while male next of kin are able to
inherit the widows in SSA, the unequal property and inheritance laws deny AIDS
widows the right to the deceased’s property. As observed by Fortmann, (2001),
“women’s uncertain access to land credit and education denies then exposure to and
control of new technologies that might help them out of the mire of poverty” Bearing
in mind that these women, especially widows usually care for other children
orphaned by HIV/AIDS, the unlawful appropriation of the property of AIDS widows
and orphans by relatives or others in the “community” can be so marginalising that
they sink into destitution. Studies have shown that “the absence of any systematic
land inheritance right laws based of Western models is a significant causation of
female dependency and the resolve to prostitute.” UNAIDS, (2004). FAO, (2004). For
example in Lesotho, South Africa, Kenya, Tanzania and Malawi where the impacts of
HIV/AIDS on land tenure systems have been studied, one major impact of the
epidemic was identified to be “the increase in the vulnerability of women, children
and poor households to dispossession by patrilineal kin on the death of male

6
household heads” Aliber et al, (2004), Strickland, (2004), FAO, 2004). The resulting
life options which predominantly consist of selling or exchanging sex for money and
other forms of child abuse heighten their risk of contracting HIV/AIDS. Similarly,
UNAIDS, (2002, p. 190) points out that “Children’s deprivation when denied their
inheritance rights is compounded by the paucity of options they have for legal
recourse.” Expounding on the plight of these homeless children, Savenstedt et al.,
(2000) assert that most resort to life on the streets where most girls are preyed upon
by paedophiles and traffickers; maximising their risk of contracting HIV/AIDS. The
gender-biased obstacles for victims attempting to assert their rights to property or
inheritance include, “fear of violent reprisal, sluggish bureaucracies and official
indifference” UNAIDS, (2004). As such, these victims of dispossession lack
recourse. The main recommendation emerging from the various studies is “the need
to draw up and prioritise legislation that can protect the land rights of women and
children in policies seeking to address HIV/AIDS. Aliber M, et al., (2004)

HIV/AIDS and prostitution.

In Africa as in the rest of the developing world, it is suggested that, “AIDS has a
woman’s face” http://www.jendajournal.com/issue7/mutangadura.html. In this
seemingly gender-biased statement, women are not only synonymised with
HIV/AIDS, they seem to be blamed for it. In fact, in Sub Sahara Africa, sex workers
are the personification of HIV/AIDS despite the reality that prostitution can only
persist if it satisfies the economic law of supply and demand; prostitution will not
exist without the demand for recreational sex. According to Wilton, (1992, p.56),
“prostitution is not primarily a moral issues but an economic one” derived principally
from women’s lack of appropriate survival options. The resolve to prostitute has
generally been explained by “women’s limited access to economic and social
resources which renders them dependent on men to provide for them.” Fieldhouse,
(2003, p. 8). The reality in the safeguarding of oneself against the potential infection
with HIV/AIDS is that “women who use sex in exchange for gifts, money or services

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have difficulty negotiating safer sex, as well as obtaining adequate health services”
AIDS Infothek (2000, p. 24). According to WHO, (2000) “these women serve as an
important source of HIV infections for their male clients, once infection is
established.” According to the World Bank (2000), “the role of prostitutes in the
sexual transmission of HIV in Africa is apparent from various studies.” For example
in Africa, the highways serving the multi-national extractive industries have become
red-light environments where;
- The development of prostitution to service truck drivers on transcontinental
trade routes is one example of the ways in which travel interacted with sexual
activity to further the transmission of HIV”

Fieldhouse, ( 2003, p. 9)

While not ignorant of the heighten risk involved in unsafe sex, especially in
prostitution, the WHO, (2000) suggest that “women’s destitution and desperation to
sustain themselves and their families in spite of the visible lack of basic resources in
times of increasing demand on their nurturing services are directly correlated to the
ramifications of gender inequality”. According to UNAIDS, (2004) it is the resulting
dependency and the remedial lifestyle and practices that heightens women’s risk of
contracting HIV/AIDS. Citing the powerlessness to enforce the use of protective
measures like condoms to prevent infection, UNAIDS, (2004) argues that the power
deferential between the man and woman deprives the latter of the right to enforced
safe practice. In SSA where women are perceived and treated as the properties of
their husbands; thanks to the dowry system “the power dynamics of heterosexuality
make it difficult or impossible for women to protect themselves from HIV” Doyal et
al., (2004 p. 3); Wilton, (19923, p. 61). While the logical empowering policy
suggestion would be to initiate and implement policies that would reduce female
dependencies; giving them the assertiveness to make safety and informed decisions
in sexual matters, some analysts rather advocate “the education of men to reduce
their risky lifestyles of multiple partners in addition to the use of condoms in high risk
encounters.” Fieldhouse, (2003, p.10). Nevertheless, and bearing in mind that two-
third of the world’s illiterates are women; WHO, (2000); that by being mostly
economically dependent they are vulnerable and powerless, World Bank, (2000),
any anti HIV/AIDS policy that is underpinned solely on employing women’s
assertiveness to safeguard them against possible infection is bound to be futile.

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 Patriarchy, the African woman and HIV/AIDS

My argument on patriarchy are theorised on the disproportionate and prevalently

exploitative power dynamics between men and women in developing countries.
Cognisant of the reality that global societies are essentially patriarchal, Goldberg,
(1977, p. 26); there is plausible logic to infer that “the power deferential in
heterosexuality makes it difficult or impossible for women to be assertive-enough to
protect themselves from HIV/AIDS in sexual encounters” Doyal et al., (2004 p. 3);
Wilton, (19923, p. 61). The reasons for this are not hard to locate since “two-third of
the world illiterates are women; WHO, (2000); a situation that deprives them of the
means to access independent lives. Their resulting dependency and destitution
means that these women are compelled by circumstance rather than by choice into
lifestyles and actions that heightens their risk of contracting HIV/AIDS. For example,
where the use of condoms would have mitigated the spread of HIV, there is
consensus that male dominance vis-a-vis women’s powerlessness or oppression
means that women are subordinated into risky unprotected sex. Wilton, (1992, p.
61). As Awasum, (2006, p. 12) points out, in most Sub Saharan cultures, it is the
norm rather than the exception for women who attempt to assert their preferences
within a heterosexual relationship to be “socially ostracised, turned out by their
partners or husbands, beaten up, raped or even killed for trying to refuse sex.”
Studies carried out under the traditional gender relations in Botswana show that,
“women take significant economic and psychological risks when they refuse to have
sex or unprotected sex. By refusing sex or insisting on condom use women may be
denied or thrown out of marriage and lose the privileged social status and financial
security of married women” Lunga. (2002),
http://www.comminit.com/en/node/220072/38. Within this context, until appropriate
legislations are put into place to address these gender-discriminatory practices with
a corresponding framework to enforce and monitor outcomes, the ramifications of
these women’s HIV/AIDS plight will have far-reaching social, economic and political
repercussions both within and beyond their indigenous states.

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 HIV/AIDS and the Virgin Myth.

In those African cultures where there is the myth that sex with a virgin can either
safeguard against HIV/AIDS infection or actually cure the disease, UNAIDS (2004)
noted that not only are men increasingly raping girls, children are similarly being
sexually abused. Studies suggest that, “these human right abuses are responsible
for the comparatively high incidences of HIV/AIDS infection in South Africa.” Heyzer,
(2002) Michiels, (2001). WHO, (2000). While most nations treat rapes as criminal
offenses, until developing countries actually enforced punitive legislations to deter
perpetrators, the economic and social cost to the general wellbeing of the respective
nations could be catastrophic. Similar attention also needs to be paid to the practice
of genital circumcision or mutilation. Apart from the fact that such practices invade
the personal privacy of girls this non-medical interventions using rudimentary tools
greatly expose women to infections. In fact, feminist as well as human rights
campaigners including medical professional are consensual that female
circumcisions heighten the risk of HIV/AIDS infection. For ‘rights’ reason and
women’s dignity, the elimination of this practice must take pride of place on all
HIV/AIDS gender-neutral policies.

Multiple sexual partnership and polygamy in HIV/AIDS infections.

My experiences of Sub Saharan culture indicates that while women are supposed to
be faithful to their spouse, the entrenched gender inequality allows men to either be
polygamous in their marriage or have extra-marital affairs. While there is consensus
that multiple sexual partnerships heighten the risk of HIV/AIDS infection, for the
patriarchal African man, multiple sexual partnerships is synonymous with being
macho. Discriminatorily and as typified in ‘Sharia laws’, female prostitution or female
infidelity is not only perceived as deviant, it carries such stigma that can socially
exclude ‘promiscuous’ women from proactive participation in most social and cultural
activities. From a moral perspective, in SSA “there has always been an association
between sickness and sin; the undeserving and the guilty.” Awasum, (2006, 7).
10
Consequently, women’s health within the context of HIV/AIDS prevention is not only
a key concept of self and health, but is intrinsically connected with morals and
responsibility. Thus prejudicially for women in SSA, being diagnosed as HIV/AIDS
positive or being associated with promiscuity is synonymous with “badness”,
“immorality” and “irresponsibility”. Compared to men, women diagnosed as HIV/AIDS
positive are seen as having departed from the socially accepted behaviour worthy of
the righteous and therefore undeserving of any sympathy. The label, stigma and
negative symbolisms surrounding HIV/AIDS and involving women’s implicit image of
the contagious, sexually deviant and irresponsible person are arguably significant
constraints in the decisions to self-present for HIV/AIDS diagnosis or treatment. To
encourage women, especially prostitutes to self-present for diagnosis, and therefore
mitigate potential infection, relevant communities need to be educated against the
prevailing prejudicial blame practice. More so, the myths of the macho man with
multiple sex partners need to be discouraged. The problem with implementing
preventative HIV/AIDS policy is that there are no implicit ways of either enforcing of
monitoring what are virtually people’s private lives. Bearing in mind that gender
inequality stands accused of exacerbating the spread of HIV/AIDS, dogmas that
advocate abstinence are self-defeating since they collude to control the sex life of
women. Even the customary ‘say no’ approach can never be effective in the
economic and social circumstances where women are compelled by multiple
deprivation rather than objective choice to succumb to risky sex lifestyles. For
example, in Cameroon as elsewhere in patriarchal Sub Saharan Africa (SSA),
studies carried out in Zambia showed that, “Less than a quarter of Zambian married
women believe they can refuse sex with their husbands; only 11 percent said they
could ask him to use condoms (UNAIDS 2000). This gender-induced compliance to
unsafe sex with persons whose lifestyles makes them HIV/AIDS liability is directly or
indirectly attributable to the ramifications of gender inequality. As earlier noted, in
some African cultures, gender inequality or women’s powerlessness is evident in the
practice of widow inheritance. Traditionally, widows are supposed to be inherited by
the next of the kin for assimilation into the family after the death of the husband.
Another major gender-based determinant in the spread of HIV/AIDs in SSA is the
extent of sexual encounters between older men and adolescent girls. According to a
literature review by Loewenson and Whiteside, (1997) “over 45 studies reviewed
found that this is the norm, including a widespread transactional component.” These
11
reviewers further point out that “the greater the age difference between them, the
greater the girls’ risk of infection, due to the power imbalance, and increase in unsafe
behaviours, such as non-use of condoms and multiple partners for both the men and
the girls (ibid.)

A Success-proven Model of Intervention

The problem facing policy makers in addressing gender inequality concerns in

HIV/AIDS is that, despite the awareness of the risk associate with ‘unsafe sex’, how
can one convince maybe a mother of five children living in abject poverty; socialised
into learned-helplessness; denied her inheritance and access to land or other means
of empowerment; yet expected to care for her family and maybe additional orphans
from her extended family not to prostitute? More so, having been born into a
patriarchal culture of female subjugation, and subsequently socialised into learned
helplessness, how can women in developing countries be suddenly expected to
assert their human rights including condom use in sexual encounters? Age-wise how
can a child sold into early arranged marriage be expected to subsequently become
competent-enough to understand, let alone safeguard herself from HIV/AIDS when
her older and multiple-partner wield limitless power over her? How can a
predominantly illiterate female be expected to access relevant empowering
information in a technologically alien environment? While these dilemmas may seem
complex and difficult, addressing these gender concerns in the prevention of
HIV/AIDS is not impossible. For example, where poverty or social exclusion is
perceived as the root of women’s deprivation, the instinctive policy recommendation
12
is to advocate “the economic empowerment of women as one of the key strategies of
reducing the rate of HIV/AIDS infections, amongst women and girls.”
http://statehousekenya.go.ke/oafla/speeches/f-lady/june05/2005020601.htm. In fact,
addressing delegates at the First Ladies round table on the economic empowerment
of women and the fight against HIV/AIDS in Kigali, Rwanda in June 2005, Lucy
Kibaki first lady of Kenya while citing various gender-focused studies undertaken in
East Africa in the prevention of HIV/AIDS stated that

- There is evidence that poverty and subsequent dependence on men has

increased their vulnerability to HIV/AIDS. The empowerment of women,
therefore, constitutes an integral aspect of the fight against HIV/AIDS.”

As a remedial suggestion, Mrs Kibaki, pleaded with relevant agencies

- “to push for the formulation and implementation of policies, which can
facilitate integration of women into mainstream economic processes;
including improving access to education by girls, guaranteeing sexual and
reproductive health rights, ensuring women's wealth and inheritance rights,
increasing women's share in political and public office and redoubling efforts
to combat violence against women and the girl child.”

While her recommendations seem very rational, with the potential to succeed, the
concern will be how men who have hitherto dominated women would react to any
challenge to their despotic or autocratic attitudes. In the Cameroons, research by the
Centre Universitaire de Science de la Santé (CUSS, 2006, p.16) is indicative that,
using the power of the all-powerful chiefs; the church and elders, all of whom are
held with very high and unquestionable esteem, to educate men not only to respect
women, but to dissuade them from polygamy and multiple sexual partners is
significantly reducing both the prevalence and incidence of the HIV/AIDS in the
country. This policy approach is informed by the fact that in most of SSA, “elders are
traditional educators, teachers and purveyors of cultural values, ideals, and rituals;
younger people are accustomed to viewing them as repositories of wisdom,
guidance, and advice May, (2003). As in Cameroon, these assets could be utilised in
developing effective gender-neutral interventions, as could the potential of using the
all-powerful chiefs (men) to provide peer counselling and dogmatic advice to their

13
subjects on the respect of female and the practice of safe sex. Equally important,
there is an urgent need for developing countries to take measures to empower
women who dwell in rural areas as farmers. This can be done through the
transformation of agriculture from low value-added primary production, to the
production of less labour intensive; high value-added finished products that can
compete in international markets. It is imperative that governments implement
policies that will encourage agro-based industries and enable agriculture to go
beyond the level of subsistence and to the market-place. This commercialisation of
traditional farming will inject new dimensions into the profile of women, expose them
to the world of commerce and improve their incomes. This is what Malaysia did with
spectacular success where in addition to legalised land rights, the marketisation of
surplus agricultural products enhanced women’s independent abilities to sustain
themselves and relevant dependents. Not having to dependent on men, meant that
women would not have to succumb to unsolicited and risky sexual encounters that
hitherto heightened their risk of contracting HIV/AIDS.
While preceding examples have been locally-based, at an international level, there is
need for relevant agencies of the United Nations to initiate and enforce legislations
that compel countries to safeguards women’s rights. As a precedent, in July 2001
the UN General Assembly held a Special Session on HIV/AIDS calling on States to
“enact, strengthen or enforced as appropriate, legislation, regulations and other
measures to eliminate all forms of discrimination, in multi-sectoral national strategies
that address the stigma and gender dimensions of the HIV/AIDS epidemic”. May,
(2003) Specifically, the declaration called for measures to be taken “to increase the
capacities of women and adolescent girls to protect themselves from the risk of HIV
infection, principally through the provision of healthcare services, including sexual
and reproductive health, and through prevention education that promotes gender
equality within a culturally gender-sensitive framework.” UNAIDS, (2001)

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 Appraisal

While advocating the prioritisation of relevant gender-neutral policies in the fight

against HIV/AIDS amongst women and girls may appear simple, a major constraint
is the fact that the cultures, people and the operational framework of healthcare
systems in the developing world and their respective needs are not homogeneous.
Added to the identified lack of systematic data to inform policy, constructing
appropriate and effective interventions are not only complex but problematic.
Similarly, in our patriarchal world where the man stands to lose through female
empowerment, relinquishing his perceived right to dominate women is bound to face
resistance especially in SSA where the payment of dowry objectifies rather than
humanise females. Indeed in prostitution, the man, the payer of the piper, the
dictator will always feel entitled to dictate the tune. Cognisant of the reality that even
in advanced Western societies, gender inequality is both institutional as well as
inherent, then it will come as no surprise to suggest that in essentially patriarchal
cultures of Africa, addressing gender inequality is both complex and problematic.
For example, how do you tell a man who perceives his wife as his property by
reason of having paid a dowry, not to use this ‘property’ as he so wishes? Similarly,
how can women who have been born into a culture of dependency and subsequently
socialised into self-helplessness be expected suddenly to become so empowered as
to assert sexual preferences? In an HIV/AIDS gender investigation by the World
Health Organisation,( 2000) in Sub Saharan Africa, it was observed that “women
who attempt to assert their preferences within a heterosexual relationship may be
socially ostracised, turned out by their partners or husbands, beaten up, raped or
even killed for trying to refuse sex.”
http://www.unhchr.ch/html/menu2/7/b/hivbpracism.doc. This practice is chronic in
cases of prostitution where by virtue of their dependency, sex workers are compelled
to summit to male sexual preference as the only exit option from either starvation
from abject poverty. Within this context, the gender-based anti HIV/AIDs campaign
needs to be focused not essentially on empowering women, but conversely of
educating their polygamous partners to respect women. Pertaining to the alleviation
of poverty, the concern is that the concept of poverty is not just a social construct, it
15
lacks homogeneity in its impact on the various female societies, constraints that
render it both complex and problematic to initiate and generalise gender neutral
policy in the HIV/AIDS campaign.

Policy suggestion

According to UNIFEM, (2005) policies to address gender inequality in the prevention

of HIV/AIDS should be right-based, “embodying strategies that make clear links to
violence against women, feminized poverty, security and women’s limited voice in
decision-making.” From an empowerment and user-involvement perspective if
gender neutral policies to combat HIV/AIDs are to be effective, it seem logical to
suggest that they must be designed by women for women so they can address
women’s specific needs and vulnerabilities. For example, in order for women to
protect themselves from HIV and other sexually-transmitted diseases, they must
have access to prevention methods—such as female condoms and microbicides—
that give them control over their own sexual decisions. www.africaaction.org. In
recommending relevant education, the United Nation Population Fund,(UNFPA)
“studies in many countries have linked education especially at higher levels with
increased AIDS awareness and knowledge, higher rates of condom use, and greater
communication on HIV prevention among partners which can significantly reduce
girls' vulnerability to HIV” http://www.unfpa.org/gender/index.htm. Additionally,
education is the pathway to economic independence; a sure weapon for female
empowerment. Similarly, any gender-neutral policies should be designed to reduce
“violence; protect property and inheritance rights of women; ensuring their access to
health care; investing more in female-controlled prevention technology, including
microbicides and female condoms; and supporting programs designed to enhance
access to education and economic opportunity.” Lobe, (2004)
http://www.commondreams.org. Finally, any policy to put gender inequality at the
heart of HIV/AIDS prevention must be informed by the nonnegotiable right of every
human being to be perceived and treated as equals.

16
 Conclusion

In the attempt to elucidate the contentious and complex dimension of employing

gender equality in the prevention of HIV/AIDs, preceding discourse has exposed the
“lack of sex and age disaggregated data to enhance relevant analysis. Despite the
awareness of the central role of women in securing livelihoods and in efforts to
eradicate poverty within local communities in developing countries, Strickland,
(2004) asserts that “this knowledge gap remains”. Consequently, Mutangura, (2002,
p.11) proposed that if the prevention of HIV/AIDS is to be addressed from a gender-
neutral perspective, “such information about the gender division of labour and
responsibility can help shape more effective and equitable policies.” Equally, there is
need for robust evidence on the impact and effectiveness of mitigation intervention
so that a systematic form of prioritisation can be developed and adapted for
particular nations of the developing world. Similarly, rather than the ad hoc policies of
the past, a systematic monitoring and evaluation of data will ensure that gender-
based interventions actually make a difference in the lives and experiences of these
women; providing a basis for adjusting intervention to make them more effective. In
emphasising the imperative to put gender inequality at the heart of the HIV/AIDS
prevention in Sub Sahara Africa, Stephen Lewis (2002) observed that “the practice
of ignoring a 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.” The concern with gender inequality in addressing HIV/AIDS is not
that nothing is being done, but that not enough is being done systematically,
consistently and comprehensively.

17
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