Gender, Power, and Death




O

f
the approximately 40 million people in the world living with HIV,
almost half are women. The AIDS pandemic has moved from a disease
that afflicts primarily males to one that progressively victimizes
females. Dr. Kathleen Cravero, deputy executive director of the
United Nations Program on HIV/AIDS notes, “Increasingly the
face of AIDS is young and female.” In Sub-Saharan Africa, just
under 60 percent of HIV infected individuals are female. The number
of women and girls contracting the disease is rising in every region
of the world. 


There
are two primary reasons for the dramatic increase in female HIV
infections. To begin, a growing body of evidence indicates that
women and girls are physiologically more vulnerable than men and
boys to HIV infection through heterosexual intercourse, the primary
method of transmission. This biological susceptibility is compounded
by violence and discrimination perpetrated against socially, politically,
and economically pow- erless females in the developing world. 


A
recent United Nations report stated: “The fact that the balance
of power in many relationships is tilted in favor of men can have
life-or-death implications” for women. Nowhere is this more
evident than in the context of marriage. A study by Human Rights
Watch found that married women in Uganda have little sexual autonomy
and are routinely abused by their husbands. An HIV-positive woman
infected by her husband stated, “He used to force me to have
sex with him after he became ill.” Dying of AIDS and too weak
to beat his wife, the man ordered his brother to continue abusing
her. 


Shelley
Clark of the University of Chicago discovered that in some regions
of Kenya and Zambia early marriage was equivalent to an AIDS death
sentence for young girls. She found that 32.9 percent of married
girls in Kenya were HIV-positive compared to 22.3 percent of unmarried
girls. Comparable figures for Zambia were 27.3 and 16.5 percent. 


Clark
offers three primary explanations for these counterintuitive findings.
First, marriage ends condom use because couples desire children.
Second, the frequency of intercourse increases dramatically with
marriage. Third, because men need considerable time to save money
for the “bride price” required by the girl’s family,
husbands are typically five to ten years older than their wives.
During this period a man will have numerous sexual partners and
is more likely to become HIV-positive. 


Although
single girls have more sexual encounters than married girls, their
(single girls’) boyfriends had fewer sexual experiences than
older males and were more likely to use condoms. Clark concluded
that frequent unprotected sex (as in marriage) was a more critical
factor in the likelihood of a girl contracting HIV than the number
of one’s sexual partners. 


Thailand
may well be the most shocking example of the gender, marriage, and
AIDS relation. In the early 1990s the overwhelming majority of HIV
transmissions in that Asian country occurred between prostitutes
and their clients. Today, nearly half of all new infections are
the wives of men who frequent prostitutes. A study of HIV-positive
women in India found that 93 percent were married and 91 percent
overall had only one sex partner—their husbands. In Mexico,
one-third of HIV-positive females learn they are infected after
their husbands are diagnosed with the disease. 


Many
observers believe that the highly-touted ABC approach (Abstain,
Be Faithful, and use Condoms) to preventing HIV will have limited
success as long as girls and women remain subservient to males.
Thoraya Obsaid of the United Nations Population Fund notes, “Abstinence
is meaningless to women coerced into sex. Faithfulness offers little
protection to wives whose husbands have several sex partners….
And condoms require the cooperation of men.” One commentator
summarized the relation between gender and HIV in the developing
world: “While men are driving the AIDS epidemic in large degree,
women become the victims.” 


This
victimization of females is especially tragic as it relates to AIDS
orphans whose numbers are increasing rapidly across Africa, Asia,
and the Carribean. In Zambia alone, a nation of about 11 million
people, between 600,000 and one million children are AIDS orphans
or live in households where one or both parents are infected. 


When
a mother and/or father become ill as a consequence of AIDS, girls
are much more likely than boys to be removed from school to provide
care for the sick. Prolonged illness usually leads to financial
problems and girls find employment as housemaids, child-care workers,
and vendors in local markets.



If
income from these sources is insufficient to meet family needs,
young females often turn to prostitution and risk contracting AIDS
as well as other sexually transmitted diseases. On the Zaire-Zambia
border, girls carry five gallon water containers to truck stops
for less than 50 cents a day or prostitute themselves for $2.30
an hour. In some regions of Africa the sexual coercion and rape
of girls is fueled by the mistaken belief that young females are
HIV-negative and the myth that sex with virgins will cure AIDS.
It’s no accident that in much of Sub-Saharan Africa HIV infection
rates are five to six times higher for adolescent girls than boys. 


In
light of overwhelming evidence of the abuse and exploitation of
females in the developing world, health experts have argued that
donor organizations and countries should make the protection of
women’s and girls’ rights a central component of AIDS
programs. United Nations AIDS chief physician Peter Piot stated
that the link between “gender inequality and death has never
been so direct as with AIDS.” He believes that if females are
not at the heart of international HIV prevention measures we will
lose control of this pandemic.



 





George J. Bryjak
is a professor of sociology at the University of San Diego.