Women & AIDS in Africa


ith the establishment of the Global Fund
for AIDS, Tuberculosis and Malaria it is estimated that a million
and a half people gained access to anti-retroviral treatment around
the world. In sub-saharan Africa, this means that 11 percent of
the 4,700,000 people infected are receiving treatment, though this
is well below the goal of 3 million that the WHO had aimed for in

Unfortunately, as with almost all advances in the fight against
AIDS, this one is tragically compromised by women’s inequality. 

In Africa tests for HIV are now routinely offered to women as part
of antenatal medical consultations. Between 5 and 8 percent of pregnant
women in Africa have, as added incentive, the possibility of taking
nevirapine if they are positive, thereby reducing the chance of
transmitting the virus to the fetus by 53 percent. In Botswana pregnant
women are automatically tested for HIV as part of antenatal care,
unless they make clear their desire to opt-out. 

However, for many married women, the choice to get tested for HIV
can be considered selfinculpatory, according to Foro Maimouna, president
of the Association of Midwives of Burkina Faso and a midwife at
a clinic for Sexually Transmitted Infections (STIs). If a woman
is pregnant, since it is a routine test, there are fewer problems
explaining it to her husband, says Maimouna. “However, if she
went to get tested of her own volition, they will say she suspected
herself of something, she knew she was guilty, or she was sleeping
around. If she tests positive and her husband is also infected,
they will say it is her fault. Here, it can degenerate to the point
where women who test positive are beaten and thrown out of their

A 2005 study looked at the links between revealing one’s HIV
status and conjugal violence in the lives of women in a slum in
Kenya. Following HIV testing, 42 percent of the women who tested
positive and informed their partners of the results were victims
of conjugal violence (compared to 16 percent of women who tested
negative). Among the HIV positive women, 15 percent of them had
their relationships end. 

A report published in 2005 by the International HIV-AIDS Alliance
describes the case of an African support group for HIV-positive
women, of whom many practiced prostitution. It was revealed that
the majority of those who were sex workers had begun prostitution
as a means of financial survival after being thrown out of their
homes for testing HIV-positive. 

“I lived through the case of one of my aunts who tested positive,”
Maimouna says. “Now her husband says, ‘Well, if she went
to take the test it’s because she is recognizing her own guilt,
she is admitting that she cheated.’ Many months later, he has
begun to speak to her again. However, he still flat out refuses
to get tested himself. 

“Look at my case. Every year all of the midwives test ourselves
at the clinic. I show my results to my husband. He is happy. He
says, ‘You are HIV-negative, then I am HIV-negative.’
I say ‘That’s not enough, you need to get tested.’
He refuses.” 

Linda, a peer educator in HIV and STI prevention, agrees. “It
happens often that a woman comes to get tested and treated for an
STI, but the husband refuses to and often, if he still has the STI,
he ends up reinfecting her.” 

Maimouna continues, “We know it is with boyfriends and husbands
that women are getting HIV. That goes for all women in Africa because
there is not a single husband who wants to use condoms.” 

women now constitute the majority of people with HIV in sub-saharan
Africa where transmission is primarily sexual, there are two reasons,”
says Jodi Jacobson of the Centre for Health and Gender Equity. “The
first is their greater biological vulnerability to HIV during unprotected
heterosexual intercourse. The second is their inequality in all
areas and the consequent difficulty of insisting on condoms.” 

A UNIFEM study in Zambia found that less than 25 percent of women
said they could refuse sex with their husband even if he had been
demonstrably unfaithful or was infected with HIV. According to WHO,
in Zambia and Kenya young married women had a higher rate of HIV-infection
than their non-married peers. 

The portrait is similar in South Africa where the rate of HIV prevalence
is 21.5 percent. “In South Africa women are extremely vulnerable
to HIV. Despite the rhetoric, their status has not changed in reality.
The most vulnerable are the ones who cannot insist on condom use,
primarily married women. Even sex workers who contract HIV usually
contract it from their boyfriends or husbands,” according to
Britta Rottman, a lawyer with the Sex Worker Education and Action
Taskforce, an NGO based in Capetown, South Africa that defends the
rights of sex workers. 

In South Africa a proposed new law could complicate the situation
even more. If passed, an individual who knows they are positive
and participates in high-risk behaviors could be punished by a prison
term. “Women’s groups argue that such a law would unfairly
punish women since they are the ones who know their status and since
they are unable to insist on condom use. On top of this, in a context
where many women are severely beaten and then thrown out into the
street when they reveal their status, it becomes tantamount to criminalizing
a self-defense mechanism,” says Rottman. “If the law passes,
the other major effect will be that less people will go get tested,
since you are guilty of nothing if you don’t know your status,”
a phenomenon that, according to Rottman, will only increase the
vulnerability of women and prevent many more from accessing treatment. 


Crago recently returned from Niger where she researched material for
this article.