Gender inequality increases women's vulnerability to HIV

"One night, I was coming back home at 3 am, drunk, and I decided to have a short cut, but in that corner, suddenly from nowhere, two men appear, one in the front and one behind me. By that time, I didnt know I was at risk of HIV, but I knew that the rape situation changed me forever. Now that I have studied the issue, the connections between violence against women and HIV, I can tell you that is so evident, that we cannot avoid working with that. You really have to link those two issues.”

Gracia Violeta Ross Quiroga from La Paz in Bolivia was 22 years old when she walked home that fateful night that would change her life forever. She had a good background, her father was a minister and she had a good education. But being a woman means finding yourself automatically lower in the gender system and more vulnerable to gender-based violence, including rape. Rape means a risk of contracting HIV. This is what happened to Gracia Violeta Ross Quiroga, but instead of giving up she began a fight for treatment in Bolivia at a time when people were dying of AIDS every week. She co-founded the first Bolivian network of people living with HIV and AIDS, REDBO, and by the time of the interview she was also part of the UN Women Civil Society Advisory Group for Latin America and The Caribbean.

Her story is nothing unusual. Gender based violence against women is a word wide problem and one of the main sources for the spread of HIV. For many years HIV and AIDS were associated with homosexuality, prostitution and drug addiction and focus was put on these particular groups. Policies didn’t target women. It wasn’t until many years later the world realised that all women - from girls to mothers to widows - could also get infected. Since their situation wasn’t given enough attention, they didn’t have any knowledge of the disease and how it spread, which made them more exposed.

Feminisation of the epidemic

Despite progress in many aspects of the global HIV response, women - particularly adolescent girls and young women - continue to be disproportionally affected by HIV. According to the HIV and AIDS charity organisation Advert, HIV is the leading cause of death among women aged 30-49 and the third cause of death for women 15-29.

“Women get infected at a much, much earlier age than males. For example, for every five girls that are infected of HIV, only one boy is infected within the age group of about 14-19. […] When the girls have sexual activity, they are not having it with people of their age, they are having it with people that are older than them. Some older males feel that younger women is a safer group to have sex with”, says legislator and activist Priscilla Misihairabwi Mushonga, when she talks about the AIDS situation in Zimbabwe in a recording from 1998.

Priscilla Misihairabwi Mushanga from Zimbabwe talks about the differences between how men and women are affected by HIV. She was one of the first HIV experts who started to mobilize the government and international community on the dangerous AIDS situation in Zimbabwe.

Sadly, the situation seems to have been the same ten years later when Staffan Hildebrand interviewed Ian Dungu who at the time worked at NGO HIV-Free Generation in Kenya. He noted that the HIV rate in Kenya was five times higher among girls compared to boys in the same age group:

“If you look at the age group 15-24, the prevalence rate for girls is about 5,8% against boys which is about 1,2% […] This disparity in prevalence rates between boys and girls is driven by the inequality in wealth distribution amongst women and men, it is also driven by a lot of socio-cultural practices and norms, including early marriages for young girls, including tolerance of violence against women, including cases of rape as well. That heightens the risk for infection amongst young women and girls.”

Ian Dungu, consultant working with the HIV-Free Generation initiative in Kenya, discusses the reasons why women are disproportionately affected by HIV.

Gender norms makes it possible

Interviewees in the Face of AIDS archive, from Bolivia to Zambia to Indonesia, believe that women are most hard hit in the AIDS epidemic because of gender insensitive cultures - i.e men control the relationships. These patriarchal structures force women out of power and lock them in their home with no right to information and knowledge. They are behind the scenes, at home taking care of family and children. Thus many women don’t know how to use a condom, and even fewer have the power to ask their husbands to use one.

Should they dare to ask, the risk is high that they will be beaten or accused of being a prostitute. Priscilla Misihairabwi Mushonga sums up the situation by saying that the greatest risk factor for AIDS in Zimbabwe is marriage. This is confirmed in interview after interview with AIDS activists around the world.

“I told my husband, you have to use a condom if you go with another woman. He didn’t want to use a condom, because he believed that he would not get the best taste of sex. My husband was not afraid of HIV. […] African women don’t have power. If the man wants to sleep with you, even if you are sick, the man will sleep with you. It’s like you are his property. [In my marriage], I was like a dog every day. I would say, 95% of African men control their women, and that’s why I say enough is enough”, says Skytt Mukeli Nzambu, peer educator in the Kenya Network of Women with AIDS, in a recording from 2008.

She got to know about her HIV status after she had separated from her husband. At first she was traumatised and wanted to kill herself, but after being helped by her sister and children, she decided to go for counselling. At the time of the interview she worked with orphan children and home based care for people living with HIV and AIDS in the Kambio slum area in Nairobi. After she got infected she gave her ex-husband an ultimatum to either start using a condom with his new wife or she would go public. He then left the country and was never seen again.

Peer educator Skytt Mukeli Nzambu tells her own story, and discusses the relationship between men and women in Kenya.

Skytt Mukeli Nzambu is ironically one of the lucky ones. Many women don’t have the chance to leave their marriages due to cultural expectations. In many parts of the world a woman can’t even go to the hospital to get treatment unless her husband allows her.

Empowering women is crucial...

Considering that the number of girls and women getting infected still are on the rise it is difficult to be optimistic about the future. But there is hope, not least because women in many parts of the world also gain more power. And that is exactly what is needed to stop the trend according to many AIDS activists.

First and foremost there must be a change in the power structure between boys and girls and girls need to understand that they are equal to men. By empowering young girls and teaching them about their human rights this could be the beginning of the end of the patriarchy. However, this is easier said than done. According to Edford Mutuma who at the time of the interview worked for Youth Vision Zambia, women in Zambia look at men as providers and don’t think that they can do what men do. He believes that it’s going to be hard work, but that AIDS can be stopped with a lot of commitment and education.

Bolivian activist Gracia Violeta Ross Quiroga agrees that changing the power structure is a prerequisite for ending the epidemic. It’s only when more women start to reject oppression that the number of AIDS infected women will decrease. This will also lead to less men being infected because it is mainly women who raise the children and teach them gender roles.

”There is an important step every woman can take, she can decide to stop being a victim and begin to be a survivor. Women can change a complete generation if they decide to do so. Many don’t realise that potential.”

Bolivian activist Gracia Violeta Ross Quiroga discusses women’s role in the HIV response.

And it seems that we don’t have to wait that long. In a recording from 2006, Purnima Mane, Director for Policy, Evidence and Partnership at UNAIDS, says that change has started.

“There is enough evidence to show that change is already happening. We have so many women out there working with men in occupations that men have always dominated. […] The dynamic in the family is also changing, an earning woman, a woman who is educated, is seen differently, because she is able to act differently. But it is a difficult change for the one who has to give up power.”

Purnima Mane, Director for Policy, Evidence and Partnership at UNAIDS, talks about changing customs in the power structure between men and women.

...but in the end, it’s the men that hold the key

However, no lasting change in gender norms will be possible in the long term if men are not included. Many of the activists interviewed in the Face of AIDS archive express the view that the best way to give women more influence over their sexuality is that men give up their influence over them. For this to happen men need to understand that women are equal.

But changing gender norms is a slow process, made even slower by the fact that those who make policy decisions often have their own perception about gender that they are unwilling to question. The key is therefore to work with young people, not least with young men. According to the Sida report ”HIV/AIDS and gender relations” from 2006 studies from Brazil indicate that repeated group discussions on manhood, sexuality, violence and fatherhood with young men resulted in both increased condom use with primary partners as well as new critical thinking on traditional views on manhood and sex.

”Gender norms put both men and women at risk. Some say that men are not victims because they have the power, but they are. Men are forced to behave in certain ways. A man for example was taken to a brothel by his father a passage to adult life. He said ”go and be a man”, but the kid was so scared. The level of violence on women is a cry for help, says Gracia Violeta Ross Quiroga.

Mony Pen, peer educator in the Cambodian Community of Women Living with HIV and AIDS, thinks that is crucial to start early, otherwise the boys will follow in their fathers footsteps. To avoid this it is also important to include parents to make them understand why changes are necessary. She learned of her status only when her husband died of full-blown AIDS two years after they married.

"In the future I would like to see men and women work together with compassion, heart, solidarity and equal power. Men and women need to complement each other, she says.

HIV activist Mony Pen from the Cambodian Community of Women Living with HIV/AIDS talks about what is needed to create equality between men and women in Cambodia.

Anandi Yuvaraj works for the International HIV Alliance and got the infected with HIV by her husband. She says that one of the biggest problems is that many men don’t understand that their actions have a negative effect on women. The messages to men are mostly negative and alienates them. It’s therefore important to create safe spaces where men and women can come together and help each other understand the issue. This will in turn increase equality in other areas.

“Men are one level higher than women, and this disparity is transferred through generations. We haven’t addressed this issue of gender inequality, and it therefore remains the same. It is time to change the equation, I feel. HIV has brought the opportunity to change the dynamics, and to change inequality and bring both men and women together.”

In this 2006 interview, Anandi Yuvaraj, Senior Programme Officer at the International HIV/AIDS Alliance in India, discusses gender inequality, and how to change it.

To sum it up: boys are equally oppressed by gender norms as women. Therefore, it is crucial to work with both boys and girls, men and women so that they learn to respect each other. Women and men need each other to fight both HIV and the gender norms that gave rise to the feminisation of the epidemic.

Published: 2020-01-09