HIV/AIDS and Women
A discussion of the factors influencing women’s prospects would be incomplete without a conversation about AIDS, which has been cited as the major cause of premature deaths in South Africa. In 2013, about 6.3 million people were estimated to be living with HIV in South Africa, or about 19 percent of the adult population aged 15-49. The mortality rates jumped 79 percent between 1997 and 2004, with women experiencing a higher increase than men.
Indeed, women have been the greatest victims of the disease. They account for approximately 54 percent of the South African population that is HIV positive. Women between 25 and 29 years old have been affected the most—up to 36 percent—and have eight times the infection rate of their male counterparts.112 Children are especially vulnerable, as well, given the high rates of mother-to-child transmission as well as the likelihood of becoming orphans.113
The 2007-2011 South African National Strategic Plan (NSP) on HIV and AIDS has as its primary goals the reduction of the number of new
HIV infections by 50 percent and the expansion of access to appropriate treatment, care, and support to 80 percent of all people diagnosed with those infections. By achieving these goals, the impact of HIV and AIDS on individuals, families, communities, and society will decrease.114
The NSP has acknowledge the role that unprotected sexual intercourse and multiple sexual partnerships plays, but it has stated that “the fundamental drivers of this epidemic in South Africa are the more deep rooted institutional problems of poverty, underdevelopment, and the low status of women, including gender-based violence, in society.”115 The NSP also recognizes that cultural attitudes and practices increase South Africans exposure to HIV infections. It cites the gender inequalities that are inherent in patriarchal cultures as a contributing factor since women’s lower status significantly limits the choices that they can make about sexual intercourse. According to the NSP, “Such decisions are frequently constrained by coercion and violence in the women’s relationships with men. In particular, male partners either have sex with sex workers or engage in multiple relationships, and their female partners or spouses are unable to insist on the use of condoms during sexual intercourse for fear of losing their main source of livelihood.”116
HIV infection is also believed to occur during some of the rituals that traditional healers conduct. One such practice recommends sex with a virgin as part as a treatment for disease.117 According to the NSP, other cultural beliefs and practices increase exposure to infection:
Young men’s rites of passage to adulthood, rites of marriage such as premarital sex, virginity testing, fertility and virility testing, early or arranged marriages, fertility obligations, polygamy, and prohibition ofpost-partum sex and also during breastfeeding, and rites related to death such as levirate (or spouse inheritance) and sororate (a widower or sometimes a husband of a barren woman marries his wife’s sister) are also believed to spread HIV infection.118
The HIV/AIDS pandemic in South Africa is placing enormous physical, economic, and emotional burdens on those who care for the sick and needy. Women in South Africa are carrying a disproportionate amount of those burdens. A national survey shows women provide eight times more care related to all illnesses than men and over two-thirds of the care for people living with AIDS.119 In fact, care is seen as a woman’s job in the country, so they really have no choice in the matter. For many women, such caretaking is a full-time job that keeps them from earning money outside of the home—even though many people don’t think that a woman is actually doing work when she is caring for the ill.120 Some nongovernmental organizations are making efforts to get men more involved in HIV/AIDS care work.121
The main challenge is the loss of women’s lives to the pandemic. But with so many infected, women often have a sense of hopelessness toward HIV/AIDS. They view the situation with a fatalistic attitude, believing that it’s impossible to stem the spread of the disease. Maria Phalime recalls the time when she was practicing medicine and working at a day hospital in the Western Cape:
The number of times I’ve spoken to women who say, ‘Well, we’re all gonna get it at some point.’ The sense of acceptance of it was overwhelming. I felt like shaking so many people. It’s like, ‘Your test results have come back, and show that you’re HIV positive.’ And their attitude would be ‘Oh, that’s the way it is. It’s God’s will,’ or ‘What can I do about it now?’ or ‘I’ll just tell my boyfriend,” or I’ll just tell my husband.’ I think this could really pull back gains that women have made. 122
On World AIDS Day, December 1, 2009, Jacob Zuma introduced South Africa’s new policy on pregnant women to prevent mother-to-child transmission (PMTCT). The new policy allowed pregnant HIV patients to begin receiving drugs 14 weeks into their pregnancy versus 28 weeks under the previous policy. In an effort to keep both male and female HIV patients healthy and active, he also announced that they could receive drugs before they became sick, allowing those infected to live longer and reducing death rates. In addition, state health facilities began to provide free male circumcisions in an effort to reduce the risk of transmission.
By 2011, advances had been made: 95 percent of infected pregnant women were receiving antiretroviral drugs to PMTCT, and more children were receiving AIDS treatment.123 But despite that progress, AIDS remains South Africa’s leading cause of death today.
Of course, Zuma’s own risky behavior has not gone unnoticed. During his speech, the South African leader promised to get another HIV test and urged the nation “to use condoms consistently and correctly during every sexual encounter.”124 It is difficult to say which message South Africans, especially male South Africans, will take to heart—the one that emerged from his rape trial or the one spoken on World AIDS Day. Actions typically speak louder than words.