HIV and AIDS

by Alice Welbourne, Joanna Hoare

Overview

This book takes a look at the key challenges of HIV and AIDS from a gender perspective, and describes positive responses in areas of the world as diverse as Cambodia, South Africa, the UK, and Papua New Guinea. The impacts of HIV on women and men across the world are devastating and wide-ranging. Girls may have to drop out of school to look after sick relatives, boys to earn money. The death of working-age adults can mean that surviving family members struggle to get by, with grandparents shouldering the burden of looking after orphaned grandchildren, often in dire poverty. Young women may have to resort to sex work, and other risky survival strategies to support themselves and their families. Young men are growing up with ideas about masculinity that include violence and the sexual domination of women, and would be ostracised by peers if they acted otherwise, contributing to the spread of HIV. The contributors analyse these contexts, exploring the links between HIV, AIDS, gender inequality, and poverty. They present accounts of successful interventions, recording experience, describing good practice, and sharing information about resources. This book is essential reading for development practitioners and policy makers involved in responding to the HIV and AIDS crisis. Each title will be edited by a key thinker in the field, and will include an up-to-the- minute overview of current thinking and thoughts on future policy responses.

Product Details

ISBN-13:	9780855986032
Publisher:	Oxfam Publishing
Publication date:	05/28/2008
Series:	Oxfam Working in Gender and Development Series
Edition description:	New Edition
Pages:	234
Product dimensions:	6.10(w) x 9.10(h) x 0.60(d)

About the Author

Alice Welbourne

Joanna Hoare works for Oxfam GB in the fields of gender and development.

Read an Excerpt

CHAPTER 1

HIV/AIDS, globalisation, and the international women's movement

Sisonke Msimang

HIV/AIDS and globalisation

Globalisation has been described as 'the drive towards an economic system dominated by supranational trade and banking institutions that are not accountable to democratic processes or national governments' (Globalisation Guide, www.globalisationguide.org /01.html). It is characterised by an increase in cross-border economic, social, and technological exchange under conditions of (extreme) capitalism. As human bodies move across borders in search of new economic and educational opportunities, or in search of lives free from political conflict and violence, they bring with them dreams and aspirations. Sometimes, they carry the virus that causes AIDS, and often, they meet the virus at their destinations.

As corporations increasingly patrol the planet, looking for new markets, and natural and human resources to exploit, they set up and abandon economic infrastructure – opening and closing factories, establishing hostels. In so doing, they create peripheral communities hoping to benefit from employment and the presence of new populations where previously there were none. And when they move on, once they have found a cheaper place to go, they leave in their wake communities that are extremely susceptible to HIV/AIDS.

This is because the virus follows vulnerability, crosses borders with ease, and finds itself at home where there is conflict, hunger, and poverty. The virus is particularly comfortable where wealth and poverty co-exist – it thrives on inequality. It is not surprising, then, that Southern Africa provides an excellent case study of the collusion between globalising processes and HIV/AIDS.

The economy of the region has been defined in the last two centuries by mining: gold and diamonds. In an era of plummeting gold prices, and an increasing shift towards the service industry, Southern Africa is shedding thousands of jobs. Yet the last century of globalisation has provided a solid platform for the current AIDS crisis.

If there was a recipe for creating an AIDS epidemic in Southern Africa, it would read as follows: 'Steal some land and subjugate its people. Take some men from rural areas and put them in hostels far away from home, in different countries if need be. Build excellent roads. Ensure that the communities surrounding the men are impoverished so that a ring of sex workers develops around each mining town. Add HIV. Now take some miners and send them home for holidays to their rural, uninfected wives. Add a few girlfriends in communities along the road home.

Add liberal amounts of patriarchy, both home-grown and of the colonial variety. Ensure that women have no right to determine the conditions under which sex will take place. Make sure that they have no access to credit, education, or any of the measures that would give them options to leave unhappy unions, or dream of lives in which men are not the centre of their activities. Shake well and watch an epidemic explode.'

There's an optional part of the recipe, which adds an extra spice to the pot: African countries on average spend four times more on debt servicing than they do on health. Throw in a bit of World Bank propaganda, some loans from the IMF, and beat well. Voilà. We have icing on the cake.

As the gap between the rich countries of the North and the poor countries of the South grows, we are beginning to see serious differences in the ways that states can afford to take care of their citizens. Access to technology, drugs, and strong social safety nets in the North, mean that HIV/AIDS is a manageable chronic illness in most developed countries. Yet there are pockets of poor, immigrant, gay, and otherwise marginalised communities within these countries, where HIV prevalence is on the rise. An analysis of the complex intersections between inequalities tells us that it is not enough to belong to a rich country – that alone does not protect you from vulnerability to HIV infection, nor does it guarantee treatment. Where you sit in relation to the state is equally important – whether you are a woman, a poor woman, a black woman, an educated woman, a lesbian, a woman with a disability who is assumed not to be having sex, an immigrant who is not entitled to many of the social security benefits of citizens. All these factors determine your vulnerability to HIV/AIDS.

Now what does this mean for a 25-year-old woman living in Soweto? Jabu works as a security guard at a shopping centre in Johannesburg. Every day she spends two hours travelling to work because of the distances the architects of apartheid set up between city centres and the townships that serviced them. Jabu is grateful to have a job. Her two little ones are in KwaZulu Natal with their grandmother until Jabu can get a stable job. She is on a month-to-month contract with the security company. She watches expensive cars all day, protecting their owners' investments while they work. The company doesn't want to take her on as staff so each month she faces the uncertainty of not having a job the next month. Joining a union is not an option – she's not technically a staff member and she can't afford to make trouble. Jabu's boyfriend Thabo drives a taxi. Their relationship saves her cash because he drives her to and from work every day – a saving of almost one-third of her salary each month. She has another boyfriend at work, who often buys her lunch. She has to be careful that Thabo doesn't find out.

In addition to race, class, and gender, Jabu's life is fundamentally shaped by the forces of globalisation – where she works and how secure that work is, where her children live, even how she arrives at work. These factors all influence her vulnerability to HIV infection.

HIV/AIDS and feminism

During the last eight years of my work on sexual and reproductive rights, my focus has been primarily on HIV and AIDS. For me, the pandemic brings into stark relief the fact that states have failed to provide their citizens with the basic rights enshrined in the declaration of human rights.

Twenty years ago, AIDS was known as Gay Related Immune Disease – so associated was it with gay men. Today, the face of AIDS has changed. It looks like mine. It is now black, female, and extremely young. In some parts of sub-Saharan Africa, girls aged 15–19 are six times more likely than their male counterparts to be HIV-positive. Something is very wrong.

In the next ten years, the epidemic will explode in Asia and in Central and Eastern Europe as well as in Latin America. The pandemic will have profound effects on the burden of reproductive work that women do, and this in turn will have far-reaching consequences for the participation of women in politics, the economic sector, and other sectors of society. The very maintenance of the household, the work that feminist economists like Marilyn Waring, Diane Elson, and others tell us keeps the world running, may no longer be possible.

As older women are increasingly called upon to care for children, and as life expectancy shrinks to the forties and fifties, in Africa we face the prospect of a generation without grandparents, and an imminent orphan and vulnerable children crisis that will effectively leave kids to take care of kids. As the orphan crisis deepens, child abuse is on the rise. Girls without families to protect them are engaging in survival sex to feed themselves and their siblings, and we are told that communities will 'cope.' There is a myth of coping that pervades the development discourse on AIDS. What it really means is that women will do it. What it translates into is that families split up, girls hook for money and food, and a vicious circle is born.

While there is some feminist analysis of the AIDS epidemic, we have not yet heard a rallying cry from the women's movement. A recent article by Noeleen Heyzer, UNIFEM's Executive Director, begins to formulate some arguments about why in the context of AIDS, women can no longer wait for equality with men (www.csmonitor. com/2002/0718/p13s02-coop.html). Dr. Heyzer points out that it takes 24 buckets of water a day to care for a person living with AIDS – to clean sheets fouled by diarrhoea and vomit, to prepare water for bathing (sometimes several times a day), to wash dishes and prepare food. For women who must walk miles, and still do all the other chores that always need doing, the burden becomes unbearable.

This past spring in New York, I was asked to speak to a group at a high school in Brooklyn about HIV/AIDS and violence against women in the South African context. They were an intelligent group, well versed in feminism. I was not the only presenter. Ayoung American woman who had worked with Ms. Magazine talked about pop culture, and the politics of wearing jeans and letting your G-string show. I left the meeting feeling disconcerted. I had made my presentation and received a few awkward questions about men in Africa. I cringed on behalf of my brothers because I certainly was not trying to demonise them, but the students were feeding into a larger narrative of the familiar discourse of black male laziness, deviancy, and sexual aggression that I was careful to point out to them. Aside from that, they found little else to talk about.

On the other hand, the woman from the USA struck a chord with them. They talked about eating disorders and the media, about Britney Spears and Janet Jackson. It was fascinating. Having lived in the USA, I was able to follow and engage, but my interests as an African feminist do not lie in this subject matter. It was a clear example of how far apart we, as feminists, sometimes are from one another.

Contexts vary, and of course the issues that are central in the global North will be different from those of Southern feminists. And amongst us there will be differences. I understood where the high-school students were coming from. Indigenous feminism must be rooted in what matters most to women at a local level. At a global level within feminism, however, I fear that we may be in danger of replicating the G-strings versus AIDS conversation. I am worried by the relative silence from our Northern sisters about a pandemic that is claiming so many lives.

A way forward

In the context of HIV/AIDS, it is no longer enough to frame our conversations solely in terms of race, class, and gender. These are primary markers of identity, but increasingly, we need more. We need to look at where women are located spatially in relation to centres of political, social, and economic power. We need also to examine how where we live – rural, urban, North or South – intersects with poverty and gender. We also need to think about how the experience of poverty interacts with, and not just intersects with, gender. Culture is another factor that deserves attention.

We are beginning to see dangerous patriarchal responses to the epidemic – from virginity tests to decrees about female chastity from leaders. In part this is simply an extension of deeply rooted myths about female sexuality. However, with HIV/ AIDS, it can also be attributed to the fact that in many cases women are the first to receive news of their sero-positive status. This is often during pre-natal screening, or when babies are born sick. Bringing home the 'news' that there is HIV in the family often means being identified as the person who caused the infection in the first place. We know that, in the vast majority of cases, this is simply not true.

The Treatment Action Campaign (TAC), a movement begun by and for people living with HIV/AIDS in South Africa, has managed to mobilise national and international support for the idea of universal access to drugs for people with AIDS. The group began their campaign by using pregnant women as their rallying cry. The right to nevirapine for pregnant women opened the door for TAC's broader claims about the rights of all people with HIV/AIDS to HIV medication. The campaign has been hugely successful. TAC encouraged the South African government to take the pharmaceutical industry to court and the government won, paving the way for a win at the World Trade Organization. Companies' patent rights can no longer supersede the rights of human beings to access life-saving medicines.

TAC's strategy needs to be vigorously debated and analysed by feminists. TAC did not use arguments about reproductive and sexual rights. They simply said, 'It is unfair for the government not to give drugs to pregnant women so they can save their babies' lives.' It was a classic 'woman as the vessel' argument. TAC's interest was not in women's rights – but in the rights of people living with HIV/AIDS, some of whom happen to be women. The campaign's success was largely based on the notion that the average South African found it difficult to accept that 'innocent' babies would die because of government policy. This requires some serious feminist interrogation. TAC has since been pushed by gender activists within the movement to ensure that the drugs do not stop when the baby is born.

Gender activists to date have struggled to get their voices heard in the doctor-dominated AIDS world. The mainstream women's movement needs to get on board and face up to the challenge of HIV/AIDS. AWID's (The Association for Women's Rights in Development) 'Globalise This' campaign provides an opportunity to highlight the HIV/AIDS epidemic and the threat it poses to women.

At precisely the moment when we need international solidarity to focus on the impact of AIDS on poor women's lives, and their need to be able to control their lives and their bodies, we have to oppose the US administration's cutbacks on funding for essential reproductive health services. We are also still waiting for the G8 to enact their long-standing commitment to spend 0.7 per cent of GDP (gross domestic product) on overseas development assistance each year. How likely is it that they will ever reach this target if they focus instead on supporting the war against Iraq?

Our sisters in the North need to develop a consciousness about the fight against AIDS as a feminist fight. We need civil society and feminist voices in developing countries to challenge their governments to tackle HIV/AIDS as a health issue, as a human-rights issue, and as a sexual and reproductive rights issue. If we lose this fight, it will have profound effects on the lives of girls and women into the next century.

CHAPTER 2

Challenges and opportunities for promoting the girl child's rights in the face of HIV/AIDS

Mildred Tambudzai Mushunje

The nature and scope of childhood has dramatically changed in the context of the HIV/AIDS pandemic. A large proportion of children in Zimbabwe today do not experience true nurturing in their childhood. Their childhood is taking place against a backdrop of unprecedented political, economic, cultural, and social changes. Worst of all, the backdrop includes HIV/AIDS, the impact of which manifests itself in the breakdown of extended family safety nets, orphans' consequent loss of a protective family environment, and widespread child-headed households.

UNAIDS et al. (2004) estimates that globally, close to three million children under the age of 15 years have been infected with HIV. In 1996 alone, around 1,000 children died daily of AIDS and even more became infected. At the end of that year, it was estimated that 830,000 children under 15 years of age were living with the virus, a number that UNAIDS expected to rise to one million by the end of 1997. Well over 90 per cent of these children would be in developing countries.

In 2002, an estimated 1.8 million Zimbabweans were living with HIV/AIDS, of whom 240,000 were children. UNAIDS et al. (2004) reports that a third of the Zimbabwean population is HIV-positive, and a child dies every 15 minutes. Zimbabwe now has the fourth-highest number of people with HIV in the world, and life expectancy has declined from 61 years to only 33 years (UNICEF 2004). At the 2002 International AIDS Conference in Barcelona, UNAIDS projected that by 2005 Zimbabwe would have lost 19 per cent of its workforce to HIV/AIDS.

The Zimbabwe National Plan of Action (NPA) for Orphans and Vulnerable Children (OVC) estimates that there are currently 1.3 million orphans. Of these, about 980,000 have been orphaned by AIDS. In 2004 alone, 160,000 children lost a parent. The scale of the AIDS orphan crisis is somewhat masked by the time lag between HIV infection, death, and orphaning. Even if all new HIV infections were to stop today, the number of orphans would continue to rise for at least the next ten years (Fredriksson and Kanabus 2005). The impact of HIV/AIDS on children is catastrophic. Worst affected is the girl child.

(Continues…)

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Table of Contents

Introduction—Alice Welbourn; PART I EXPLORING THE ROOT CAUSES OF HIV: 1) HIV / AIDS, Globalisation, and the International Women’s Movement—Sisonke Msimang; 2) Challenges and Opportunities for Promoting the Girl Child’s Rights in the Face of HIV / AIDS—Mildred Tambudzai Mushunje; 3) ‘I’m Too Young to Die’: HIV, Masculinity, Danger, and Desire in Urban South Africa—Shannon Walsh and Claudia Mitchell; 4) A Gendered Response to HIV / AIDS in South Asia and the Pacific: Insights from the Pandemic in Africa—Madhu Bala Nath; 5) Sage Motherhood in the Times of AIDS: The Illusion of Reproductive ‘Choice’—Carolyn Baylies; PART II RETHINKING ‘OUR’ ATTITUDES TO ‘OTHERS’ REALITIES: 6) Diversifying Gender: Male to Female Transgender Identities and HIV / AIDS Programming in Phnom Penh, Cambodia—Barbara Earth; 7) Young Men and HIV—Doortje Braeken, Raoul Fransen, and Tim Shand; 8) HIV-Positive African Women Surviving in London: Report of a Qualitative Study—Lesley Doyal and Jane Anderson; PART III PRACTICAL MULTIPLE APPROACHES: 9) Mitigating Impacts of HIV / AIDS on Rural Livelihoods: NGO Experiences in sub-Saharan Africa—Joanna White and John Morton; 10) Danger and Opportunity: Responding to HIV with Vision—Kate Butcher and Alice Welbourn; 11) ‘Mainstreaming’ HIV in Papua New Guinea: Putting Gender Equity First—Janet Seeley and Kate Butcher; PART IV POSITIVE AGENCY AND ACTION: 12) Advocacy Training by the International Community of Women Living with HIV / AIDS—The International Community of Women Living with HIV / AIDS; Conclusion—Alice Welbourn; Resources—Joanna Hoare; Index.