Panos Institute - September 17-30, 1999
Stella Mhura

In Africa, as elsewhere, women fulfil key social roles as family caretakers and providers of food.

Studies carried out in Southern Africa, where the epidemic is hitting the continent hardest, confirm that women are burdened with the task of caring for and supporting those who are ill with AIDS-related diseases.

They also look after orphans left by relatives while being expected to fend for their families, including producing food for the household, often from few resources.

The state is no help - health facilities are collapsing and more and more patients are forced by lack of resources to return from hospital to home-based - that is, women's - care.

One non-governmental organisation, the Southern Africa AIDS Training Programme (SAAT) which supports women advocacy projects in 11 Southern African countries, found out that in caring for the sick, women encounter both physical and financial problems.

"Usually they do not have money to buy things like food, bedding and utensils for them to adequately provide home-based care to the patients after they are discharged from hospitals," says Howard Kasiya, SAAT's Country Liaison Officer for Malawi.

When a man falls ill, his female partner must not only look after him but become the breadwinner. In rural areas, where the majority of Africans still live, time spent on patient-care means there is little time to fetch or produce food or to earn money.

In most Sub-Saharan African countries, 60-70 percent of food is produced by small-scale farmers, the majority of whom are women. "The more time women spend caring and supporting HIV/AIDS patients, the less the food production and this threatens family, household and eventually national food security," says Kasiya.

The SAAT study also revealed that many women struggle to bring up children after their husbands die, particularly in situations where household property is snatched by the men's relatives.

Care of orphans too is a burden which falls disproportionately on women. A 1999 UNICEF study in Zambia revealed that poorer Zambian households are much more likely to take care of orphans than richer households.

Grandmothers with no steady source of income are major caregivers for orphans. "Grandmothers, who are supposed to be cared for, are becoming mothers again and are forced to cultivate to produce food for the children and some for sale,' Zambia's UNICEF representative Peter McDermont told the conference.

By 1998, Zambia had approximately 800,000 orphans while UNICEF data put the number of orphans in the sub-Saharan region at 7.8 million by 1997. Another 40,000 to 50,000 children were estimated to have been born with HIV in Zambia.

Brigitte Syamalevwe, a 40-year old Zambian woman, points out that in addition to coping with the fact that she is living with HIV/AIDS, she has to take care of five orphans left by her dead brother and sister.

She told the conference that in rural African settings such situations are becoming increasingly common.

More and more households are headed by children as their mothers are weakened by the infection. Statistics from the UNICEF study show that some Zambian households are wholly headed by children. Very few are headed by single men because, some experts argue, many husbands leave their wives for other women once they find that their wives have contracted the disease.

Syamalevwe says that although she is a professional woman, she still has problems maintaining her children and the orphans she has taken in. "What an African woman living with HIV/AIDS needs is encouragement - economic empowerment to make her self-reliant - and not abandonment," she says.

High infection rates among women of child-bearing age is another trauma. A study carried out by the Malawi National AIDS Control Programme (NACP) established that about 500,000 women - 20 percent of all those between 15 and 45 years old - have contracted HIV.

The Malawi study also found another dimension to the problem. Women with HIV are faced with a dilemma on how they can bring up their new-born children since there is a high risk of virus transmission from mother to child through breast feeding.

NACP chief, Dr Wilfred Chalamira Nkhoma, explains that women are caught between two undesirable options. If they do not have enough money to buy milk formula to replace breast-feeding, the child risks contracting HIV. If they can afford the formula the child risks contracting other infections since bottle feeding does not boost an infant's immunity in the same way as mother's milk does.

Ellen Mhone, 29, a Malawian mother of four children who last year tested positive while pregnant, said although she was counselled not to breast-feed her baby, she had no other option.

"When my husband died early last year, he did not leave any money or property. We sold any valuable thing that we had in order to pay for treatment expenses for my husband. As a result I did not have any choice but to breast-feed the baby who later on tested HIV-positive as well," she said at the conference.

Ellen and her baby often suffer from scabies and other AIDS-related diseases such as pneumonia and diarrhoea. Treatment is not always available since government hospitals do not have adequate medicines.

As people living with HIV/AIDS, women are further discriminated against when they seek access to loans and credit for farm inputs. "Some of the institutions segregate us thinking that because we have the AIDS virus we may die very soon and they would not recover their money. It is a pathetic and sad situation," Ellen said.

Ellen points out that though women usually contract the virus from their husbands, it is the wife who is blamed when it is discovered that one partner or the other is HIV-positive.

In his remarks at the opening ceremony, Mozambican prime minister Pascal Mokumbi conceded that the social tolerance for men's behaviour in Africa contributes to the wide spread of the epidemic. Mokumbi called for all married men to use condoms and for a global approach to the problem which should have a gender perspective as its cornerstone.

"In a nutshell, the strategy to control, stop, and reduce the HIV epidemic in the region, in the African continent, needs to incorporate a clear gender perspective."

The World Bank and UNAIDS - two international agencies involved in social projects in Africa - acknowledged that though some funding has strengthened social amenities such as education, health and providing of clean drinking water, the gender dimension of HIV/AIDS has received little attention.

"What is needed now is for African governments to enhance women's participation in projects that are likely to benefit them at grassroots levels with the different aid that they receive," says UNAIDS chief executive, Dr Peter Piot.

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