San Francisco Chronicle - Friday, March 9, 2001
Sabin Russell, Chronicle Medical Writer

During an International Women's Day symposium, researchers issued a new AIDS prevention plan aimed at reversing social and economic inequities that leave women especially vulnerable to the disease.

"Gender inequality is fatal," said Geeta Gupta, president of the International Center for Research on Women, a Washington, D.C.-based advocacy organization that developed the plan with the University of California at San Francisco's AIDS Research Institute.

Africa is the epicenter of the global AIDS epidemic. The World Health Organization estimates that 25.3 million of the world's 36.1 million people living with HIV reside in sub-Saharan Africa. Three out of four of the 20 million who have died of AIDS are African.

Young African women are bearing the brunt of the AIDS epidemic on that stricken continent: Among those ages 15 to 19, adolescent females are infected at six times the rate of males.

"Women have much less control over sexual interactions than men -- much less control over when, how, where and with whom they have sex," said Gupta.

Financial dependence on men "makes it more likely that women will exchange sex for money or favors, less likely that they will succeed in negotiating protection, and less likely that they will leave relationships they perceive to be risky," she said.

Nancy Padian, director of international programs for UCSF's AIDS Research Institute, said AIDS prevention efforts such as condom distribution and HIV testing cannot be effective where women "have no power in their relationship with men."

Padian's group conducts clinical research in Harare, Zimbabwe, where an estimated one-quarter to one-third of the adult population is infected with HIV.

It is an uphill struggle for Zimbabwean women. "Just seeking treatment may be a public declaration that you are infected," she said.

The plan offered by Gupta and Padian calls for more research on so-called "female-controlled" prevention technologies such as microbicides -- vaginal gels that kill HIV, the virus that causes AIDS.

Women's rights, the plan says, should be "respected, protected, promoted and fulfilled," so that women are protected from male violence and have equal access to medical care.

The proposal urges that AIDS prevention efforts be blended with reproductive health programs.

Prisca Nyakutombwa, an HIV counselor at the UCSF clinic in Harare, told the gathering how she first lost a daughter, a husband and her son to AIDS. Yet when she disclosed her own infection with HIV, she said tearfully, she became an outcast among her relatives. "They felt I had disgraced and tarnished the family name," she said. "Only my mother stood by me." Her own husband accused her of bewitching him, and she became a pariah in her own community. "If I am seen talking to a child, and later the child became ill, then automatically it is me who caused it," she said.

"The love, the care that I get, is from my white friends," she said. "But that is not enough. I'd love to be loved by my own people, but they feel I am a bad woman."

Kim Dickson-Tetteh, who directs a reproductive health program in Johannesburg, South Africa, said that a culture of silence about sexuality and HIV continues to leave women vulnerable to AIDS.

"In many African cultures," she said, "women are seen as inferior to men. They are seen as possessions." The incidence of rape in South Africa is high -- rape by strangers, date rape and coercive sex and beatings by spouses.

When a man dies of AIDS, she said, it is not uncommon for his widow to become the sexual property of a brother-in-law, a practice known as widow inheritance.

There is hope, she said, in South African programs such as Love Life, which promotes open and frank discussion of sexuality and AIDS among teenagers.

"Their theme is: Talk about it," she said. "If we do not talk about it, we cannot even begin to make a difference."

Dickson-Tetteh cited a proverb from Swaziland: "If we do not cry out," she said, "we will all die unheard."
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