Women must break the silence before the battle can begin
Sunday Times, South Africa - July 16, 2000 Ranjeni Munusamy
A 10-YEAR-OLD Ugandan girl's account of her rite of passage into womanhood - mutilation with a blunt knife by four drunk women - drew gasps of shock from delegates at an International AIDS Conference workshop this week. One woman sat on the girl's chest to prevent her from writhing; two others held her legs firmly apart. The fourth performed the procedure - thereby elevating the girl's social standing and making her eligible for marriage. A cloth, stuffed in her mouth, stifled her cries. The girl is just one of millions of women around the world who are victims of physical, sexual and psychological violence. She is a prisoner of culture, condemned to a life where tradition defines male and female roles. This week's 13th International AIDS Conference set out to break the conspiracy of silence that perpetuates the stigma attached to people infected with HIV; a silence that retards efforts to turn the tide of the pandemic. According to the World Health Organisation, heterosexual transmission is the most dominant method of spreading HIV - almost entirely so in Africa and South and Southeast Asia. As with most sexually transmitted diseases, women are biologically at least four times more vulnerable to HIV infection than men - they have a large mucosal surface and there is more virus in sperm than in vaginal secretions. And, as one research study after another at the conference showed, unequal gender relations play a key role in women's inability to protect themselves from sexually transmitted infections - increasing their susceptibility to HIV and AIDS. The president of the International Centre for Research on Women, Dr Geeta Rao Gupta, argues that the social and cultural structure of society - which determines the role of women and limits their decision-making - significantly increases their vulnerability to HIV. Culture often dictates that "good" women are expected to be ignorant about sex and passive during sexual interactions. "This makes it difficult for women to be informed about risk reduction or, even when informed, makes it difficult for them to be proactive in negotiating safer sex," Gupta says. The tradition of unmarried girls being virgins, is another factor that increases young women's risk of infection, as it restricts their ability to ask for information about sex, for fear that they will be thought to be sexually active. Gupta says virginity puts an extra burden on young girls since men, according to a widely held belief, think sex with a virgin could cleanse them of sexual diseases. In many cultures, motherhood - like virginity - is considered a feminine ideal and using barrier methods or non-penetrative sex as safe options present a serious dilemma for women. Economic insecurity, research shows, also makes it acceptable for women to have unprotected sex for money. Violence against women, the most disturbing form of male power, remains a major barrier to HIV prevention and care. Its many forms - rape, incest, wife battering and sexual abuse - mean that sex is often coerced, which is itself a risk factor for HIV infection. An International Community of Women Living with HIV/AIDS study showed that in Zimbabwe 78% of HIV-positive women interviewed reported that they were forced to have sex with their partners. Gupta says that in many societies it is believed that variety in sexual partners is essential to a man's nature and men will seek multiple partners. This in turn leads to risk-taking behaviour that exacerbates the spread of sexually transmitted diseases and has been the major cause of HIV infection among monogamous married women. "In many societies, being socially ostracised, marginalised and even killed are very real potential consequences of exposing one's HIV status," Gupta says. South Africa provided the world with one of the most horrendous examples of HIV discrimination when Gugu Dlamini was stoned to death in December 1998 in KwaMashu, KwaZulu-Natal, for divulging her HIV status. In exposing the power imbalances in gender and sexuality and how they fuel the AIDS epidemic, conference participants petitioned the international AIDS community to seek urgent interventions to stop the cycle of madness. The male condom is seen as a "male-controlled" method of protection and the introduction of alternative womencontrolled methods are seen as a high priority. These include female condoms and microbicides - colourless, odourless substances which reduce transmission of sexually transmitted infections. Conference members this week also proposed the integration of sexually transmitted disease treatment with family planning services, improving women's access to treatment and counselling services without fear of social censure. The creation of a supportive policy and legislative context for women is another crucial requirement for containing the spread of HIV. The head of the Department of Health's AIDS programme, Dr Nono Simelela, says that while South Africa has all the laws to empower and protect women, they will remain trapped in subservient roles until tradition is addressed. "There needs to be change within families and the household. While we have strong role models of women leaders in positions of power, there is little hope if these can't be translated into equitable relationships in the household and in women's personal lives," she says. But for most women, the battle does not lie in measuring up to male power. Instead, it is about fundamental rights, protecting themselves and their daughters from customs that expose them to life-threatening conditions and diseases. And it is about having the right to define their needs and desires in a society determined by men. But the battle will only start once their screams are heard.
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Always watch for outdated information. This article first appeared in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.
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