HIV & AIDS, Women and Vulnerability in Zambia
Through the use of photography and story telling, this report explores the human face behind the statistics of HIV and AIDS and it’s impact in Zambia. The report directly focuses on the vulnerability of women as a result of the beliefs and values, as well as the structures, which perpetuate their subordination. The report also describes the dignity, resolve and strength of women in confronting these realities.
All photography © Gareth Bentley
Introduction
The vast majority of us cannot even begin to imagine what our lives would be like if what has happened in Zambia as regards HIV and AIDS happened to us. This report and its accompanying photographs try to capture something of the realities of HIV and AIDS in Zambia today.
Our title was given to us by Mutonga Muketukwa from Itufa near Senanga in Western Province, who insisted that despite all that had happened to her and despite the anger of those around her ‘… this is what has happened, and whether you like it or not, I am living positively’. Mutonga epitomised one of the key lessons of the research– the resolve of so many women to continue with their lives and to live positively despite the devastating impact of the virus on them and on their families. What began as a chronicle of the various vulnerabilities women in Zambia face, became the story of persistence, strength, resolve and hope. While the HIV and AIDS pandemic has stripped bare many of the weaknesses and failings of Zambian society, it has also emphasised the immense potential of Zambian women, a potential as yet unrealised.
This report explicitly focuses on the vulnerability of women in five key areas as a direct result of the beliefs, values and structures in Zambian society that discriminate against women.
In compiling ‘This is what has happened…’, we set out to provide a representative sample of the stories behind the statistics and to give those infected and affected the opportunity to tell their story.
The stories gathered here graphically illustrate a key issue in that they focus on a series of political issues that are not unique to Zambia or indeed southern Africa. They are issues of importance the world over – issues of governance, accountability, policy making and prioritisation, service infrastructure and resourcing and the broad political landscape upon which these issues work themselves out. They also tell a story of injustice. The injustice of economic, social, cultural, educational and political sub-ordination of women and, of necessity, it is also the story of the dominance of much that a particular definition of ‘manhood’ stands for. While women continue to bear too much of the burden of HIV and AIDS, men are at the heart of the matter – the stories make this abundantly clear. What began as a research and documentation project on women in Zambia very quickly became one about universal issues and values, which ultimately impact on each and every one of us.
Valerie Duffy and Ciara Regan
Photographer Gareth Bentley adds:
It has been my privilege to contribute through my photography. Having lived in this country all my life, I need no reminder of the dreadful hardship that the HIV and AIDS epidemic inflicts on all of Zambia’s people, and most especially her women and girls. However, faced with this reality every day, it becomes all too easy to hear the statistics, see the images, be shocked of course, even angry and then get on with our lives, still significantly detached.
It is not until you set aside the time to talk, face to face, with individual people in all walks of life, that their daily struggle simply to live, finally hits home. Hearing these intensely intimate stories of hardship and grief, of hope and joy, of battles won and lost, makes it simply impossible to ignore any longer. My goal was do my utmost to capture each person truthfully, simply and without preconception, in an image that gives some insight, even if just for a moment, into the lives of each of these very different people. It is my sincere hope that I have achieved this goal.
Gareth Bentley, Lusaka, World AIDS Day 2010
Foreword by Michael J. Kelly
HIV and AIDS is not a democratic disease. It infects selectively. It discriminates easily. It victimizes readily. It shows this in the people it infects and the communities it affects in Zambia and several of the countries of sub-Saharan Africa. Most of all, it shows its discriminatory character in its preferential option for women and girls.
This comes out in the ways the epidemic continues to have an increasing and disproportionate impact on women and girls as compared with men and boys. Zambia is experiencing a steady increase in the number and proportion of women living with the disease. Compared with boys and men, girls and women are becoming infected with HIV at younger ages and are dying at younger ages of AIDS-related illnesses. And in every area of life, women and girls are finding themselves more extensively affected by the epidemic.
A great deal has been written about this feminisation, as it is called, of HIV and AIDS. But much that is written is not readily available or is presented in technical and academic language that does not speak to the lived situation of the reader. The real person, infected with HIV or affected in some way by the epidemic, seems to disappear. Instead, we are left with concepts, ideas, statistics, theories and models, but we lose sight of the real human person that these are all about. As a result, we often put away the book or article, agreeing with all that it says, but not affected enough within ourselves to want to do something about changing things for the better.
“The real person, infected with HIV or affected in some way by the epidemic, seems to disappear. Instead, we are left with concepts, ideas, statistics, theories and models, but we lose sight of the real human person that these are all about.”
This book is different. It presents the picture of the AIDS epidemic’s preferential option for women and girls in terms of real people from many parts of Zambia. You will read here what the disease means to farmers, nurses, teachers, traditional leaders, fishing people, former commercial sex workers, community workers and others. You will read what infected persons are saying about themselves, how they feel, how they are coping. You will read about their joys and hopes, their grief and anguish. You will come to know their courage and resilience.
You will enter into the very private lives of many of them and when you come away you will feel yourself grateful and inspired: grateful that they have shared with you on some very intimate matters that affect them deeply; inspired by the unbroken spirit and bravery that ordinary people, above all women, can show when faced with what seem to be overwhelming odds.
“…so many of these difficulties are rooted in the low status of women, in the systematic and intrinsic subordination of women that originates or aggravates these problems and increases women’s vulnerability to HIV and AIDS”
But you will also feel yourself angry and sad as you read about the difficulties so many of these people, nearly all of them women, experience in keeping themselves alive: heavy transport costs in getting to clinics for their medical check-ups and renewal of antiretroviral drugs; break-downs in CD4 count machines at clinics resulting in long delays before people can begin antiretroviral therapy; stock-outs of essential drugs; long queues, even for those who are quite ill; costs and sexual risks of overnight accommodation; inability to get sufficient food of the right kind to accompany their medication; having to sell a cow or a TV to pay for necessary medicines. The problems occur for everybody, but most of all for women and for those living in rural areas.
Running through the text you will find another theme: the way so many of these difficulties are rooted in the low status of women, in the systematic and intrinsic subordination of women that originates or aggravates these problems and increases women’s vulnerability to HIV and AIDS.
The book identifies five levels at which women and girls become more vulnerable to HIV and AIDS and their impacts. At each of these levels, the vulnerabilities are either created or magnified by the ways society organises itself or behaves. The testimonies coming from infected and affected individuals, men as well as women, provide unassailable evidence that women and girls become more vulnerable to HIV and AIDS through sexual activities that increase the risk that HIV may enter their bloodstream, the denial of their rightful economic independence, a wide range of social and cultural practices that express their subordinate status, legal structures, provisions and practices that favour men, and practical discrimination against them in educational and career opportunities.
Perhaps the critical point in all of this is that the majority of these vulnerabilities have been socially constructed. They owe their origin to the values, attitudes and traditions developed by communities and families and passed on to children in the almost unreflecting process of socialisation. Since they have been socially constructed, they can be socially deconstructed and replaced by values, attitudes and ways of behaving that embody equality, respect and the commitment of real power to both women and men.
Hence the challenge coming from this book is to address the norms within communities that give rise to attitudes, behaviours and practices that have the effect of subordinating women and simultaneously making them more vulnerable to HIV and its negative impacts. These norms influence behaviour, not only in the sexual sphere, but across the whole spectrum of social, cultural, legal and economic life. What is needed is to change them so that they no longer manifest themselves in behaviours that are to the advantage of men and the disadvantage of women.
Unfortunately, programmes dealing with HIV seldom set out to do this. Many programmes acknowledge that existing norms are debasing and disempowering for women and degrading and destructive for men. But thereafter the approach is not concerned with changing these norms into something that better reflects the dignity of men and women alike. Rather it is concerned with how to reduce the HIV transmission risk in behaviours that arise within the framework of existing norms (which, in practice, heighten the vulnerability of women). Given the length of time it will take to transform cultures, this is necessary. But it is not sufficient. Unless something more is done, to get down to the deep roots that legitimise the risk behaviours, these will continue indefinitely. The prevention work will be never ending, because the roots of the problem continue to flourish.
Perhaps the critical point in all of this is that the majority of these vulnerabilities have been socially constructed. They owe their origin to the values, attitudes and traditions developed by communities and families and passed on to children in the almost unreflecting process of socialisation.
This very challenging book could have been written as a narrative commentary on what the great human rights activist Jonathan Mann said a quarter of a century ago:
The central AIDS issue isn’t technological or biological: it’s the inferior status or role of women. When women’s human rights and dignity are not respected, society creates and favours their vulnerability to AIDS
This book presents a shocking exposé of the way society in Zambia has done just that. It has allocated an inferior status and role to women and girls and thereby has failed to respect their human rights and dignity. And by the fact of doing so, it has created and favoured their vulnerability to HIV and AIDS.
The challenge for each one of us is: can I be satisfied that it should remain so? If not, then what am I going to do about it?
Michael J. Kelly,
Luwisha House, Lusaka
October 26th 2010