Understanding the Vulnerability of Women

For the greater part, this stalking of women by HIV and AIDS arises from society’s unjust allocation to them of an inferior status. Were it not for the unjust treatment and exploitation that women experience, the epidemic would not have its current worldwide grip. It would not have its current stranglehold on southern Africa. Fewer men would be infected. Fewer women would be infected, and because this would reduce the incidence of parent-to-child transmission, fewer children would be infected.

Michael J. Kelly SJ (2006)

It is now undeniable that HIV and AIDS is more than ever, a devastating attack on women, most notably on women in sub-Saharan Africa – the only region in the world where, according to UNAIDS, HIV rates are higher among women than men. Of the 23 million adults currently infected in sub-Saharan Africa, 57% are women with women aged between 15 and 24 years, three times more likely to become infected than men of a similar age. This increase in the number of women and girls becoming infected at ever younger ages is now referred to as the ‘feminisation of HIV and AIDS’. This reality is not simply devastating for the women affected; it impacts at a variety of fundamental levels on society in general with consequences for the future development and well-being of all.

In the initial stages of the spread of HIV, men appeared to be more infected. More recently though, it is women who have become more vulnerable, especially in countries where the primary transmission is through heterosexual intercourse. The negative impact of the virus for the lives of women is more severe than for men principally due to their subordinate status in society. In many sub-Saharan African countries, socio-cultural practices and traditions sustain women’s unequal status leaving them vulnerable to poverty, discrimination and violence – and ultimately to HIV infection.

The vulnerability of women can be highlighted at five fundamental levels:

Biomedical Vulnerability

Women remain biologically seven times more vulnerable to the transmission of the virus during sexual intercourse than men; cultural practices reinforce this and women's role as the primary care givers also leaves them vulnerable.

Social & Cultural Vulnerability

Certain cultural practices associated with the subordination of women to men help ensure women's vulnerability to HIV and AIDS. The practice of multiple concurrent sexual partnerships is lethal in this context.

Economic Vulnerability

The poverty experienced by women and their economic dependence on men leaves them vulnerable often with little option but to sell themselves in order to survive or to feed their children.

Legal & Political Vulnerability

While women are seen to be equal in rights to men in theory, the practice often denies this with traditional law as well as constitutional law often discriminating against women and structures and institutions routinely enforce this discrimination.

Educational Vulnerability

The ongoing challenge of ensuring female access to, and completion of, education at primary and post-primary levels contributes to the subordination of women.

Biomedical Vulnerability

A disproportionate number of girls and women in southern Africa are infected with HIV, with levels of infection far exceeding that of men in the region and several orders of magnitude higher than that of women in other settings.

Helen Rees and Matthew Chersich (2008)

Physically women are more vulnerable than men to infection during sexual intercourse. Male to female HIV transmission is seven times more likely than female to male transmission – often referred to as biological sexism. This is due to the fact that the mucous membranes on the cervix of the uterus are especially vulnerable to sexually transmitted infections including HIV. In particular, the vulnerability of teenage girls is further aggravated by how susceptible their immature cervix and genital tract is to tearing, lacerations and infection during intercourse, with this risk doubling during and just after pregnancy.

Although there has been a significant increase in the number of campaigns promoting the use of condoms in order to prevent HIV transmission, research has shown that condoms are more generally used in commercial sex than in the home. The stark reality for some women is that unless they are empowered to have some degree of control in a sexual relationship, the use of a condom during intercourse will depend on the male, thus highlighting underlying gender inequality. It is widely recognised that more needs to be done in order to empower women to take greater control of their sexuality.

Since 2005, Anti-Retroviral Drugs (ARVs) have been supplied free from clinics and hospitals across Zambia. Despite this, not all people in need of treatment are receiving it. This is due to the fact that the ‘accessibility costs’ can be very high in terms of distance (especially for those unable to afford transport or the associated food and accommodation costs) plus the length of time people have to wait (often for days) because there is no doctor or because the machine is unavailable or broken. ARVs are not always readily available from some clinics especially those in the more rural areas. If a person is bedridden or cannot afford to pay, they regularly end up defaulting on their medication. This is detrimental to the patient’s long term treatment and well being. Although some clinics have support teams to service their clients, this is not true for the majority of clinics.

Although the biological vulnerability of women does not explain the reason why women are becoming infected at younger ages, or why some women resort to selling their bodies in order to provide for themselves or their family, it is still a significant factor in the infection rates of women.

“It thus remains that the vulnerability of women due to biomedical factors is exacerbated by a deep-rooted lack of social capital, income inequality, and social and gender justice, in themselves highly important predictors of HIV.

Helen Rees and Matthew Chersich (2008)

Social & Cultural Vulnerability

Growing aspirations in societies where the gap between rich and poor is widening and women perceive few options for obtaining financial independence, coupled with cultural allowances for age-disparate relationships and exchange expectations in sex, make young women of southern Africa exceptionally vulnerable to HIV infection.

Suzanne Leclerc-Madlala, 2008

A critical factor aggravating the problem that AIDS poses for African women is the definition of the place of women in very many African societies. Of particular significance in terms of why sub-Saharan Africa has been hardest hit by HIV and AIDS is the subordinate social status of women and the many negative cultural practices and traditions that sustain that subordination. The majority of the vulnerabilities women face are not only maintained but are reinforced by cultural practices such as those at initiation (where women often are required to publicly display subordination), those relating to women’s health (traditional ‘infertility treatments’), those during sexual intercourse (e.g. ‘dry sex’ which increases women’s vulnerability to infection during such sex) and the generally accepted practice of men having multiple concurrent sexual partners. Currently the social group with the highest risk of HIV infection are married women where infection routinely occurs through external affairs by husbands and partners. Women do not have sufficient power to negotiate condom use within a relationship. Furthermore, women have insufficient power outside of a relationship to leave it if they are at risk of infection.

Other cultural practices and traditions contribute such as polygamy, levirate (marriage by a man’s brother to his widow) or sororate (concurrent marriage with a wife’s sister) and sexual cleansing. The gender role prescribed for women and ‘femininity’, demands a submissive role, passivity in sexual relations, while the role prescribed for men requires them to be more dominating, knowledgeable and experienced about sex. This also puts many young men at risk as such perceptions prevent them from seeking information and also promotes promiscuity.

Poor educational attainment generally entrenches gender inequalities leaving many women uneducated or ill-informed as regards issues such as the transmission of HIV and protection. Violence towards women compounds the link between gender inequalities and vulnerabilities where some women are continually subjected to abuse and rape. This is particularly of concern in countries with high prevalence rates (such as Zambia) as there is a high possibility of HIV transmission if a woman is raped.

Many cultures and religions give more freedom to men than to women. For example, in many cultures it is considered normal — and sometimes encouraged — for young men to experiment sexually before marriage. Also, in many cultures, it is considered acceptable for men — even married men — to have sex with sex workers. These cultural attitudes towards sex are leading to HIV infections in both men and women — often the men’s wives.

– UNAIDS, 2001

Economic Vulnerability

In the fields, in the home, and in the marketplaces throughout Africa, women workers reign. Although ‘household activities’ are not calculated into the national income, we all know how invaluable their work, while sometimes invisible and nearly always undercompensated, can be.

Linda Fuller, 2008

Even though African women produce three-quarters of the continent’s food, they are still amongst the poorest of the poor. Despite the fact that women do the majority of the informal work within the economy, they are still heavily dependent on men due to the lack of access to capital or credit or control over household resources and due also to patriarchal practices and traditions including those that relate to the economic position of women. These practices and traditions extend into the ownership of land or property. In many cases, women are restricted in owning or inheriting land or wealth. Lacking power or control over household or communal resources makes women subservient to men and relatively powerless in negotiating, including in the realm of sexual relations, thus increasing their vulnerability to infection.

Only 10% of economically active women earn wages in the formal economy and are likely to earn the least amount in the informal sector. Due to the informal nature of the majority of their work, women’s vulnerability is heightened by the fact that if they or a family member becomes ill, they do not get paid for days missed while caring for themselves or a family member.

It is for reasons such as these that many women are often forced into prostitution or ‘transactional sex’ (or risky sexual relationships with, for example, older men or ‘sugar daddies’) as an economic necessity in order to provide for their families, despite knowing that this may lead to the transmission of HIV. It is a survival strategy for many as they are sometimes left with few other options.

Many girls are taken out of school early in order to help at home or to provide care for sick family members and are subsequently deprived of education, thus reinforcing their subordination, vulnerability and disempowerment.

Global evidence suggests that the relationship between poverty and HIV risk is complex, and that poverty on its own cannot be viewed simplistically as a driver of the HIV epidemic. Rather, its’ role appears to be multi-dimensional, and to interact with a range of other factors – such as mobility, social and economic inequalities, and social capital – which converge in a particularly potent way for young women living in southern Africa.

– Julia Kim, Paul Pronyk, Tony Barnett and Charlotte Watts 2008

Legal and Political Vulnerability

Zambia’s constitution prohibits the enactment of any law that is discriminatory on the basis of sex or has such discriminatory effect. But it also recognizes a “dual legal system”, which allows local courts to administer customary laws, some of which discriminate against women.

Human Rights Watch, 2007

Most cultures in sub-Saharan Africa are patrilineal, so when a woman marries through customary law, she will then be a part of her husband’s family or tribe and therefore any property will be passed along through the males in the family. Women can often only access land or property through their fathers, brothers, husbands or male relatives and cannot legally own land. If a relationship ends between a woman and her husband, there is a good chance that the woman will lose her home, land, livestock, household goods, money and any other property. These violations thus perpetuate women’s dependence on men and undercut their social and economic status. Women, therefore, have little or no access to property or reproductive rights.

Although equality, reproductive and sexual rights are supposed to be guaranteed under international and regional human rights treaties, unless they are recognised and enforced by national-level courts, they are of little or no value. This situation is exacerbated by the fact that in much of rural sub-Saharan Africa, there is limited access to legal information or to African national courts in particular when it comes to the rights of women.

In Zambia, there are two ‘legal systems’ – the ‘civil’ court system and the ‘traditional’ court system and, depending on location and practice, these systems do not view issues identically with the traditional system being predominant. Women, and especially rural women, are routinely at the mercy of traditional courts because of the patriarchal nature of traditional practices. This can greatly affect women especially in terms of finance, and specifically in relation to owning property.

Poor educational capacity is often further compounded by lack of access to even basic information on, for example, ‘property grabbing’ by the family of a deceased husband or partner and what the law allows – this increases the vulnerability of women when faced with the economic realities of HIV and AIDS. The link between powerlessness and the risk of HIV infection is key to understanding the sources of women’s vulnerability.

There is one factor more than any other that drives me crazy in doing the Envoy job: it’s the ferocious assault of the virus on women. We’re paying a dreadful and inconsolable price for the refusal of the international community, every member of the community without exception, to embrace gender equality. And in so many parts of the world, gender inequality and AIDS is a preordained equation of death.

– Former UN Special Envoy Stephen Lewis, 2004

Educational Vulnerability

As it has become increasingly clear that keeping girls in school is protective against HIV, achieving Education for All (EFA) would be a critical contribution to HIV prevention … Focusing EFA efforts on the poor, who are the least likely to attend school, will have particular benefits in the fight against HIV. Poverty and HIV are intertwined issues in southern Africa … While increasing levels of general education can be effective, tailored HIV prevention curriculum also has a role to play…

Matthew Jukesa, Stephanie Simmonsa and Donald Bundy, 2008

The educational challenge of HIV and AIDS in Africa is deeply rooted in the pervasive gender inequalities in African societies and the subordinate status of women and girls. For economic, social, family, health and cultural reasons, many young girls are forced to leave school early. This reality contributes greatly to lowering female literacy rates and to generally poor educational attainment. The lack of effective education and poor literacy contributes to the disempowerment of women. In the context of women’s health and HIV and AIDS, it puts them at serious risk, not only prior to infection, but also post-infection. Poor education attainment generally reinforces gender inequalities leaving many women uneducated or ill-informed as regards issues such as the transmission of HIV and on how to protect themselves from becoming infected.

There are a number of key issues which must be highlighted and addressed with regards to girls and women’s education. The main focus points are the threat HIV and AIDS poses to the progress already made in girls access to and completion of basic primary education; how education is a ‘critical mitigating force’ for developing life skills and knowledge in terms of supporting themselves and their families; and that by assisting girls in overcoming the effects of HIV and AIDS and supporting them in gaining access to education, they become more empowered to support themselves, their families and communities and also contribute to national development.

In the longer term, and more generically, education plays a key role in establishing conditions that render the transmission of HIV and AIDS less likely conditions such as poverty reduction, personal empowerment, gender equity. It also reduces vulnerability to a variety of factors, such as streetism, prostitution, or the dependence of women on men, which are a breeding ground for HIV infection.

– Michael J Kelly, 2000