The Deadly Gender Gap

Fighting AIDS in Africa means convincing men to take responsibility for what is often thought of as a woman's disease

Dakar, Senegal—"I really trusted my husband," says Brigitte Syamaleuwe, a 40-year-old Zambian woman. She knew she hadn't had sex with anyone else, so when she tested HIV-positive she felt "totally shattered."

She's hardly an exception. A study from nearby Uganda found that 60 percent of HIV-positive women were married and monogamous. Yet in a way, Syamaleuwe is lucky.

While her husband at first refused to believe her diagnosis—and turned hostile—he eventually came around, and the couple now works together educating others about HIV.

No such reconciliation happened for a woman from Togo, who told her story on condition of anonymity. Her boyfriend didn't use condoms even though, as she later found out, he had known he was infected for several years. When she told him she had tested HIV-positive, he left her—and later tried to run her over with his car.

Many such stories emerged as about 500 AIDS workers from 40 nations gathered in this vibrant West African city earlier this month for the seventh international conference of the Society of Women Against AIDS in Africa (SWAA). As if to underscore the stigma against women with AIDS, just last week a South African activist, Gugu Dlamini, was stoned and beaten to death by her neighbors, furious that she had spoken out about her life with HIV.

But rather than using such tales to define AIDS as it has come to be understood in the developing world—as a woman's disease—this conference cast AIDS as a man's disease. "Without men there would be no AIDS epidemic," declares AIDS and Men, a new book published by the highly regarded Panos Institute and widely discussed at the conference. Men account for 80 percent of all injection-drug users, and virtually every sexual case of HIV involves a man (in many cases only men).

Moreover, notes AIDS and Men editor Martin Foreman, it is usually men "who determine whether sex takes place and whether a condom is used." The vagina is biologically more susceptible to HIV than the penis, and men generally have more partners than women. So, Foreman explains, "women are more liable to contract HIV without passing it on, men more liable both to contract and transmit the virus to others." Even prostitution, clearly a vector of transmission, is driven by male desire.

Foreman cautions that perhaps "no more than a quarter of men endanger themselves and their female or male partners," and conference participants stressed that castigating men would only backfire. In particular, African men have often been stereotyped as hypersexual, and no one wants to inflame such bigotry. Yet a problem clearly exists: As AIDS and Men notes, hundreds of millions of men from every continent seem to "regularly act without thought and leave women to deal with the consequences."

That's a major reason why the conference theme was "Enhancing Men's Participation." Noerine Kaleeba, one of the architects of Uganda's world-renowned educational response to AIDS, notes that "boys are supposed to chase girls, and girls are supposed to run," so countless AIDS prevention programs have tried to help girls keep running. But it's at least as important to persuade boys to ease up on the chase or act responsibly if they catch up. As Foreman puts it, "Persuading 10 men with several partners to use condoms, sterilize needles, or have fewer partners has a far greater impact on the epidemic than enabling 1000 women to protect themselves from their only partner. The 10 men are at the beginning of a chain of infection; the 1000 women are its last link."

No one is suggesting abandoning the struggle to empower women, especially not in sub-Saharan Africa, where AIDS is running rampant. Two-thirds of people with HIV—which killed 2.3 million people this year—live in sub-Saharan Africa, where the virus has infected more than a fifth of the adult population of some countries. Peter Piot, director of the Joint United Nations Programme on AIDS, says the epidemic will surpass every African catastrophe "since the slave drive."

Boosting women's power provides a proven bulwark against the virus. A Zambian study, for example, found that women who finish school are four times more likely to avoid HIV than women who drop out. But women's rights are inseparable from economics, and the poverty that envelops much of the continent was made poignantly clear by Emilia Mwange, a woman from rural Zambia who organizes home care for people with AIDS and other diseases in her village. Her volunteers spare food when they can, but often they have only enough for their families. "So you just go to do what you can—sweep, draw water, bring firewood," she says. "Sometimes the patient needs aspirin, but you don't have money for that."

Such dire circumstances magnify the consequences of women's powerlessness. Poor hygiene and limited health care foment sexually transmitted diseases, which strike women more than men and make HIV transmission more likely. "How can we say to a woman, 'Donhave sex for money,' when she has to eat?" says SWAA cofounder Fathia Mahmoud of Sudan. "Poverty is still killing us."

Westernization often makes matters worse, at least in the short term. During a freewheeling plenary discussion, a woman from Burkina Faso lamented urbanization, noting that social cohesion was tighter in traditional villages. "But in the city," she said, "a man can do anything he wants against women, even beat them." In Zambia, notes Syamaleuwe, privatization of the copper mines is leading to layoffs of many miners, thrusting families into deeper destitution and aggravating male frustration and rage.

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