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

Many laws and customs keep women second-class citizens. "Men are allowed to divorce on account of infidelity, but in many countries women don't have this right," said Kaleeba. Several participants noted that while polygamy is accepted in many countries for men, it is universally condemned for women. In some cultures, women cannot own property; when a woman's husband dies, she can lose everything to his relatives.

Finally, there is the personal power men wield, and discussions on this topic were often wrenching. "In sexual relations," said a woman from Niger, "maybe we shouldn't call men our partners, but rather our bosses." Another woman told how her boyfriend, who had infected her, was sleeping around. "How can you protect these other women?" demanded a member of the audience, but no one offered an answer. And another woman said, "When I go back home to Nigeria, my husband will say, 'What is this about a condom?' And I cannot force him to do what he doesn't want to do."

That's why news about the female condom sparked so much excitement and debate: Women need something to protect them—now—before the transformation of society is finished. A pouch that fits in the vagina, the female condom has not taken off in the United States, where it is more expensive than the male condom, makes noise during sex, and sometimes causes discomfort.

But at the conference, a study from Senegal documented "high demand" for the female condom, and that apparently mirrors the experience of women in other African countries. "In Zimbabwe, it's enormously popular," says Helen Jackson, director of SAfAIDS, an HIV information service for southern Africa headquartered in Zimbabwe. She says that country's initial shipment of female condoms sold out much more quickly than expected, and that it sold well in both rural and urban areas. When they weren't available, she says, a few women "were even found experimenting with plastic bags," trying to fashion homemade versions of the female condom.

Why would African women seize on something American women have rejected? "They're desperate to have something," answers SWAA president Eka Esu-Williams. "Women want something they control."

Still, there is some skepticism over the cost, acceptability, and proper use of the female condom, along with fear that subsidizing it would drain money from other prevention programs. There is even concern about men "misrouting" their penises to go under the pouch instead of in it. "This gadget," says Kaleeba, "is difficult to use without the cooperation of men."

But such arguments miss the point, says Jackson: "The female condom is for use when male condoms won't be used," leaving the woman with no protection at all. "It's so much better than nothing, so for God's sake why are we hesitating?"

Whatever its virtues, the female condom is a technological fix to what might be called the problem of masculinity. In many parts of Africa, says Jackson, "Men call STDs 'battle scars.' They're an honor for men, but they're stigmatizing for women." As the only incurable and fatal STD, says Mwange, AIDS stacks death on top of sexual shame to create an even more frightening stigma.

To avoid it, some women even risk harming their children. Researchers in the Ivory Coast studied whether a short regimen of AZT can prevent mother-to-child transmission. Women took their pills religiously—until they went into labor, when suddenly less than half took the drug as directed. Part of the reason was certainly the trauma of giving birth, but researchers believe another reason was fear of exposure. African women give birth surrounded by relatives, and taking AZT would reveal the mother's HIV status, exposing her and her baby to abandonment or violence by her husband.

There is certainly hope for change. In some Zambian cultures, when a husband dies, his wife used to be ritually cleansed through having sex with one of the dead man's brothers. Now, because of AIDS, that cleansing almost always takes place through another, nonsexual ritual. But at the conference, speaker after speaker called for men to make an inner transformation, a change not just in rituals but in values and attitudes, in what it means to be a man.

But how? Men are caught in a catch-22. They "run the national AIDS programs," says Esu-Williams, "but they don't do the work on the ground." This means much more than just a heavier burden for women. It means "there isn't that platform to mobilize men, to bring them together. There's a vacuum."

MacDonald Maswabi is trying to change that in Botswana, which has the world's second-highest HIV-infection rate. He's the coordinator of a pilot program called "Men, Sex and AIDS," which convenes small groups where men discuss their sexuality—not merely HIV. "The image a man has of himself as a man, sexual object, lover, etc.," explains the program's description, "might influence sexual behaviour just as much as the fear of an unwanted STD."

Surprisingly, Maswabi adapted the program from one targeting gay men in Norway—and not surprisingly, it wasn't a perfect fit. The Norwegian version required Maswabi to discuss his fantasies—something that would never happen in the traditional culture of his southern African country. "I was thinking, 'These white men are crazy!"' he recalls. But he overcame his "hell no" reaction and modified the program for sensibilities in Botswana.

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