By Jared Chausow
By Katie Toth
By Elizabeth Flock
By Albert Samaha
By Anna Merlan
By Jon Campbell
By Jon Campbell
By Albert Samaha
Additional articles in this series.
Harare, Zimbabwe and Nigeri Village, KenyaSipewe Mhakeni used herbs from the Mugugudhu tree. After grinding the stem and leaf, she would mix just a pinch of the sand-colored powder with water, wrap it in a bit of nylon stocking, and insert it into her vagina for 10 to 15 minutes. The herbs swell the soft tissues of the vagina, make it hot, and dry it out. That made sex "very painful," says Mhakeni. But, she adds, "Our African husbands enjoy sex with a dry vagina."
Many women concur that dry sex, as this practice is called, hurts. Yet it is common throughout southern Africa, where the AIDS epidemic is worse than anywhere in the world. Researchers conducting a study in Zimbabwe, where Mhakeni lives, had trouble finding a control group of women who did not engage in some form of the practice. Some women dry out their vaginas with mutendo wegudosoil with baboon urinethat they obtain from traditional healers, while others use detergents, salt, cotton, or shredded newspaper. Research shows that dry sex causes vaginal lacerations and suppresses the vagina's natural bacteria, both of which increase the likelihood of HIV infection. And some AIDS workers believe the extra friction makes condoms tear more easily.
Dry sex is not the only way African women subordinate their sexual safety to men's pleasure. In a few cultures, a woman's vagina is kept tight by sewing it almost shut. But in most African societies, the methods are subtler: Girls are socialized to yield sexual decision-making to men. Prisca Mhlolo is in charge of counseling at The Centre, a large organization for HIV-positive Zimbabweans. "You're not even allowed to say, 'Can we have sex?' " she notes. "So it's very hard to bring up condoms."
Mhlolo speaks from both professional and personal experience. She is HIV-positive, infected by her late husband. As AIDS eroded his immune system, he suffered from herpes, which broke into open sores on his penis. Mhlolo suggested condoms, "but he said, 'Now that I'm sick you have gotten yourself a boyfriend.' It was very hard."
Many people balk at discussing the sexual practices of particular cultures because the issue is too sensitiveand, in Africa, too racially charged. Whites have caricatured African sexuality for centuries, casting black men as sexual beasts, and some whites still whisper that this is why HIV is running rampant among Africans. But such stereotypes miss the point, which is not the libido itself but the culture in which it finds expression. HIV spread through the American gay community because having anal sex with many partners was common, and the virus infiltrated the Thai army because soldiers routinely patronized prostitutes. In Bombay, where AIDS has exploded, slum lords demand payment in sex. I.V. drug use aside, male sexual privilege is what drives the epidemic.
Studies from many different cultures show that men average more partners than women do and have more sex outside marriage. Because a man ejaculates into a woman, men are more likely to transmit the virus, whereas women are more likely to contract HIV without passing it on. So far, males have outnumbered females in HIV cases, partly because having more partners means more chances to encounter the virus. But new figures show that in sub-Saharan Africa, 55 percent of all infected adults are women.
Of course, Africa contains thousands of cultures, some of which have strict sexual codes. But common to many sub-Saharan societies are the gender roles epitomized by dry sex: Women are unable to negotiate sex, and so must risk infection to please the man. In fact, there are very few female checks and balances on male behavior. This stark inequality "is part of our culture," Mhlolo says, "and our culture is part of why HIV is spreading."
Africa today is far removed from its traditional, tightly knit communities that did constrain men, mostly to their wives. Africa is also very different from the West, where women exercise a relatively large degree of power. Many parts of contemporary Africa are suspended in a limbo that combines the worst of both worlds, and HIV has exploited this. For example, men retain the mindset of polygamy, but now have many partners through commercial sex or "sugar daddy" relationships that lack the social cohesion of traditional marriages.
But AIDS is forcing African culture to changeand because the virus in Africa is spread mainly through heterosexual sex, the epidemic's largest social transformation may well be in the relations between women and men. Women could emerge from the epidemic with more power, and there is a strong push to make that happen. But there is also a backlash, a call to reimpose restrictions on women in the name of strengthening traditional African cultures and curtailing AIDS.
The battles are being fought not only over sexual practices, but also over larger economic and social forces that subordinate women and facilitate the spread of HIV. The World Bank reports that illiteracy rates among women south of the Sahara are almost 50 percent higher than among men. Many African girls cannot attend school because they are assigned time-consuming chores such as fetching water and firewood. Indeed, African women work longer than menand harder. Studies from Ghana and Tanzania show that rural women transport four times as much as men, often carrying the loads on their head, and other studies show that women do up to 90 percent of hoeing and weeding. Yet they make far less money than men and rarely own property. In Cameroon, for example, fewer than 10 percent of all land certificates belong to women.
African women also lack authority. Just this year, Zimbabwe's Supreme Court ruled that women have no more status or rights in the family than a "junior male"usually an adolescent. If a wife wants to take a trip, explains Thoko Matshe, director of the Women's Resource Center in the capital Harare, "she has to sit her husband down, get the guy in a good mood, and ask him if she can go. If you cannot negotiate that, you cannot negotiate sex."
In most sub-Saharan traditional cultures,men pay for their wives, which gives them license to dominate the relationship. The very concept of marital rape doesn't exist in most of Africa, and even the auntiestraditional marriage counselors for many young African wivestell women that they cannot refuse sex with their husbands. Thoko Ngwenya of Zimbabwe's Musasa Project, which fights domestic violence, explains the mindset: "Once a man has paid lobola"the word for dowry in several southern African languages"they are not forcing their wife to have sex. It's just their right."
The sexual subservience of women is inculcated long before adulthood. For example, traditional Shona girls are taught to pull the lips of their labia to lengthen them so that men can play with them during foreplay, yet women are not supposed to touch their husband's penis. Indeed, in some cultures, female circumcision removes the most sexually sensitive part of a woman's bodyher clitoris. "For women," says Caroline Maposhere of Zimbabwe's Women and AIDS Support Network, "there is no sexuality, only fertility."
Ironically, the prohibition against wives participating fully and actively in sex can itself promote the spread of the virus. Eliot Ma-gunje runs counseling groups for men at The Centre. He hears men complain that their wives' passivity "destroys the enjoyment of sexshe's just lying there like a log. 'Why are we going out?' men ask. 'Because a prostitute is 100 percent what I want. My wife is just for cooking and washing.' "
Of course, real-life relations between men and women are more complex. Jane, a Zimbabwean woman who asked that her last name not be used, says, "If your husband demands sex you are not allowed to deny him, but in practice you communicate and understand each other." The trouble is that such communication takes place on a field steeply tilted in favor of the man. Jane, for example, knew that her husband had a girlfriend on the side, and she took the step of asking him to use a condom. "My husband answered, 'I cannot use a condom with my wife,' " Jane recalls. "So I think that's why I got infected." She's not alone. A study from Zimbabwe found that more than half of women with STDs contracted their illnesses from their husbands. Marriage, say many AIDS workers, is a risk factor.
Anecdotal reports indicate that dry sex is waning among educated, urban young people. But there are also loud calls to reject Western gender roles, which are said to emasculate men. Even in the cities, says Matshe, "it's 50-50." Of course, most Africans still live in rural areas or small towns. And changing sexual practices is never easy, in part because they touch fundamental issues of personal identity and sexual roles.
It's not surprising that men like dry sexthe swollen tissues make the vagina smaller and, therefore, make the man feel bigger. Also, some men (and women) find vaginal secretions repugnant, while others don't like the sound of wet sex. And to many men, a vagina that is too wet and loose can signify infidelity.
But some women also prefer dry sex. Mhakeni stopped only because she is HIV-positive and wants to protect herself against getting any sexually transmitted diseases that might weaken her immune system. Despite the pain of dry sex, she favors it. "It's our culture," she explains. Then she adds a reason researchers and AIDS workers say they hear over and over again: "If I don't use herbs, our men will go with someone else." Indeed, Mhakeni sells the herbs, and even when she warns women of the risks, they still buy. "They say, 'It is okay if HIV is brought in by my husband, because at least I will still be married.' "
Fanuel Adala Otuko looks every inch the leader of Kenya's Luo people: old, ramrod straight, missing six lower teeth pulled at age 12 as a rite of passage. "It is painful," he says, "but you cannot cry."
The Luos no longer pull their children's teeth, but Otuko and other elders want to revive some of the Luo's other traditions, especially those they believe might slow the spread of HIV, which has devastated them. In Kenya, Luo land is one of the hardest-hit areas in the country, with the rate of infection among adults in Kisumu, the city where Otuko lives, topping 20 percent.
All over Africa, AIDS workers are beginning to target male behavior. Around Kisumu, they are especially concerned about the fish merchants on the shores of Lake Victoria, who lure young girls with money. But Otuko and other Luo elders focus on women.
For example, the elders want to revive the ideal of female virginity. Traditionally, on the afternoon of a wedding, a dozen or more married women went to the newlyweds' home to check for blood, believed to be a sign of a woman's virginity. They also checked the mannot for virginity, but for sexual prowess. They "witness that she has a normal man," explains Otuko, "a man who can have sexual relations with her."
The elders also want to take more aggressive steps. Against the recommendations of most public-health workers, they want to identify HIV-positive women and impose restrictions on them. "They should be controlled, quarantined in their areas," Otuko says. (Only when asked does he say that this restriction could also apply to men.) "AIDS is serious," he says. "There is no cure. So people should avoid contact with infected women, sexual contact especially." There's the rub, because one venerated Luo tradition usually involves sex with a widowand AIDS has caused a proliferation of widows.
Like many cultures in East and southern Africa, the Luo practice what is variously translated as home guardianship or, more commonly, widow inheritance. When a husband dies, one of his brothers or cousins marries the widow. This tradition guaranteed that the children would remain in the late husband's clanafter all, they had paid a dowry for the womanand it also ensured that the widow and her children were provided for. When the guardian takes the widow, sexual intercourse is believed to "cleanse" her of the devils of death. A woman who refuses to take a guardian brings down chiraill fortuneon the entire clan. Of course, if her husband died of AIDS, she might very well pass on the virus to her guardian. Millicent Obaso, a Luo public-health worker with the Red Cross, says: "We have homes where all the males have died because of this widow inheritance."
Danger to the inheritors is only one reason AIDS is putting this tradition under strain. Guardians are supposed to provide assistance, but even the elders concede that inheritors often take a widow only for sexual pleasure or to seize her property. According to tradition, a guardian must already have a wife of his own, so no matter how well-intentioned he may be, poverty often makes it impossible to support a second family.
Anna Adhiambo is standing where she and her husband used to live: in Ngeri village, on a fertile hillside that slopes down into the blue expanse of Lake Victoria. It's the first time she has been back since her late husband's family forced her off the property two years ago. Her husband died of AIDS in 1996, and she was inherited by his cousin. She expected him to help her feed her three children and pay their school fees (education in Kenya, as in most African countries, is not free). But he was a fisherman who had a family of his own, and "whenever he came from the lake," Anna recalls, "he said he didn't have enough. That was the song." They quarreled frequently, and five months after she was inherited, Anna decided to separate.
The consequences were swift and harsh. A group of men from the clan told her she and her children would have to leave the next day. She remembers that they called her an ochot, a whore who "goes from one man to another." When she asked them to "please leave me alone in my house," she recalls one of her brothers-in-law retorting, "This is our home. You shouldn't answer me rudely like that, and if you do so again, I will beat you."
Consolata Atieno is Anna's mother-in-law. She has been smoothing the earthen walls of a new hut, and on her hands the thick mud dries and cracks as she talks. Anna "violated tradition, broke a taboo," she says, so "we had to chase her and her children away. We felt the furniture and things in the house were my son's, so we took them. Anna did not buy them. And the land we took: Some we gave to my other sons, some we sold. In our tradition, a woman is the property of her husband's family. He bought her with the dowry."
Unable to farm, Anna now makes less than $10 a month doing odd jobs in a nearby town. The Akado Women's Group, a local agency, is assisting her, but so far only one of her three children is in school. How does Atieno feel about her grandchildren suffering? "When Anna was making this decision, she must have known the consequences." But if Anna cannot provide for them, her children will be at greater risk for continuing the cycle of infection. A study in Zambia, for example, found that a lack of education quadrupled the chances that a woman would contract HIV.
Otuko and the elders believe home guardianship could strengthen families like Anna's. What the elders want is to strip this tradition of its sexual component, transforming it into what they call "symbolic inheritance." They point out that nonsexual cleansing was practiced with aged widows who were past menopause. And in parts of Zambia and Zimbabwe, such symbolic rites have gained ground.
University of Nairobi philosophy professor Oriare Nyarwath believes nonsexual inheritance could bring "a dignified death to the practice, without making people feel culturally destitute." But, he notes, even symbolic guardianship implies that women are subservient to and dependent upon men. "The culture is patrilineal and patriarchal," he says. "The woman goes to live in the man's home, the woman fits within the man's culture. So necessarily she's not on the same footing as the man."
The most pernicious inequality is poverty, by no means a uniquely African phenomenon. Of the world's 1.3 billion living in abject poverty, 70 percent are womenand most of them face the same basic problems as African women. "In pre-industrial societies women are trapped in their reproductive roles," says Geeta Rao Gupta, president of the International Center for Research on Women. In ICRW's numerous studies on HIV, women from Latin America, Asia, and Africa report that they dare not insist on safer sexor object to painful sexfor fear of being abandoned by their men and spiraling down into destitution. No wonder that in a 19-country study, ICRW found that the lower women's status, the higher HIV.
There are few places where poverty is worse than in Nairobi's slums, vast warrens of tin shanties, open sewers, and garbage-strewn dirt roads. In Korogocho, one of the poorest and meanest sections, a maze of narrow passageways leads into a one-room shack where the aroma of vegetable stew simmering on an open fire competes with the stench of raw sewage wafting in from outside. This is the home of Mary, who asked that her last name not be used. Two babiesMary's seventh child and her first grandchildlie on the bed.
Just a week ago, one of Mary's johnswho pay as little as 75 cents for sexslapped her in the face when she asked him to use a condom. "I can't eat a sweet in its wrapper," he said. Flashing back eight years to the man who beat her so viciously that she couldn't work for two days, she let her latest violent customer go ahead. He may pay for his pleasure with AIDS, because Mary is HIV-positive.
Mary wasn't born in the slums, but in a rural area 100 kilometers outside of Nairobi. There, rich red earth nourishes broad green leaves of the plantain tree, the billowing shrubbery of coffee plants, and the yellow-tufted stalks of maize. Mary's mother Beth sits in a hut, the door propped open with a machete, and explains why her daughter left. Her account corresponds exactly to the one given independently by her daughter. The tale they tell is an allegory of how women's powerlessness fuels the AIDS epidemic.
Mary's husband "was a drunkard," Beth says. He beat Mary virtually every week, burned her clothes, and denied her food. Once, when he was drubbing Mary, one of their children got in the way. The husband literally threw the seven-year-old girl aside. She landed on a rock, injured her lung, and was hospitalized for two weeks. Mary fled to her parents.
At first Mary's father, who died just this year, welcomed her home. But after a few days he realized that Mary and her children were extra mouths to feed. Mary recalls, "My father told me 'I have my own kids, so you're a burden to me. Pack up and go.' "
There are thousands of women like Mary in Nairobi, not to mention all of Africa, and to help curb the spread of HIV they need much more than AIDS awareness. "The women I work with say they'd rather die of AIDS tomorrow than die of hunger today," says Ann Waweru, director of the Voluntary Women's Rehabilitation Centre, an organization that helps sex workers, including Mary, find alternative work. It's not easy. "Most have no skills and no place to get a loan to start a business. A man is almost never burdened with children, so he can do casual work, earn 20 shillings, and survive on that. But most of the women we work with have children. They are driven to commercial sex by poverty."
According to the custom of the Kikuyu people, Mary's brothers were each given a plot of land to farm. But as a female child Mary was given nothing. At first, she tried to stay in the village, supporting herself and her children by doing odd jobs such as drawing water from the well and helping people till their fields. But her father wasn't satisfied and he would beat Mary and her mother. After six months Mary fled for Nairobi with her children and virtually nothing else.
In the city, she spent her first night at the home of a friend, who told her, "I'm going to show you how to get money." Mary turned her first john that night, and, she recalls, "I was happy because I got money to feed my children."
Research intern: Christine Brownlee