May 25, 2007
New Report on HIV/AIDS in Africa First to Link Discriminatory Beliefs Against Women with Vulnerability to AIDS
A landmark study released today by Physicians for Human Rights (PHR) connects
widespread discriminatory views against women in Botswana and Swaziland to
sexual risk-taking and, in turn, to extremely high HIV prevalence. Seventy-five
percent of HIV-positive 15-25 year-olds in sub-Saharan Africa are female.
PHR's study, Epidemic of Inequality: Women's Rights and
HIV/AIDS in Botswana & Swaziland: An Evidence-based Report on Gender
Inequity, Stigma and Discrimination reports the results of a
population-based study conducted in 2004 and 2005 with 1,268 respondents in
Botswana and 788 participants in Swaziland, designed to assess factors
contributing to HIV infection. In
addition, 24 people living with HIV/AIDS
in Botswana and 58 people living with HIV/AIDS in Swaziland were interviewed,
along with key informants in both countries. The full report can be accessed here.
Four key factors were found
to contribute to women's vulnerability to HIV: women's lack of control over
sexual decision-making, including the decision to use a condom, and multiple
sexual partners by both women and men; the prevalence of HIV-related stigma and
discrimination (which hinders testing and disclosure of status);
gender-discriminatory beliefs, which were associated with sexual risk-taking;
and a failure of traditional and government leadership to promote the equality,
autonomy, and economic independence of women.
"If we are to reduce
the continuing, extraordinary HIV prevalence in Botswana and Swaziland,
particularly among women, the countries' leaders need to enforce women's legal
rights, and offer them sufficient food and economic opportunities to gain agency
in their own lives. Men and women must be educated and supported to acknowledge
women's equal status with men and abandon these prejudices and risky sexual
practices. The impact of women's lack of power cannot be underestimated," said
PHR's Senior Research Associate Karen Leiter, JD, MPH, lead investigator of the
study.
While anecdotal evidence has strongly suggested a link
between gender inequity and HIV infection, PHR has conducted the first rigorous,
large-scale field survey of gender discriminatory beliefs and analyzed their
association with sexual behavior. The report suggests that women's rights must
be made the top priority by the countries' leaders if HIV prevalence is to be
reduced.
In Botswana, for example, 95% of women and 90% of men surveyed
held at least one gender discriminatory belief. Botswana community survey
participants who held three or more such beliefs had 2.7 the odds of those who
held fewer beliefs to report having had unprotected sex in the prior year with a
non-primary partner. Discriminatory beliefs accept and reflect upon
women's inferior legal cultural and socioeconomic status.
For
example, 19% of all community survey respondents in Botswana agreed with the
statement that it is more important that a woman respect her spouse or partner
than it is for a man to respect his spouse or partner.
Interviews
indicated that many HIV-positive women are forced to engage in risky sex with
men in exchange for food for themselves and their children. As one interviewee
put it, "Woman are having sex because they are hungry. If you give them food,
they would not need to have sex to eat."
According to PHR
research, the very fear of being subject to HIV-related stigma (as opposed
to the actual experience of it)—being abandoned by friends or shunned at work,
for instance—was pervasive. For instance, in Botswana, 30% of women and men
believed that testing positive and disclosure would lead to the break up of
their marriage or relationship.
Interviews conducted by PHR and
its partners indicate that women in Botswana and Swaziland frequently do not
have the option to make decisions about having sex due to their lesser legal
status.
"Here in Swaziland, the husband is
the one that bosses you around so there is nothing you can do without him. My
rights lie with my husband. He decides whether we use condoms. I don't have a
choice about prevention."—an HIV-positive interviewee
In
interviews, people living with AIDS highlighted women's dependency on male
partners as the most significant contribution to women's greater vulnerability
to HIV when compared to men. Testimony also revealed that women's lesser status
in Botswana fosters ongoing harm to women even after they become infected, and
increases the precariousness of their ability to meet basic needs for food,
shelter and transport.
Participants in Swaziland repeatedly
pointed to a lack of political leadership—from government officials and
traditional leaders—in protecting and empowering vulnerable women and girls.
"HIV/AIDS interventions focused solely on individual behavior
will not address the factors creating vulnerability to HIV for women and men in
Botswana and Swaziland, nor protect the rights and assure the wellbeing of those
living with AIDS. National leaders, with the assistance of foreign donors and
others, are obligated under international law to change the inequitable social,
legal, and economic conditions of women's lives which facilitate HIV
transmission and impede testing, care and treatment," said Leiter.
PHR's study also examined the following:
A background chapter on HIV/AIDS in Southern Africa, including discussion of
the dimensions of the epidemic and its consequences, drivers of the epidemic
including stigma and discrimination and gender inequality, and national and
international responses is available.
The study was
designed and implemented by PHR and two local field partners: Members of the
Faculty of Nursing at the University of Botswana in Gaborone, Botswana, and
Women and Law in Southern Africa Research Trust (WLSA) in Mbabane, Swaziland.