The best songs speak truth to a society and its people. During one of my trips to Tanzania, a choir welcomed my colleague and me with a song that had a haunting refrain: “HIV kills everyone — men, women and children. They are all being killed.” That is the reality of life in Tanzania. Yet there is a starker truth that the lyrics did not name: HIV kills proportionally more men, women, and children who are poor. The overwhelming majority of people with HIV, some 95 per cent of the global total, live in the developing world. The prediction is that these numbers will increase even more as infection rates continue to rise in countries where poverty, poor health-care systems and limited resources for prevention and care fuel the spread of the virus.
In 1998, there were 33 million people worldwide living with HIV/AIDS, and almost 6 million new infections. Seven years later, the number grew to a staggering 40.3 million. Moreover, the epidemic is now rapidly spreading to new locations such as rural India and Eastern Europe. Each day, 16,000 people are newly infected with AIDS. AIDS has now become a poor person’s disease, taking a heavy toll on life expectancy and reversing the gains of recent decades. Sub-Saharan Africa alone has 25.8 million women, men, and children living with AIDS. For at least nine nations in Africa, the prediction is for a loss of about 17 years in life expectancy by 2010. This will set those nations back to the levels of the 1960s.
In the seven years from 1998 to 2005 the picture has not improved. Today we see countries on the brink of collapse due to AIDS. Again, the truth is stark. The ravages of AIDS are far more devastating in the slums of Nairobi, Johannesburg, and Lusaka than in those cities’ wealthier neighbourhoods. The discrepancy can be found in the residents’ savings accounts — the more financial padding the more effective the coping mechanisms. The fact is that in one part of town, people have access to and can choose among life-prolonging drugs. In poor neighbourhoods where most people live on an income of $1 a day, the choice is either having one meal a day or buying anti-retroviral drugs.
For many victims living with AIDS, it is affirming to have someone of Nelson Mandela’s stature acknowledge that his son, a middle-class lawyer in his 40s, died of the disease. Mandela’s statement confronted the stigmatization of the AIDS disease and helped make the conversation public. But the dour reality of AIDS in Africa is that it is intrinsically linked to poverty and in Africa, women are the poorest of the poor. All statistics agree: women are the group most affected by AIDS in Africa. In some southern African countries, the infection rate for women is 57 per cent. As well as poverty, their vulnerability to HIV infection is related to biological differences, the sexual behaviour of their partners, the exercise of power, social attitudes and pressures in a context where poverty has a feminine face.
While rooted in the African social context, feminine poverty has been intensified by economic policies and structural adjustment programs advocated and fiercely implemented by international monetary institutions such as the World Bank and the International Monetary Fund. Their economic polices have reduced ”development” to the simplistic exercise of resource allocation, efficiency, and cost-effectiveness. This short-sighted, business-like approach discounts human development and in the process has undermined the small gains Africa had made on health and education, the two sectors that most help women to overcome structural, systemic, and social disadvantages by giving them resources to rise out of poverty. Because health and education do not generate revenue or resources, African governments chose to sacrifice them to repay their international debts. Without addressing the root-causes of poverty by increasing and sustaining development aid for at least one generation, the battle against AIDS and poverty is at risk of being lost. In some situations, it has become easier to obtain anti-retroviral drugs than adequate nutrition and clean water. What is the point of having drugs but no access to food?
An important facet of AIDS in Africa is that women and girls are the primary caregivers for those suffering from AIDS. Disproportionately more girls than boys drop out of school to take care of infected family members, exacerbating the pre-existing gender-biased disparities in education. The situation creates conditions that place people and especially women at greater risk of HIV infection. It is within poor communities and social groups most affected by declining health conditions that HIV infection has gained the strongest foothold.
More than on any other continent, African women carry on their shoulders responsibility for the economic development and well-being of families. Women are providers, and caregivers. They work in the fields, markets and in the informal business sector, which accounts for 60 per cent of the African economy. Women play an incredible role as food growers, merchants, educators and caregivers, and they do all this while keeping the family together. In light of all these factors, we can infer that investing in women and girls is strategic in the battle against AIDS and poverty.
With the economic fabric of Sub-Saharan Africa rapidly disintegrating due to the impact of AIDS, people are pushed towards riskier behaviour. Young girls with neither skills nor education step into the roles of their sick or dying mothers and look for ways of providing for families for whom they have become the sole breadwinners. Women, and young women in particular, become increasingly vulnerable given their increasingly restricted access to health, education, and economic resources. The situation forces them into precarious lifestyles, often involving the sex trade. In such a context, they have little ground to negotiate for safer sexual practices.
HIV/AIDS is a barometer of women’s status in African societies, and it is killing them at an unprecedented rate. It is killing them because they are uneducated, poor and have limited choices. As the refrain says: “HIV kills everyone—men, women and children. They are all being killed.” A new line could be added: “It kills more women because they are poor”.
