Evelyn Appiah-Donyina

The number of people suffering from AIDS continues to rise, especially in Africa. Women are particularly at risk. Evelyn Appiah-Donyina explores the gender issue, describes fully how women are affected in various ways and suggests what role adult educators can play in combating this disease. The author works at the Institute of Adult Education (IAE) at the University of Ghana and has already contributed a number of papers to this journal.

Gender Impact of HIV/AIDS/STIs: Some Implications for Adult Education Practitioners in West Africa

Introduction: What is Gender?

There are two basic differences between women and men; these are Sex and Gender. Sex is the physical, biological difference between women and men. It refers to whether people are born female or male. Gender, on the other hand, is not physical like sex. Gender refers to the expectations people have from someone because they are female or male. Gender attitudes and behaviours are learned and the concept may change over time. In short, we can say that sex is biologically determined and gender is socially determined.

Adopting a gender focus to developmental issues is the result of the realization that women often do not benefit from development activities and in several cases become poorer and more marginalized. One may say that the ultimate goal of gender and development is to achieve gender equity.

Some Key Gender Concepts

Gender Approach: This refers to the attempts made to give equal opportunity to men and women, where men are made to share the burden and recognize women as equal partners. Gender Awareness: This is used to describe the situation where people are sensitive to the needs and interests of men and women in the implementation of an activity. Gender Role: This refers to the duties and responsibilities attached to the positions occupied by males and females in society. Roles can change according to the geographical, social, economic and political environment. Gender roles refer to expectations regarding the proper behaviour, attitudes and activities of males and females.

As adult educators/social catalysts there is a need for us to recognise that in most West African societies low-income women have a triple role: women undertake reproductive, productive and community managing activities, while men primarily undertake productive and community activities. Sexual Division of Labour: The way work is allocated and valued according to whether it is performed by women or men. Globally, feminists argue that in the world economy women are the most exploited workers as a result of the sexual division of labour. Socialisation: Socialisation refers to how people are taught to accept and perform the roles and functions that society gives to them. Men and women are socialised into accepting different gender roles from birth. Establishing different roles and expectations for men and women is a key feature of socialization in most societies.

Stereotyping: It is based on prejudices and fears about certain social groupings usually seen as inferior to the dominant group. Individuals are then judged according to their group identity. In other words, the belief that all people that belong to a certain group – gender, age, or tribe – do, or should, act alike. Gender Sensitivity: It refers to awareness that there are both biological and gender differences between women and men. Also that women and men in different parts of the world have been gendered in different ways. Gender sensitivity also means building a critical edge to counter the gender oppression that we have been socialised into.

Gender and HIV/AIDS/STIs – The Problem

The first official report of the disease now known as AIDS (Acquired Human Deficiency Syndrome) was published on 5 June 1981. The one-paragraph report by the US Centre for Disease Control catalogued five cases. That was about 21 years ago. The epidemic has since spread to every corner of the world. Reports indicate that almost 22 million people have lost their lives to the disease and over 36 million people are today living with the Human Immune Virus (HIV), the virus that causes AIDS. It is a known fact that the majority of People Living With AIDS (PLWAs) can be found in Africa south of the Sahara. Failure to significantly contain rising rates of the global AIDS pandemic has led to the rethinking of earlier response strategies to the infection.

It is generally accepted that 80% or more of all HIV/AIDS infections can be traced to unprotected sexual intercourse. There is a need for a gender-based response that will focus on how the different social expectations, roles, status and economic power of men and women affect and are affected by the epidemic. The above implies that it is these relationships, together with physiological differences, that determine to a great extent women’s and men’s risk of infection, their ability to protect themselves effectively and their respective shares of the burden of the epidemic.

It has been argued that HIV prevention is a gender issue since seroprevalence rates tend to be much higher amongst certain groups of young women. Furthermore, the responsibilities of care for AIDS patients often fall on women, and the role of women in child care means that their health is especially important in ensuring continued reductions in child mortality and reducing the number of orphaned children. There is therefore a need to place special emphasis on the education of girls and women about risk patterns and safe practices, alongside efforts to encourage men to be better informed and adopt patterns of behaviour that reduce the spread of HIV.

By promoting a culture of rights and gender equality, responsibility and choice in relation to HIV/AIDS, adult educators can play a meaningful role in ending women’s overwhelming biological, social and economic susceptibility to HIV and can affirm the right of all people to life and dignity.

Physiological Vulnerability of Women and Men

Evidence from research suggests that women’s risk of HIV infection from unprotected sex is at least twice that of men. A woman’s body has the ability to retain a high concentration of semen in the vaginal canal. Similarly, women are exposed to infection because of the extensive surface area of mucous membrane in the vagina and on the cervix through which the virus may pass. Uncircumcised men are also at risk because the delicate area under the foreskin may expose them to infection if they have unprotected sex. Young women are at a greater risk because of abrasions they may have during unprotected sex since they tend to have a thin vaginal lining.

Sexually Transmitted Infections (STIs)

STIs in women tend to be asymptomatic (they go unnoticed because they are internal). Unlike men, women may experience no pain initially and are thus less likely to seek prompt medical treatment. The situation is often compounded by the stigma attached to STIs, inaccessibility to clinics, lack of money, negative attitudes of health workers to infected women and women’s own preoccupation with too many domestic responsibilities.

The World Health Organisation (WHO) estimates that at any point in time there are as many as 330 million curable STIs worldwide. This calls for much concern, considering the fact that the condition predisposes infected individuals to HIV/AIDS.

Cultural Practices

Some cultural practices aggravate women’s physiological risk of HIV infection. Examples are men’s preference for “dry sex” (often with the active connivance of women), “rough sex” which may lead to sores in the mucous membrane, and female genital mutilation, which could lead to extensive tearing and bleeding during sex. The practice of widow inheritance has also contributed significantly to the increasing rates of infection.

Other Gender-related Vulnerability and Obstacles to Prevention and Coping

(i) Male sexual dominance – Most often, where sex is concerned, everything is centred on the pleasure of men. The practice tends to neglect females’ needs and to inhibit open discussion between couples about safe sexual behaviour.

(ii) Economic vulnerability and sexual services – Women’s economic dependence makes them vulnerable since training and economic opportunities are few. Some women may exchange sexual services (barter) for money, jobs, promotion or other privileges.

(iii) Control over sexual relations within and outside the marriage – Lack of control over sexual relations within and outside marriage because of polygamy, multiple sexual partners, etc., could expose couples to HIV/AIDS infection.

(iv) Violence against women – This takes the form of rape, defilement, and violent or coerced sex. Unfortunately, these negative practices have become commonplace in our part of the world in recent times. In some communities, marital violence is condoned.

(v) Blame and rejection – Gender stereotypes allow women to be blamed for spreading HIV/AIDS. Often women are the first to be tested because of pregnancy, a sick baby, etc. When found positive, they are the first to be blamed.

(vi) Lack of information – Many women have a poor understanding of their own bodies, mechanisms of HIV/STI transmission and their level of risk in unprotected sex. Many men also lack adequate information about their own bodies and tend to have even less information about women’s bodies and needs.

(vii) Interpersonal communication – Research has shown that young people prefer that their parents talk to them about sex. Poor communication between parents and children and between partners about relationships, male and female sexual needs and responsibilities can lead to risk behaviours on the part of young people and adults alike. For example, young people of either sex should be given negotiation skills to enable them to counter pressure from peers and older persons to indulge in early sex.

(viii) Family stress – It has been said elsewhere that the AIDS pandemic, if it does not infect you will affect you. The impact of AIDS on the family can be devastating. Apart from the toll it wreaks on the family’s resources, AIDS-related stigmatisation and the extra burdens of care brought by the disease have to be contended with. This tends to worsen existing gender inequalities, increasing women’s vulnerability and exploitation. For example, girls may be withdrawn from school to look after family members. Older people who should be enjoying their retirement also have to help with the care burden by providing for AIDS orphans. We must view this in the light of the already serious poverty levels existing in West Africa.

Some Suggestions for Changing the Status Quo – The Role of Adult Education Practitioners

Gender-sensitive strategies are needed to decrease men’s and women’s vulnerability to infection, reduce stigmatisation and discrimination and curb the epidemic’s socio-economic impact. Shared responsibility for prevention and care between women and men is critical to the entire process. Below are a number of strategies that could help to change the existing situation with regard to HIV/AIDS/STIs:

Advocacy Strategies

Ideas and social norms that keep women in inferior social positions must be challenged. As much as possible, adult education practitioners should strive for structures that will give women equal access to education, training and income-earning opportunities. There is a need for governments of West African countries to ensure that broad-based national policies on HIV/AIDS are formulated.

These should mention in clear terms what each country considers as unacceptable human rights abuses, with particular reference to the perpetration of harmful and oppressive social practices that militate against the general well-being of women and PLWAs. A national policy should also cover issues like availability of formula/breast-milk substitutes for HIV positive mothers, free access to HIV testing as well as pre- and post-counselling services.

Laws ought to be put in place by governments to strengthen and expand women’s democratic rights. In Ghana, for example, the Intestate Succession Law (PNDC Law 111) spells out clearly how the assets of a spouse who dies without preparing a will should be divided among surviving dependants. To a large extent this Law has provided some respite to widows and their children who otherwise would be thrown out of their homes on the death of their sole provider. There is a need for governments to ensure the full implementation of such laws to raise the status of women in reality and not just on paper.

All stakeholders in the fight against the spread of HIV/AIDS must create a compassionate and enabling society in which women and men assert their equal right to life by freely exercising responsible choices for prevention and treatment. Adult educators and other gender advocates on their part should challenge unequal gender relations and the gender subordination of women in all institutions. They must encourage open discussions about gender power relations and HIV/AIDS.

Educational Strategies

Basic information about HIV/AIDS and STIs should be made available to all persons, whether young or old. Adult education materials should be simplified for literacy learners. All stakeholders must promote the message that apart from abstinence and mutual faithfulness, safe sex is the only good sex. In most African societies men tend to be the dominant sexual partner. Condom use must be encouraged and it must be seen as both men’s and women’s mutual responsibility to demand condom use and protection.

It is important to strengthen efforts aimed at countering the belief that AIDS is a “women’s disease” by stepping up male involvement in reproductive health programmes and by encouraging all men to assume mutual collective responsibility for the spread of the disease and to see the urgency of its prevention for their families, their communities and their country. More often than not reproductive health programmes are targeted at women even though the final decisions regarding sex and use of contraceptives rest with the men.

Social Support Strategies

There should be shared decision-making power between women and men at all levels: in relationships, community affairs, political and economic structures. Affected families must be provided with back-up support for home-based care. This ought to include subsidised medical care and counselling. Effective strategies for caring for people living with HIV/AIDS must be put in place, in a manner that ensures that women do not bear a disproportionate burden of caring for those who are HIV positive, neglecting their own health and becoming even more marginalized economically.

Cultural practices that can assist in HIV/AIDS prevention such as pre-marital virginity for both boys and girls must be encouraged. Even for those who are sexually active already, the advantages of secondary or tertiary virginity must be stressed.

Conclusion

There is an urgent need to strengthen the coping capacities of families in order to reduce fear and stigma round HIV/AIDS and to allow prevention strategies to really work. It is important for adult educators and other stakeholders to help create a compassionate and enabling society in which women and men assert their equal right to life by freely exercising responsible choices for prevention and treatment. They must also endeavour to integrate a gender perspective into all HIV/AIDS/STI programmes.

References

Facing the Challenge of HIV/AIDS/STD: A Gender-based Response. UNAIDS, Geneva & KTI, Amsterdam, 1998

Fighting Back: HIV/AIDS and Development”. In Development (Journal of the Society of International Development) Ed. Wendy Harcourt, Rome, 1995

Mackenzie, Liz. On our feet, taking steps to challenge women’s oppression: A handbook on gender and popular education workshops. IIZ/DVV, Bonn, 1993

Moser, Caroline. Gender Planning and Development: Theory, Practice and Training. Routledge, London, 1995

Statement of Concern on Women and HIV/AIDS, 13th International Conference on HIV/AIDS. Round table by Agenda, the Gender AIDS Forum and the AIDS 2000 “Amasiko” Programme on June 18th and 19th 2000 (UNAIDS)