By: Blossom Makhubalo, Klerksdorp CRS, Klerksdorp, South Africa
During one of our community engagements events, we heard a statement from one of the male attendees, “Are we not HIV fatigued? We are always hearing about HIV all the time.”
My response (being the social worker that I am): “Until we win the fight against HIV/AIDS we can never have the luxury to claim that we are fatigued.”
Not while adolescent girls and young women in South Africa are at the greatest risk of HIV infection. In South Africa, HIV prevalence in women aged 15-24 is nearly four times greater than men of that same age. More than 120,000 women in this age group are thought to become HIV positive every year. Therefore, today more than ever, we can never be fatigued when 2000 young women in South Africa are infected with HIV weekly.
Perhaps we are fatigued by the way HIV prevention awareness is conducted, and more innovative ways of providing HIV education are needed.
The majority of women who are at risk of HIV are disempowered, and a range of socio-economic circumstances contributes to placing them at risk. Now more than ever, we need to escalate our efforts in the fight against HIV/AIDS and ensure that these prevention messages and tools reach our women, and are tailored for women in our communities. It is important to understand the factors that place women at risk in order for us to tailor our prevention strategies to meet their needs.
What places women at risk
Women are more vulnerable than men are to HIV infection through sexual intercourse (Rodin & Ickovics, 1990). Studies have shown that heterosexual transmission from men to women is two to four times more likely than from women to men. Major factors that make women more vulnerable to HIV infection include the larger mucosal surface area in women that can be exposed to the virus (Cheryl De La Rey, et al, 1997: (Contemporary issues in Human Development, A South African Focus). Rates of infection are higher among younger women than among older women. One reason for this could be that the immature cervix and relatively low vaginal mucus production in young women presents less protection against HIV (WHO, 1994). One could argue that when it comes to our physiological vulnerability to HIV Infection, all women are created equally.
Where the “playing fields” for women are not equal is our socio-economic circumstances. For many women in South Africa their socio-economic circumstances place them at a greater risk for HIV infection. South Africa remains one of the most unequal societies in the world according to the World Bank. Many South African women have not yet achieved economic freedom, and many women still depend on their male partners for financial support, placing them in a disempowered position. Women still occupy powerless positions in South African society, often dictated culturally. Unequal power dynamics between men and women still exist today, and are exacerbated by patriarchy.
What my 15 years as a practising social worker have shown me is that a powerless woman is likely to be less sexually assertive, and may find it impossible to negotiate condom use even when she knows her partner has many other sexual partners. Men enjoy more power, and their positions are reinforced by gender discrimination and inherent traditional roles. Men are usually the dominant partner in the sexual relationship, and that position is even more amplified if the man is the financial provider. Women are socialised to be “good wives” and never question their partners. When a young woman seeks advice from older females in the family, her unhappiness with the relationship is downplayed and she is told, “Yamazela,” meaning to endure.
South Africa is also characterised by high rates of gender-based violence. A woman may be beaten for refusing sexual advances or recommending condom use. According to Statistics SA, one in five women experienced violence at the hands of an intimate partner. The rape of South African women is among the highest in the world.
Women at times feel that they have no option but to stay with their abusive partners. “Where will I go?”, lack of family support, and extended families who are facing their own struggles and cannot afford to financially support women, all contribute to women feeling trapped and staying in an abusive relationship. When a woman does decide to leave, usually the family encourages her to return to her abusive partner. The longer she remains in abusive relationship, the greater the risk for HIV.
We cannot win the fight against HIV if we do not understand and address the factors that place women at risk. We should engage with young women when designing HIV prevention strategies. Just providing HIV education and prevention tools to women is not enough. We need to address the structural factors that place women at risk in order for prevention programs to be successful and impactful.
Until we have overcome HIV in our beautiful country, we can never be fatigued.
Blossom Makhubalo is the Community Engagement Manager and Thandiwe Papalagae is the Recruitment and Retention Team Leader at the Klerksdorp CRS, in Klerksdorp, South Africa.
Cheryl De La Rey, Norman Duncan, Tamara Shefer, Ashley Van Niekerk. (1997). Contemporary issues in Human Development, A South African Focus.
Statistics SA, (2016) Demographic and Health Survey.
Rodin, J, Ickovics, JR, (1990). Women’s Health: Review and Research agenda as we approach the 21st Century.
World Health Organisation (WHO) (1994). Women and AIDS: Agenda for Action