AIDS in Africa: Feminization of the Epidemic

Published on 26th April 2010

The latest AIDS Epidemic update by the UNAIDS provides a glimpse into the drivers of the global epidemic. In this article, I discuss the continued feminization of HIV/AIDS in Africa. This continued female face of AIDS in Africa has major development implications.


Women and HIV/AIDS in Africa


In contextualizing the impact of HIV/AIDS on African women, it is important to note that African women are already disadvantaged regarding basic indicators of health. The World Health Organization (WHO) noted recently that in almost every health indicator category, African girls and women record the worst rates in the world. This adverse state of health exists despite African women providing 80 percent of healthcare in Africa through their care of loved ones in home settings. African women have the highest rate of maternal mortality in the world. African women ages 20 through 60 are seven times more likely to die prematurely compared to their peers in Western nations.


African women represent 60 percent of all individuals living with HIV/AIDS in the continent, the highest rate in any continent. African women represent more than 70 percent of all women living with HIV/AIDS around the world. In addition, African women account for nearly 90 percent of all maternal transmission of HIV to newborns. The WHO had noted that women in Africa provide 90 percent of AIDS supportive care. The WHO notes that the round-the-clock support care by women are “unsupported, unrecognized and unremunerated.” AIDS related illnesses continue to be the leading cause of death among women in Africa. AIDS is also the leading cause of morbidity among women in the continent. In some parts of Africa, teenagers ages 15 through 19 have rates of HIV infection three times higher than male peers. 


Divorce or widowhood is a high risk factor in HIV transmission among African women. In Guinea, widows are six times more likely to be living with HIV/AIDS compared with single or married women. In Tanzania, 25 percent of widows live with HIV/AIDS compared to 6 percent for those married or cohabiting.


Women in long term, stable relationships are at high risk for HIV transmission for two major reasons, according to the UNAIDS. First, women are at high risk if their husbands or partners live with HIV. Second, the women are also at risk if they are uninfected at the same time as their partners engage in concurrent relationships with other women. Sugar daddies remain important drivers of the epidemic, helping fuel relatively high rates of infection among young women compared to their male peers. Migrant husbands and partners also increase the risk of HIV transmission to their wives and partners. 


Another major risk factor in the feminization of AIDS in Africa is domestic violence.  Women living with HIV are more likely to have experienced violence in their lifetime compared to uninfected women, according to the UNAIDS and the WHO. Younger women living with HIV are ten times more likely to have been victims of violence compared to uninfected peers. Closely related to the issue of domestic violence is the problem of sexual coercion. The United Nations estimates that 33 percent of women around the world have been coerced into sexual relationships, often with the threat of bodily harm. In some African countries, the rate of sexual coercion is even higher: in Ethiopia, studies by the WHO indicate that 59 percent of women had suffered sexual coercion; in Tanzania, at least 47 percent of women.


Acts of violence or threats of violence have tragic consequences: female victims of domestic violence often shun HIV preventive programs. In addition, these women are among the least informed about HIV preventive measures. Acutely sensitive to the corrosive effects of stigma and discrimination, African women may shy away from HIV preventive and AIDS treatment programs. New moms living with undisclosed HIV infection face the choice of either breastfeeding their newborns or risk scrutiny and hostility from suspicious family members if they are not breastfeeding.


Gender inequities in many parts of Africa make it more difficult for women to negotiate safer sexual practices. For example, married women may not be in a position to insist on safe sexual practices with their husbands even when the husband is known to be HIV positive. A survey in Lesotho, a country with one of the highest rates of HIV infection in the world indicate that 47 percent of men and 40 percent of women believe that women cannot refuse intimate relations with their husbands or partners.  


Widows with small children face special difficulties. Widows may be denied access to family properties or financial resources. They may have limited say on where and how their children go to school. To make ends meet, widows abandoned by their family may engage in high risk behaviors to put food on the table for their children.


What to Do?


For Africa to address the continued feminization of the AIDS epidemic, all stakeholders  need to seek ways of addressing century old beliefs and social mores about women that may unwittingly place them at risk of HIV transmission. These widely held views and practices include cultural beliefs and practices on widowhood, access to family properties by widows, sexual expectations for wives and female partners, and, access to education and health services for girls and young women.  It is important to note that many African societies have made progress in addressing gender inequities. Many African countries have invested heavily on education for girls and young women. However, it is an open secret that cultural and social mores that perpetuate gender inequities persist in Africa despite gains in female education, political representation and economic well being. Tackling deeply entrenched cultural beliefs and practices that put women at risk requires sustained change at family and community levels throughout the continent.


A comprehensive, step-by-step family and community focused strategy of ending female gender inequities in the continent should be Africa-led and Africa-driven. The continued female face of HIV/AIDS in Africa should be a powerful motivating factor.


Throughout Africa, an indigenous army of motivated individuals, community leaders, government officials, the organized private sector, professional associations and civil society entities should work diligently on ending female gender inequities within families and communities as a primary weapon in the fight against AIDS.  


A community-based, community-led campaign against gender inequity in Africa cannot come too soon. The HIV/AIDS epidemic exposed wide cultural and social fault lines in gender relations across the continent. In 2006, I co-authored a book on AIDS orphans in Africa and their grandparents that showed that even female AIDS orphans living with mostly frail grandmothers were not spared the corrosive impact of gender inequities.  Some of the female AIDS orphans became pregnant and became teenage moms.  


In addition, the role of African governments in ending gender inequities and other risk factors of HIV transmission is very critical. In particular, the legislative and judicial branches of government in Africa can play very powerful roles in crafting and enforcing new laws that end gender inequities and enforce the human rights of all citizens. In particular, laws against gender discrimination, gender violence and sexual coercion should be updated and enforced as part of national HIV/AIDS strategies. 


Outside of the government, organizations that advocate for human rights have important roles to play. Professional organizations and civil society entities focused on vulnerable populations have major roles as well. These organizations should address the full range of issues that place women at risk of HIV transmission or prevent women from seeking timely access to preventive and treatment programs.  Advocacy for the education of girls and young men is also important. In addition, public, private and civil society organizations should work together to provide vulnerable women with timely access to health services; robust legal representation on gender-based human rights violations; and, sustained access to HIV preventive programs. 


Finally, public and private sector effort will be needed to improve economic self reliance among African women. This effort requires a two-step process. First, African governments and international development partners should create enabling, supportive environment for the millions of female petty traders in the continent to expand their businesses. African petty traders should have access to micro financing services and community banking lending services to expand their business operations. Petty traders should be encouraged to form cooperatives and small/medium scale enterprises. Second, the organized private sector in Africa should support female owned small and medium enterprises by including them in supply chains, franchises and selling outlets for finished goods. In addition, the organized private sector should support entrepreneurial training programs for women seeking to expand their businesses. I often wonder what will happen in Africa if the ingenuity of millions of female petty traders is harnessed for maximum potential. It takes a lot of determination and courage for female petty traders in Africa to rise at dawn, prepare older children for school, tie infants or toddlers behind their backs, walk some kilometers to stake out a tiny space in a market or by the roadside, and brave the elements to sell small quantities of goods and services to help support their families.


In conclusion, African women remain at high risk of HIV transmission. The feminization of AIDS is unlikely to end until African governments, the organized private sector and the civil society jointly address cultural and social mores that put women at risk of contracting HIV. African governments have a primary role in utilizing legal, economic and political processes to empower women throughout the continent. No foreign partner or government will take the primary role and responsibility of African governments, national and local stakeholders in ending gender inequities at family and community levels throughout the continent. The continued feminization of AIDS in Africa is not only preventable but also reversible. Time is of the essence. 


By Chinua Akukwe,


Chair of the Technical Board, Africa Center for Health and Human Security at the George Washington University, Washington, DC. He is also the Executive Chairman of the Africa Union Africa Diaspora Health Initiative, Washington, DC. He has written extensively on HIV/AIDS in Africa, including four books on health and development issues.

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