K. Amponsah-Manager
Among the estimated 22.5 million people living with HIV in Sub-Saharan Africa, women and girls continue to be disproportionately represented. In South Africa, for instance, it is estimated that one-in-three women aged 25-29 are living with HIV (Human Sciences Research Council (2009). Another estimate puts the proportion of maternal orphans – those who have lost their mother – orphaned by AIDS as over 70 percent (Budlender, D. et al., 2008). This is surely a dispiriting statistic. Several reasons can be attributed to this trend including rape and other sexual abuses, cultural practices and societal expectations of women. There are also biological factors that contribute to this inclination. For instance, the female genitals have a more exposed surface area than the male genitals have. Also, there are higher amounts of HIV in semen than in vaginal fluids while again more semen is exchanged during sex than vaginal fluids. These together with the social and cultural factors above precipitate a situation that places the woman at a more disadvantage point of view.
There are several steps communities and policy makers can take to reduce the women’s vulnerability to the epidemic and reverse this distressful trend. These include:
Involving men: In a typical African relationship, the man controls when and how sex happens. The man decides the frequency of sex and whether any protection is used during sexual relationship. The current education targeting men to use condoms should continue but it should place a bigger accent on educating men to respect the women’s choice and needs in sexual relationships. Gender-based violence and stereotypes should be core of any anti-HIV campaigns in African communities.
Accessibility to healthcare needs: Past anti-HIV and family planning campaigns have focused on the man, but it is time to pay attention to the needs of the woman if we can really cut the percentage of women that continue to be afflicted by the HIV epidemic. While the female condom (FC) is available to most women in the developed countries who want to use it, FC is merely another indulgence that the African woman cannot just afford. The situation gets even more challenging as the female condom can be several times more expensive than the male condom. It is therefore crucial for health policy makers and private organization to step in and offer to make these products accessible to the women at a cost that they can afford. Also, women who are abused sexually should have free access to blood tests and other medical services to determine their status. This will halt the further spread of HIV and other sexually-transmitted diseases (STDs) they might have contracted during the assault. Studies show that women with other untreated STDs are more likely to contract the HIV virus than their STD-free counterparts or those who have access the reproductive healthcare needs.
Economic Opportunities and Education: It is sad fact that in the African society, the bread-winner is automatically self-empowered to call the shots and since in most cases, it is the man who holds that title, the women in these societies are the always at the receiving end when it comes to decisions affecting sexual intercourse. A journey to economic empowerment will be relatively long, but in the long run, it is the surest strategy that will place women in positions that they can influence decisions that affect their own lives. According to the UNAIDS, women without education are four times more likely to have the belief that there is no way to prevent HIV. These women do not expect and do not demand any protection during sex even when they know their partners have multiple sexual partners. Early sexual intercourse and early marriages are big factors in predicting a girl’s vulnerability to HIV. In Niger, for example, 50% of girls get married by the age of 15. However, studies show that girls with more education tend to delay marriage and tend to delay their first sexual intercourse. Providing every girl child with at least the basic education will certainly make a dent.
Campaign against social and cultural practices harmful to the woman: Some practices are ‘universally’ classified as sexual violence but are accepted practices in some communities across African and other parts of the world. These include female genital mutilation or female circumcision, marital rape and girl trafficking. In a survey in Kenya, 14% of women said their own husbands (most of whom have multiple sexual partners) had raped them in the past. All these practices disproportionately expose women and girls to HIV and other sexually transmitted diseases. According to the UN, women who have experienced any of such abuses are three times more likely to be infected by HIV.
Reducing the woman’s vulnerability to HIV is vital in curbing the prevalence and saving the unborn. In fact 390 000 out of the global 430 000 children newly infected with HIV during 2008 were from sub-Saharan Africaas a result of mother-to-child transmission (USAIDS). Why should we wait any longer in tackling the woman’s sexual health needs?
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