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HIV-positive mother and child in Tanzania: Low economic and social status, along with other factors, leave women more vulnerable than men to infection.

Photograph: PictureNET Africa / Frederic Courbet

Out of nearly 25 million Africans today living with HIV/AIDS, almost 60 per cent are women, reports the Joint UN Programme on HIV/AIDS (UNAIDS). In some African countries, more than two-thirds of people with the virus are women.

It was therefore appropriate that UN Secretary-General Ban Ki-moon appointed an African woman, Ms. Elizabeth Mataka, as his new special envoy for AIDS in Africa. A citizen of Botswana, Ms. Mataka has lived and worked in neighbouring Zambia for many years, and since 1990 has been on the frontline of Africa鈥檚 struggle against the disease, as a community activist, programme director and international advocate. At the time of her UN appointment on 21 May, she was serving as executive director of the Zambia National AIDS Network and as vice-chairperson of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The struggle against HIV/AIDS requires a far greater focus on women, says Ms. Mataka. 鈥淯nless we empower women not just economically, but with technology that they can initiate and control to protect themselves against infection, we will remain with very limited success,鈥� she told Africa Renewal from her office in Lusaka.

The reasons for women鈥檚 particular vulnerability to HIV, which is transmitted by sexual intercourse and exposure to infected blood, are complex and varied. Sexual assault and other forms of violence against women is one important factor (see Africa Renewal, July 2007). Biology can also make women more susceptible to infection.

But the factors that leave women most at risk, says Ms. Mataka, and the ones that must be tackled if the epidemic is to be defeated, are economic, social and political. 鈥淟ook at the economic position of women,鈥� she says. 鈥淢ost women find themselves totally dependent on their male partner. That tends to limit their negotiating power in terms of safer sex.

鈥楥onnect the dots鈥�

The consequences of gender inequality are not limited to Africa. UNAIDS reports that nearly half of the 37 million adults living with HIV/AIDS globally are women 鈥� and that their numbers increased by more than 1 million between 2004 and 2006. The UN helped launch the Global Coalition on Women and AIDS in February 2004 to raise awareness of the mounting crisis among women and to develop prevention and treatment programmes tailored to their needs (see Africa Renewal, October 2004).

In July 2007 the World Young Women鈥檚 Christian Association organized a women鈥檚 conference on AIDS in Nairobi, Kenya. It drew more than 1,800 people from throughout the world and focused on expanding women鈥檚 leadership in anti-AIDS initiatives. The conference鈥檚 call to action declared that women had a human right to equal access to HIV/AIDS services and demanded an end to economic and social discrimination ().

Dr. Peter Piot, the head of UNAIDS, told delegates that 鈥渢his is the time to connect the dots between AIDS and gender equality.鈥� He declared that the 鈥渇eminization鈥� of AIDS is the most significant development in the evolution of the global epidemic. 鈥淭he first question we need to ask for every AIDS activity is, of course: 鈥楧oes it pass the test for women?鈥� There is no such thing as a gender-neutral programme.鈥�

A rape victim being comforted at a ceremony in Khayelitsha, South Africa, the site of an experimental programme to treat people with anti-retroviral drugs.

Photograph: iAfrica Photos / Eric Miller

Success starts with solidarity

Focusing on Africa specifically, Ms. Mataka notes that 鈥渋n some of the cultures we have here, women are taught from the cradle to be subservient and obedient.鈥� Such an upbringing, combined with economic dependence, she says, makes it very difficult for women to protect themselves from infection, or to get tested and treated. 鈥淗ow many women, if they went for testing, would go home and announce their status if they are positive and hope to remain in that home? And if they are thrown out of the house, what options do they have? Where do they go?

Even women who have decided to end a dangerous or abusive relationship can find themselves isolated and trapped. 鈥淲omen are under real pressure to remain in a marriage,鈥� Ms. Mataka explains. 鈥淢ostly, society will not support a woman in her decision to divorce if she thinks that marriage is risky. People just say: 鈥楾hat鈥檚 how it is. That鈥檚 how men are.鈥� They need support to get away from risky situations.鈥�

Yet changing the economic and social factors that put women at risk is 鈥渁 huge job,鈥� she admits. The starting point, she adds, 鈥渨ould be for us to build very strong solidarity movements to support each other鈥�. Before you can do anything else you must have somewhere to sleep, something to eat. You must feel comforted by other women, supported by them. Women must come together irrespective of status, education and wealth.鈥�

Many early anti-AIDS programmes for women, she argues, failed to focus specifically on women鈥檚 real needs and lacked concrete targets. Simply 鈥渕ainstreaming鈥� gender into AIDS programmes did not work. It is vital to set numerical targets and specific timeframes. She cites the successful effort to increase by eight times the number of Africans on lifesaving anti-AIDS drugs in just three years. 鈥淲e must have the same thing with women鈥檚 empowerment,鈥� she asserts. 鈥淲e must have definite programmes so that women are supported.鈥�

Progress amid setbacks

For both men and women, the battle against AIDS remains daunting. Despite a thirtyfold increase in funding for global anti-AIDS programmes since 1996, the number of new infections and deaths continues to rise. Spending on HIV/AIDS prevention, care and treatment is expected to reach $10 bn in 2007, but that is less than half the amount needed.

Access to lifesaving anti-retroviral drugs has soared since 2003. They now reach 2 million people in developing countries, including over 1 million in Africa. Yet that is less than a quarter of those who need the medicines, and the rate of new infections is six times the number of new patients entering treatment annually. 鈥淭his is not acceptable and it is not sustainable,鈥� Dr. Piot cautions, noting that such trends could doom efforts to reach the UN target of universal treatment access by 2010.

As grim as such numbers may seem, they are worse for women. Just 11 per cent of pregnant women receive treatment to prevent passing the virus to their newborns, and in some of the worst-affected African countries, just one in 10 women has access to HIV testing.

But to Ms. Mataka, there are signs of progress. 鈥淭he fatalism that I sensed maybe five or six years ago is certainly on the decline,鈥� she says. 鈥淧eople think the response is in their hands and they can do something about it.鈥�

The availability of treatment, in particular, has begun to fundamentally change public attitudes, she notes. 鈥淧eople know that if they are ready for treatment, there will be treatment. Increasingly, people are no longer seeing the diagnosis of HIV/AIDS positivity as a death sentence. People are going back to work. Children are growing up with their parents.鈥�

There are other modest signs of progress. Although infection rates are static or increasing in most African countries, the rate of increase has begun to slow among 15- 24-year-olds in eight East African countries. UNAIDS reports that young people in Kenya and Malawi are having fewer sexual partners, a sign that years of HIV prevention programmes are beginning to have an impact on personal behaviour.

Ms. Mataka also cites advances in technologies that women can control, such as microbicides and female condoms, and wider use of male circumcision, which appears to reduce infection rates among men. She cautions, however: 鈥淲e can鈥檛 lead people to believe that it [technology] is a panacea to everything. People still have to practice other safer sex strategies like minimum sexual partners and condoms.鈥�

African solutions

Despite the challenges, special envoy Mataka is optimistic about the future. 鈥淭here is new hope in Africa.鈥� More needs to be done to recognize 鈥渢he positive developments that Africa is making, that communities are making鈥�. People are mounting prevention and treatment programmes in the workplace, addressing issues of stigma and defending the rights of people living with HIVAIDS.鈥�

At the end of the day, she asserts, 鈥渢here must be an African solution to this problem鈥�. This is not to say that Africa does not need international resources. Africa needs massive international support.鈥� African ownership and political will in the fight against AIDS is indispensable, 鈥渂ut until that political will translates into resources, it will have a questionable impact on the epidemic.鈥�

Africa itself must do more. 鈥淚t鈥檚 a critical emergency,鈥� she concludes, and women are the key. 鈥淲e need to build capacity and women鈥檚 leadership so that they take control of programmes that are designed for the needs of women. Africa needs to realize that without dealing with the issue of women, there will be no progress in turning HIV/AIDS around.鈥�