BRIDGE Report 13: Gender and HIV/AIDS in Sub-Saharan Africa: The Cases of Uganda and Malawi

Author: R. Marcus
Publisher: Institute of Development Studies UK
Publication Date: Sep 1993
How does HIV/AIDS affect women differently from men in Sub-Saharan Africa' What are the implications of dynamics in sexual relationships for prevention strategies' This report discusses the gender aspects relating to HIV/AIDS in Sub-Saharan Africa, with particular attention to Uganda and Malawi. The primary focus of the report is heterosexual transmission of the virus, which accounts for approximately 90 percent of its transmission. Evidence suggests that prevention strategies often either do not reach women effectively, or leave them feeling powerless as they lack control in sexual relations. Prevention and care strategies must recognise that women are both particularly vulnerable to the disease, and carry the heavy burden of caring for AIDS patients and orphans.

From early on in its recognition of HIV/AIDS as a serious socio-economic and health problem, the Ugandan Government has been relatively open about the issue, and permitted considerably more research (both local and foreign) on HIV/AIDS than other African countries. A number of inferences can be made from this Ugandan research to other countries in the region, where data is lacking. Further research is needed to investigate gender issues and HIV/AIDS, to ensure that they are taken into account at national level and incorporated into prevention and care programmes. In particular, prevention technologies that are beneficial to and can be controlled by women must be pursued.

Based on existing evidence, the following conclusions can be drawn:
- Women do not have the power to refuse sex with their partners, nor to insist that they use condoms. Additionally, women often receive information about HIV/AIDS prevention later than men and through indirect channels.
- Men are reluctant to use condoms because they are perceived as reducing sexual pleasure and are negatively associated with multiple partners and prostitution. Men in general lack a sense of responsibility for their sexual behaviour.
- Messages in prevention campaigns tend to be moralistic and focus on advocating fidelity or abstinence from sex, reinforcing gender-based power in sexual relationships. Women often feel powerless to take action against HIV/ AIDS, when they are unable to refuse sex.
- Generally, the task for caring for people with AIDS and AIDS orphans falls on women.
- HIV/AIDS prevention, control, and management efforts are not reaching rural areas. The following are recommended for addressing gender concerns relating to HIV/ AIDS in Sub-Saharan Africa:
- Develop and fund mechanisms for strengthening women's NGOs, as they have an important direct and indirect role in HIV/AIDS prevention, awareness, and care.
- Develop and make available affordable alternative technologies, such as virucides (chemicals that destroy viruses) and female condoms (for insertion into the vagina) which are controlled by women. In the meantime, promote male condom use by tackling the stereotypes hindering their use.
- Expand prevention strategies to include the entire population, not just those 'at risk', and develop gender-sensitive campaigns for each age group. Much greater attention must be given to how these campaigns can influence men's sexual behaviour and promote male responsibility.
- Support organisations working in rural outreach, particularly to women affected by HIV/AIDS, and place more effort on improving rural health infrastructure.
- Increase needed support to carers of AIDS patients and orphans.
- Conduct research into the composition of people who receive counselling and care (sex, class, ethnicity, geography, and educational level) to examine the extent of gender bias in service provision.