Global Policy Forum

By Noeleen Heyzer*

As President Bush visits countries of sub-Saharan Africa, I hope he will take the time to speak with African women infected and affected by HIV and AIDS. What he will hear is often ignored, yet their voices can give shape to an effective strategy to counter the relentless growth of AIDS in the region. Simply put, women's unequal status is the central cause of the rapid transmission of AIDS.

Power imbalances between men and women in families, in education, in employment, in governance and in conflict are why 58 percent of those infected with HIV in sub-Saharan Africa are women. One of the primary reasons that strategies fail to counter AIDS is that women have not played a significant role in the design and implementation of these programs. If there is one vaccine that exists today, it is women's empowerment. Focusing on women is the key to reversing the AIDS crisis.

Based on the United Nations Development Fund for Women's work in Africa, we know that women's inequality fuels the transmission of the virus in multiple overlapping ways. First, in many societies, women lack the power in relationships to refuse sex or negotiate protected sex. The prevalence of child marriages and forced marriages further exacerbates women's lack of power and leads to early pregnancies and lack of education. In addition there are strong cultural pressures on women to be innocent in sexual relationships, and thus strong societal impediments to sex education. The threat of violence also impedes the ability of women to protect themselves against unsafe sex. There is a link between violence and the spread of AIDS, particularly in conflict and refugee situations in which women are subjected to untold rapes and sexual assaults.

Second, poverty and economic dependence severely compromise a woman's capacity to refuse sexual relations that she perceives are dangerous. Poverty leads to increased sexual exploitation. Without economic security, many women are forced to engage in prostitution to provide food for their children. Thus, dealing with this crisis is not just about protection but also about prevention, which includes providing women with equal access to education, training and employment.

Third, the poverty facing women in Africa is all the more severe because they have assumed the burden of care. Women are sacrificing their lives to fill the gaps left by governments. Women are the health care resources for countries constrained by debt and poverty. Because of the care burden, women have dropped out of the productive sector, and they are pulling their daughters out of school, leading to further intergenerational poverty and lost potential. In addition, one of the causes of the famine in southern Africa is rural women's responsibility for farming. If they are caring for the sick, this work cannot be done. The depth of their burden threatens entire economies, yet their care is little valued and never subsidized. Women, who are denied inheritance from their husbands or the right to own property, are thus left to head households while sick, impoverished and vulnerable.

What can be done to catalyze change? I recently met with courageous women in South Africa who are members of the Positive Women's Network throughout sub-Saharan Africa. They offer a blueprint for shaping an effective response to the AIDS crisis. This includes: