PUBLISHED IN FAIR LADY MAGAZINE - Nov 2000
ARE MEN SPREADING AIDS?
While women are blamed for and suffer the brunt of the HIV/Aids epidemic in South Africa it is men, say the experts, who need to start accepting their role in the spread of the disease. By MARIANNE THAMM
THE COMMUNITY workers found her cowering in the cane fields.
With nowhere else to go, Sindiswe Dindi and her five year-old-daughter, Nqobile, lived in the dense plantations near Gingindlovu in KwaZulu-Natal for four months barely surviving on the occasional kindness of strangers.
Until the health workers found the mother and child and took them to the Holy Cross Aids hospice nearby, Sindiswe was just one of thousands of "the disappeared" - desperately ill HIV positive rural women who are shunned by terrified communities and left to die on their own.
Sindiswe has been at Sister Priscilla Dlamini's rudimentary AIDS hospice in Gingingdlovu for about three months now and has recovered some of her strength. Nqobile too is looking healthier. How long they will survive without medication is anyone's guess but at least they are lucky to have found shelter in the converted cowsheds.
The hospice, which has about 30 beds and cots, does not receive a single cent from government and survives on donor funding and volunteer assistance. The cluster of buildings, with their cheerful home-made curtains and walls decorated with pictures cut from magazines, are a physical tribute to Sister Dlamini's vision to do something for the neglected, rural poor in KwaZulu Natal, a province with the highest rate of HIV infection in the country.
Said Jill Whitehouse, a retired doctor who volunteers her services at the hospice; "We are only able to take in people who have nowhere else to go. Treatment here is very basic. We cannot test for HIV and we do not have any drugs but Sister Dlamini makes her own herbal preparations from the African potato and that seems to help some people regain their strength for a while".
Sindiswe and her daughter were driven into the cane fields by the stigma that is still attached to HIV/Aids after more than a decade of public awareness and education. Also, the dangerous myth that women are responsible for the spread of the disease still continues, placing an unfair burden on women, especially in rural areas.
The irrational fear and prejudice that lead to the murder of KwaZulu Natal Aids activist, Gugu Dlamini after she disclosed her HIV status, has sadly not diminished.
There are some 4 million South Africans living with HIV/Aids according to the 1999 South African Institute of Race Relations Survey and based on anti-natal research. The majority of them live in rural areas and most of them are women.
Says Rhoda Kadalie, outspoken former human rights commissioner and current director of the Impumelelo Innovations Awards Programme; "The gender breakdown is that 60 per cent of women are concentrated in the poorest rural areas. The other 50 per cent of households are matrifocal - or headed by a woman. This is what we term the 'feminisation' of poverty. In the past 20 years or so poverty has become a women's problem."
And because HIV/Aids is a disease of lifestyle i.e.; access to fresh clean water, medication, adequate diet and community support, it is virtually impossible manage and treat the effects of the disease in circumstances, like those in rural areas, where all of these are virtually absent.
"Many of these rural women have no access to even the most basic of health care", said Rhoda adding that the psychological effects of knowing that children would soon be orphaned were also "tremendous".
"Apart from that they have to face the stress of living in constant fear of being 'found out'. Many of these women rely on home-based care and peer counselling. For most, life is about day-to-day survival," she said.
Vicci Tallis, a lecturer in Gender studies at the University of Natal agrees that low priority is given to women's health needs.
"Women are given little formal and informal support in caring roles and are expected to carry the increasing burden of care-giving in the context of HIV/Aids" she wrote in a recent edition of Agenda magazine.
Over and above this, she says, women have less control over sexual relationships and the sexual behaviour of male partners adding that the only female-controlled method for prevention available is the female condom that is not freely available to the majority of women.
It is the nature of South African patriarchy, adds Rhoda, where "domestic and sexual violence is the order of the day" that is also one of the largest contributing factors to the inability to curb the spread of the disease.
Said Rhoda; "Women have no right to say no or to determine the nature of sex and sexuality. Men in turn seem unable to accept their responsibility. Some view the disease as a government conspiracy. They say in the past the state intruded in every aspect of their lives and now want to tell them what to do in the privacy of their bed."
THE THEME OF WORLD Aids Day on December 1 was the meaningful involvement of men in the epidemic, an issue most Aids workers and activists agree is critical in combating the rapid spread of the disease in South Africa.
"The theme serves as a reminder of the pivotal role that men have played - and should increasingly be playing - in this ever unfolding drama," said Aids activist Kevin Osborne.
And despite the fact that we pride ourselves on the number of women in Parliament, he added, one of the greatest struggles was still "the attitudes that flow from our highly patriarchal society."
There is a growing understanding that "without men there would be no AIDS epidemic" a statement that has drawn attention to the way in which masculinity is defined and how this has facilitated the spread of HIV.
It has also resulted in a shift in emphasis of HIV/Aids education from the vulnerable (women and children) to the powerful - men and boys - who are beginning to understand that casual unprotected sex is a "death wish rather than an assertion of manhood".
"Messages that encourage women to be abstinent, monogamous, or to use condoms every time they have sex ignore the reality that often it is their partners behaviour rather than their own that puts women at risk," said Megan Gottemoeller, a community educator and women's health advocate with the Centre for Health and Gender Equality.
She added that a woman could not protect herself by being faithful if her partner was not.
"Nor can a woman insist on a condom use. Too often, the economic or social consequences of insisting on safe sex, in terms of lost trust, abandonment or abuse can be more threatening than the risk of contracting the disease," said Megan.
Gay men, says Kevin Osborne, accepted the responsibility for the spread of the disease in the community and modified their behaviour accordingly. The infection rate decreased because of education awareness and an acceptance of that responsibility.
"The important lesson here is that men as the all too frequent initiators and drivers of sex, accepted their pivotal role in this epidemic. And with that came a renewed sense of responsibility. Of self and of others," he said.
According to Vicci Tallis, women are unable to stop the spread of HIV/Aids alone and neither can they bear the burden of the personal, social and economic costs.
"It is vital," she says, "that practices that disempower women are challenged. Focussing on women alone both adds to women's burden of HIV and often leads to or fuels the view that they are to blame."
In an attempt to mobilise men globally UNAIDS 2000 noted that: "all over the world, men tend to have more sex partners than women, including more extra-marital partners, thereby increasing their own and their primary partners risk of contracting HIV, a risk compounded by secrecy, stigma and shame."
Janet Bujria, a Senior Lecturer in the Department of Peace Studies a the University of Bradford and who recently completed a comparative study of AIDs in Tanzania and Zambia, noted that African feminists have become increasingly vocal about men's violence against women.
"The brutalisation of women in African societies ravaged by war has become a particularly charged issue. African societies in general tolerate multiple sexual partners for men, but exert moral and social sanctions on women," she says adding "but evidence suggests that men on average have more sexual partners than women whether we do the counting in Britain or Botswana."
In South Africa we have pockets of patriarchy and while African and some Muslim men openly practice polygamy, western men do so clandestinely having extra-marital affairs or by visiting sex workers. No one "group" of men in South Africa escapes the conditioning of their masculine identity and how that relates to their dominance of women. But if men believe that being a man means having multiple sexual partners and that "monogamy is not seen as an attractive way to demonstrate masculinity" how can this view be transformed in the context of safer sex campaigns?
The answer, say those in the field is the deconstruction of male identity as a single or fixed entity and for the issue of gender identity to be included in any AIDS programme or project.
But targeting men, experts warn, should not occur at the expense of women
Ultimately it is men and women together who will be able to fight the spread of the disease but as long as some men continue to abuse their social, political or economic power at the expense of women we are both doomed.
"The sooner men accept and do something about this the better for all of us," is Kevin's wise conclusion.
Ends
Contact Sister Priscilla Dlamini on 083 725 5918
For more on men, women and Aids visit the Agenda website at www.agenda.org.za
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