28 April 2008
analysis
Washington, DC — "Despite gradual improvements in the government's response to the HIV epidemic and the adoption of a widely-welcomed five-year plan, five and a half million South Africans are HIV-infected - one of the highest numbers in any country in the world. Fifty-five percent of them are women. South African women under 25 are three to four times more likely to be HIV-infected than men in the same age group. ... the level of new HIV infections amongst women in South Africa continues to increase, while overall incidence of the disease has levelled off." - Amnesty International
In a report released in March, based on interviews in two South African provinces and extensive consultation with South African agencies involved with the issue, Amnesty International provides a detailed portrait of the situation of rural women, and the interaction among violence, poverty, and the risk of HIV/AIDS. The report's title, quoting one of the women interviewed, is "I am at the lowest end of all."
The full 124-page report is available at
http://www.amnesty.org/en/library/info/AFR53/001/2008/en In this and another issue sent out today, AfricaFocus Bulletin provides brief excerpts from the report's overview and the section on violence against women. The overview also provides a useful concise survey of the development of the AIDS epidemic in South Africa, including the debates about government policy and the active role of civil society.
For previous AfricaFocus Bulletins on related issues, see http://www.africafocus.org/healthexp.php
"I am at the lowest end of all"
Rural women living with HIV face human rights abuses in South Africa
March 2008 AI Index: AFR 53/001/2008
Amnesty International
[Excerpts from preface and introduction only. For full 124-page report, including footnotes and references, see
http://www.amnesty.org/en/library/info/AFR53/001/2008/en]
Summary Table of Contents
Introduction
HIV and AIDS in South Africa The female face of the HIV epidemic: the impact of discrimination, violence and poverty
Violence against women and HIV
Sexual violence and its consequences Domestic Violence as a long-term threat to women"s health Caring for the survivors: overcoming barriers to their right to health Reducing the risk of HIV transmission: The provision of post-exposure prophylaxis (PEP)
Gender-based discrimination as a barrier to prevention, treatment and care for HIV
Legal Framework Now social status and vulnerability to HIV infection and its consequences Denial of women"s sexual and reproductive rights Gender-based discrimination & access to treatment for women living with HIV
HIV testing and disclosure of results
Human rights standards Abuses and abandonment of HIV-infected women by their partners Men"s reluctance to test
Poverty as a barrier to the realization of rural women"s right to health
Consequences of poverty for rural women living with HIV Lack of access to adequate food Accessibility of health services: distance and transport costs as barriers Availability and accessibility of health services: barriers to treatment and care Increasing the availability and accessibility of accredited facilities.
Conclusion
Recommendations to the Government of South Africa
Recommendations to Second Governments and donor institutions
Preface
In South Africa in late 2006 a new spirit seemed to have taken hold in public discussions on how to achieve a more concerted, effective response to the country"s epidemic of HIV infection. The ensuing collaborative efforts, which drew in health department officials, civil society organizations and medical specialists, resulted eventually in agreement on a number of issues: notably that the challenges posed by persistent poverty as well as violence and other forms of discrimination against women had to be addressed as part of an effective overall response to the epidemic and the realization of the right to health of those affected and infected by HIV. The consensus on this and other issues was reflected in a new plan adopted by Cabinet in May 2007 to guide the work of the next five years.2
This report, which reflects research undertaken by Amnesty International (AI) in 2006 and 2007, provides an analysis of patterns of human rights abuses against women who are exposed to the risk of or are already living with HIV in rural contexts of widespread poverty and unemployment. It draws on the testimonies of 37 women who, to varying extents, had experienced incidents of violence from intimate partners or strangers, were unable to secure a stable income, faced periods of hunger, but were striving to maintain their access to health services and adhere to treatment despite the consequences of poverty, stigma and their low social status.
The women involved were interviewed by AI in Mpumalanga and KwaZulu Natal provinces, in collaboration with local service providing organisations with whom AI has worked for some years. The interviews were conducted with the assistance of interpreters in most cases and the support of the organizations" lay-counsellors.
The interviewees" identities have been protected throughout this report to ensure their right to privacy and to avoid any possible harmful consequences resulting from their identification.
Identifying place names have also been excluded when referring to their testimonies.
While there were singular aspects to each of their stories, some common themes emerged which pointed towards wider, more systemic factors which affected the women"s ability to realize their right to health. In the following chapters some of these factors are examined, including the direct and indirect impact of gender-based violence, discriminatory attitudes and gender stereotypes, and economic marginalisation. In attempting to assess their effects, AI has drawn on information provided to it in meetings and other communications with nongovernmental and government sector service providers, human rights and advocacy organizations, policy development and research institutions, health professionals and government officials.
The report"s analysis has also benefited from some of the extensive published research undertaken by South African and international organizations. Finally, the report"s analysis and conclusions are underpinned by a framework of human rights standards which reflect the consensus of the international community. South Africa since 1994 has participated in the further development of these standards, as well as shown its acceptance of them through its commitments made under key international human rights treaties.
This report and associated campaign are intended as contributions towards South African efforts to overcome the legacies of the past and address current human rights abuses.
Introduction
HIV and AIDS in South Africa
South Africa is continuing to experience a severe HIV epidemic.5 Five and a half million South Africans are HIV-infected, the highest number of people in any one country in the world.
Fifty-five per cent of them are women.6 UNAIDS estimated that 320,000 people died of AIDS in 2006.7 The epidemic developed rapidly from the first case recorded in 1982,8 to a national prevalence rate of at least 16 per cent in 2005.
The epidemic had begun during a period of extreme state violence and political and racial oppression which included government imposed states of emergency from 1985 to 1990, and continued to develop while the country was largely preoccupied with the efforts to negotiate the end of the apartheid system and National Party rule and securing the transition to nonracial democracy in 1994.
Initially perceived in South Africa as a disease particularly affecting gay men and people receiving blood transfusions, it became apparent that HIV and AIDS was not confined to particular "at-risk" groups but was becoming a generalised epidemic in certain communities.9 From 1991 onwards the majority of transmissions in South Africa were through heterosexual intercourse. In 1993 the national prevalence rate amongst pregnant women attending antenatal clinics was 4.0 per cent; in 1996 it was 14.2 per cent; and by 1999 22.4 per cent of pregnant women attending antenatal clinics were HIV-infected.10 In 2005 data from a population survey indicated that 16.2 per cent of adults 15 to 49 years were infected, while UNAIDS, using antenatal clinic data, published an estimate of 18.8 per cent prevalence for adults 15 to 49 years of age.11
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