2 December 2013

Africa: 'Aids Has a Women's Face', or Does It? Beyond the Gender and HIV Dyad

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This post was published on the IDS Knowledge, Technology and Society blog on 29th November. With World AIDS Day being celebrated on 1st December, and as we move into 16 days of activism against gender-based violence, I am prompted again, to reflect on some of the important links between gender-based violence and HIV, and also some of the problematic assumptions that perpetuate uncritical thinking on the gender-HIV dyad.

A Discomfort with Development Categories

Meet Zama, a 33-year old South African woman and an old friend of mine; she has been an AIDS activist and professional HIV treatment literacy practitioner in South Africa since the height of AIDS denial in the early 2000s. Zama lives in Khayelitsha, which means 'new home' in isiXhosa. Its name is rather cynical, given that in this area homes are rarely ever permanently sunk into the earth. Space matters here when the only source of water is a leaky tap, whose muddy veins run down unlit side alleys where women risk rape when they leave their homes at night, or when all adults and children risk electrocution (from illegal wires that wind through the sand) when walking to the single toilet that also serves their 500 - 1000 closest neighbours. Khayelitsha is also the space where women have stood with men, in conjunction with the Treatment Action Campaign and Médecins Sans Frontières, to call on the state to provide essential AIDS medicines; it is the place where these medicines were first made available through the MSF trial in 2001.

Like almost 33% of Khayelitsha's residents, Zama is also HIV-positive; and like almost two million South Africans, she is on ARVs. She explains,

'It's like when the skies fight, when the clouds are angry and dark. They crash into each other and lightning flies across the sky. You never know where the lightning is going to hit. That's what it's like with HIV.' (Zama, 2011).

In this conversation, Zama told me how she had initially found it difficult to negotiate safe sex, or sex at all, when she was a young woman. Zama had been wary of narrating this 'illness history' because it colluded with the 'development category' of the poor, black HIV-positive woman who was unable to actively navigate her own life. In fact, she eschewed labels like 'HIV-positive woman' and considered herself to have substantial personal power to negotiate her current sexual, socio-economic and political relationships.

Looking beyond Victimhood: Between Agency and Structure

While the presence of gender inequality, and its brutal manifestation as sexual violence in girls' and women's lives, is a strong feature of my work, I - like Zama - have been confronted by the explanatory limitations of epidemiological assertions that stipulated a correlation between gender inequality and higher rates of HIV infection among women compared to men. I do not dispute this correlation; my research has been informed by the multiple and intersecting inequalities that seemed to drive HIV, in epidemiological terms, into women's lives and bodies. This was most striking when, in 2008, young women in South Africa were almost four times as likely to be HIV-positive compared to young men of the same age (20 - 24) (Johnson et al., 2013, Dorrington et al., 2006). Overall prevalence in this age group has subsequently declined, but the characteristics of prevalence according to sex remained the same: young women are still more likely to be HIV-positive than men (UNAIDS, 2012).

Studies link these statistics to sexual violence. Articles with titles like 'AIDS has a woman's face' or 'Troubling the angels' proliferated in research that explored this correlation. Other research suggested that sexual violence and its relationship to HIV occurs against an inflected backdrop of pervasive and entangled inequalities in South Africa, where gender, sexuality, race and class powerfully intersect to reinforce poor Black women's vulnerability (Dworkin et al., 2012, Jewkes and Morrell, 2012).

Although these studies give texture to the correlation between gender inequality and high rates of HIV incidence among women compared to men, they may also (unwittingly) support a paradigm that has fuelled development interventions to 'empower' women by foregrounding women's relative lack of power compared to men. Ascribing HIV transmission, in epidemiological terms, to entrenched gender inequality does not, in itself, engage with the complex pathways that women navigate between desire and risk in their sexual relationships, and in extremely difficult socio-economic contexts. In this respect, my research shows that women are subtly, and sometimes with great difficulty, negotiating their intimate relationships with men by forming separate households and by working and establishing their financial independence. This was not a straightforward matter of asserting agency or submitting to intersecting structures of inequality.

The Biopolitics of Violence: Bringing a Global Network of Actors into View

In my research on gender and HIV, and now as I convene the Sexuality, Poverty and Law Programme at the Institute of Development Studies, I suggest that we - researchers, policy makers, activists - need to be careful about situating vulnerability in individual bodies and relationships. I propose that we nuance our analyses to look at how people's bodies and lives are located in a far more complex network of actors. I suggest, then, that the gender-HIV dyad is problematic not only because it positions women as passive victims of men who are, conversely, held to be active perpetrators (or even more unhelpfully, 'vectors of transmission'). More fundamentally, it is problematic because these discourses direct our attention towards individuals or 'cultures of inequality' and away from the biopolitics of violence in which national, regional and global actors are implicated.

While we certainly need to address the manifestation of inequality in people's lives, the bolts of lightening, we also need to explore the context - the skies that fight - in which women's lives are located. This includes a recognition: of the subtle ways that women hold agency, albeit fraught and contested; that men are a part of the solution in working towards equality; and that national, regional and global actors need to be held to account for the ways they intimately affect our lives, from a distance, at the most molecular level.

Elizabeth Mills is a Research Fellow in the IDS Knowledge, Technology and Science research team. She works on health, citizenship and HIV/AIDS.

The Participation, Power and Social Change (PPSC) blog is written by researchers from the Institute of Development Studies (IDS), UK. It also includes contributions from other experts. The PPSC Team at IDS works in partnership with diverse collaborators from around the world to generate ideas and action for social change. The posts on this blog reflect the opinions of each individual, and not necessarily those of IDS.

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