WHO report puts Aids as the leading cause of death worldwide among people aged 15-59 , and female HIV infection rates now supersede that of men in some areas. African women are challenging the social issues that surround HIV/Aids to cut the death toll Sam Burcher
Twenty-five years after the start of the Aids epidemic that has so far claimed 25 million lives worldwide , the stigma of immorality remains for people that contract HIV. This has made it particularly difficult for women to speak out about their HIV positive status, and to help other women to protect themselves against the disease.
World Health Organisation (WHO) reports that at the end of 2005, there were 17.5 million women worldwide out of a total of 38.6 million living with HIV/Aids [2 ], but in sub-Saharan Africa more than half of all the adults affected are women, the majority young women.
More precise data on the rates of female infections and death from HIV/Aids have been recorded in the US , where in 2005 , black women represented 67 percent of HIV infection rates among all women , despite accounting for only 12 percent of the total female population. During the same year, the HIV case rate for black women was 49.9 per 100 000, or 24 times the rate of white women. Aids is also the leading cause of death amon g US black women aged 25-34 . In 2003, the death rate per 100 000 aged 25-44 was 23.6 for black women compared to 1.3 for white women . Black women and children have been used as guinea pigs in controversial Aids drugs trials both in the US and in Africa [6, 7] Guinea Pig Kids in AIDS Drugs Trials , NIH-Sponsored AIDS Drugs Tests on Mothers and Babies , SiS 27 )
A United Nations Aids epidemic update  identifies gender inequal ity in social and economic status, and in access to prevention and care services, as one of the reasons for the rising rates of female HIV infection. The report published in 2006 also highlights sexual violence against women, loss of property and/or physical violence if they become widowed or infected by HIV.
It is vital, therefore, that women everywhere challenge the traditions, cultural practices, and stereotypes to overcome these negative social effects and to regain power over their own bodies and lives. To that end, a number of African women in conjunction with the Centre of Development and Population Activitie s a re leading the way in getting their voices heard.
The Reverend Annie Kaseketi is determined to go public about her HIV positive status. Like millions of African women she watched helplessly as her husband and children died. She spoke publicly about her experiences at Washington's Capitol Hill and also on the award winning internationally syndicated public and community affairs radio programme , A World of Possibilities . Reverend Kaseketi explained that at first she did not know she was HIV positive. Her husband died of meningitis and four of her five children also succumbed. It was only when both she and her surviving child tested positive for HIV that she realised what might have happened to the rest of her family. After she shared her HIV status with her congregation, she felt very guilty and wondered if she had done the wrong thing. It was as if “I had poured a bucket of cold water all over them,” she said. But her fears evaporated when many people came to her in confidence with personal stories of their own. Kaseketi's story is one of tolerance, of tragedy, and of transformation. And she will keep working to break down the taboos, and the denial surrounding HIV infection.
Rhoi Wangila, a former fashion model, is another ambassador for HIV positive African women. Her message is a proactive approach to tackling the underlying contributory factors of the disease. She also spoke out on A World of Possibilities . She said that the best way of slowing down the spread of HIV transmission is to confront its stigma. Wangila defines the underlying “causes” of Aids as social, economic and cultural. She says that the essential factors that must be addressed to empower women in the fight against Aids are:
A landmark study has recognised that gender violence against women is a universal norm . UN Secretary General Kofi Annan, who released the report, said, “Violence against women persists in every country in the world as a pervasive violation of human rights and a major impediment to achieving gender equality”. The study makes explicit the link between violence and discrimination against women and calls for the increased resources for national action plans to prevent and eliminate violence against women and girls. It also notes the bold and visible leadership qualities emerging from African women.
Africa's first woman head of state, Liberian president Ellen Johnson-Sirleaf, makes gender parity her top priority and sets out positive measures to achieve it . Oprah Winfrey, a US celebrity of African descent has opened her Leadership Academy for Girls in a well-kept suburb of Johannesburg, South Africa, in January 2007 . The school will train 152 girls that show academic and leadership potential from households with incomes of less than £370 per month in its first year. Although critics say that many schools in the region could have been improved and issues of gender discrimination within education tackled by the 40 million dollars invested by Winfrey .
Rhoi Wangila believes that young women in Africa are vulnerable to HIV because of persistent discriminatory traditions, customs and stereotypes. Furthermore, she adds that cultural norms such as forced marriage dictate that women have little power over their bodies because their bodies, in fact, belong to men. Entrenched cultural attitudes make it difficult for women to negotiate the use of condoms, to say no, and to protect themselves from infection. “When woman has power and dignity there is hope for the whole community”, she said.
Globalization, shifting populations, and civil wars have all increased women's vulnerability. The rapid spread of urbanisation has removed the mechanism of accountability to the elders for the bad behaviour of men. In a traditional community, if her husband abused the woman, she could go to the elders for help, and then, if necessary, back to her family. In centralized urban settings there is no such safety net for women, and domestic violence is on the increase. However, problems exist in rural communities as well. As Wangila points out when husbands go to find work in the city, they may have unprotected sex with prostitutes and then expect unprotected sex with their wives when they return home.
Women in Africa are also most likely to be the last to seek medical help. For example, in countries such as Kenya and Zambia, it is thought that young women are at least three times more vulnerable to HIV  than young men of the same age. Women of all ages also bear the added burden of the primary caregiver in largely extended families that have lost either one or more parent to an Aids related disease. To date, there are an estimated 15.2 Aids orphans worldwide having lost one or both parents to the disease, 12 million of which live in Sub-Saharan Africa .
In 2007, the number of people receiving HIV antiretroviral therapy in sub-Saharan Africa has surpassed the one million mark for the first time . This represents a tenfold increase in treatment since December 2003, but as the region accounts for 70 percent of the global unmet treatment need, there is much to be done to achieve the goal of universal treatment by 2010. Men in sub-Saharan Africa have access to only 10 condoms on average per year, while only half the numbers of condoms that are needed in low-income countries are available. The lack of both male and female condoms is not conducive to halting the spread of sexually transmitted diseases.
The World Food Programme (WFP)  has highlighted food and nutritional support as an often-overlooked part of essential care for people living with HIV. Good nutrition is vital for everybody to have a healthy life, and all the more so for HIV positive individuals, who may also be coping with the rigours of toxic drug regimes. There are many relatively inexpensive nutritional treatments that can fill the gap until universal treatment for HIV is achieved. In I-SIS' report Unraveling AIDS , we examined a wide range of nutritional support from vitamins  and mineral supplementation , probiotic treatments  and African plant medicines  that can treat the severest symptoms of HIV/Aids; such as appetite and weight loss, coughs, sweats and skin conditions. Interestingly, the active chemical compounds of one such plant are derived from a bush that grows abundantly in South Africa where the Aids epidemic is prevalent.
It cannot be over-emphasized that nutritional and therapeutic support is key for people living with HIV whether they are receiving antiretroviral treatment or not. The need for nutrition and basic prophylactics in developing countries must not be overlooked in the colossal budgets allocated to tackling Aids, most of which is deployed to the pharmaceutical industry to deliver more toxic antiretroviral drugs  in line with the government initiatives of rich nations. The toxicity of the drugs will be greater for the malnourished and underfed, and it would be unethical to give drugs without making sure that good nutrition as well as sanitation is also provided, as we have recommended in our report .
Data from the UN states that at least 102 of the 192 member states have no specific legal provisions on domestic violence, while marital rape is not a prosecutable offence in 53 countries.
One European study quoted within the UN report says that of the 1,322 marriages across six villages in Kyrgyzstan, nearly half were the result of kidnapping, and up to two thirds were non-consensual.
The UK Government has set up a “Forced Marriage Unit” that intervenes in around 300 forced marriages per year.
The UN Population Fund (UNFPA) estimates that 5 000 women are murdered by family members each year worldwide in “honour killings” to protect the reputation of certain cultural norms with certain families or communities.
In India, official crime statistics for 2002 reveal that 6 822 women were killed (1 woman every 77 minutes) in domestic arguments by the grooms family relating to insufficient dowry payments by the bride's family.
Article first published 04/03/07
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