Change is possible
In South Africa, as in many parts of the world, poverty and unequal power relations between men and women continue to shape the nature of sexual relationships.
What does it mean for a girl to abstain from sex, when her relationship with an older man ensures that there will be food on the table?
How does being faithful protect you, if your husband’s infidelity is widely accepted as part of “being a man”?
And for the one-in-four women experiencing domestic violence in this country, how can they suggest using a condom, knowing this will provoke suspicion and anger?
Women now make up the majority of those infected with HIV in sub-Saharan Africa, and young women face three times the risk of young men. Clearly, the conventional “ABC” HIV-prevention messages—“abstain, be faithful, use condoms”—are failing to take into account the reality of women’s lives.
But is it possible to tackle these difficult social realities? To many, it seems like poverty, gender inequalities and violence are deeply entrenched aspects of our society—ones that will take generations to change, if at all.
Yet, our experience working with some of the poorest communities in South Africa suggests that change is indeed possible.
Recognising that empowerment is about more than money, we introduced “Sisters for Life”, a 10-part gender and HIV training programme, into routine fortnightly loan repayment meetings.
Over a period of six months, the participatory sessions encouraged women to open up and discuss difficult issues such as gender roles and culture, sexuality, communication with partners and children, domestic violence and HIV.
Following this training, loan centres elected members whom they felt were “natural leaders”. These women then led their centres in sharing and applying what they had learned with their families and communities.
The goal of the Image project was to test whether this combined approach of microfinance plus education might have an impact on women’s empowerment and their experience of domestic violence.
The study, involving more than 850 women and 4 000 young people in Limpopo, represents a five-year collaboration between the School of Public Health at the University of the Witwatersrand, the Small Enterprise Foundation, and the London School of Hygiene and Tropical Medicine.
The results of the trial, published in this week’s issue of the medical journal the Lancet are exciting. Two years after joining the programme, women’s risk of physical or sexual violence from an intimate partner was reduced by 55%, relative to a matched control group who did not participate in the intervention.
The Small Enterprise Foundation, a microfinance organisation based in Tzaneen, administered the loans, which women used to start a variety of businesses—from dressmaking, to selling second-hand clothing, or running local spaza shops.
The resulting financial gains combined with the training led to improvements in women’s empowerment—including higher self confidence, the challenging of traditional gender norms, and greater communication with partners and children about sex and HIV.
This year’s Nobel Peace Prize went to Muhammad Yunus, founder of the Grameen Bank, in recognition of his pioneering contributions to the field of microfinance, which now reaches more than 100-million of the world’spoorest around the globe.
Critics of microfinance have asked whether simply providing loans to women, without addressing broader gender inequalities, can really lead to improvements in women’s status. Others have cautioned that attempting to empower women, without bringing men on board, might even lead to a backlash.
What the Image project suggests is that in South Africa, adding an educational component to microfinance can maximise empowerment benefits, while reducing rates of domestic violence.
There is an argument that interventions must work with men in order to have any impact on gender-based violence. The Image project worked directly with women. But targeting women does not mean excluding men.
All women have men in their lives and if equipped with resources, knowledge and skills, can find creative ways to bring them on board. Divorce rates did not increase among participants—instead they reported better communication and conflict resolution with their partners.
Collectively, women found the courage to enter traditionally male domains, in order to work together with community leaders to raise awareness about domestic violence and HIV. Some simply began at home, deciding that they wanted to change the way they were raising their boys.
It is time to move beyond simplistic “ABC” prevention messages to begin tackling the deeper social and economic realities that put these prevention strategies out of reach for so many. The Image project offers encouraging evidence that these realities are not untouchable. For too long, responsibility for addressing HIV has remained primarily within the health sector.
It is time to break out of that box and to build the kinds of creative inter-sectoral partnerships that will make a broader HIV-prevention strategy possible.
Julia Kim is a physician and researcher based at Rural Aids and Development Action Research, School of Public Health, University of the Witwatersrand and the London School of Hygiene and Tropical Medicine
For more information about the Image project, contact the Small Enterprise Foundation (SEF). Website: www.sef.co.za, or www.wits.ac.za/radar
