Tradition, the subservient role of females and pervasive poverty contribute to the soaring rate of HIV infection among women in sub-Saharan Africa.
Recent UNAids statistics show that up to 30% of pregnant women in Malawi carry the virus, in Ethiopia 1,1-million women are infected compared with 800 000 men, and in Uganda health officials fear a massive resurgence of HIV infection among young women in camps for internally displaced people.
Girls aged 15 to 19 in the region are six times more likely to be HIV-positive than boys of the same age and females are twice as likely as males to be infected during unprotected sex.
Mangochi village lies between Lake Malawi and Lake Malombe. Older women continue the traditional practice of teaching groups of 12- and 13-year-old girls how to please a man sexually.
“After they have been instructed, a man will come at night to the hut they share,” says Ndasowa Msosa, a reproductive health counsellor. “One by one, he has sex with them and it is said he is removing the dust from their vaginas. We do not believe condoms are being used.”
Things aren’t much better in Lilongwe, a sprawling city of almost 800 000 people a few hundred kilometres to the north. There even educated young women rarely ask their boyfriends to use condoms and tolerate promiscuous behaviour.
“If a woman does not please her man sexually she is expected to lose him,” Msosa says. “She knows that if he goes away or goes to someone else, she will not be married, or if she is married the family will be left with nothing.”
Given the subservient position of women, few men wear condoms. “They say: ‘If you take a sweet when it is in its pack, do you think you can taste the sweetness?'”
Jimmy Kadongola, an HIV/Aids counsellor, says many people also believe that condoms contain HIV and that the lubricant sterilises women.
About 64% of Malawians live below the poverty line and women are the poorest of the poor.
“Selling your body for money is pervasive,” Msosa says. “Schoolgirls whose parents have died work in the bars selling themselves to continue with their education. Girls who don’t have school supplies or girls at boarding school can be found on the roadside after classes offering themselves to men.
“Girls who run away from home deep in the villages come to the centres with no education, no money and no way to make any except by commercial sex work,” Kadongola says. “Other girls of 13, 14 and 15 are brought in by relatives who cannot afford to keep them any more. They also become sex workers.
“When a woman or girl initiates sex for money she can’t ask a man to wear a condom.”
In Ethiopia, the Orthodox Church teaches that God forbids the use of condoms and that wasting sperm is sinful. Women have little say in sexual matters and wives generally are not allowed to refuse their husbands sex. Few wives or sex workers demand that their partners use condoms.
According to UNAids data, though almost everyone in the country knows about HIV/Aids, only 13,4% of women and 30% of men reported that they had used a condom the last time they had sex with a non-regular partner.
Mulatu Monashe lives in Lai Gayint, an impoverished community 500km north of the capital, Addis Ababa. The 25-year-old says Ethiopian culture is so conservative that nobody in her family even mentioned sex when she was growing up.
Her friend Wodiye Gete (16) says men intentionally keep women in the dark. “Many people in this village believe the man is greater than the woman. Keeping young women ignorant about sex is said to preserve our innocence.”
Unicef reports that more than 3,7-million (58%) girls at primary school level in Ethiopia do not attend school and the adult-literacy rate for women is 33%. Many girls do not have access to the information they need to keep safe.
Fikre Niguse (18) is a sex worker who has been working in Lai Gayint for the past six months. At eight she was married to a man who beat her, so she ran away. “When I got here I was completely ignorant about HIV/Aids,” she says. “Now I have learnt about the methods of protection — but maybe it’s already too late.”
Women and girls are still abducted as a form of marriage. Though illegal, most marriages by abduction involve forced sexual relationships. Child prostitution is also on the increase. Girls as young as 11 are recruited to work in brothels, but are not taught about the risks of HIV/Aids infection.
About 90% of Ethiopian women have undergone circumcision. Asengay Sena (50) is a traditional birth attendant in Jarso, a town on the lip of the Blue Nile Gorge. Until she was informed about the dangers of circumcision a few years ago, she routinely excised the clitorises of girls as young as five and had done so for 20 years. She removed the clitoris with a knife or razor blade from as many as 10 to 12 girls at a time, several times a year.
“There are many places in this country that are extremely isolated and I’m afraid the practice will continue there with all of its deadly consequences.”
Uganda has been cited as sub-Saharan Africa’s success story for its measures to control the spread of HIV/Aids, reducing HIV prevalence from a reported high of almost 30% in 1986 to between 5% and 7% today.
But the situation is far different in the north, where a 17-year civil war has forced 840 000 people into camps for internally displaced people. There up to 82% of the people live below the poverty line.
“Girls routinely sleep with soldiers and other men for money,” says Stella Laloya, an HIV/Aids counsellor. “Because they are offering themselves as sex workers, those men usually refuse to wear condoms.”
Soldiers who are supposedly in the camps to protect the masses from attack by the Lord’s Resistance Army (LRA) rebels are often accused of rape.
Families fear their children will be abducted by the rebels, so many parents send their children to spend the nights on the streets of larger towns such as Gulu and Kitgum.
“Since young girls are desperate for better lodging, men take advantage and offer a more comfortable sleeping space, trading it for sexual favours. With their lives already in jeopardy, the girls also warm themselves with other young boys — and they don’t use protection.”
Human Rights Watch reports that the LRA has abducted about 20 000 children. The boys are forced to become soldiers and the girls the “wives” of rebel commanders. These “wives” are usually passed from one commander to the next. If they escape, they almost always carry sexually transmitted diseases, including HIV/Aids.