Nomvula Nhlapo fell in love at the age of 16 and, to the fury of her father, left home to live with her boyfriend. Four years later, she returned, terminally ill with Aids. Her father refused to allow her into the house. She collapsed under a tree and stayed there for the last few weeks of her life.
Neighbours washed and fed her and moved her out of the sun when it got too hot, but her father never relented. She died three weeks ago — in the open, a short distance from her family home.
Nomvula’s lonely death sums up the course of the epidemic here. Compared with Aids in the developed world, in South Africa the disease is primarily one affecting women: more women than men carry the virus, they are infected at a younger age, and they die earlier.
It is the mothers, wives, sisters and daughters who are giving up jobs and dropping out of school to care for dying relatives. Two-thirds of those caring for Aids patients in their last year of life are female relatives.
The first comprehensive nationwide study of HIV prevalence reported, at the end of last year, that 17,7% of women between the ages of 15 and 49 were HIV-positive, compared with 12,8% of men. The highest rate of new infections is in women aged 15 to 20, and HIV has just been identified as the leading cause of death in pregnant women.
One reason for the higher rate of infection in women is biological; the virus does not survive long outside the body but it does stay alive in the vagina long enough to be able to enter the bloodstream through little tears.
But probably the primary underlying reason for the higher rate is cultural, resting with the patriarchal nature of much of African society, as illustrated by Nomvula’s intransigent father.
The status of women is low, and rape and domestic violence are common. In 1998 alone, 49 286 rape cases were reported to police, 41% of which were to do with people under the age of 17.
‘Women are being coerced into sex at a young age,’ said Rachel Jewkes, director of the Medical Research Council. ‘It tends to be girls who in some way challenge patriarchal norms – by drinking in bars, rejecting sexual advances, or even wearing short skirts. There’s a lot of gang rape, mostly by young men.’
Rape, particularly violent rape, hugely increases the chances of HIV infection because of internal injuries.
Jewkes says that the girls tend to favour older men, those who give them gifts or food or pay their bills — but who also have other partners. The power imbalance makes it more difficult for girls to negotiate safer sex practices, such as condom use. Multiple partners also increase the risk of infection.
Professor Isak Niehaus, of the University of Pretoria, who has extensively researched African masculinity, believes the solution lies in focusing on the men. He talks of the ‘wound in the psyche of the oppressor in the male dominated society’, citing suicide figures which show that men, compared with women, are four and a half times as likely to kill themselves. He sees the rape epidemic as masculine domination in a section of society that has suffered successive assaults. Apartheid turned black men into servants and destroyed the family structure through removals of communities from land reserved for whites. Migrant labour in mines caused further havoc.
The arrival of democracy in 1994 brought further stress. Then, unrealistic expectations of life turned to bitterness as thousands of jobs vanished through market liberalisation. Privatisation and the decamping of corporate giants hit employment figures. And the foreign investment that was expected to follow the opening of markets largely failed to materialise. Forty two per cent of black people are unemployed.
Men’s response to this insecurity has been to cling to traditional roles. Women are more likely to embrace modernity. They tend to be better informed about Aids as they are counselled and offered tests at ante-natal clinics before being offered anti-retroviral drugs to prevent passing the virus to their babies.
And, while both sexes tune into the media, often it is the women who favour soap operas — several of which have HIV-positive characters and actively promote women’s rights. Men are more likely to discover they are HIV-positive when they become ill.
Niehaus says the answer is education and positive role models. There are two examples of prominent men altering the way others think, he says. One is Nelson Mandela, who praises his wife, Graca Machel, for not taking his name, never mind the fact that her name is that of her previous husband, Samora Machel. Mandela’s dignified response to his humiliating treatment by his former wife, Winnie, during their divorce, was also a source of debate among African men.
More surprising is the hit by Mandoza, the king of Kwaito music, an African version of hip hop much admired by young black people. The song ‘Let’s go 50/50’ calls for the independence of women.
Meanwhile, in another twist in the battle with the government over anti-retrovirals, the Treatment Action Campaign has charged Manto Tshabala-Msimang, the Health Minister, and the Minister of Trade and Industry Alec Irwin, with manslaughter.
Hundreds of the campaign’s supporters were arrested in a nationwide display of civil disobedience. Participants claim that 600 people die daily, who could be saved by anti-retrovirals. The government, using newspaper adverts, claims it is doing everything possible to combat the epidemic and awaits a costing committee to report on the feasibility of a universal antiretroviral scheme.
The action campaign plans further civil disobedience until the government announces a start to universal treatment. – Guardian Unlimited Â