/ 17 June 2004

Facing the future

In 1976 we were toddlers. Although both of us are black and female, our lives were profoundly different then. One of us was crawling around on a floor in KwaMashu, the other, a few months older, was learning to walk in Lusaka.

When freedom came in 1994, one of us was a 21-year-old studying in the United States. The other — age 19 — stood in a long, laughter-filled queue under a brilliant April sky in Natal, along with millions of others.

Ten years later our lives are so similar we could be sisters. We are both middle class, wear trendy clothes and eat in cafés and restaurants in whichever part of town we like. What is different about us is not visible to the passer-by. It lies between our skin and our bones; in our flesh and blood. Both of us have tested for HIV. One of us is HIV-positive and one of us is not.

Because we are middle class, we are among South Africa’s lucky few — indeed, we are among Africa’s lucky few. We are healthy, educated and financially independent. For the one with HIV, anti-retrovirals are taken twice a day every day; a life-saving regimen available to only 3% of all Africans living with HIV.

We have access to good health care through our medical insurance schemes, and can chat easily with our general practitioners. In short, we represent what the children of 1976 dreamed for themselves.

In 1991 the Organisation of Africa Unity adopted June 16 as the Day of the African Child. As we mark this important day, too many girls and young women across South Africa and the states that supported us during the long years of struggle, are not as lucky as we are.

Africa is the only continent in the world in which there are more women living with HIV than men — 58% of HIV-positive Africans are female. For younger women — those aged 15 to 24, things are not looking too hot. In this age group, females represent 75% of all infections.

Aids may be a problem for all young people but the figures speak for themselves: it is a much bigger problem for girls. Sadly, two decades of not addressing the particular needs of girls is beginning to take its toll.

Clearly, there are underlying factors that make girls more vulnerable to infection and its consequences than their male peers.

The most obvious is biology. It is easier for HIV to be transmitted from males to females. Yet the significance of this scientific fact is often over-stated. Biology wouldn’t matter so much if the social drivers of girls’ infection were not so significant.

The primary underlying issue is poverty. A Medical Research Council (MRC) survey found that a fifth of women who participated in a survey in Soweto had engaged in transactional sex. (Transactional sex is a technical term that simply describes an alarmingly commonplace arrangement: a woman has sex with a man in exchange for groceries or transport, or school fees.)

This figure is stunning because of the powerlessness it implies. Girls and young women have little ability to dictate the terms of sex when they are having it out of need rather than desire.

The second factor driving high prevalence rates among girls is sexual violence. Throughout the region, women are routinely sexually assaulted on the streets and in their homes.

Girls who are sexually abused often have troubled adulthoods. They are more likely to have sex with a known risky partner, to have sex while intoxicated, to have anal sex and engage in all other manners of dangerous sexual liaisons. In essence, we have on our hands a generation of abused girls whose emotional scars run so deep that they are deliberately putting themselves in harm’s way.

These social factors are fundamentally linked to the age at which girls begin having sex. For the reasons listed above, girls have sex at significantly younger ages than boys, with partners who are usually a lot older than them. Typically, the age gap is five to seven years. The younger the woman — the bigger the age gap — the higher the vulnerability.

When young women are known to be HIV-positive the stigma and discrimination they face is different from that suffered by men. Too often, they are blamed for bringing HIV into the home when in most cases the opposite is true.

Not only are girls more infected than boys, they are more affected when someone with HIV/Aids lives in their homes. We all know that girls and women do the bulk of care-giving in most contexts. The burden of care has a serious effect on girls’ ability to go to school, and to get decent work later in life.

Despite this, many of the large Aids programmes encourage the payment of small stipends to home-based care “volunteers”. The very word “volunteer” denies the reality that many girls do not choose to care — they have to. It also ignores the fact that many girls and young women — sometimes sick themselves — are cleaning up diarrhoea, wiping vomit, lancing boils and cleaning suppurating wounds with little or no compensation or support.

Ironically, efforts by women’s organisations to empower girls have often been criticised as discriminatory. Women’s organisations have been criticised for ignoring men. Often, it has been suggested that men need help too.

This is true. It is not true, however, that men are being ignored by mainstream Aids agencies. Rather, Aids programmes often reinforce the status quo by ignoring or deepening the divides between women and men. Male condoms are budgeted for; female condoms are decried as too expensive. Research on men’s bodies continues apace, while the search for an effective woman-controlled prevention method — the microbicide — requires more financial support.

To address this, the United Nations secretary general last year established a task force to institute urgent action for women and girls in Southern Africa. It comprised dedicated women and men of a range of ages from the nine African countries hardest hit by Aids.

The task force did not simply assess and consult, it got to work and produced a hard-hitting and honest report, Facing the Future Together: Women, Girls and HIV/Aids in Southern Africa, which will be launched in July.

In the long term, the task force called for a sustained assault on customs, practices and attitudes that oppress women.

On June 16 we remember the young people who changed the course of history. But we also reflect on the state of young people today. Young women in Southern Africa face multiple threats — often from people who are supposed to love and protect them.

As young African women who are lucky enough to have access to those with power, we know that our efforts will mean nothing if in communities across the region, girls and young women remain desperately hungry, and shamefully neglected.

We are certain that we can arrest the effect of Aids on young women and girls if we approach the challenge in the same way as the children of 1976 tackled apartheid — by refusing to accept the gender inequality that others say is an inescapable part of being young black and female in this part of the world. The two of us are living proof.

Promise Mthembu works for the International Community of Women living with HIV/Aids. Sisonke Msimang works for the UNAids Eastern and Southern Africa Regional Support Team