“Africa needs to realise that without dealing with the issue of women, there will be no progress in turning HIV/Aids around,” says the United Nations special envoy for HIV/Aids in Africa, Elizabeth Mataka.
“Unless we empower women we will remain with limited success,” she says. “We need to build capacity and women’s leadership so that they take control of programmes that are designed for the needs of women.”
Early anti-Aids programmes, she says, failed to focus on women’s needs and lacked concrete goals. Simply adding women to existing Aids programmes did not work: “We must have the same thing with women’s empowerment. We must have definite programmes so that women are supported,” she says.
Mataka speaks from experience. She is the executive director of the Zambia National Aids Network and serves as vice-chairperson of the Global Fund to Fight Aids, Tuberculosis and Malaria.
Nearly 60% of the 25-million Africans living with Aids are women. The situation is little better elsewhere, with women now accounting for almost half of all infections worldwide.
The reasons for women’s vulnerability to HIV are complex and varied. Sexual assault and other forms of violence are important contributors and biology makes women more susceptible to infection. But the most critical factors, says Mataka, are economic, social and political.
“Look at the economic position of women. Most women find themselves totally dependent on their male partner. That tends to limit their negotiating power in terms of safer sex,” she says.
In some cultures women are taught from the cradle to be subservient and obedient. Such an upbringing, combined with economic dependence, she says, makes it difficult for women to protect themselves. “How many women if they went for testing would go home and announce their status if they were positive and hope to remain in that home? And if they are thrown out of the house, what options do they have? Where do they go?”
Even women who have decided to end an abusive relationship can find themselves isolated and trapped.
“Women are under real pressure to remain in a marriage,” Mataka says. “Mostly society will not support a woman in her decision to divorce if she thinks marriage is risky. People just say: ‘That’s how it is. That’s how men are.’ They need support to get away from risky situations,” she says and it is up to other women to provide it.
Despite a thirty-fold increase in funding for global anti-Aids programmes since 1996, the number of new infections and deaths continues to rise. Spending on HIV/Aids prevention, care and treatment is expected to reach $10-billion this year, but that is less than half the amount needed.
Antiretroviral drugs now reach two million people in developing countries. Yet that is less than a quarter of those who need treatment and new infections are increasing faster than treatment programmes are being rolled out. Just 11% of African women receive treatment to prevent passing the virus to their newborns. In some African countries barely one in 10 women have access to HIV testing.
But Mataka says there is reason for optimism. “The fatalism that I sensed maybe five or six years ago is certainly on the decline. People think the response is in their hands and they can do something about it.
“There is new hope in Africa,” she says. “People are mounting prevention and treatment programmes in the workplace, addressing issues of stigma and defending the rights of people living with HIV/Aids.”
Africa still needs international support, she says, but “there must be an African solution to this problem” and Africa itself must do more.
Michael Fleshman works for the UN’s Africa Renewal