This document discusses how the HIV/AIDS epidemic in sub-Saharan Africa affects gender inequality for women. It notes that women make up 60% of people living with HIV in the region due to various biological and sociocultural factors that increase women's susceptibility. These factors include female genital mutilation, lack of education limiting economic opportunities, expectation of abstinence but not for husbands, and polygamy allowing spread of the virus between wives. While the epidemic initially seemed to undermine progress on gender equality, it also increased recognition of women's rights and needs.

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Hayley Bosworth
International Baccalaureate Dipoloma Programme
Extended Essay in World Studies
To what extent does the HIV/AIDS epidemic in sub-Saharan Africa
affect gender inequality for women?
Word Count: 3125

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The connections between the HIV/AIDS epidemic and the
progression of gender equality in Sub-Saharan Africa
The horrible disease known as AIDS affects millions of people worldwide. Transferrable
only through direct contact of bodily fluids, such as blood, semen or breast milk, its effects are
deadly and devastating (“How is AIDS Transmitted?”). Human Immunodeficiency Virus leads
the world in cause of death of otherwise healthy young women. In fact, sub-Saharan Africa
constitutes 69% of the global population living with HIV (“Regional Fact Sheet). Of that 69%,
“women constitute 60% of all people living with HIV” in the world, while men of the same
region in Africa take only 9% of the world’s HIV positive population (World Health
Organization Fact Sheets). Within this region, “young women aged 15-24 are as much as eight
times more likely than men to be living with HIV” (“Fact Sheet”). Th significant difference
between the two genders is mostly due to women’s steepened susceptibility to the virus for two
distinct reasons. Women are at a much higher risk of contracting HIV because of biological and
cultural barriers that degrade women and often leave them without control of their livelihood and
their health. This may seem as though women have back-tracked in their fight for equality due to
HIV, but the repercussions of the virus has led to more recognition of women’s needs and rights
as well. Prior to the recognition of the HIV/AIDS epidemic women received little to no
acknowledgment in the face of gender equality. Women in sub-Saharan Africa continue in an
uphill battle against societal norms and the fight against HIV/AIDS.
Human Immunodeficiency Virus, or HIV, is a virus that attacks the host’s immune
system. It does not have direct effects or illnesses attached to it, but rather it allows other viruses
that your body naturally protects against to attack, and without the immune system, it is

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impossible for your body to fend for itself. The virus reproduces, eventually killing all T-cells
cells that act as protectors against other foreign viruses, like the flu or other infectious bacteria.
As the virus kills more and more T-cells, or CD4 cells, it inevitably causes Acquired
Immunodeficiency Syndrome, otherwise known as AIDS. AIDS is the final stage of HIV that
leaves the body completely vulnerable to OI’s, or opportunistic infections. These are viruses that
your body naturally protects you against, but without a high enough T-cell count (at least 200 T-
cells per millimeter), the OI has no barrier against it. While you can be born with HIV, AIDS is
acquired through life experience and currently without a cure (AIDS.gov). HIV is more prevalent
in sub-Saharan Africa than anywhere else in the world; with an estimated more than 6 million
infected, almost 2.5% of the adult population live with this infection (Hunter). Of all HIV-
infected persons in the world, 69% live in sub-Saharan Africa. Of that 69%, 60% are sub-
Saharan women (World Health Organization). This uneven distribution can be viewed as results
of biological susceptibility as well as societal inequity.
HIV is essentially symptomless for any given amount of time; between two weeks and
three months after contracting the virus, an infected body will often experience Acute Retroviral
Syndrome. ARS, as it is called, is a painful flu with brutal side effects, but usually only lasts
between three and fourteen days. Regardless of whether or not the body experiences ARS, the
HIV virus is undetectable and inactive for often ten years or longer. It isn’t until the virus has
developed into final stages of HIV or initialized into AIDS that there are signs and indications of
the disease (Perlmutter, Glaser, Oyugi). HIV is contracted through sexual intercourse in most
cases, through semen and blood, which can intermix through cuts within the body. Due to female
anatomy, these cuts that would create vulnerability are inside the body and virtually

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unnoticeable. Rape is especially prevalent in the cities of sub-Saharan Africa, and these openings
can form during the violence of the attack (World Health Organization).
Female Genital Mutilation, or Female Circumcision, is a cultural tradition in most
African countries that eliminates sexual pleasure for women. Although it has been outlawed by
the United Nations, it is regularly practiced in most communities. Over one hundred forty million
girls and women worldwide experience FGM, one hundred and one million being African
natives. It is typically practiced between infancy and the age of fifteen, sometimes more than
once in the case of Type III FGM (World Health Organization). During the procedure, HIV
infection is a high risk. With the open cuts and possibility of non-sterilized tools young girls are
vulnerable to the virus as these procedures are rarely done by medical physicians (Holmes,
Essien and Monjok). This cultural practice targets young women unable to make informed
decisions about their health because of the young age that it is put into practice. Although it has
been banned in many countries and by the United Nations, it is still routinely practiced. Some
countries, such as Somalia and Dijibouti, have prevalence rates of 98% of all women (Holmes,
Essien and Monjok). The recognition of how this practice increases gender inequality and
degrades women has led to little statistical change, but has encouraged discussion and action
against it. There are now documentaries and organizations that spread awareness, and the oldest
campaign, Campaign Against Female Genital Mutilation, that was founded by African women
physicians in Nigeria still houses and cares for women who have undergone the procedure
(Equality Now). While it may not be much, it is a start. Although foreign powers have attempted
to limit the practice of FGM since the mid 1970’s, only a few years before HIV/AIDS was
acknowledged and named as an epidemic, it wasn’t until 2012 that the United Nations took an

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official and unanimous vote to eradicate the practice of Female Genital Mutilation as a violation
against women’s rights (Bonino).
Virginity testing is another cultural tradition involving the degradation of women. This
procedure is intended to determine whether or not a woman is a virgin and is primarily practiced
just before marriage (Grinker, Lubkemann, Burghard). Although it is outlawed in many
countries, like Female Genital Mutilation, it is still culturally accepted and routinely practiced as
a way to prevent the spread of HIV. The Zulu tribe of South Africa looks at Virginity Testing as
a solution to the widespread epidemic of HIV and teenage pregnancy. The mentality behind this
procedure being that if all women remain virgins until marriage, they cannot spread the virus you
contracted from other sexual encounters, and they cannot have illegitimate children, who could
then be born HIV positive themselves (Brulliard). If a girl is inspected and deemed not a virgin,
she is shunned by her family and her community. Men, on the other hand, have no expectations
to remain abstinent or to practice safe sex. As prevalent as this practice is throughout sub-
Saharan and South Africa, the shaming of women, who are subjected to humiliating
ramifications, is seen as a resolution to the epidemic of HIV. This shaming of women suggests
that women are the reason for this pandemic, rather than victims themselves.
Violence is another leading factor in the high prevalence of HIV in sub-Saharan Africa.
Due to the instability within the region- constant rebellions, revolutions, and police violence-
violence is more common and accepted as a part of life than in westernized countries. The
sentiments of rape are different than the mentality of other cultures towards rape. In a study
performed in Gauteng, South Africa, it was “found that more than a quarter of women (27%) and
nearly one third of men (31%) agree that forcing someone you know to have sex with you is
never seen as sexual violence” (1999-2000 Surveys on Sexual Violence 4). The further

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oppression of women through this understated idea of sexual assault allows more women to be
forced into sex, because, as this study shows, it is not considered “sexual violence.”
Within marriage, the rules and roles of women are distinct: women cannot demand
fidelity from their husbands, they cannot demand their husband use protection during sex, and
they cannot refuse sex to their husbands (Matlin and Spence). Men ultimately have the dominant
role in the marriage and it is common for men to even purchase their wives. Lobola, translated as
bride wealth, is the purchase of a wife, making her comparable to property or objects rather than
a partner (Mathabane). This solidifies that women have no rights in their marriage- no ability to
leave, defy or disagree- because your husband had purchased you, and refunds were not
acceptable in society. The relationship of a lobola marriage reaffirms each wife’s lack of control
over her marriage, her sex life or her HIV status.
Polygamy, the practice of having multiple spouses at the same time, is routinely accepted
in much of sub-Saharan Africa. This creates an open environment for HIV to transfer from one
spouse to another and so on. Polygamy is, in almost cases, one husband with multiple wives,
relaying the notion that wives are expendable but the husband is essential to a functioning
family. Non-HIV positive women can contract the virus from their unfaithful husband, and
quickly spread the disease to their children. Treatment for pregnant women in order to ensure a
healthy baby is becoming more and more available throughout Africa, although antiretroviral
medications are still withheld from the majority of the HIV-positive population within the region
(“Around 10 Million”).
In the event that a husband and/or father dies, whether it be due to AIDS or other
unrelated reasons, all women of the house are often subjected to the loss of their homes and their
economic status. In many cases, mothers and daughters alike turn to prostitution as a way to

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support their family. Rarely do they have an alternative option. Already limited by their gender,
women are typically expected to stay in the home and focus on child-care and housework.
Similarly, the few jobs that are available to them never pay as consistently as prostitution (Matlin
and Spence). Other women transition into prostitution as ordered by their husbands as ways to
increase their income (Sellix).
In many cultures within tribal sub-Saharan Africa, girls are married before or at the age
of puberty and are not educated to the extent that men are. In forty-four of the forty-seven
countries in Africa below the Sahara desert, “there are 139 million illiterates ages 15 years and
above” which amounts to 37.6 percent men and 62.4 percent women” (Report on the State of
Education in Africa 1995 74). There’s an undoubtedly high correlation between education levels
and the HIV-positive population of an area. Many girls marry by the ages of twelve, unable to
grasp the seriousness and risks of HIV and far too young to request the practice of protected sex
within the marriage. Because they are not educated to the extent necessary to understand how to
live on their own, they are entirely dependent on their husbands as the bread-winner and are
quickly given their own responsibilities as a mother and a home-maker. Girls who are sent to
school, even as little as primary school, face a real threat of assault by their teachers, or other
classmates or school officials (Sebunya). Girls are targeted through education and taught that
education is not necessary because their husbands will know and provide what is necessary,
creating complacent women without the ability to speak for herself or become independent from
her husband.
In the early times of the HIV/AIDS outbreak, there were few options in terms of
programs and outreach. Since the recognition of the seriousness of HIV, foreign governments
and many non-profits have launched educational and preventative programs help the situation.

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The United States’ President’s Emergency Plan for AIDS Relief, commonly referred to by its
acronym as PEPFAR, is a global attempt to prevent HIV and treat those who are positive that
was established in 2003 under George W. Bush’s presidency. Providing medications and
treatments for pregnant HIV-positive women. In 2005, President Bush launched an abstinence
only pledge as a new plan for PEPFAR. This plan, praising abstinence until marriage and fidelity
in a relationship, enraged women in all of sub-Saharan Africa spoke against it. Many women
contract their HIV-positive status from their philandering husbands, and this is where Bush’s
theory falls short. Proposing protected sex only for “’high-risk’ groups like prostitutes and truck
drivers” doesn’t protect the disempowered woman within her marriage. In Nairobi, Kenya, one
woman protested “We are expected to abstain when we are young girls and to be faithful when
we are married to men who rape us, who are not necessarily faithful to us, who batter us”
(Goldberg). While, yes, PEPFAR has saved over one million lives in the past ten years and
provided anti-retroviral medicines to prevent new HIV-positive children born into the disease, it
has socially condemned women to accept the HIV-status of their husbands who are not tied to
the same abstinence pledge that they are.
In the early years of the Human Immunodeficiency Virus, fear and ignorance of the virus
and its implications ran ramped and still do today. At first break, it was simply a plague that
targeted gays, prostitutes and drug abusers. It was not a medical illness but a “moral issue”
(Goldberg). Myths of ways to cure your HIV, such as the belief that raping a virgin will cure
your AIDS, led to attacks on children as young as infants. Child rape is a tragedy that occurs
across the world in all cultures, but infant rape is an entirely different crime on its own. Despite
its being an unfounded myth, it is still a recurring and believed in. In 2001 in Upington, South
Africa, a nine month old baby girl was raped by six men, at least one of which being HIV

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positive, shocking the world at the extent of sexual violence and abuse that South Africa had
reached as a country. While the men were tried, the theory was still not put to rest (Flanagan). In
differentiating the difference between child rape and infant rape, Dr. Graeme Pitcher and Dr.
Douglas Bowley note that "child rape of children from five years and over occurs all over the
world but the rape of infant girls occurs only here." Here, referring to South Africa, the country
with the highest annual rape count and the only country with infant rape in the world. According
to 2001 statistics, “between 1500 to 1700 new HIV/AIDS infections occur daily in South Africa,
or nearly one seventh of the 14000 new infections worldwide” (Earl-Taylor). This includes those
who are infected at birth, from their spouses, through unprotected casual sex, and those
victimized by the “Virgin Cure.” This myth of the Virgin Cure has been used over and over
again in cases of new Sexually Transmitted Diseases: the first cases of syphilis, gonorrhea, and
others created a frenzy of rapes and attacks on infants, children, and barely pubescent girls who
were expected to be virgins. It was founded on the concept that “an intact hymen and smaller
amounts of vaginal secretions in young girls prevents transmission of the disease through sexual
intercourse” and is first dated to the sixteenth century Europe (Earl-Taylor, Hu). Other myths
included treatments and remedies that gave a false hope to HIV-positive people, and while they
did not seek medical treatment because of this false idea that they were being cured, they grow
increasingly worse until they inevitably succumb to the diseases cause from AIDS. In Gambia in
2007, President Yahya Jammeh proclaimed his medicinal concoction consisting of seven natural
herbs would undoubtedly cure HIV. Even though he does not have a medical degree and
Gambian health officials openly stated that this false hope will condemn many to an early death
(Koinange).

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In the traditional cultures of sub-Saharan Africa, societal standards and expectations are
placed at a high priority. Culturally, it is unacceptable and embarrassing for a woman to be single
or for a couple to be without children by a certain age. For the sub-Saharan region, it is typical
for girls to be married prior to hitting their first signs of puberty (“Child Marriage Fact Sheet”).
Past puberty, working and schooling are second thoughts to their priority of finding a husband
and starting a family. While girls are expected to refrain from premarital sex, men, or suitors,
still often demand sex. In their quest to find a husband, it is not uncommon for women to seduce
their men to persuade them into marriage. However, in doing so, some may have multiple
partners, both long and short term, which broadens their possibility of contracting the virus
astronomically. Later, either out of fear or ignorance of the repercussions of disclosing their HIV
status, may not tell their past partners until too late (“UN Joint Programme”).
It is also expected of women to quickly and fruitfully bear many children and start a large
family. This requires both unprotected sex and the possibility of multiple partners if their
husband is unable to have children. In the situation where a husband may be infertile and unable
to impregnate his wife, he would be considered unmanly and inferior. As a diligent and fearing
wife, seeking a baby elsewhere is a valid conclusion to the frightening possibility of telling your
husband that he is HIV positive. If women continue to not bear their child, they will be labeled
by their husband and their community as inferior. In response, men will seek fruitful women that
are not their infertile wives. This creates a possible scenario where women may contract the virus
through their husbands in retaliation to their inability to have his children (“UN Joint
Programme”).
The progression of gender equality, while slow, is apparent and on the rise. The
recognition of HIV/AIDS has both positive and negative effects on women’s fight for freedom:

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while women are, in fact, blamed in many cases for contracting the virus, this truth is at least
recognized and fought against by people of the community, women’s rights activist groups and
(mostly foreign) governments interested in helping spark the movement to gender equality. In
recent times, first steps towards equality have begun: South African women are now allowed to
vote, can have legal abortions and can run for government positions as highly ranking as
Parliament (Mutame). The vicious cycle of shaming women for their HIV status which in turn
lowers their place in society, thus targeting women and young girls for HIV continues each day,
and their undeniable interaction calls for change- from their own governments, from foreign
governments and from non-government organizations who fight for their rights.

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