Project Description

This edition of the ALQ focuses on core beliefs and underlying factors fuelling the HIV pandemic. The various articles in this issue examine a broad range of realties as to the extent to which various core beliefs and/or underlying factors not only fuel the HIV and AIDS pandemics, but also impact on the effectiveness of HIV prevention, treatment, care and support initiatives and programmes. The impact of various gendered realities on the pandemic, the link between sexual violence and HIV, the pandemic in the context of violence, the involvement of men in responses to HIV, the ‘region specific’ underlying factors of the pandemic, perceptions of gender and gender violence amongst adolescent boys, as well as the right to be different, the right to make reproductive choices and the ‘excuses’ for the violation of rights are some of the issues explored in this edition.

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Gendered realities…
The underlying factor?1
In South Africa, legislative and policy measures aiming to protect fundamental rights and
freedoms are in place and yet, reality remains to be marked by prevailing gendered
inequalities and imbalances, by seemingly ever-increasing levels of poverty and
unemployment, by an alarming increase in the number of people living with, and affected by,
HIV and AIDS, as well as high incidences of sexual violence and abuse – and disproportionately
impacted and affected by these realities are women and girl children.
Reality also remains to be marked by persistent
stigmatisation, discrimination and violation of
people based on their sex, gender, sexuality
and/or HIV status. Education and awareness
programmes are in place and yet, the general
lack of knowledge about human rights, as well
as HIV and AIDS prevails, the number of new
infections and the HIV prevalence rates are
rising annually, indicating, amongst other
things, great disparities between the sexes,
between provinces and between the poor and
affluent members and sectors of society.
THE LEGISLATIVE
FRAMEWORK
While the Constitution2 of South Africa
guarantees everyone the right to equality and
non-discrimination (Section 9), the right to
have one’s dignity protected and respected
(Section 10), the right to life (Section 11), the
right to bodily integrity and to be free from all
forms of violence and abuse (Section 12), the
right to privacy (Section 14), and the right to
have access to healthcare and social security
(Section 27), people continue to encounter
numerous obstacles and discrimination based
on their sex, gender, sexuality and/or HIV
status in claiming their fundamental human
rights and freedoms.
Giving effect to the constitutional
provisions, legislative and policy measures
provide similarly for equality and nondiscrimination.
Yet, it is the inadequate
application and implementation of these
measures, as well as a general lack of
knowledge, that limits the extent to which they
can be accessed, and thus provide protection. In
addition, it is the persistence of discriminatory
attitudes, beliefs and practices in all spheres of
society, including amongst service providers,
which often deny people living with, and
affected by, HIV and AIDS, the access and
thus, benefit from these protective measures.
And finally, it seems to be the gendered context
of society and the persistent male dominance in
all spheres of society that further defines why
women and girl children are not only most
vulnerable and at risk of HIV, but also why
women and girl children are the ones
disproportionately affected and impacted by
prevailing inequalities and injustices.
As a result, the reality is characterised by
continuing stigma, discrimination and violation
of rights based on one’s sex, gender, sexuality
and/or HIV status. On a daily basis, incidences
of HIV testing without consent, disclosing
Johanna Kehler
aLQ – June 2006 1
A Publication of the AIDS Legal Network June 2006
Suite 6F, Waverley Business
Park, Mowbray, 7700
PO Box 13834, Mowbray 7705,
Cape Town, South Africa
Tel: +27 21 447-8435
Fax: +27 21 447-9946
E-mail: alncpt@aln.org.za
Website: www.aln.org.za
In this issue: 1 Gendered realities… The underlying factor?
2 Editorial 7 The right to be different… 10 Sexual Violence and HIV:
Can we ignore the links? 15 ‘Dethroned men’… an underlying
factor fuelling the pandemic? 19 We’re not supposed to know about
these things… A call to embed sex education within a human rights
framework 23 Women’s reproductive rights in the context of HIV
and AIDS: Experiences from Botswana 29 What really drives HIV and
AIDS in Southern Africa 33 HIV and AIDS, gender and power
relations: A context of violence 38 Excuses, Excuses, Excuses… A
facilitator’s reflection on discrimination 41 Provincial view
44 Regional view 50 Comment 55 Feedback
aLQ – June 2006 2 Editorial
I
Bringing AIDS under control will require tackling with
greater resolve the underlying factors that fuel these
epidemics – including social inequalities and injustices
… these are extraordinary challenges that demand
extraordinary responses. [UNAIDS, 2005]
It is these very same ‘underlying factors’ that seem to
be the persistent challenge to the effectiveness of current
responses to HIV and AIDS realities. Despite the
enormous efforts, resources and time spent in addressing
the pandemic and its underlying factors, gendered
inequalities and injustices, gender violence, and social,
cultural and religious belief, value and norm systems,
justifying the ‘status quo’, prevail – persistently fuelling
the pandemic.
It is within the context of ‘tackling’ these factors that
this edition of the ALQ focuses on core beliefs and
underlying factors fuelling the HIV pandemic. The various
articles in this issue examine a broad range of realities as
to the extent to which various core beliefs and/or
underlying factors not only fuel the HIV and AIDS
pandemics, but also impact on the effectiveness of HIV
prevention, treatment, care and support initiatives and
programmes. The impact of various gendered realities on
the pandemic, the link between sexual violence and HIV,
the pandemic in the context of violence, the involvement
of men in responses to HIV, the ‘region specific’
underlying factors of the pandemic, perceptions of gender
and gender violence amongst adolescent boys, as well as
the right to be different, the right to make reproductive
choices and the ‘excuses’ for the violation of rights are
some of the issues explored in this edition. The integral
features of the ALQ introduce experiences with core
beliefs from an NGO in Mpumalanga, and experiences
from a VCT study site in rural Tanzania. This issue is also
‘making a point’ about workplace approaches to HIV and
AIDS.
In this edition, Johanna Kehler examines various
gendered realities as to their impact on the HIV and AIDS
pandemics. Analysing the inherent barriers of the
gendered societal context to the effectiveness of current
approaches to HIV and AIDS, she argues that as long as
gendered inequalities, imbalances and injustices are not
addressed and challenged as ‘the’ underlying factor,
efforts will remain to have little impact and gendered
realities will continue to fuel the pandemic.
The meaning and implications of the ‘right to be
different’ as provided for in the Constitution is explored
by Pierre de Vos. Discussing various constitutional
provisions and their interpretation by the Constitutional
Court, he argues that any views, culture and beliefs used
to justify the marginalisation or exclusion of anyone from
the benefits of social acceptance, is against the
constitutional imperative to respect difference and not to
reject it.
Recognising the link between sexual violence and HIV,
Meaka Biggs raises the question as to whether or not the
relationship between the two is adequately understood
and addressed. She examines the various realities,
underlying factors and correlations of the two pandemics
and argues that only as and when the underlying factors
of women’s lack of reproductive and sexual autonomy and
choice, as well as the gendered nature of power and
control in society are taken into account, can prevention
strategies and awareness campaigns be effective.
The concept of ‘dethroned men’ is introduced by
Dumisane Remombo. Acknowledging unequal gender
relations as the most serious underlying factor that fuels
the HIV pandemic, he explores the impact of the ‘new
social order’ on men and argues that the success of
responses to the pandemic will remain limited, since
current HIV strategies and approaches fail to involve men
as solution seekers and partners.
Findings of a study exploring the perceptions of
adolescent boys pertaining to gender, sex and violence
are introduced by Rachel Elfenbein. Based on research
data indicating a lack of a critical engagement with issues
of gender, sex and violence in the boys’ lives, she argues
that this very same environmental context could
contribute to the perpetuation of gender violence and the
spread of HIV, if not addressed by means of human
rights-based sex education for children and youth.
Katharina Tangri examines the extent to which
women living with HIV and AIDS are in the position to
make reproductive choices. Analysing various underlying
factors of the pandemics in Botswana, such as gender
inequalities, violence and abuse, as well as stigma and
discrimination, she argues that it is imperative to make
informed reproductive choices, if the fundamental right to
found a family is to become a reality for every woman,
irrespective of her HIV status.
Recognising the seemingly relentless spread of the
HIV pandemic in Southern Africa and the disproportionate
impact on women and girl children, Suzanne Leclerc-
Madlala raises the question as to the ‘real’ underlying
factors for the pandemic in the region. She examines the
impact of various ‘region-specific’ underlying factors and
argues that reducing multiple concurrent sexual
relationships, introducing male circumcision, and
addressing gender inequalities, especially from the
perspective of male involvement and responsibility for HIV
prevention, are some of the interventions carrying hope
for effective and relevant responses to HIV in the region.
Focussing on the context of violence,
Editorial
continued on page 4
S
someone’s HIV status unlawfully, discrimination and dismissals at the
workplace, refusing medical treatment, expelling learners from school
based on their, or their parent’s, actual and/or perceived HIV status,
refusing access to medical schemes, refusing access to credit facilities are
reported – and this list seems to be endless, despite constitutional and
legislative provisions based on principles of equality, non-discrimination
and human dignity.
GENDERED REALITIES
In addition, HIV and AIDS realities seem to be increasingly
characterised by the feminisation of HIV and AIDS in that women and
girl children remain to be at greater risk of HIV infections and are more
affected by HIV and AIDS realities and challenges. It is the gendered
context of society, defining females largely as ‘inferior’, as the ‘weaker
sex’, as the ones who are socialised to become ‘good women’ and who
should respect the male ‘head of the household’ at all times that creates
an environment in which women are not in the position to make choices,
let alone informed choices. Hence, women will remain to be more
vulnerable to HIV infection.
Statistics indicating that 60% to 80% of all women infected had only
one sex partner in their life and 80% of all new HIV infection in women
occur in marriages and/or long-term relationships3 are but two of the
indicators that female socialisation seems to perpetuate women’s
vulnerability. Furthermore, statistics4 indicating that abstinence until
marriage and faithfulness are not necessarily sufficient in preventing
especially women’s HIV infection, also seems to question the efficacy
of the ABC prevention message. Since this approach to HIV
prevention is based within the gendered societal context defining that
women and girl children are seldom in the position to make choices,
including sexual choices, the ABC prevention message, arguably, fails
to ‘protect’ the most vulnerable to HIV infection; fails to ‘provide’ an
environment in which equal decision making about, and participation
in, prevention can take place; fails to emphasise the need for everyone
to make informed choices; and thus, perpetuates the status quo of who
is at greater risk of infection. This seems to indicate that as long as HIV
prevention strategies fail to take into account the unequal gendered
societal context in which prevention occurs, women will remain to be
largely excluded from accessing, controlling and/or benefiting from
HIV prevention efforts.5
The gendered context of society also defines sex and sexuality for
women largely as a means to reproduce, and women as the ones, who are
the ‘passive recipients’ of sexual choices and decisions of their male
counterparts. Subsequently, women are seldom in the position to
negotiate conditions of sex, even less so, safer sex, and thus, are seldom
in the position to prevent HIV infections.6
High incidences of violence and abuse, including sexual violence,
further impact on the extent to which
especially women are in the position to make
sexual choices and to reduce the risk of HIV
infection. While violence and abuse, or the
threat thereof, limit the ability to negotiate
conditions of sex and thus, increase the risk of
HIV infection, sexual violence and/or
coercive sex exacerbates this risk as a direct
consequence of physical trauma, injuries and
bleeding. Violence and abuse impact not only
on women and girl children’s vulnerability to
HIV infection, but also the extent to which
women who are living with HIV are in the
position to access treatment, care and
support, as well as to claim their rights. Often,
women’s choices to access treatment, care and
support and/or to disclose their HIV status to
their partners and families are limited due to
fear of rejection and blame, as well as due to
fear of subsequent violence and destitution7.
It is within this context that violence and
abuse is as much a cause for women’s
increased vulnerability to HIV infection, as it
is a consequence.
The above seems to highlight the
gendered context of society as one of shared
determinants between gender violence and
HIV and AIDS. If the nature and extent of
gender violence, including sexual violence, is
a reflection of existing social, cultural and
economic inequalities and injustices between
the sexes, then, as could be argued, the
gendered context of society determines the
extent to which women are ‘prone’ to not only
be violated and, thus, more vulnerable to HIV
infection, but also to be violated based on,
and in the context of, HIV and AIDS.
The very same gendered context of
society defines females primarily by their
caretaking and reproductive responsibilities.
Thus, women and girl children are the ones
who carry the brunt of the burden of not only
taking care of the sick and dying in their
families and households, but also in their
communities. This is further strengthened by
the fact that care and support programmes
and interventions, such as home-based
care, thrive on the very same caretaking
responsibilities of females. In addition, taking
care of the sick and dying limits the extent to
which women are in the position to generate an
income and to participate in paid employment.8
Statistics are one of the indicators reflecting
the impact of the gendered context of society
on local, regional and global HIV and AIDS
realities. According to statistics9, the majority
of the estimated 6 million people living with
HIV and AIDS in South Africa are female.
aLQ – March 2006 3
Gendered realities…
The underlying factor?
…statistics indicating that 60% to
80% of all women infected had
only one sex partner in their life
and 80% of all new HIV infection
in women occur in marriages
and/or long-term relationships…
Rakgadi Mohlahlane looks at various factors fuelling the
HIV and AIDS pandemic. Analysing various forms of
violence, including structural violence, she argues that as
long as strategies and approaches to violence and to HIV
and AIDS perpetuate, rather than address, the polarised
environment of ‘men as perpetrators’ and ‘women as
helpless victims’, responses to either pandemic will
remain limited.
Recognising the gap between rights and realities,
Emma Harvey reflects on discrimination and the
various ‘excuses’ for its occurrence. Exploring factors,
such as culture, religion, upbringing and ‘human
nature’ as the common reasons for discrimination, she
argues that these very same reasons become ‘excuses’
to justify the continued occurrence of discrimination of
the ‘other’, despite the fundamental right not to be
discriminated against.
Experiences from Nelspruit, Mpumalanga, in responding
to the concurrent pandemics of sexual violence and HIV
and AIDS are introduced by Barbara Kenyon. She
discusses some of the sexual assault realities, including
the impact of the ‘virgin myth’ and approaches to
prevention, and argues that current prevention strategies
fail to de-mystify and/or respond to prevailing myths and
beliefs fuelling the pandemics.
Project Afiki, a behavioural/social science intervention
on HIV incidence is introduced by Laurie Abler, Gad
Kilonzo and Jessie Mbwambo. The article highlights
realities and challenges of community-based VCT
research in rural Tanzania, and discusses some of the
experiences and initial findings in affecting motivations
and barriers to test from the study site in Kisarawe,
Tanzania.
Looking at workplace approaches to HIV and AIDS,
Shawn Hattingh is ‘making a point’ about the extent to
which current HIV workplace policies and programmes
are in the position to enable the constitutionally
guaranteed right to fair labour practices. He examines the
impact of various HIV workplace policies and programmes
and argues that current responses to HIV in the workplace
will remain to have limited impact, since they fail to
address stigma and discrimination in all its forms, and to
take into account workers’ human rights in the
development and implementation of HIV workplace
policies and programmes.
Identifying and examining the various underlying
factors fuelling the HIV pandemic, seem to highlight the
real challenge – how to ‘tackle’ the core beliefs
apparently ‘justifying’ the persistence of the underlying
factors. Irrespective of the particular identified ‘factor’, the
recurring challenge seems to be ‘gender’, which is
perpetuating inequalities, injustices, violence in all its
forms, and the marginalisation and exclusion of the ‘less
powerful’ – often reasoned, explained and ‘justified’ by
core beliefs. However, despite its recognition, it appears
that ‘gender’ is continuously the ‘factor’ least considered
and, thus, HIV approaches and strategies remain
largely ineffective.
If we are to agree that ‘gender’ is the core belief that
needs to be addressed and challenged, then we need to
agree that this is indeed an ‘extraordinary challenge’,
since it questions the very same foundation of society, the
very same foundation of who we are to be as people and
how we are to interact with one another, of what we belief
to be ‘appropriate’ behaviour and/or treatment of people.
It is also the very same foundation that, with
persistence, describes who is the ‘victim’ and who is
the ‘perpetrator’, as it, with the same amount of
persistence, resists to change, especially to the much
required ‘behavioural change’.
However, if we are to ‘tackle with greater resolve the
underlying factors’ fuelling pandemics in the context of
‘gender’, then one of the ‘extraordinary responses’ may
have to include the acknowledgement that in the context
of current pandemics, people are equally ‘at risk’ to be
‘helpless victims’, ‘perpetrators’, ‘solution seekers’
and/or ‘agents of change’. Similarly, it might need
acknowledging that people are equally as ‘prone’ to be
violated, marginalised, excluded and discriminated
against, as they are ‘prone’ to violate, marginalise,
exclude and discriminate against the ‘other’. Thus, the
‘extraordinary response’ required seems to be
‘engendering’ society, its various realities, and the various
responses, strategies and approaches to society’s
’extraordinary challenges’.
So, if, the ‘response’ is to create an enabling
environment for ‘bringing AIDS under control’, then the
environment needs to be ‘engendered’ so as to be
‘enabling’ for people to be ‘in control’ of the pandemic. If
we fail to create such an environment, the underlying
factors will remain unchallenged; the gendered nature of
society will continue to determine the gendered nature of
any pandemic; and the access to, and realisation of,
fundamental rights and freedoms will remain gendered
and so ‘justify’ the marginalisation and exclusion of the
‘other’ who is ‘less powerful’. Thus, the extent to which
people are in the position to claim and enjoy human rights,
and to ‘take control’, will continue to be determined by
their ‘gender’, rather than their ‘humanness’.
Subsequently, the persistent failure and/or resistance to
‘engender’ society will manifest itself in ‘lack of ability’ to
develop and implement effective responses to the
‘extraordinary challenges’ of the HIV and AIDS
pandemics. And so, ‘gender’, if not ‘tackled with great
resolve’, will remain to be the ‘status quo’…
JOHANNA KEHLER
4 aLQ – June 2006 Editorial
continued from page 2
AWhile the estimated adult prevalence rate in South Africa is 25%, the
prevalence rate amongst women attending antenatal clinics is 29.5%. In
addition, it is females, aged 15 to 24, who are three times more at risk of
HIV infection, than their male counterparts. A further gendered and
regional view at statistics reveal that in Sub-Saharan Africa, 75% of all
people living with HIV are female; that of all women living with HIV
worldwide, 75% are African; that more than 75% of all young people
(aged 15 to 24) living with HIV are female; and that of all the ones caring
for people living with HIV and AIDS, 75% are women and girl children.10
It is argued, that societal, cultural and religious practices, attitudes and
beliefs enforcing ‘gender appropriate’ behaviour, and the continuous
stigmatisation, marginalisation and discrimination against the one who is
perceived not to conform are but another determinant perpetuating the
gendered nature of the pandemic and its underlying factors.
POVERTY AND HIV: THE GENDERED LINK
It is within the context of underlying factors fuelling pandemics that
the link between the feminisation of poverty and the feminisation of HIV
and AIDS realities has to be recognised, in that HIV and AIDS contributes
to increasing levels of poverty, while simultaneously the increasing levels
of poverty reduce the ability to cope and manage the disease. According
to statistics11, 48.5% (21.9 million) of South Africans live in absolute
poverty12, the majority of whom are women (54.4%). And while females
are expected to take care, females are the ones least provided with the
necessary resources and support to provide the much needed care.
While many households experience loss of income as a result of HIV,
there is no social security provision in place. Even though, there is the
provision to access a Disability Grant, it is the inadequate application of
this grant, as well as its eligibility criteria, which create a situation in
which the potential of the grant to improve the well-being and quality of
life of people living with HIV and AIDS is rather limited, if not lost.13 In
addition, increasing levels of poverty are related to the fact that larger
proportions of the household income are spent on healthcare and
treatment, as well as funeral costs.14
It is further argued, that while HIV and AIDS exacerbates especially
women’s economic and social insecurity, it is the very same economic and
social insecurity of women that increases their vulnerability to HIV
infection.15 Not only are women mostly affected by prevailing
socio-economic inequalities and imbalances, but these very same
imbalances also place women at greater risk of exposure to HIV.
Engaging in transactional sex and the perceived inability to leave abusive
relationships, due to economic dependency, are but two of the indicators
illustrating women’s greater vulnerability to contracting HIV based on
prevailing gendered socio-economic inequalities and imbalances.16
In addition, it is women and girl children who are not only carrying
the increased burden of care, but also the ones who are increasingly taken
out of education and spheres of paid employment, so as to care for the
sick and dying family, household and community members.17
Acknowledging the correlation between the feminisation of
poverty and the feminisation of the HIV and AIDS pandemics is but
one of the examples that clearly highlight the common underlying
factors of persistent structural and systemic gendered inequalities and
injustices that determine, amongst other things, female’s greater
vulnerability to poverty and to HIV infections. It is female’s
continuous lack of access to, control over, and benefit from available
resources and opportunities that underpins both, the feminisation of
poverty and the feminisation of HIV.
CHALLENGES
It has to be acknowledged that a large
amount of time, resources and effort has been
dedicated to issues of the HIV and AIDS
pandemics in an attempt to address various
factors underlying HIV and AIDS realities,
including the gendered nature of the pandemics.
However, it is the efficacy of these efforts that
seems to be limited in accordance with not only
the prevailing gendered belief, value and norm
systems, but also with persistent discriminatory
attitudes, beliefs and practices, as well as the
seemingly resistance to change behavioural
patterns and attitudes. As a result, the gendered
societal context, as one of the underlying
factors fuelling the HIV and AIDS pandemics,
will ‘ensure’ that females continue to be
disproportionately infected and affected.
As long as HIV prevention efforts, such as
the ABC approach, fail to take into account
existing societal gendered inequalities,
imbalances and injustices, impacting not only
on behaviour, but also on choices, HIV
prevention efforts will continue to have little
impact – since it is the very same gendered
realities that define women’s greater
vulnerability to HIV and the extent of women’s
choices in negotiating sex. For HIV prevention
efforts to carry the potential of reducing the risk
of HIV infection, they need to take into account
the reality in which prevention is to be applied
and implemented; the reality in which existing
inequalities and imbalances limit prevention
choices and decisions accordingly. Only as and
when HIV prevention is available and
accessible to everyone, can preventative
choices be made and the risk of HIV infection
be reduced. Subsequently, challenging the
aLQ – June 2006 5
Gendered realities…
The underlying factor?
…it is women and girl
children who are …
carrying the
increased burden of
care… who are
increasingly taken
out of education and
spheres of paid
employment, so as to
care for the sick…
S
factors, fuelling the pandemic, need to be addressed.19 This, arguably,
includes challenging and transforming the existing inequalities and
injustices, as it includes challenging and transforming the newly created
inequalities and injustices based on, and in the context of, HIV and
AIDS. It also requires acknowledging that the violation of one’s
fundamental human rights and freedoms is as much a cause of the
pandemic as it is a consequence. Hence, the efficacy of responses to
HIV and AIDS realities and challenges will remain limited, as long as
the violation of fundamental rights and freedoms as the underlying
factor fuelling the pandemic, as well as the violation of fundamental
rights and freedoms based on, and in the context of, HIV and AIDS are
not addressed, challenged and transformed.
In summary, if we are to address the gendered realities as the
underlying factor fuelling the HIV and AIDS pandemics, it is the very
same societal core beliefs and gendered prescription of behaviour,
limiting not only individual choices, but also the access to, and realisation
of, fundamental rights and freedoms accordingly, that need to be
challenged and transformed into concepts based on the right to equality,
non-discrimination and human dignity guaranteed to everyone,
irrespective of one’s sex, gender, sexuality and/or HIV status. If we fail to
challenge, and/or resist to challenge, the gendered inequalities,
imbalances and injustices, then the main underlying factor fuelling the
pandemic will remain unchallenged and, thus, ‘reality’ will continue to
‘fuel’ the pandemic, despite numerous efforts of HIV prevention,
treatment, care and support.
This means that as long as the gendered nature of society and its lived
realities are not taken into account, attempts to ‘equalise’ society and to
address ‘pandemics’ and their underlying factors, will continue to have
little or no impact. Hence, the disproportionate impact of ‘pandemics’,
such as HIV and AIDS, gender violence and poverty, on people with
limited access to available resources, opportunities and information, as
well as limited ‘ability’ to make choices will continue. And so, if not
adequately addressed, the ‘feminisation of pandemics’ will continue.
FOOTNOTES:
1. An earlier version of this paper was presented at the ‘HIV/AIDS and the struggle for democracy and rights
– implications for civil society’ Conference of the Olof Palme International Centre on 16 – 17 January 2006 in
Johannesburg.
2. The Constitution of South Africa, Act 108 of 1996.
3. The State of the World Population Report 2005, Chapter Four.
4. The State of the World Population Report 2005. UNAIDS. AIDS Epidemic Update: December 2005.
5. See also Elfenbein, R. 2005. ‘ABC: A gendered look at HIV prevention’. In ALQ, November 2005 Edition,
pp10-13.
6. See also Harvey, E. & Kehler, J. 2005. ‘Sex and sexuality in the context of HIV and AIDS’. In ALQ,
November 2005 Edition, pp1-6.
7. Fox, S. 2003. Gender-based violence and HIV/AIDS in South Africa: Organizational response.
Johannesburg: CADRE.
8. See also Harvey, E. 2006. ‘Home-Based Care: Realities and challenges’. In ALQ, March 2006 Edition, pp31-32.
9. UNAIDS. 2005. AIDS Epidemic Update: December 2005; Department of Health. 2005.
10. UNAIDS. 2005. AIDS Epidemic Update: December 2005; and also The State of the World Population 2005.
11. UNDP. 2003. South Africa Human Development Report 2003.
12. Absolute poverty refers to living below the national poverty line, which is calculated to be R354 per month
per adult.
13. See also Clark, S. 2006. ‘ARVs versus Social Grants: The dilemma of the poor’. In ALQ, March 2006
Edition, pp28-30.
14. UNDP. 2003. South Africa Human Development Report 2003.
15. Kistner, U. 2003. Gender-based violence and HIV/AIDS in South Africa. Johannesburg: CADRE, pp18-19.
16. UNAIDS. 2004. Women and AIDS.
17. Kistner, 2003:18-19.
18. The State of the World Population 2005:21.
19. UNAIDS. AIDS Epidemic Update: December 2005, p7.
gendered context of society, including the
gendered access to, control over, and benefit
from available resources, opportunities and
information has to become an integral part of
HIV prevention efforts, so as to have the
potential to address the underlying factors of
the HIV and AIDS realities.
Similarly, as long as HIV support, care and
treatment programmes and interventions not
only fail to acknowledge that it is the very same
gendered context of society that facilitates the
implementation of these programmes, but also
fail to provide adequate resources and
infrastructure for the programme
implementation, the effectiveness of these
efforts will remain limited. In addition, it is
argued that current HIV care, support and
treatment strategies will not carry the potential
to address underlying factors of the gendered
realities, as long as the gendered realities form
the very basis of these strategies.
Acknowledging the gendered realities in
which responses to HIV and AIDS are
developed and implemented, leads, as is argued,
to the recognition that it is of utmost
importance to not only address the underlying
factors of the HIV and AIDS realities, but also
to identify mechanisms and build capacity, so
as to facilitate a holistic, integrative and human
rights-based response to HIV and AIDS. Thus,
an adequate human rights response to HIV and
AIDS realities needs to encompass as much
transfer of knowledge about fundamental rights
and freedoms, including the skills and
resources to claim them18, as the challenge and
transformation of the underlying value and
belief systems that seemingly justify
prevailing discrimination, stigmatisation and
marginalisation.
Similarly, if we are to acknowledge that the
seemingly not only persistent, but societally
sanctioned, widespread gendered inequalities
are the underlying factor exacerbating women’s
and girl children’s greater vulnerability, then
the very same gendered inequalities and
imbalances need to be addressed, challenged
and transformed.
In other words, in order to address and
respond to HIV and AIDS realities from a
human rights perspective, the underlying
6 aLQ – June 2006 Gendered realities…
The underlying factor?
Johanna Kehler is the National Director of the AIDS Legal
Network (ALN). For more information and/or comments, please
contact her on +27 21 447 8435 or at johanna@aln.org.za.
…‘reality’ will
continue to ‘fuel’ the
pandemic, despite
numerous efforts of
HIV prevention…
WIn between the hundreds of thousands of agitated submissions
supporting the reintroduction of the death penalty and the scrapping of
‘rights for criminals’, there were many thoughtful and heartfelt
contributions from groups who saw themselves as marginalised, vilified
or forgotten. Members of religious and cultural minorities pleaded for
tolerance and acceptance. Gay men and lesbians demanded the right
not to be discriminated against. Abused women pleaded for protection
from violent men and the patriarchal system that protects the abuser.
Many members of traditional African communities wrote to tell about
the hardship and indignity visited upon them, because of the lack of
respect shown to them, and their culture, during the apartheid era.
The drafters of the Constitution had to come to grips with these
concerns in ways that demonstrated the importance of public
opinion in the Constitution-making process. But they had to balance
this against the duty to create a Bill of Rights that embodied the
founding values of the new Constitution, the values of human
dignity, equality and freedom. Given the apartheid past, it must
come as no surprise that they decided that equality concerns had to
be paramount in any discussion of the rights to be included in the
Bill of Rights. That is why the Constitutional Assembly decided to
include as the first substantial right in the Bill of Rights, the right
that guarantees equality for all and prohibits unfair discrimination
against anyone on any ground including race, sex, gender, sexual
orientation, religion, culture and language.1
However, mindful of the need to respect the diversity of views,
practices and beliefs in South Africa, the Constitutional Assembly
agreed to include a slew of other rights in the Bill of Rights that
would emphasise that the new South Africa would be tolerant of
diversity and celebrate the uniqueness of every individual. These
rights would point towards a society that rejected the dull uniformity
that is the aim of fascism or the oppressive normality associated
with market liberalism.
The Bill of Rights, therefore, also contains provisions that
guarantee freedom of religion, conscience, belief and opinion2 and
the right of people to enjoy their culture and practise their religion,
as long as this does not contravene any of
the other rights in the Bill of Rights.3
At first glance this solution seems rather
elegant and politically astute, because it
signals that the Bill of Rights will protect
the most marginalised, oppressed or vilified
individual against discrimination and
marginalisation – even from the views and
prejudices of the overwhelming majority –
while also celebrating and protecting the
rights of the majority, or the rights of other
dominant groups, to celebrate their cultural,
social or religious distinctiveness as
a group.
But this matter is rather more complex
and politically difficult than the members of
the Constitutional Assembly might have
realised or might have wanted to admit. It
was not too long after the adoption of the
Constitution that the Constitutional Court
was confronted with the first major difficulty
in interpreting all these rights in a harmonious
and logical way. The Constitutional Court
had to decide whether or not the long
standing beliefs or practices of the
overwhelming majority of members of
the community, which had the effect of
discriminating against particularly
marginalised and vulnerable groups, were
nevertheless acceptable, because they
represented the dominant or majority view.
In the case of National Coalition for Gay
and Lesbian Equality v Minister of Justice4
the Court decided that the criminal
prohibition against same-sex sodomy was
unconstitutional, because it discriminated
aLQ – June 2006 7
The right to be different…
The right to be different…
When the members of the Constitutional Assembly sat down to draft the South
African Constitution just more than ten years ago, they had much on their minds.
Every day, thousands of letters, postcards and odd pieces of paper arrived at the
Constitutional Assembly with requests from ordinary South Africans about what
to include and what to exclude from the brand new Constitution.
Pierre de Vos
against gay men and lesbians on the ground
of sexual orientation. Despite the sincerely
held beliefs of especially religious groups,
who believe homosexuality is an abomination
in the eyes of God, the Court found that the
Constitution calls everyone to respect the
human dignity of others and this requires
tolerance beyond one’s own world views and
beliefs. Although, the Constitution protects
the rights of other groups to practice and
celebrate their religion, beliefs or culture,
they have to do so within the confines of the
Constitution, which requires respect for
difference. As Justice Sachs stated:
Equality means equal concern and
respect across difference. It does not
presuppose the elimination or
suppression of difference. Respect for
human rights requires the affirmation of
self not the denial of self. Equality
therefore does not imply a levelling or
homogenisation of behaviour but an
acknowledgment and acceptance of
difference. At the very least, it affirms
that difference should not be the basis
for exclusion, marginalisation, stigma
and punishment. At best, it celebrates
the vitality that difference brings to
any society.5
Although, many South Africans may
have strong objections against same-sex
8 aLQ – June 2006
T …no one group should
be able to invoke their
own views, culture or
beliefs to justify the
marginalisation or
exclusion of any other
group … The most
radical aspect of this
view is, of course,
that it applies to
everyone…
The right to be different…
relationships and sexual activity, the Constitution demands from
everyone to accept the right of an individual to form such relationships
or engage in such sexual activity. As Justice Sachs astutely
remarked, this respect for difference was particularly important in
South Africa where group membership (based on race) has been the
basis of expressed advantage and disadvantage in the past. As far as
homosexuality was concerned, this meant that the very concept of
sexual deviance had to be reviewed. According to Justice Sachs, the
problem is that in South Africa a heterosexual norm was established
and gay men and lesbians were labelled deviant from the norm ‘and
difference was located in them’. What the Constitution requires at
the very least, is for us to recognise that what is statistically normal,
ceases to be the basis for establishing what is legally normative.
More broadly speaking, the scope of what is constitutionally normal is
expanded to include the widest range of perspectives and to
acknowledge, accommodate and accept the largest spread of difference.
What becomes normal in an open society, then, is not an imposed
and standardised form of behaviour that refuses to acknowledge
difference, but the acceptance of the principle of difference itself,
which accepts the variability of human behaviour.6
The Constitutional Court’s view – which is also applicable in
relation to other ‘unpopular’ or marginalised groups, such as
Rastafarians or the homeless – emphasises the important principle
that no one group should be able to invoke their own views, culture
or beliefs to justify the marginalisation or exclusion of any other
group from the benefits of social acceptance, no matter how strange
their beliefs or way of life might appear to people, who see
themselves as part of the dominant belief system. According to the
Court, we must all respect each other and respect and celebrate the
differences between us, despite the fact that our beliefs, practices
and world views might call on us to reject and vilify the ‘other’. The
most radical aspect of this view is, of course, that it applies to
everyone – from the people whose views are largely shared by
society to the smallest minority. In this area, at least, the majority
does not rule.
…the government can therefore,
not make laws or formulate
policy that will perpetuate the
marginalisation or oppression of
an ‘unpopular’ minority group – no
matter how popular such a law or
policy would be with its voters…
A
This is, of course, not an easy injunction to live by. For example,
an acceptance of this respect for difference would seem to mean that
fundamentalist Christians would have to respect and accept
homosexuals and homosexuality, despite the fact that they might
believe sincerely and passionately that homosexuals are ‘sinful
perverts’, who must burn in hell – the sooner the better. At the same
time it would seem to mean that gay men and lesbians would have to
accept the same Christians, who they believe are ‘bigots’, who
threaten their very existence and should be resisted at all cost.
Viewed thus, this ‘right to be different’ can easily be caricatured as the
right to anarchy and chaos or the right to allow anything whatsoever.
This is, however, not how the learned judges of the
Constitutional Court would see it. They may point out that the right
to be different does not mean that anything goes, because the
government still has a duty to govern the country in accordance with
the Constitution. Government must pass laws and formulate and
implement policy, but it must do so in a way that respects the
diversity of the community and without endorsing the cultural,
religious or other beliefs and practices of the dominant majority. As
a general rule, the government can therefore, not make laws or
formulate policy that will perpetuate the marginalisation or
oppression of an ‘unpopular’ minority group – no matter how
popular such a law or policy would be with its voters. For example,
legislation that would ban same-sex sexual relationships, or sexual
intercourse between Hindu’s and Christians, or that would ban
Rastafarians or former sex workers from becoming school teachers,
would not comply with the injunction to respect difference.
At the same time, the judges of the Constitutional Court would
point out that the government of the day has a constitutional duty to
safeguard the rights protected in the Bill of Rights. If the social,
cultural or religious beliefs and practices of one group – especially
the dominant group – threaten the human dignity or bodily integrity
of others, the government has a duty to curtail such practices. For
example, the state would have a duty to forbid a traditional practice,
such as the one of female genital mutilation, because it would be
harmful to women – even when this practice is widely accepted
amongst a particular group.
The constitutionally inspired respect for difference – also for
different religious or cultural beliefs and practices – is, thus,
limited. Some beliefs or practices may so
offend against the founding values of the
Constitution – against human dignity,
equality and freedom – that they are
considered beyond the pale and not worthy
of respect. Even when such beliefs or
practices are widely shared in the community,
or by dominant groups in society, they
remain constitutionally unacceptable. When
individuals, therefore, justify beliefs or
practices that harm others on the basis that
it is part of their religious beliefs, culture or
tradition, they will only have a valid point,
if their beliefs or practices do not reject
difference, but respect it.
FOOTNOTES:
1. Constitution of the Republic of South Africa Act 108 of 1996,
Section 9.
2. Section 15 of the Constitution.
3. Section 31 of the Constitution.
4. National Coalition of Gay and Lesbian Equality v Minister of Justice,
1998 (12) BCLR 1517.
5. National Coalition of Gay and Lesbian Equality v Minister of Justice,
1998 (12) BCLR 1517. para 129.
6. National Coalition of Gay and Lesbian Equality v Minister of Justice,
1998 (12) BCLR 1517. para 135.
aLQ – June 2006 9
The right to be different…
Pierre de Vos is a professor in
constitutional law and human rights at
the University of the Western Cape. For
more information and/or comments,
please contact him on +27 21 959 3287
or at pdvos@uwc.ac.za.
…if the … beliefs and practices
of one group … threaten the
human dignity … of others, the
government has a duty to curtail
such practices…
EaLQ – June 2006
violence and HIV cannot be ignored. The
challenges faced by survivors of sexual
violence and people infected by HIV are
similar in nature. These challenges relate to
prevailing gender roles in society and
involve stigmas and myths encouraging
certain beliefs about HIV and rape. Both
issues are linked to sex and beliefs about
sex, both issues have also struggled for
acknowledgement and commitment from
government often resulting in inadequate or
inaccessible services and treatment. With
regard to both issues, there seems to be a
lack of understanding about the psychological
and emotional impact on the survivor or the
person infected and affected by HIV. The
challenge seems to be to debate, research
and implement solutions that have a
practical and real effect on the daily, lived
realities of all South Africans, particularly
women who are disproportionately affected
by sexual violence and HIV.
SEXUAL VIOLENCE:
REALITIES AND FACTS
Rape is a crime of violence that is
committed through a sexual act. It is an
expression of dominance and control by one
person over another, which is humiliating,
invasive and dehumanising. It is a crime that
is not comparable to any other violent crime,
as it violates not only physical safety, but
psychological and sexual integrity. Rape is
any act of a sexual nature which has been
forced onto another person and where sexual
behaviour is used as a weapon of domination.
It is a violent, traumatic and life changing
experience that can happen to anyone, and
threats and manipulation are often the method
used to secure submission instead of physical
violence alone.
Living with HIV is a challenge that many South Africans face on a daily
basis. Combine this challenge with the fact that many women living with
HIV are also exposed to rape, sexual and physical violence and the results
can, admittedly, be disastrous, as in the case of Lorna Mlofana.1
The links between rape, sexual violence and HIV are apparent and
increasingly acknowledged. Statistics, even though they are at times
problematic, do indicate that while there is an increase in the number
of reported rape cases, there is also an increase in the number of HIV
infections.
At Rape Crisis Cape Town we assist all survivors of rape and
sexual violence who approach us, including survivors who are HIV
positive or who have been exposed to HIV as a result of rape. Thus, we
are constantly challenged to incorporate the dynamics of HIV and
AIDS into the work that we do.
INTRODUCTION
Even though, the links between HIV and sexual violence are
receiving greater recognition, the relationship between sexual violence
and HIV is not always adequately understood or addressed by the
interventions of government, civil society, the community or survivors.
This lack of acknowledgement of the intersections between HIV and
sexual violence has a number of consequences. For example, for the
survivor this could mean not being able to access medication to prevent
infection after rape, it could also mean not completing the course of
medication and/or not revealing the HIV status to the partner, due to
the legitimate fear of violent retribution, even if the partner is the
source of infection. For government it could mean inadequate or
incorrect allocation of resources and services, a lack of recognition of
the multi-faceted nature of the problem and an inability to protect the
constitutionally guaranteed rights of all South Africans. For civil
society it could mean a challenge to prevention messages and
awareness raising, whilst it also represents a challenge to the
dichotomised manner in which civil society works and the projects that
are initiated in communities.
The prevalence of rape and sexual violence in society, with
women largely being the victims of such incidents, and the increase
in the number of people living with HIV, with women being the
section of the population where the growth has been the greatest
over the past few years, indicates that the links between sexual
10 Sexual Violence and HIV:
Can we ignore the links?
Sexual Violence and HIV:
Can we ignore the links?
Rape and sexual violence are unfortunately a common occurrence
and a lived reality for many South Africans. Coping with the violation
of rape is difficult enough on its own, adding the possibility of
acquiring HIV, as a consequence of rape, represents another trauma,
which can be unbearable.
Meaka Biggs
R
Working with survivors, one realises that rape happens anywhere,
to anyone at anytime. People tend to think that it only happens to a
certain type of person, but the reality is that it is happening
everywhere, including in our families, in our homes, in our
neighbourhoods and communities, in our places of worship, education
and recreation. And it is happening to anybody, including our mothers,
sisters, wives, daughters, girlfriends, colleagues, friends and sons.
Rape often relies on an existing relationship to ensure silence and
takes many different forms from date, acquaintance and marital rape to
child sexual abuse, sexual exploitation and gang rape. ‘Stranger rape’
is what many people still consider to be ‘real rape’; the type of rape
that society seems to offer the most support to survivors for, and the
most prevention messages about. In other words, a woman walking in
a parking lot and being attacked by a stranger who grabs her and
violently rapes her, leaving physical injuries and scars will receive
society’s sympathy and support. And, it is this situation that further
seems to define rape prevention messages, telling people, especially
women and girl children, not to walk alone at night, not to accept lifts
from strangers and not to open the door unless they know who is on the
other side.
The problem is, however, that in most cases, rape and sexual
violence do not happen in this manner and the threat is more likely to
be from within the home and/or from someone known and already
acquainted with, than someone unknown. Experience shows that
society is more likely to believe and support the ‘real rape’ scenario,
rather than the instance where a woman is raped after going on a date,
having a glass of wine, and then inviting the person in for coffee. In
this instance, society questions, blames and says that ‘she brought it on
herself ’ and is reluctant to offer support, yet, the psychological,
emotional and physical impact on the survivor in both scenarios is
immense and the reaction of people who are meant to offer support,
such as families, communities and society in general, play a major role
in the healing process.
Statistics, released by the South African Police Services on rape for
the period 2004/2005, revealed 55 114 reported cases of rape in South
Africa, which is approximately a 4% increase on the 2003/2004
statistics2. Due to the narrow legal definition of rape3 provided for in
current legislation, the cases of indecent assault reported over the same
period, 10 123, need to be included in order to get a clearer picture of
the reported rape statistics in South Africa.
Research4 estimates that anywhere between 1 in 9 rapes go
unreported, which is an indication that the number of survivors of rape
and sexual violence is far larger than the reported figures. Research
also indicates that the majority of survivors of rape and sexual violence
are women and children. While men are not as vulnerable to rape as
women, rape and sexual violence against men is on the increase,
however, the vulnerability of women and
children presently far outweighs that of men.
HIV AND AIDS:
REALITIES AND FACTS
Since 2002, there has been a sharp
increase in women living with HIV in sub-
Saharan Africa. In earlier years, men had a
higher rate of infection than women, but
women are presently the fastest growing
group of people living with HIV and AIDS.
Nearly 50% of adults infected globally are
women living in sub-Saharan Africa. In South
Africa over 5.6 million adults are infected
with HIV and a vast majority of people living
with HIV and AIDS are women.5
HIV infection is affected by a number of
different factors. It is primarily transmitted
through sexual intercourse and it is, therefore,
linked to the relationship between women and
men. It is also recognised that unprotected
sexual intercourse and other high risk
behaviours create risk for any person
irrespective of their sex. However, there are
certain psychological and social factors
which increase the risk of infection and
impact on the care, medication, nutrition and
support available to people living with HIV.
Sex, gender, race, class and age powerfully
influence exposure to, and progress of, the
virus. Gender inequality is one of the primary
factors linked to the rise of women who are
infected with, and are affected by, HIV and
AIDS. Gender inequality is also one of the
greatest barriers preventing women from
protecting themselves from infection, not
simply because they are women, but because
of the discrimination and inequality that they
face as women.
Physiologically, women are at higher risk
of infection during intercourse, as they have a
larger mucosal surface, which can be exposed
to abrasions. Women also have a higher rate
of sexually transmitted infections, due to
biological factors and the unchallenged
aLQ – June 2006 11
Sexual Violence and HIV:
Can we ignore the links?
…rape is a crime … that is not
comparable to any other … as it
violates not only physical
safety, but psychological
and sexual integrity…
…in most cases,
rape … is more likely
to be from within the
home and/or from
someone known…
T norms of male ownership of women’s bodies.
This allows for easier transmission of the
virus. Unlubricated sexual intercourse
increases friction in the vagina and the risk of
physical injury, making transmission of the
virus easier. In cases of rape and sexual
violence, lubrication can be limited and the
survivor’s muscles are tense, thus increasing
the risk of HIV transmission and
compounding the trauma suffered. The risk
of HIV infection associated with rape and
sexual violence is, therefore, much higher
than that of a single act of sexual intercourse.
Other factors increasing this risk for survivors
of rape and sexual violence are that some
survivors are exposed to multiple assailants
and multiple receptive sites. At Rape Crisis
Cape Town we are seeing an increase in
survivors of multiple rapes and clients who
have been raped orally, anally and vaginally.
Women’s vulnerability to HIV infection is,
therefore, both biological and centrally linked
to their status in society and the gender roles
assigned by society.
Socially, women are at a greater risk of
contracting the virus due to the norms
prevailing in society regarding to who has
power and control over women’s bodies and
their sexual lives. Women have limited choice
when it comes to negotiating sex. Male
ownership of women’s bodies and the notion
that women should submit to men, be
unchallenging of men and not be sexually
dominant means that for women exerting
control when it comes to sex is not a ‘viable’
option. For often, in the attempt to assert
control, further violence and injury occur.
Hence, the ability to enforce one’s
constitutionally guaranteed right to bodily and psychological integrity6
seems not practical, nor safe for a majority of South African women.
These societal norms mean that adhering to the ABC prevention
message, as an example, is not a practical solution for limiting the
transmission of the virus for many women. For it is the men in their
lives that make the sexual choices and when women attempt to
challenge these choices, women often face greater harm and violation.
Women also carry the burden of HIV disclosure, due to antenatal
testing programmes and the roles of care and support that women
fulfil in families and communities. Pregnant women are the most
tested group of people when it comes to testing for HIV, which also
means women carry the greatest risks associated with disclosure and
exposure of their HIV status. Women often experience severe violence
and abuse as a result of disclosing their HIV status to their partners and
families, or as a result of being exposed in the community as someone
who is infected with HIV, which is often due to the violation of the
right to confidentiality. In many instances, women have contracted the
virus from their partners; yet, women often face retribution from the
very partner who infected her. This is but one example of the
unintended consequences that programmes and interventions can have,
when the links between sexual violence and HIV are not
fully explored.
There has also been an increase in female-headed households.
Hence, there is greater economic reliance on women, yet, at the same
time women continue caring for the sick and dying. With the burden of
care falling on young girls within the family, girl children often end up
leaving school early in order to take care of the family. This further
entrenches the inequality that young girls and women experience in
their daily lives.
Current programmes and responses to HIV and AIDS often seem
to entrench gender roles and increase the risk of violence against
women. For example, calling on women to volunteer as home-based
and community-based caregivers, entrenches the concept that women’s
work is undervalued and unpaid, reinforcing the notion that they do not
‘fit into’ the formal economy. Programmes calling on people to
disclose their status in a society where the social stigma around HIV is
mainly judgmental, blaming and unsupportive, coupled with the high
levels of rape and sexual violence, leave women in a vulnerable
position. Thus, these programmes will not have the intended effect of
support and acceptance, as initially anticipated. One reason could be
that most of these programmes fail to consider the environment in
which people are asked to disclose, as well as the effects that
disclosure can have on an individual in a community, which has a
particularly antagonistic attitude to HIV and AIDS.
Ambiguous messages from government also play a role in
12 aLQ – June 2006
…physiologically,
women are at higher
risk of infection … as
they have a larger
mucosal surface,
which can be exposed
to abrasions…
…we are seeing an increase in
survivors of multiple rapes and
clients who have been raped
orally, anally and vaginally…
Sexual Violence and HIV:
Can we ignore the links?
S
maintaining certain social stigmas around HIV. A lack of clear
direction from government assists in the proliferation of many
unfounded beliefs regarding HIV and AIDS. Programmes and
interventions need to carefully consider the impact of the intersections
between sexual violence and HIV in order to ensure that the impact is
one of improving the situation, as opposed to increasing the danger.
COMMON CORE BELIEFS
Survivors of rape and sexual violence and people living with HIV
are labelled, ostracised, rejected, intimidated and blamed by the very
people who are supposed to provide support, during the time of need.
This often prevents people from speaking out about their situations. It
also means that many survivors do not seek the medical, psychological
and emotional assistance that they need, and do not receive the correct
medication after the rape, so as to reduce the risks of HIV
transmission, as well as other sexually transmitted diseases. Because
rape survivors are often ignored, dismissed, questioned and shamed, in
very much the same way that people living with HIV are, it means that
the risk of exposure is heightened, as is the isolation.
In addition, the belief that sexual intercourse with a virgin can cure
AIDS could in fact lead to an increase in rape and sexual violation. Or
the belief that using a condom undermines manhood and that it is part
of one’s culture to have numerous partners, could further perpetuate
the spread of HIV, the subordination of women and the inability of
prevention messages to make a real difference. The links between
sexual violence and HIV go beyond the numbers to the very core
values and beliefs that many in society hold.
Sexual violence and HIV are both matters that many South
Africans are seemingly not prepared to accept as reality. When
discussing either rape and sexual violence or HIV and AIDS there
appears to be an inability to meaningfully comprehend and
acknowledge the devastating impact of both of these issues, as well as
of the responses and actions required. It is almost as if people hear the
information, but do not make it part of their conscious reality. There
seems to be a distancing from the devastating impact for many, and the
more that the effects of sexual violence and HIV are pointed out, the
greater the denial becomes. People do not want to accept this as part of
their lives and it is only as and when people are affected in a very direct
and personal manner and they can no longer deny the situation that a
shift may occur. As a result, prevention messages are ignored and there
is a general lack of knowledge about how, when and where to access
services. Subsequently, if services are available, they may not be
accessed appropriately or timeously when the
need arises.
SERVICE PROVISION
A further challenge regarding services for
survivors of sexual violence and people living
with HIV is the limited access to information
and knowledge of how to access services. In
many areas, there are no, or limited, services
and information, and accessing services free
from judgement and insult can often be a
challenge in and of itself. Survivors of rape
and sexual violence encounter many
problems when trying to access the criminal
justice system at the various levels from the
health system to the police and the courts.
People who are infected with HIV also have
problems accessing services, as not all clinics
provide testing facilities and the necessary
medication and information for treatment.
Services at the various levels are provided
by people, who come from communities. So,
if stereotypes and judgements prevail in the
community, the individual providing the
service will bring the same beliefs into the
clinic, police station or court. As a result,
survivors of sexual violence and people living
with HIV encounter the same judgements
from within the system of service provision,
as they encounter from within the community.
Hence, services that are meant to protect and
support, are in fact, unsafe and discriminatory.
Experiences highlight that counselling
services, offered by social services, are
notoriously limited and the huge gaps that
government funded services leave, are not
able to be filled by civil society, as civil
society faces capacity and resource
constraints. As a result, a person, who is a
survivor of rape and has potentially been
exposed to HIV, has little or no access to
counselling unless the person is able to pay
for this costly service. Or, the woman who
reveals her status and as a result thereof is
beaten, abused and violated may have to wait
for months, before she can obtain an
aLQ – June 2006 13
…women often face
retribution from the
very partner who
infected her…
…male ownership of women’s
bodies and the notion that women
should submit to men… means
that for women exerting control …
is not a ‘viable’ option…
Sexual Violence and HIV:
Can we ignore the links?
R 14 aLQ – June 2006
appointment for appropriate psychological
and emotional assistance. This, arguably,
indicates that the psychological and emotional
impact of rape and sexual violence is not fully
understood, nor is the psychological impact of
HIV on people who are infected and affected.
Rape and sexual violence, and HIV and
AIDS present already significant challenges
as separate issues confronting South African
society. The challenges in addressing service
provision around these issues are further
complicated by the complex and often
unexamined intersections between these
issues. Service provision that does not
adequately take cognisance of the
intersections, may unintentionally remain
ineffective in addressing the needs of
survivors and those infected and affected by
HIV and AIDS.
In the past, rape and sexual violence and
HIV and AIDS have been distinctly separate
and dichotomised. Acknowledging that there
are links and that these intersections cannot
be ignored would mean that the various
sectors need to complement each other and
work together, rather than remaining in the
‘silo’ mentality of operation. For example, to
access services, a rape survivor would need to
go to an organisation dealing with rape and
sexual violence for counselling and support,
and then to another organisation for voluntary
testing and counselling relating to HIV.
Specialisation of services can, therefore,
increase the financial and emotional burden
for an already traumatised survivor. By
sticking only to one speciality and not
developing a holistic approach, or a well
thought out and operational referral system,
service providers are not assisting in the
overall healing and support of the survivor.
The move to an integrated approach is a
challenge both at government and civil
society level to the manner in which services
are provided, and prevention and awareness
campaigns are conceptualised.
WAY FORWARD
As sexual violence is increasingly linked to HIV and AIDS,
prevention strategies and awareness campaigns need to take women’s
lack of reproductive and sexual autonomy and choice into account. If
such programmes fail to do so, then women will continue to constitute,
by far, the majority of people at risk of sexual violence and HIV
infection. Care strategies should address, challenge and transform the
gender roles within the family and community. Treatment strategies
need to reach women in their own right, rather than solely in their
reproductive roles, as is the case with Prevention-of-Mother-to-Child-
Transmission (PMTCT) initiatives; or in cases where women have
reported sexual violence. Programmes and responses need to begin to
reshape attitudes, beliefs and values and what has come to be
understood as ‘acceptable’ behaviour or culture.
Prevention, care, support and treatment for HIV are mutually
reinforcing and not inseparable and are linked to the gendered nature
of power and control in society, as are the constructs involving rape and
sexual violence. Initiatives of government and civil society pertaining
to sexual violence and HIV need to take cognisance of the links
between these two issues and effectively work together to decrease the
impact of HIV and sexual violence. To ensure the impact of these
concepts in their entirety, arguably, encompasses the need to further
develop the understanding of how they intersect; plan and implement
programmes and services from the perspective that they are linked;
consider the impact of such links; and form partnerships across sectors
that recognise and address these intersections successfully.
Challenging the State to enforce existing legislation and policies,
and to enact new legislation, will also assist in changing the realities of
sexual violence and HIV. Adequate resource allocation and taking the
issues faced by many South African women serious, rather than simply
paying lip service, will impact on the effectiveness and implementation
of programmes that recognise the links between sexual violence and
HIV. We cannot ignore the links. We do so at out own peril.
FOOTNOTES:
1. Lorna was a 21 year old HIV activist, who was killed after informing her rapist that she is living with HIV.
2. www.saps.gov.za/statistics/crimestats/2005.
3. The legal definition of rape only includes vaginal penetration by a penis. Other forms of rape are currently
trialed as indecent assault.
4. Medical Research Council report, 2002, as cited in www.oneinnine.org.za.
5. UNAIDS. 2005. AIDS Epidemic Update. December 2005. See also 2005 World Population Report.
6. Constitution of South Africa, Act 108 of 1996, Section 12.
Meaka Biggs is the Advocacy Coordinator at the
Rape Crisis Cape Town Trust. For more information and/or
comments, please contact her on +27 21 447 1467
or at meaka@rapecrisis.org.za.
…programmes…
need to begin to
reshape…
‘acceptable’
behaviour…
…challenging the State to enforce
existing legislation and policies,
and to enact new legislation, will
also assist…
Sexual Violence and HIV:
Can we ignore the links?
S
Introduction
It is a known fact that even before the discovery of HIV, women and
girls experienced discrimination and oppression based on welldocumented
gender related factors. HIV and AIDS merely
exacerbated a situation of inequality and injustice that already
prevailed in all Southern African countries and many other parts of
the world. For example:
• The incidence of all forms of violence against women is an
indicator of the status of women. Sexual violence including
rape is quite common.
• In most communities, women are less educated and by
extension less economically independent than men, though
recently there has been a positive shift in this regard.
• Women and girls are disproportionately saddled with
household work and responsibilities.
• In most Southern African countries, women are still
discriminated against by law and/or through the biased
implementation and interpretation of the law. Even in the
South African context, with a world acclaimed democratic
Constitution, there are still rights that women are not in the
position to enjoy.
There has been long standing socio-cultural factors that have made
women and girls in Southern Africa more likely to become infected
with HIV and less in the position to protect themselves, and/or fight
for their rights at all levels. In addition, the extent to which men were,
and are, affected by the new social order creates a debate that needs to
be included in the equation, so as to closely look into some of the
underlying factors that fuel the HIV pandemic.
Inequalities between men and women
As cited above, the question of unequal gender relations is one of
the most serious underlying factors that fuel the pandemic. For
example, many women are not in the position to either negotiate safer
sex or make overall decisions about their reproductive health, which
leaves women vulnerable to poverty, dependency to their male
counterparts, and sexual violence. Complementing WHO’s (2002)1
report, research on women has shown that women who experience both
sexual and physical abuse from intimate partners are significantly
more likely to have had sexually transmitted diseases, including HIV.
It seems, however, that HIV prevention, care and support strategies
address this issue merely in research papers
and political talk, without proper and
effective programmes on the ground.
Men and the effects of rigid gender
roles
Socio-cultural changes affect men as well,
even though at a different level. For example,
men’s health and well-being are seriously
jeopardised by rigid gender roles. Indeed,
researchers suggest that ‘gender is one of the
most important determinants of health
behavior’, and that ‘men engage in fewer
health-seeking and have less healthy lifestyles
than women’2. When men are not taught to
reform such behaviours, or if excluded from
projects, collectively, efforts will be
greatly challenged!
Similarly, other studies have documented
the effects of ‘masculine ideology’ on
condom usage, and sexual and reproductive
health in general, and indicate that traditional
men’s gender roles lead to ‘more negative
condom attitudes and less consistent condom
use’ and promote ‘beliefs that sexual
relationships are adversarial’3 .
As is indicated by a number of recent
studies4, these gender roles leave men
especially vulnerable to HIV infection, and
also decrease the likelihood that men will
seek voluntary counselling and testing
services, or access medical services, until
they are already very ill. A recent study of
anti-retroviral treatment in Johannesburg
conducted between April and June of 20045
reported that women accessing ARVs
outnumbered their male counter parts, as
many men would only access ARVs by the
time they are very sick.
However, most of the current HIV strategies
focus mainly on challenging men to stop
these types of behaviours, or pointing a finger
aLQ – June 2006 15
Dethroned men…
an underlying factor fuelling the pandemic?
‘Dethroned men’… an underlying
factor fuelling the pandemic?
Dumisani Rebombo
aLQ – June 2006 P 16
of blame to men – which in turn leaves men
with a perception of being the alienated
gender group. It has to be recognised that men
are not a homogenous group and, therefore, it
is crucial to heed an inclusive approach,
which creates spaces to work with men as
solution seekers. This does not suggest that
where men have perpetrated any form of
violation or practiced injustice, this should be
treated with soft gloves, but rather that
universal punitive masculine ideology that
suggests a narrow definition of masculinity,
will miss the underlying factors of
certain behaviours.
Men dethroned
Though this might sound cynical, a
thought must be shed here in that there is a
belief that colonisation has dethroned men,
especially African men, as ‘head of families’.
Prior to colonisation, men herded cattle and
ploughed fields and, therefore, the masculine
identity and wealth was built and accepted in
this way. In addition, men had to pay lobola
(the dowry) to as many wives as they so chose,
this dimension giving birth to dictatorship and
control of women and reinforced the ‘head of
the family’ concept. This norm was practiced
and accepted for many decades without doubt
that many African men enjoyed this privilege
(if it is a privilege at all!), without realising or
taking stock on how this affected women and
children. Colonisation, amongst other things,
introduced municipal by-laws (therefore not
every man would have big herds of cattle and
large plough fields), and paying of taxes. This, combined with
industrialisation resulted in many of the ‘head of families’ having to
migrate to cities in search of work – and though, the men held on to
the title, their women counterparts became in reality the new ‘head
of families’.
The inevitable new social order
Patriarchy in all its forms had to be challenged and continues to be
dismantled. However, currently, as can be argued, only ‘enlightened
men’ applaud the new dispensation that is spearheaded by the UN’s
declarations and most heads of state. Similarly to the colonisation era,
this was bound to happen, since, unfortunately due to limited
transitional processes that are in place, some men, if not most men, see
the new order as a continuation of their dethroning.
The new order ‘forces’ men to consider sharing household chores;
to accept equality with women and the fact that women can be ‘above’
men economically – not to mention the rising unemployment figures
that ‘allow’ women to be ‘bread winners’ and, sometimes to be perceived
as ‘arrogant heads of families’ forced on men by the new social order,
which is also misunderstood as a challenge to the wisdom of men
(whether from a cultural or religious perspective). Fortunately, these
beliefs and perceptions cannot completely stop the progressive
development dispensation, even though human development can, in
many ways, be seriously challenged by these beliefs and perceptions,
especially with regard to the HIV pandemic.
The point, however, is that if there is not a constructive focus on
how to allay these fears and perceptions from the masculine centred
beliefs, yet another underlying factor that fuels the pandemic, will be
missed. A few examples would be:
• When men feel that their dominant powers over women and
systems are ‘dethroned’, they may resort to violence, especially
sexual violence in the HIV context; due to these misguided
misconceptions.
• Sometimes it might not be violence per se, but engaging in
casual sex or with multiple sexual partners (with harmful
repercussion to HIV awareness and prevention programmes) as a
form of retaliation to loss of power. This behaviour can also be
viewed as a consolation to the ‘hurting male pride’.
…mixed HIV messages can send
out negative perceptions and false
hopes … after all there seems to
be no need to panic, as HIV is just
another health condition…
…traditional men’s
gender roles lead to
‘more negative
condom attitudes’ …
and promote
‘beliefs that sexual
relationships are
adversarial’…
Dethroned men…
an underlying factor fuelling the pandemic?
I• Men might resent female leadership, because of how they feel
inside, coupled with the lack of understanding the changing
external environment.
• Mixed messages and expectations, e.g. on what it means to be
a man from the order of the past, linked with the little
‘know-how’ on the new definition and expectations of who a man
should be in the context of the new era. For example, some men
are still expected and told to be the ‘bread winner’ or
‘provider’, even though this is no longer as practical, failing
which could subject these men to direct or indirect ridicule or
undermining.
It is, therefore, imperative that such gaps be bridged in order to
arrive at workable solutions that will benefit not only specific
initiatives and programmes, but all the infected and affected.
Mixed national HIV messages
It is argued, that the more mixed HIV messages are sent out to the
nation, the less effective they become. According to Dr. Liz Floyd,
director of the provincial ministry of health, more than 80% of the
population has been successfully reached with HIV and AIDS
messages.6 The question then is, why does South Africa has the
highest number of new infections, even though there is adequate
condom distribution? Why are there such high rates of stigma
resulting in less behavioural change? Sending out different mixed
messages to the nation, as compared to one single message, is what,
arguably, can create ‘resilience’ and self-belief to ignore certain
messages of life and death.
In Uganda, for instance, the central message for the nation, over
and above the ABC approach, was that of ‘no to zero grazing’, which
means ‘no’ to multiple sexual partners, including ‘no’ to casual sex.
South Africa sends out messages about ‘HIV as a killer’ and
simultaneously messages of hope.
When one thinks of the different forms in which masculinities get
to be performed or identified, these mixed HIV messages can send out
negative perceptions and false hopes to some people, since after all
there seems to be no need to panic, as HIV is just another health
condition. Furthermore, if ‘HIV gets you’, there are monetary grants
and anti-retroviral treatment available to assist.
In South Africa, it seems that politically HIV is the sole
responsibility of the ministry of health,
whereas it is a well-known fact that a
comprehensive approach by all government
departments, including the presidency, is
critical in the response to the pandemic. The
presidential approach to HIV is, arguably, a
bit casual – bringing about ‘casual approaches’
in some circles.
Swaziland, for example, has recently
launched centralised HIV messages, one
about the need for life and the other about
being faithful to one partner and it is believed
that this will yield positive responses from the
nation. This does not suggest that a holistic
approach to HIV prevention and care
strategies is not needed, but that there is the
need to prioritise and centralise behavioural
change messaging for optimum national
response and benefit.
Changing HIV strategies and
approaches
Whether this is due to current needs,
trends or donor driven preferences, there has
been changes and/or shifts of priority interest
in the response to the HIV pandemic. Where
HIV prevention was a strategy of focus, it was
soon swallowed by the interest for orphaned
and vulnerable children (OVC). This too did
not last long as voluntary counselling and
testing (VCT) entered the fray. Soon after,
treatment took the centre stage and the cycle
seems to roll on. However, what is needed is
a holistic approach, in which HIV prevention,
care and support activities are given equal
aLQ – June 2006 17
Dethroned men…
an underlying factor fuelling the pandemic?
…the presidential approach to HIV
is, arguably, a bit casual – bringing
about ‘casual approaches’
in some circles…
…perceptions in some
circles that working
with men equals
wasting scarce
resources and time,
as there is a strong
belief that patriarchy
in all men cannot be
changed…
C
attention and are parallel activities at all times,
so as to ensure sustainable and effective
programmes responding to the pandemic.
Fewer programmes target men
As alluded to in the introduction, men are
immensely shaped and challenged by
socio-cultural changes and, therefore,
working with men is of paramount
importance, since leaving men to themselves,
whether by default or due to radical feminist
ideologies, will hamper most of the good
work that is done, even for women and
children. There are, however, perceptions in
some circles that working with men equals
wasting scarce resources and time, as there is
a strong belief that patriarchy in all men
cannot be changed. This view is, arguably, a
dangerous one, since there is an urgent need
for a social movement of men and women to
respond to the pandemic – so, the exclusion
of men (or their inclusion as perpetrators)
has, and will continue, to challenge many of
existing programmes.
In conclusion, these underlying factors in
the response to the pandemic need urgent
attention and all efforts are needed to fill in
the gaps and to redress harmful beliefs and
perceptions that constantly present
themselves. Researchers and strategy
formulators have done enough in their
profession. It is time that efforts to capacitate
communities to be HIV and gender
competent be exerted, since a competent
community is the one that knows,
understands, and is able to respond to the
issues effectively within the constraints of
limited resources. These kinds of communities are in the position to
enhance and sustain programmes in their communities, without
constant help from experts.
Recommendations
The recommendations listed below are an attempt to provide
mechanisms of how to address the issues and to obtain a
common understanding.
• Incorporate and increase male involvement in all HIV
strategies – e.g., have more male targeted programmes (that are
not setting the agenda for women’s emancipation), but that
support the women’s agenda. Men’s fears and negative beliefs
and perceptions need to be addressed. Safe spaces need to be
created for men and women to dialogue on all issues of concern,
and women organisations need to unite and work together.
• There is a need to have one or two national HIV messages that
the nation can identify with – e.g., everyone in South Africa can
identify with the Treatment Action Campaign T-shirt and the Soul
City emblem.
• Capacitate communities to be gender and HIV competent – as
much as research, monitoring and evaluation, and other strategies
are needed to be in place, it is recommended that communities
need to be given skills to stand up, and be involved in the
planning and implementation of HIV programmes and initiatives
in their respective communities.
• Provide community education on policy and the sociocultural
changes by both government and civil society – this
should include gender equality, human rights, including a
simplified version of the Constitution. Traditional healers and the
faith-based organisations are to be included in the process.
• There is a need to strengthen civil society in order to advance
policy and advocacy work, especially with government, and to
hold government accountable to all its constitutional obligations.
FOOTNOTES:
1. Dunkle, K.L. et al. 2004. ‘Gender-based violence, relationship, power, and risk of HIV infection in women
attending antenatal clinics in South Africa’. In Lancet. 9419, 1410-1.
2. Courtenay, W. H. 1998. ‘College men’s health: An overview and a call to action’. In Journal of American
College Health, 46(6), 279-290.
3. Noar, S. M. & Morokoff, P. J. 2001. ‘The Relationship between masculinity ideology, condom attitudes, and
condom use stage of change: A structural equation modeling approach’. In International Journal of Men’s
Health, 1(1), 2001.
4. Courtenay (1998).
5. Pettifor, A., Rees, H. & Stevens, A. 2004. HIV & Sexual Behaviour among Young South Africans: A
National Survey of 15-24 year olds. Johannesburg: University of the Witwatersrand.
6. Floyd, L. 2005. Presentation at the Gauteng AIDS Conference, Johannesburg.
18 aLQ – June 2006
Dumisani Rebombo, who wrote this article in his personal
capacity, is a gender activist working for EngenderHealth
South Africa. For more information and/or comments,
please contact him on +27 11 833 0502 or at
drebombo@engenderhealth.org.
…have more male
targeted programmes
(that are not
setting the agenda
for women’s
emancipation)…
Dethroned men…
an underlying factor fuelling the pandemic?
T
High rates of gender-based violence exist in South Africa.1 Rape and
all forms of gender-based violence are telling examples of high levels
of gender inequality in the country. Research has revealed and
explained the link between gender-based violence and the spread of
HIV and AIDS in South Africa.2 The need to understand what
contributes to the perpetration of gender-based violence is, therefore,
imperative, because, as argued by UNAIDS [2004]
…if HIV-prevention activities are to succeed, they need to occur
alongside other efforts that address and reduce violence against
women and girls.
Most counselling, advocacy and research initiatives and
programmes on issues of gender-based violence in South Africa focus
on girl children and women – on responding to their trauma – and not
on the prevention of gender-based violence. Furthermore, most
gender-based violence counselling, advocacy with and research
activities in South Africa, that focus on men, focus on men, who are
already sexually active and violent. As such, an ‘in-depth
understanding of why and how men come to act as they do sexually is
absent’. [Jewkes, Maforah & Wood, 1998:17]. Little work has been
accomplished in understanding how boys in South Africa are
socialised and come to be perpetrators of gender-based violence.
This article focuses on how adolescent boys in South Africa, who
have yet to engage in sexual relationships, come to understand issues
of gender-based violence as they develop their own sexual and gender
identities. The information presented in this article is based on a study
exploring the perceptions of pre-sexually active South African
adolescent boys pertaining to gender, sex and violence, and the
mechanisms of how these issues are communicated by various role
players in their environments. Based on the research results, this
article argues that sex education for children and youth must be based
on a human rights framework, if it is to be effective in preventing
gender-based violence and the spread of HIV.
Research background
A random sample of the population of eighth grade boys at
Lowveld High School in Nelspruit, Mpumalanga, was drawn for this
research. From this sample, fifteen boys, aged twelve to fifteen,
participated in in-depth qualitative interviews in 2004.3
Children come to attend Lowveld High School from homes all
throughout Mpumalanga and, in some cases, from other provinces and
countries. The selected random sample that participated in the
interviews, therefore, reflected the various language and cultural
groups of the province and the region.
Permission to conduct this study was received
from the School for International Training,
the administration of Lowveld High School,
the participants in this study and their parents
and/or guardians. Participants were assured of
the anonymity of their responses and were
offered counselling and information services,
if they felt they were needed.
Perceptions of gender,
sex, and violence
The research participants were asked a
series of questions in order to probe the ways
in which they perceived and conceptualised
gendered identity. Most of the participants
spoke of clear differences between a woman
and a man, with a man described in terms of
strength, power, and control, while a woman
was often described as less powerful and
more nurturing and caring.
The research participants had conflicting
perceptions of sex, both individually and
within their group of male peers. Most of the
participants understood sex to serve a
reproductive function, while a minority of
participants understood sex to be an
expression of love. At the same time, most
participants viewed men to be in control of the
initiation of heterosexual sex, yet, they also said
that a couple initiates sex once they have built
up a sense of trust and commitment with each
other and they have discussed the issue.
The research participants were further
asked a series of questions to probe as to how
sex and heterosexual relations are broached
within their families. A small number reflected
on engagement and discussion of these
issues. In general, the participants reflected
upon a limited amount of discussion within
their families about sex, especially with their
fathers and other men in their families. Just aLQ – June 2006 19
We’re not supposed to know
about these things…
A call to embed sex education within a human rights framework
Rachel Elfenbein
Sex education
within a human rights framework
S
over half of the participants’ parents were
talking to their boy children about sex in any
way at all. If the participants’ parents did talk
about sex, it was most often to tell the child to
abstain, while a minority of the participants
said that they were able to have varying
degrees of open dialogue about sex with
their mothers.
When asked to describe rape, almost every
participant defined rape in terms of
unwanted sexual contact, but participants
differed in their description of who can be
perpetrators and victims of rape. At the same
time, almost every participant thought that rape
can occur in marital and dating relationships.
Most of the participants thought that men
rape in order to cure themselves of loneliness
and/or HIV. One-fifth of the participants
thought that men rape in order to gain
ascendancy amongst their peers, or to have
fun. Only one participant perceived men to
use rape as an act of power and control over
women. He said that men are ‘power hungry:
they want to be shown respect and prove that
they’re bigger and stronger than the other sex’.
Similar to issues involving sex, the
participants’ mothers and female family
members were more willing to talk about rape
with the boy child, than their fathers and male
family members. Four of the participants
reflected that they received explicit messages
from members of their families that they
should not force sex on women. The same
number of participants reflected that
their families have never approached the issue
of rape.
From the participants’ responses, it seems that their families were
more likely to approach the issue of rape, if someone within their
families is known to have been a victim of the crime.
Most respondents described little tolerance for rape in their
communities. Three participants stated that members of their
communities do not address the issue of rape at all. The response of
four participants, who described a climate of revenge and taking
justice into one’s own hands within their communities, warrants taking
note. In general, these respondents said that community members,
either actively or passively, advocate for the death penalty for
perpetrators of rape. For example, one boy said that, in his township,
…parents don’t even want to think about rape: they come down
with full force on known rapists, they do anything to get you
behind bars.
He went on to state that members of his community capture and
take suspected or known rapists to a cliff and throw them off it.
Another of these respondents stated that a woman in his township
community was raped and the following day, community members
killed the alleged rapist. A similar number stated that various members
in their communities do not forgive alleged rapists, including their
religious leaders, who say that God does not forgive a rapist.
When questioned how young men in their communities address the
issue of rape, half of the participants responded that young men either
take an implicitly permissive stance to rape, or they actually commit
rape themselves. For example, one participant said of young men in his
community: ‘They are with rape. They say you can’t just rape
somebody, that women are most probably willing’. On a more overt
level, several participants reflected on how young men in their
communities openly commit rape. ‘They say rape is a kind of hobby for
some young men: they don’t know what to do with their life, so they
start raping and it becomes a process,’ – one participant noted. Another
participant answered, similarly to his response as to why men rape, that
boys and young men commit rape to gain ascendancy within their male
peer groups. ‘Gangs want to rape girls and women. They are usually
men nineteen years old and out of school, but a few young ones, like
my old friend who is twelve years old’.
At the same time, the participants perceived young women in their
communities to be silent about the issue of sexual violence. Overall,
their responses indicated that rape is not an issue that they perceived to
be dialogued openly and constructively by, and between, various role
players in their communities, as only two participants reflected on
initiatives in their communities to address issues of sexual violence in
a non-violent manner. 20 aLQ – June 2006 Sex education
within a human rights framework
…most of the participants
thought that men rape in order
to cure themselves of loneliness
and/or HIV…
…a random sample of
the population of
eighth grade boys …
fifteen boys, aged
twelve to fifteen,
participated in
in-depth qualitative
interviews in 2004…
AIn most cases, participants reflected that, if rape was discussed
within their classrooms, it was initiated by female teachers and not
male teachers. The participants’ responses indicated that they received
different messages from teachers with regards to issues of sexual
assault, if they did receive information at all. At the same time, the
participants’ responses showed that teachers are not delivering a
standardised curriculum or programming that addresses issues of
sexual assault.
Conclusions from the research
Although the data in this study do not illustrate any direct examples
of gender-based violence perpetrated by the research participants, their
responses indicated that most key role players in their environments
are not critically engaging issues of gender, sex, and violence with
them. Most of the participants described a limited engagement of these
issues on interpersonal, family, educational, and community levels,
even though many did describe a climate of violence and revenge in
these environments. The data presented in this research, therefore,
points to the conclusion that the general environmental context that the
research participants described could contribute to the perpetration of
coercive sex within adolescent sexual relationships.
Related to the general silence around issues of sexual violence in
the research participants’ lives is their lack of critical engagement and
examination of gender roles. Most of the boys’ views reflected gender
inequalities. The majority of the participants defined men as strong in
comparison to women, and some explicitly noted that men are more
impulsive and violent, than women. Many of the participants defined
women in relation to men, specifically positioning women as
subservient and in less powerful roles. Moreover, views on gender
influence the roles that people play within their sexual relationships, as
the majority of the boys interviewed thought that men were the ones
who control sexual activity within heterosexual relationships.
One cannot help but draw the conclusion that the boys who
participated in the research did not critically engage with gender roles,
because almost all of the adults in their lives do not directly approach
gender issues and gender-based violence with the child. Moreover, the
participants’ responses indicated that the adults in their lives are not
linking the incidence of sexual assault to gender roles, and gender
inequalities in society at large, and that this crucial connection is,
therefore, not communicated to the boys.
The boys noted that, if they received any sort of sex education from
adults, it was more often from the women in their lives, whether the
women were their teachers or family
members or community members.
Furthermore, when adults in these boys’ lives
chose to broach sexual issues, they paid
attention to matters, such as abstinence and
HIV and AIDS. From the data presented, one
can conclude that there is an overall neglect
of the issue of rape and, to some extent, tacit
condonement of sexual violence in these
boys’ environments. Moreover, when the
adults in their lives chose to address the issue
of rape, they often perpetuated myths and
stereotypes surrounding the issue.
Furthermore, one cannot help but draw
the conclusion that most of the boys who
participated in the research did not
understand the causes of rape and sexual
violence, because of the ways that the adults
in their lives choose to address or, more often,
not to address the issue of gender-based
violence. Overall, the boys did not see rape as
a crime that is reflective of gender inequality,
in which someone uses sex as a tool to assert
their power and control over another person.
Participants talked of rape as an issue distant
from their lives, because they did not view
rape as something that can, and more often
does, occur in intimate relationships.
In addition, the research participants’
words reflected a general reactionary
approach to the issue of rape, to the neglect of
a preventative approach. When the boys did
speak of disapproval of rape by the adults in
their lives, they usually referred to either
indirect or direct violent reactions. Moreover,
several of the boys’ descriptions of men in
their communities seeking revenge for crimes
committed against community members and, aLQ – June 2006 21
Sex education
within a human rights framework
…‘they say rape is a kind of hobby
for some young men: they don’t
know what to do with their life, so
they start raping and it becomes a
process’…
…there is an overall
neglect of the issue of
rape and, to some
extent, tacit
condonement of sexual
violence in these boys’
environments…
Wsubsequently, choosing to take the law into
their own hands demands urgent notice. Such
violent reactions to rape by adult men, as
described by the boys, tie back to generally
accepted social constructions of gender.
What therefore needs to be examined and
questioned is the belief that men have the
right to employ violence as a tool to solve
interpersonal and community problems.
Furthermore, the very construction of gender
roles needs to be scrutinised, and, in
particular, as the data presented suggest, the
absence of dialogue between adult males and
adolescent boys about issues of sexual and
gender identity development must be
addressed. What also needs to be questioned
is who is responsible for educating children
about sex and why the responsibility is being
left to women. The lack of dialogue with older
men in these boys’ lives limits their
opportunities to seek correct and appropriate
information and advice regarding issues of
sexual health and gender relations. The
overall lack of information and resources can
effectively place children at risk for unhealthy
and violent sexual behaviour in the future.
Implications for human rights
and sex education
The results produced from this research
carry a practical relevance for everyone
working with and responsible for providing
sex education to children and youth. The
Children’s Charter of South Africa demands
that all child- and youth-related stakeholders
…contribute to children’s physical and
emotional wellbeing. In terms of the
Charter, a child has the right to be
appropriately educated about sexuality,
AIDS, and human rights. All children
have a right to sexuality education. [Kelly, Oyosi &
Parker, 2002:60]
Everyone who has a stake in children’s well-being, therefore,
bears the responsibility to ensure that children’s right to sex education
is realised.
In addition, sex education that aims to prevent HIV will only be
effective, if it addresses issues, such as gender-based violence, that fuel
the spread of the pandemic. As UNAIDS [2004] states:
In many places, HIV-prevention efforts do not take into account
the gender and other inequalities that shape people’s behaviours
and limit their choices… These factors are not easily dislodged
or altered, but until they are, efforts to contain and reverse the
AIDS epidemic are unlikely to achieve sustained success.
In conclusion, the results of the research highlighted in this report
indicate that sex education is not grounded within a human rights
framework, which demands that everyone has the right to equality
(Constitution4, Section 9), the right to be free from all forms of
violence (Constitution, Section 12(1)(c)), the right to make decisions
concerning reproduction (Constitution, Section 12(2)(a)), the right to
security in and control over their body (Constitution, Section 12(2)(b)),
and the right to access any information that is required for the exercise
and protection of any rights (Constitution, Section 31(1)(b)). Sex
education must, therefore, be based on respect and the promotion and
equal enjoyment of human rights, as enshrined in the South African
Constitution, if it is to be effective in preventing gender-based violence
and the spread of HIV.
REFERENCES
Jewkes, R., Maforah, F. & Wood, K. 1998. ‘He forced me to love him’:
Putting violence on adolescent sexual health agendas. Medical Research
Council Technical Report.
Kelly, K., Oyosi, S. & Parker, W. 2002. Pathways to action: HIV/AIDS
prevention, children, and young people in South Africa. A literature review.
Save the Children.
UNAIDS/WHO. 2005. AIDS Epidemic Update: December 2005.
FOOTNOTES:
1. Smith, C. 2005. Keeping it in their pants: Politicians, men, and sexual assault in South Africa. Harold
Wolpe Memorial Lecture, 17 March 2005, University of KwaZulu-Natal.
2. Jewkes, R., Levin, J., Penn-Kekana, L., Ratsaka, M. & Schreiber, M. 2001. ‘Prevalence of emotional,
physical and sexual abuse of women in three South African provinces’. In South African Medical Journal, Vol.
91, No. 5. pp421-428.
3. Kistner, U. 2003. Gender-based violence and HIV/AIDS in South Africa: A literature review.
Johannesburg: CADRE.
4. This research was conducted as part of studies for a Masters of Intercultural Service, Leadership, and
Management at the School for International Training. The research participants were asked a series of
questions, including if they were sexually active. All of the respondants indicated that they were not sexually
active. The conclusions from this research are, therefore, based on the assumption that the participants were
telling the truth, and, in interpreting the research results, this limitation must be recognised.
5. The Constitution of South Africa, Act 108 of 1996.
22 aLQ – June 2006 Sex education
within a human rights framework
Rachel Elfenbein is the Trainer/Facilitator at the AIDS Legal
Network (ALN). For more information and/or comments,
please contact her on +27 21 447 8435 or at
rachel@aln.org.za.
…the belief that men
have the right to
employ violence
as a tool to solve
interpersonal and
community problems…
B
’We are normal. We are like everybody else. Why should I stop living,
because I tested HIV positive? Why should I stop doing the things I have
been doing before?’ – says Onie, a woman living with HIV and mother of
two children, who are not infected with HIV. ’But when I met a man I
wanted to marry and have children with, there was an outcry in his family’.
Onie’s experience is not an uncommon scenario faced by women
living with HIV in Botswana. Many of the women want to have
children and found a family, a common desire that would not generate
opposition under other circumstances.
While women’s reproductive rights have always been a subject of
discussion and contestation, a new focus has now, however, emerged in
this southern African country – the focus on the rights of women
living with HIV and AIDS to make reproductive choices.
Every woman has the right to found a family. This is a universally
recognised fundamental right. Women living with HIV and AIDS,
however, are being systematically discouraged from establishing a
family, either because they are not considered ‘fit’ to take care of a
baby, or because it is believed they will automatically transmit the HI
virus to the infant.
In February 2006, a Member of Parliament in Botswana was
quoted in the media saying that he was concerned about HIV-positive
women who continue to become pregnant and contribute to the spread of
HIV and AIDS. This view seems to suggest that women living with HIV,
who become pregnant, can be targeted as ‘scapegoats’ for the epidemic.
‘Many people connect HIV automatically with death. So they
assume that if you are HIV positive you are going to die. And your child
will also die’ – says Onie, explaining the discrimination she
experienced when she revealed her wish to have a family of her own.
The broad public perception in Botswana is that HIV infected
pregnant women tend to increase the infection rate. This involves
moral judgment and, as a result, HIV infected pregnant women face a
great deal of discrimination. On the surface it appears that there is a
conflict between the individual rights of these women and a societal
goal of reducing the spread of HIV and AIDS.
After three workshops with women living with HIV, held in 2006
around the country by the Botswana Network on Ethics, Law and
HIV/AIDS (BONELA), it appears that the situation is much more
complex than it may seem. BONELA, an NGO centred on human
rights issues related to HIV and AIDS, has been engaged in factfinding
missions to determine the ability of women living with HIV in
Botswana to actually make decisions as to whether or not to
have children.1
‘We need to fully understand the situation in which HIV positive
women are becoming pregnant’, says the organisation’s director
aLQ – June 2006 23
Women’s reproductive rights in the
context of HIV and AIDS
Experiences from Botswana
Katharina Tangri
Christine Stegling. She further argues that
‘While they have a right to control their
reproductive health, they may not always be
in the situation where they can make these
reproductive choices’.
Botswana: HIV and AIDS realities
To begin with, Botswana is experiencing
one of the most severe HIV and AIDS
epidemics in the world. According to
UNAIDS2, Botswana had an adult HIV
prevalence rate of 37, 3% in 2005. Severe also
are the infection rates amongst pregnant
women. According to the 2005 Botswana
HIV Sentinel Surveillance Data, the HIV
infection rate amongst pregnant women aged
15 to 49 years was 33.4%. Thus, the issue of
whether or not women infected with HIV
should have children seems to be one
deserving serious discussion.
Onie, like other women, already knew her
HIV status when she and her husband, whose
HIV status is negative, decided to have
children. They had always wanted children
and it was part of their plan and a personal
fulfilment to her and her husband. So, in
order to have children and prevent mother-tochild-
transmission, she enrolled in a
PMTCT Programme.
Botswana is not only the first African
country to offer anti-retrovirals (ARVs)
through the public healthcare system, but also
to implement the first national preventionof-
mother-to-child-transmission (PMTCT)
programme on the continent. At the beginning
of 2002, the ARV and PMTCT programmes
were made available free of charge, to nationals
and non-nationals married to a Botswana
national, who met the relevant criteria.
Access to the PMTCT programme allows
couples, where HIV transmission is a risk, to
found families under the safest possible
conditions. Such developments, arguably,
affect the choices of women who live with
HIV, as to how and when to become pregnant,
if they so choose.
Reproductive rights
Experiences from Botswana
A
A year after the ARV and PMTCT
programmes were introduced, the uptake by
women was only at about 39%. One of the
factors why so few women were willing to
participate seemed to lie in the fact that HIV
still carried a great deal of stigma.3 However,
a recent study4 on the PMTCT programme in
northern Botswana showed that in areas
where access to the public ARV programme
was available, women were enrolling more
and more often. The study also suggested that
76% of the women who agreed to be tested
for HIV, possibly as a first step to enter the
programme, had known a person who was on
anti-retroviral medication and this influenced
their decision to get tested.
Infection of an infant by an HIV infected
mother around the time of birth is what is
referred to as mother-to-child-transmission
(MTCT) of HIV, also known as vertical
transmission. Without effective medical
intervention, there is a 25 to 35% risk of a
child born to an HIV infected mother to
become infected during pregnancy (in utero),
during labour and delivery (intrapartum).
The major mechanism of vertical
transmission (60 to 85%) is during labour and
delivery. This risk can be reduced if the baby
is delivered through a caesarean. The
additional risk of transmission during
breastfeeding through infected breast milk
(postpartum) is estimated to be about 15%,
which depends also on the duration of
breastfeeding.5
PMTCT programmes can reduce the risk
of vertical transmission to as low as 1%, if the
enrolment with the programme is started on
time, when a woman is 28 weeks pregnant. A
pre-requisite to successful prevention is a mother’s knowledge of her
HIV positive status, which provides the opportunity for appropriate
care. Medical advice may then be offered to the pregnant woman,
including information on medication, caesarean section, and
breastfeeding. The woman has the chance to look after her own
well-being, treatment and health and, thus, it also provides the
opportunity to protect the baby from HIV infection.
In short, the knowledge of a woman’s HIV status may enable a
woman to make informed choices about future pregnancies and will
allow more appropriate counselling about delivery and infant feeding
practices. Crucial to the process is a supportive environment that can
encourage women to enrol in the PMTCT programme. But, in general,
people still lament the lack of community participation in such
programmes, as well as the specific lack of male involvement.
Clearly, it always takes two to make a pregnancy happen. Women
in Botswana do, however, not always have the control over getting
pregnant. But, as illustrated by the negative attitudes directed towards
women infected with HIV, it is often the case that the blame is placed
solely on women.
‘In this era of HIV, everyone should be responsible. Men who are
impregnating these women are not equally being asked about
engaging in unprotected sex’, argues Mary Motse, a spokesperson for
Bomme Isago Association, a network of women living with HIV and
AIDS in Botswana.
In the midst of the social pressure and a hostile environment faced
by women living with HIV and AIDS, a clear violation of the right to
make a private and freely negotiated decision becomes evident.
Onie argues that while most people have knowledge about how
HIV is transmitted, the issue remains hidden.
When my husband and I decided to get married, my in-laws
begged him not to marry me, an HIV-positive woman. They said
that I would give them AIDS and would never be able to bear
children. They thought I would bring shame upon the family.
Gender Inequalities
As is widely recognised, HIV and AIDS is not only a medical
problem. Only by considering social, economic, political, as well as
cultural factors can the difficulties faced by HIV infected women,
when becoming pregnant, be better understood.
It is a concern when, for example, people start asking childless
24 aLQ – June 2006
…Botswana is … the
first African country
to … implement the
first national
prevention-of-motherto-
child-transmission
(PMTCT) programme
on the continent…
…without … medical intervention,
there is a 25 to 35% risk of a
child … become[ing] infected
during pregnancy, … during
labour and delivery. PMTCT
programmes can reduce the risk
… to as low as 1%…
Reproductive rights
Experiences from Botswana
A
I
couples why do they still not have children. A woman might want to
have children, but is afraid, due to her HIV status and does not want to
disclose her status, because of the stigma attached to the disease. A
married woman may feel a lot of pressure from others if she does not
have any children, because she is expected to have children. And, if she
does not have children, then she is called a ‘moopa’, intended to be
an insult directed towards women who are barren. In Botswana,
women feel a considerable pressure to have children. These are
some of the experiences women living with HIV revealed at the
BONELA workshops.
These women’s anxieties are, in part, a reflection of gender
relations in the Botswana context as they play into HIV infected
women’s ability, or lack thereof, to exercise their reproductive rights.
The choices permitted to individual women are severely limited by
strongly held social and cultural values, as well as various legal
restrictions. For women living with HIV, who are poor or socially
stigmatised – for example, sex workers and women living with
disabilities – it is particularly difficult to make decisions about whether
or not to have children.6
In Botswana, women and girls who live with HIV, face numerous
constraints, including social expectations and gender roles, in claiming
their reproductive choices. Women in Botswana have traditionally been
seen as inferior to men.
Botswana is a patriarchal society. And therefore, women are
subordinate to men and have historically endured various forms
of discrimination and disempowerment on account of their being
women, for example, in access to and control of resources such
as land, cattle, power, education and business opportunities.7
In Botswana, the position of women within the family is generally
one of subordination to their husbands. Social expectations of the role
of women continue to be held most strongly in rural areas. Many
women are expected to remain in the home, serving primarily as
caregivers to children and men. Women are also expected to bear
children. These expectations can affect the ability of women to decide
whether or not to have children. The inequalities between men and
women often translate into disempowerment of women. Because
women are often considered to be inferior, they are unable to
negotiate, or even discuss, sexual and reproductive matters with their
male counterparts.
Botswana has a middle–income country status, but the inequalities
in the distribution of income are amongst the highest in the world.8
This inequality severely affects especially women, because they are
disproportionately working in the informal sector. The combination of
a patriarchal social inheritance and poverty is a particularly ‘deadly’
one for women.9 The specific context of poverty and gender
inequalities also has a great impact on the high infection rates amongst
women in Botswana.
In many relationships, women are
virtually entirely dependent on men for their
economic existence. Women have had
difficulties in gaining access to resources,
such as land, credit, finance, education and
information. The resulting financial and
economic dependency increases the
vulnerability of women to the demands of
men, and, especially their husbands. This
also makes it difficult for many women to
insist on safer sexual practices and to make
choices about their own sexual and
reproductive health.
A directly related effect is the transactional
sexual relationships some young women are
involved in. Age difference and economic
inequalities within sexual relationships are
widespread in Botswana, in that young
women date older men and, in return, they
receive money and other valuables.
Known as ‘sugar daddy’, ‘ghost’ or ‘small
house’ relationships, this exchange of gifts
and financial benefits, which sometimes
includes paying the rent for a flat or buying a
car, often place young women in a position
where they are not able to negotiate the
practice of safer sex. While older men, in
their strategy to attract younger women,
established these forms of transaction, they
also enforce the bargain to get something in
return, often including unprotected sex.
Older men with relative affluence are
more likely to control the conditions of sexual
intercourse, including condom and
contraceptive use, and the infliction of
violence. Young women are not likely to insist
on condom use, partly because of social
norms (differences in power relations and the
perceived lack of need to discuss sexual
relationships) and the economic dependency
established.10 Besides the fact that there is a
high risk of HIV infection, the outcome is
often unintended pregnancy and only a few of
these older men take the responsibilities in
the aftermath.
aLQ – June 2006 25
… if she does not have children,
then she is called a ‘moopa’,
intended to be an insult directed
towards women who are barren.
Reproductive rights
Experiences from Botswana
…the combination of a
patriarchal social
inheritance and
poverty is a
particularly ‘deadly’…
AViolence and abuse
In these relationships and others, domestic
violence sometimes plays a role. Women who
are involved in abusive relationships are often
not in the position to negotiate safer sex with
their partners, which places women at risk of
getting and passing on HIV.
Asking the question as to why it is so
difficult to negotiate condom use with their
partners, many women respond that they are
afraid of being beaten up and suffering other
forms of domestic violence, which includes
physical, emotional and economic abuse. My
partner, they say, would take it as an insult
and as questioning of his faithfulness, if I
asked him to use a condom.
A great number of women experience a
constant threat of rape, sexual assault
and domestic violence. While women
experience this at the community level,
most cases of crime against a woman occur
in intimate relationships. Yet, in many
instances, immediate police assistance,
medical attention, ongoing healthcare,
counselling and support services for
survivors of sexual violence are widely
unvailable or are inaccessible. This includes
effective and accessible post-exposure
prophylaxis (PEP) – medication which may
help reduce the risk of transmission after a
sexual encounter where there is a risk of
HIV infection. Women who experience such
violence in their homes have even less
access to these services. The psychological
and physical trauma of violence is made
even worse by the increased risk of
contracting HIV.
Stigma and discrimination
Women living with HIV experience HIVrelated
social stigma, even more so when
making the decision to become pregnant. Because HIV is a sexually
transmitted disease, there may be certain assumptions about a person
who is tested HIV positive. Even after many years of living with HIV
in societies, individuals living with HIV, and women especially, are
perceived to have a ‘loose lifestyle’ or to be promiscuous.
Stigma creates a great barrier for women infected with HIV to
enrol in PMTCT programmes. If an HIV infected woman enrols, other
people might take notice and this can lead to discrimination from her
social surrounding. Very crucial in this context is the issue of
breastfeeding. The enrolment with the PMTCT programme includes
the choice to formula feed, instead of breastfeeding.
But in Botswana’s society, there is a big social expectation for a
woman to breastfeed her child. If a woman does not do so, she will be
automatically perceived to be living with HIV, and since women are
afraid of stigmatisation and negative assumptions, many women would
try to hide the fact that they formula feed and may even ‘give in’ to
breastfeeding their children, thus, increasing the risk of infecting
the child.
As one of many women in Botswana who live with HIV and whose
children are not infected with HIV, Onie decided to formula feed her
children. From government healthcare facilities, she obtained formula
for free, taking turns with her husband picking up the formula. And,
contrary to the experience above, they always did it out in the open.
She remembers:
I carried the formula openly on the streets, so everyone could see
it … When you try to hide the formula you just contribute to the
stigmatisation. But there is nothing we have to be ashamed of. If
you follow the medical instructions you can have a healthy child.
And that is what your primary concern should be.
Another aspect that fuels the stigmatisation of, and discrimination
against, people living with HIV, is the lack of knowledge on the part of
some healthcare workers. A recent study11 on stigma in Botswana
suggests that, even after so many years into the epidemic, healthcare
workers are still misinformed and lack information on HIV and AIDS.
About half of the nurses questioned in the study reported that they
were fearful of contracting HIV by handling patients. This sort of fear
might be one of the reasons why many patients are treated in a poor
way. No doubt, women who are afraid of being stigmatised by people,
who are meant to care, may not seek information and are prevented of
getting involved in PMTCT programmes.
According to participants of the BONELA workshops, the
counselling women receive in PMTCT programmes is not always
adequate and responsive to their needs. Women also stated that they
feel stigmatised by healthcare workers. In other instances, healthcare
workers have not given women the right information, because they
thought that it was wrong for a woman infected with HIV to have
children. But, if important information is withheld, a woman
cannot consider all the options available and, thus, cannot make an
informed choice.
26 aLQ – June 2006
…most cases of crime against a
woman occur in intimate
relationships…
Reproductive rights
Experiences from Botswana
…my partner, they say,
would take it as an
insult and as
questioning of his
faithfulness, if I asked
him to use a condom…
I
Legislative Framework
In Botswana’s legal system, general law and customary law, which
represents the traditional authorities, are combined. For example,
marriage can be registered under either system. Many believe that both
customary law, as well as national law, privilege men.
Customary law is an instrument guaranteeing male authority,
especially in the rural areas, where customary authority still holds
much sway. But customary law and general law differ in approaches to
certain matters, such as legal age of marriage, property and inheritance
rights. The dual legal system provides for a choice of law depending on
what is easily accessible. The majority of people live in rural,
semi-urban, and urban villages where customary courts are
more accessible.
In December 2004, Botswana’s Parliament passed the Marital
Power Bill, which abolishes the power of men as ‘heads of household’
and ‘sole decision-makers’ in family property and other related issues.
It also protects women’s equitable sharing of joint property upon
separation, divorce or annulment of marriage. But, traditional
authorities argued against the Bill, mainly because they thought it
stood contrary to cultural practices and beliefs. According to
customary law, the traditional role of men is the one of ‘head of
households’ and ‘decision-makers’.12
Because of the differences between general and customary law in
regard to gender equality, it is particularly important that women
understand their legal and constitutional rights. Women need to be in a
position to choose the option which benefits most and that might also
empower women in economic matters, enabling women’s
independence in exercising their rights.
Remaining challenges
Against these challenges, the decision of women to become
pregnant should be reached through open and free negotiation,
irrespective of her HIV status. This is why education around family
planning, HIV, and basic rights are so crucial in responding to the
epidemic in Botswana.
The International Guidelines on Human Rights and HIV/AIDS
state that universally recognised human rights standards should guide
policy makers in formulating the direction and content of HIV and
AIDS related policy. Unquestionably, the right to equality is one of the
fundamental human rights and prejudicial, customary and other
practices that are based on the idea of the inferiority of women are
contrary to the concept of equality. In addition, the right to privacy and
autonomy includes the right to make autonomous decisions about one’s
sexual and reproductive life, and to have the privacy to protect it.
International human rights instruments classify the right to have a
family as one of the fundamental rights. Article 16 of the Universal
Declaration of Human Rights states that:
Women of full age, without any
limitation due to race, nationality or
religion, have the right to marry and to
found a family and the family is the
natural and fundamental group unit of
society and is entitled to protection by
society and the state.
If every person has the right to have a
family, then it follows that hospital services,
as well as family planning centres and other
healthcare facilities should be accessible to
help a woman to make informed choices
about continuing and/or terminating a
pregnancy, irrespective of the woman’s HIV
status. Thus, every woman has the right to
choose whether or not to bear children and
make her own informed choices in all
reproductive matters.
BONELA workshops provided a forum to
discuss ways forward for women living with
HIV to protect their reproductive rights and
advocate for appropriate laws and other
measures that would ensure women’s rights to
bodily integrity, autonomy and reproductive
choice.
Botswana must address its lack of formal
legislation around the topic of HIV and AIDS.
It is argued that government should consider
developing and implementing legislation
specifically pertaining to the protection of the
rights of people living with HIV and AIDS.
To be effective and comprehensive, the new
legislation has to consider the gender aspects
of this epidemic, including issues on marital
rape, domestic violence, and equal
property rights.
While women must be in the position to aLQ – June 2006 27
…half of the nurses questioned in
the study reported that they
were fearful of contracting
HIV by handling patients…
Reproductive rights
Experiences from Botswana
…customary and other
practices that are
based on the idea of
the inferiority of
women are contrary to
the concept of
equality…
S
make informed choices, irrespective of their
HIV status, increasing men’s involvement in
HIV and AIDS strategies may be an equally
useful contribution. In 2006, Botswana had
its first ‘Mr. HIV-Positive’, as a counterpart to
the winner of the three–year old annual ‘Miss
Stigma Free’ pageant. The Men’s Sector – a
national focal group dealing with men’s
issues and behaviour – has been established
and chaired by influential representatives,
such as the Botswana Defence Force in its
first year, and currently the forum is chaired
by the Commissioner of the Botswana
Prison Service.
Some women believe that it would be
helpful to allow men into the maternity wards
at hospitals and to be part of counselling
sessions, as well as pregnancy preparation
classes. This could encourage men to
participate in the process of pregnancy and in
PMTCT programmes. It could be one step
forward to overcome gender prejudices and
stereotypes, which are primarily based on
stereotyped roles for women and men, and as
such a necessity to empower women to
exercise more independent decisions in the
area of reproductive health.
Women, like Onie, who participated in the
workshops, say that a gendered, human
rights-based approach to HIV and AIDS and
reproductive rights issues should also
promote HIV counselling as part of the
family planning programme, which should
include the options for women living with
HIV to bear children. More access to, and
awareness of, PMTCT programmes and its
benefits should also be enforced, especially in
the rural areas.
In addition, access to information about
reproductive and sexual health, as well as
access to healthcare facilities and medication
concerning reproductive health, can increase
the knowledge and modify the attitudes on
sexual and reproductive health issues and, thus, women, irrespective of
their HIV status, will be in the position to make informed choices
about whether or not to have children.
Onie, appropriately, will have the last word on this matter.
Women who plan to have children should go for an HIV test …
but you must not go alone. Encourage your partner to go test with
you. It holds the family together … if you are tested positive, get
enrolled in an ARV programme and PMTCT programme. Then
you can still lead a normal life. Don’t make your status a secret
and don’t be ashamed of your decision to have children … even
though we are HIV-positive, we have the same rights as
everybody else. And if we want to have children, we can have
healthy ones.
REFERENCES
Stegling, C. 2004. ‘Botswana’s HIV/AIDS Programme. A Model for
SADC? From disaster to development?’. In HIV and AIDS in Southern
Africa: Interfund Development Update. Vol. 5, No. 3., pp225 – 244.
FOOTNOTES:
1. Right to bear children. BONELA workshop. Gabarone, Botswana, April 2006; ‘Right to Bear Children of
People Living with HIV/AIDS’ – Kasane. BONELA workshop. February 2006. (Unpublished paper); Meeting
on reproductive rights of PLWHA. BONELA/Bomme Isago/International Community of Women Living with
HIV/AIDS. March 2005. Francistown. (Unpublished paper).
2. UNAIDS. 2005. AIDS Epidemic Update.
3. Stegling, C. 2004. ‘Botswana’s HIV/AIDS Programme. A Model for SADC? From disaster to
development?’ In HIV and AIDS in Southern Africa: Interfund Development Update. Vol. 5, No. 3,
pp225–244.
4. Cited in Stegling (2004).
5. Ministry of Health Botswana 2005: National Guidelines to PMTCT of HIV/AIDS; See also Sunanda, R. et
al. 2002. Parent-To-Child Transmission of HIV. SAfAIDS.
6. Alexander, A. & Mbali, M. 2005. Beyond ‘bitches and prostitutes’: Folding the materiality of gender and
sexuality into rights-based HIV/AIDS interventions. Righting stigma: Exploring rights-based approach to
addressing stigma. pp50–63.
7. Ministry of Finance and Development Planning & UN Botswana as cited in Stegling (2004).
8. Stegling, C. 2004.
9. Msimang, S. & Ekambaram, S. 2004. ‘Moving beyond the public: The challenge of women’s political
organising in the time of AIDS. From disaster to development?’. In HIV and AIDS in Southern Africa:
Interfund Development Update. Vol. 5 No. 3, pp69–89.
10. Luke, N. & Kurz, M. 2002. Cross-generational, and transactional sexual relations in Sub-Saharan
Africa. International Center for Research On Women.
11. Stegling (2004).
12. See also http://databases.sardc.net/books/bots2005/view.php?id=12.
28 aLQ – June 2006 Reproductive rights
Experiences from Botswana
…don’t make your
status a secret and
don’t be ashamed of
your decision to
have children…
Katharina Tangri is the volunteer at the Botswana Network on
Ethics, Law and HIV/AIDS (BONELA). For more information
and/or comments, please contact her on +267 393 2516 or at
katangri@gmx.de.
T
This statement was made by UN Secretary-General Kofi Annan at the
launch of the 2004 Task Force Report on Women & Girls in Southern
Africa. In many ways this was a watershed report, marking the realisation
in organisations, such as the UN, international donor agencies and
NGOs, and governments that efforts to slow the rapid rates of HIV
transmission in the region had, thus far, been directed at the symptoms,
rather than the deeper social malaise of systematic disregard of the rights
of women and girls. While it had been generally recognised for years that
gender inequalities underlie and drive the HIV and AIDS epidemic in
sub-Saharan Africa, there was a lack of gender analysis in developing
national and community prevention strategies and implementation of
responses. This deficiency helped to ensure the relentless spread of
the epidemic and its disproportionate impact on the region’s women
and girls.1
There are signs that we may be starting to get things right. A
growing number of decision makers in Southern Africa are at last
acknowledging the need for Dr. Annan’s ‘deep social revolution’ and
are preparing to commit themselves to engaging with the real
underlying drivers of HIV and AIDS in this part of the world.
In April 2006, the United Nations, together with the African Union,
declared a ‘Year of Acceleration of HIV Prevention’. During this time,
key role players are being called upon to closely analyse the evidence
on drivers of the epidemic in their particular part of the continent and
to develop innovative action plans guaranteeing that the next decade of
HIV prevention is not a sorry replication of business as usual. The
Southern Africa region, through the Southern Africa Development
Community (SADC) Secretariat, responded to this call by requesting
UNAIDS to organise an ‘Expert Think-Tank Meeting’ on HIV
prevention. This meeting took place over several days in Maseru,
Lesotho in May 2006. Out of genuine concern for the continued high
incidence and prevalence of HIV in the region, known as the epicentre
of the global HIV and AIDS epidemic, the meeting drew together a
team of experts from UNAIDS, UNFPA, WHO, UNICEF, SIDA,
USAID, members of regional national AIDS councils, HIV and AIDS
Desk personnel from SADC, and several local HIV and AIDS
researchers and resource people.
I was privileged to be invited as a member
of the latter group. My brief was to give a
summary analysis of common patterns of
sexual networking and intergenerational sex
in the region and to make recommendations
for existing or new approaches to addressing
these drivers of HIV. It was a refreshing
opportunity for me to be amongst likeminded
individuals who were familiar with
the research evidence on the nature of highrisk
behaviours in the region, and were not
there to score political points or argue about
historical misrepresentations. The majority of
participants at this ‘think-tank’ meeting
shared a basic assumption that the key to
preventing the spread of HIV, especially in
epidemics driven mainly by heterosexual
transmission, is through changing sexual
behaviour. In the context of Southern Africa,
that means placing a major focus on the
reduction of casual sex and concurrent
multiple sexual partnerships.
PRIMARY AND
SECONDARY DRIVERS
The think-tank participants agreed that a
‘lethal cocktail’ which combined a particular
socio-cultural factor with a particular
biological factor was the primary driving
force behind the exceedingly high rates of
HIV and AIDS in the sub-region. The
socio-cultural factor was identified as the
high level of concurrent multiple partnerships
by men and women, together with the
biological factor of low rates of male
circumcision. Supporting and sustaining
these twinned drivers are the secondary
drivers of high levels of viral STIs (e.g.
Herpes simplex-2) on the biological side2, and
aLQ – June 2006 29
What really drives HIV and
AIDS in Southern Africa
Across all levels of society, we need to see a deep social revolution that transforms
relationships between women and men, so that women will be able to take greater
control of their lives – financially as well as physically. [Kofi Annan, 2004]
Suzanne Leclerc-Madlala
What really drives HIV and AIDS
I
the socio-cultural driver of entrenched norms
that uphold male privilege and allow for
unfaithfulness in relationships (most
especially for men), gender-based violence,
intergenerational and transactional sex, along
with stigma and non-openness about sexuality
and the epidemic. Both the primary and
secondary drivers are further supported and
sustained by another level of drivers that
are structural in nature. These include
growing wealth differentials, high mobility
and migrancy, and high levels of poverty
and sexual violence throughout the
SADC countries.
Concurrent multiple sexual partners
It is well accepted that people in Africa or
Southern Africa in particular, are not any
more or any less sexually active, than people
in other parts of the world. In terms of
numbers of sexual partners over a period of
time, the local population is quite average.
What is unique, however, and what is now
understood to be the ‘engine’ behind the
epidemic, is the pattern of concurrency
whereby a person maintains a sexual
partnership with more that one person
concurrently. Because of the high risk of HIV
transmission during the initial acute stage of
infection, concurrent multiple partnerships
act to disseminate the infection through
complex and inclusive sexual networks.3 This
sexual partnership pattern can be contrasted
with the pattern of serial monogamy that prevails in other parts of the
world for example. HIV infection transmitted in a serial monogamous
arrangement would tend to be ‘trapped’ between two individuals over
months or even years perhaps, and, therefore, its spread would be
contained and limited. It is this common pattern of concurrent multiple
partnerships in the sub-region that has propelled, and continues to
propel HIV throughout urban areas and into rural hinterlands.
Although, condom usage could potentially negate the effects of
this sexual partnering pattern, experience from years of efforts in
advocating correct and consistent use of this preventive method
strongly suggest that condom usage is not likely to increase enough
in the future to make any significant difference4. UNAIDS estimates
only 19% condom coverage in sub-Saharan Africa overall in 2004. If
one accepts the idea that the required high rates of consistent and
correct use of condoms in the sub-region will never be achieved, then
the need to explore other options and strategies to limit HIV
transmission becomes a matter of urgency.
In concentrated epidemics, such as those that once raged in San
Francisco and Thailand, where infection was primarily limited to
specific high-risk groups (homosexuals and commercial sex-workers
respectively) condom promotion was an effective preventive strategy
and HIV declines have been attributed to high levels of condom usage.
In the context of a highly generalised epidemic, such as exists in
Southern Africa, where high-risk groups are no longer the main
epidemic drivers and longer-term concurrent partnerships are
widespread, condom promotion has had very limited success. Strong
socio-cultural ideologies militate against condom use in medium to
long-term relationships. In many places, marriage is women’s primary
risk factor, with 60-80% of HIV positive tested women in the subregion
reported to have had sexual relations only with their husbands.5
Female condoms have yet to be sufficiently programmed to judge their
impact, and microbicides are unlikely to be widely available before
2010. After several years of often heated debate over the reasons for
HIV incidence declines in Uganda, Kenya and more recently Zimbabwe,
there is now a general consensus that reduction of concurrent multiple
partners was the most extensive contributing factor.6
Male circumcision
Compounding the negative effect of rapid growth in HIV
transmission, resulting from the normative pattern of sexual
30 aLQ – June 2006 What really drives HIV and AIDS
…participants agreed that a ‘lethal
cocktail’ … a particular sociocultural
factor with a particular
biological factor was the primary
driving force behind the
exceedingly high rates of HIV…
…it was a refreshing
opportunity … to be
amongst like-minded
individuals who were
familiar with … highrisk
behaviours … and
… not there to score
political points or
argue about historical
misrepresentations…
P
partnering, is the fact that levels of male circumcision are extremely
low throughout Southern Africa. There is compelling evidence that
male circumcision in itself is protective.7 While we are awaiting the
results of two large studies on the correlation between circumcision
and HIV transmission, SADC countries have been advised to develop
a ‘male circumcision preparedness plan’ in the meantime. With a
recent local randomised controlled trial in Orange Farm, South Africa,
which was stopped early due to the striking finding that male
circumcision had a 60-75% protective impact, it is likely that this onceoff
intervention that confers lifelong reduced risk of HIV will be a
major part of a new generation ‘roll-out’ throughout the sub-region.
Sexual violence
It is estimated that about 30% of the population in the sub-region
has experienced forced sex before the age of 18.8 Extensive studies in
the region demonstrate that survivors of violence have a higher
likelihood of many risk factors, such as engagement in anal sex,
intergenerational, as well as transactional sex, and higher HIV
prevalence rates. In addition, survivors of violence are more likely to
become perpetrators themselves, even as young people. One South
African clinic that deals with cases of child sexual abuse has reported
that some 25% of the offenders are children under the age of 14.9
Sexual violence is linked to a culture of violence that involves negative
attitudes and reduced capacity or disinclination to make positive
decisions, or respond appropriately, to HIV prevention campaigns
(e.g., wilful intent to spread HIV). Therefore, reducing sexual violence
at all levels of society would no doubt contribute to HIV reduction.
Intergenerational sex
Much like the pattern of concurrent multiple sexual partnering,
intergenerational sex (with age disparities of 5 years or more) are
common throughout the sub-region. Studies indicate that economic
transfers are the normative expectation in these and most other nonmarried
relationships, and that there is a direct inverse relationship
between the wider age gap and/or larger economic transfer and the
likelihood of safer sex practices. Globalisation and the growth of
consumer capitalism are adding a new dimension to transactional sex,
as a key survival strategy for many of the sub-region’s poor women.
Sexual exchange for food and clothes is increasingly being replaced by
exchanges of cell phones and i-pods.10
Stereotypically wealthy ‘sugar daddies’ are
only part of the problem, impoverished men
also engage in intergenerational sex with their
offers of comfort, cool drink and packets of
chips. Where the balance of power is so
deeply entrenched in favour of men, as is the
case in Southern Africa, differences in
age and economic status often result in
severe life-or-death implications for women
and girls.
WHERE DO WE GO FROM
HERE?
As the purpose of the think-tank meeting
was to systematically review the evidence and
make recommendations for possible
exceptional and immediate action, the final
day was spent on developing a way forward to
include a proposal of three key priority
interventions. These included the following
recommendations:
1. Significantly reduce multiple,
concurrent partnerships for both men and
women. Explore possibilities for mass
campaigns or social movements with strong
political, religious and community leadership
(both top down and bottom up) and
endorsed by the mass media to stigmatise
and discourage multiple partnerships as a
threat to individual and public health.
2. Prepare for potential national roll-out of
male circumcision through acceptability,
feasibility and costing studies depending on
the readiness of individual countries, and/or
on the outcome of the Kenya and Uganda
randomised controlled trials of male
circumcision. Male circumcision should be
embedded within a broader context of aLQ – June 2006 31
What really drives HIV and AIDS
…what is unique…
is the pattern of
concurrency …
whereby a person
maintains a sexual
partnership with more
that one person
concurrently…
…the socio-cultural factor …
the high level of concurrent
multiple partnerships … with the
biological factor of low rates of
male circumcision…
T strengthening male sexual and reproductive
health: STI treatment, condom use, and
counselling and testing for HIV.
3. Address gender inequalities especially
from the perspective of male involvement
and responsibility for sexual and
reproductive health and HIV prevention and
support. The specific objective should be to
reduce multiple, concurrent partnerships,
intergenerational/age-disparate sex and
sexual violence through multiple channels,
including those noted for (1) above.
CAN WE DO IT?
To have issues of gender and the role and
responsibility of men in this epidemic
squarely placed at the top of the agenda for
HIV prevention, is, from my perspective as
someone long arguing for a gendered
approach to this insidious disease, nothing
short of revolutionary. For the first time, I feel
hopeful that a more effective and relevant
strategy against HIV and AIDS is possible.
Now, at least, there is real acknowledgement
that the focus of our prevention attentions
should be primarily men. For a whole host of
reasons that are no doubt linked to deepseated
ways of thinking and doing in Southern Africa that endorse
male dominance and foster female vulnerability, most of the past two
decades of the HIV and AIDS epidemic were spent focusing the
attentions on women. Tremendous efforts and resources have gone into
programmes hoping to empower women to negotiate safer sex, to insist
on condom use, to increase women’s self-esteem, their financial
independence, their sense of self-efficacy, and more lately to enhance
their abilities to care for the sick, dying and orphaned. Finally, we have
come to realise that the failure to focus on men and to engage men in
interventions has allowed this virus to reproduce like wildfire across
the Southern African landscape.
There is wide agreement that many of the existing interventions
and initiatives need to be sustained and in some cases scaled-up (i.e.,
promotion of delayed sexual debut for youth, better access to condoms
both male and female, voluntary testing and counselling, treatment of
bacterial STIs, and the further development of microbicides and
vaccines). Yet, it is clear that none of these interventions are likely to
be as effective in arresting the spread of HIV as community-driven and
community-monitored behavioural change efforts that address the
main vectors and primary drivers of our local HIV and AIDS epidemic.
FOOTNOTES:
1. According to the UN Task Force Report on Women and Girls in Southern Africa (2004), women and girls
account for 57% of people living with HIV and AIDS in the region. The impact is greatest amongst females
aged 15-24 who are three to six times more likely to be infected than young men of the same age.
2. There is growing evidence that individuals with Herpes simplex virus-2 (HSV-2) have increased risk of
acquiring HIV and of transmitting HIV to others. Thus far efforts of syndromic management of STIs have
focused on bacterial infections. Randomised controlled trials on the relationship between viral STIs and HIV
are currently underway. See Ndowa, F. 2006. Impact of Treatment of Sexually Transmitted Infections on HIV
Transmission. WHO report presented at Expert Think-Tank HIV Prevention Meeting. Maseru, Lesotho.
10-12 May.
3. Halperin D. & Epstein H. 2004. Concurrent sexual partnerships help to explain Africa’s high HIV
prevalence: Implications for prevention. In Lancet 364:1913-1915.
4. Hearst, N. & Chen S. 2004. Condom promotion for AIDS prevention in the developing world: Is it
working? In Studies in Family Planning 35:39-47.
5. UNAIDS & UNFPA 2004. Women and HIV/AIDS: Confronting the Crisis. Geneva: United Nations.
6. Hayes, R. & Weiss, H. 2006. Understanding HIV epidemic trends in Africa. In Science 311: 620-621.
7. Wilson, D. & de Beyer, J. 2006. Male circumcision: Evidence and implications. Washington: World Bank.
8. Andersson, N. 2006. Gender-Based Violence. CIET report presented at Expert Think-Tank Prevention
Meeting. Maseru, Lesotho 10-12 May.
9. Smith, C. 2004. Powerful without Authority: Sexual violence in South Africa. In HSRC Report.
Johannesburg; HSRC.
10. Leclerc-Madlala, S. 2003. Transactional sex and the Pursuit of Modernity. In Social Dynamics
29(2):213-233.
32 aLQ – June 2006
… the failure to focus
on men and to engage
men in interventions
has allowed this
virus to reproduce
like wildfire…
What really drives HIV and AIDS
Suzanne Leclerc-Madlala is the Head of Anthropology at the
Howard College Campus at the University of KwaZulu Natal.
For more information and/or comments, please contact her on
+27 31 260 2387 or at leclercmadlals@ukzn.ac.za.
…marriage is women’s
primary risk factor,
with 60-80% of HIV
positive tested women
…have had sexual
relations only with
their husbands…
S
More than twenty years into the HIV epidemic, an assumption can be
made that generally, there is abundant knowledge about HIV and AIDS
infection, transmission and prevention. However, this knowledge is
undermined by the interplay of the social, economic, cultural and
biological factors that create a barrier to behaviour modification. This
paper looks at factors that can be said to drive the HIV and AIDS
epidemic, focusing on the context of violence within which the epidemic
exists in South Africa. The violence is historical, but also takes place at
the level of intimate relationships, family, communities and institutions.1
South Africa has high infection rates which, are said to be directly
linked to the many reports of violence against women in all sectors of
society, including infant rape in recent years, coupled with neglect of
women’s sexuality. However, interventions have not necessarily
focused on gender-based violence in the same way that gender
inequality and oppression did not take prominence in the mainstream
discourse and politics of struggle against apartheid. The emphasis was
on fighting the enemy as a collective force, while the patriarchal status
quo remained intact. It was also reported that as late as 1997, the issue
of women, gender and AIDS was said to be invisible in the AIDS
reviews at national or provincial level. Progress was made however in
1998, when national training of gender trainers was initiated.2
The United Nations Commission on the Status of Women defines,
in Article 1, violence against women as
…any gender-based act which results in or is likely to result in
physical, psychological or sexual harm of women, including
threats of such acts, coercion or arbitrary deprivations of
liberty, whether occurring in public or private life.
Gender-based violence, which includes rape, domestic violence,
mutilation, murder and sexual abuse, has been identified as a profound
health problem, particularly in the age of the acute health crisis – the
HIV and AIDS epidemic3. In South Africa, as elsewhere in the world,
sexual violence ‘constitutes one of the main threats to the mental and
physical integrity of women and children’ [Ford, 2003].
Brief overview of violence in the 70’s and 80’s
In the 1980’s a phenomenon called ‘jackrolling’, where especially
young women were abducted, gang raped at gunpoint by young males
was prevalent. This was done in public, displaying a sense of
entitlement on the sexuality of girls and women.
State sanctioned violence was also common occurrence, including
military strikes, which were carried out by the
then apartheid government in the front line
states, such as Lesotho, Botswana,
Mozambique, Swaziland, Namibia (then
South West Africa) and Zimbabwe. If it was
not military strikes it was providing guns to
militia groups in Mozambique, Namibia
and Lesotho to fight against the
liberation movement.
There were reports during the Truth and
Reconciliation Commission (TRC) hearings
that it was common practice for Special
Branch Police to use the combination of
physical and sexual torture on women during
detention, including rape. It was interesting,
however, that indeed not many men reported
any experiences of rape, which could be a
reflection of a hegemonic form of masculinity
that expects men to be brave, strong and
not show any emotions. (One could ask
the question how then men deal with
traumatic experiences.)
During the run up to the first democratic
elections, South African townships,
especially the East Rand (where some of the
research was carried out) were turned into a
‘war zone’. Thousands of people were killed
in a conflict which was said to be between
Inkatha Freedom Party (IFP) and the African
National Congress (ANC), though there were
contradicting reports of a third force which
was funded by the apartheid government.
Violence post apartheid
After 1994, change was inevitable for all
South Africans at all levels and in very
different ways. There were expectations,
particularly from most black South Africans,
of equal opportunities and tangible changes.
A constitution, which has been hailed as
one of the most progressive in the world, was
put in place. Work was done to put sound
policy frameworks in place, including the aLQ – June 2006 33
Gender and power relations
HIV and AIDS, gender and power relations:
A context of violence
Rakgadi Mohlahlane
CCommission on Gender Equality (CGE),
whose mandate is to monitor, research,
protect and promote gender equality. There
was a clear shift in the traditional role of
women in society; women were more visible
in government, in commerce and education.
Parallel to all these changes, there is an
almost 50% unemployment rate, affecting
mainly black males, which brought
insecurities and resentment, often expressed
within intimate relationships. A member of a
group called Supporting Unemployed Men
argued that
…unemployed men should not allow
their women to go out and work because
when we (men) are at home and the
women say they are going out to work,
they are simply going to sell their
bodies and support their families with
prostitution money, the men are in
danger of being infected by their
female partners.4
A few observations from this statement:
there is a sense of hopelessness, blaming
women for spreading HIV, and also a sense of
entitlement and ownership of women’s
sexuality. What is rather disturbing is that
there is quite a large constituency of males,
who think and feel the same way.
South Africa is said to be a ‘rape prone
society’. Statistics indicate that:
• In 2001, 21,000 child rapes, and some
37,000 adult rapes, were reported in
South Africa. According to the South
African Police Service, only one in 35
rapes are actually reported.5
• There were 52,000 reported rapes from April 2002 to April
2003. Police estimated that perhaps one in eight assaults is
actually brought to their attention. Of the people arrested for
rape, 45% tested positive for HIV.
• There are reports of violence, in some cases death, directed at
women who disclose their HIV positive status. In 2002, a case of
a young AIDS activist Lorna Mlofana, 21, who was gang raped
and killed after she disclosed her HIV positive status is poignant.
The perpetrators were all young men ranging from age 14 to 21.6
• In 2000, 43% of rape cases brought to the attention of Child
Line were committed by people under the age of 18.7
• In another report, a four year old girl was raped by her 14 year
old cousin and his 12 year old friend. In the same report, an 8
year old boy stabbed his 10 year old brother to death; the two had
an argument.8
In a study9, that looked at HIV and AIDS and trauma amongst
abused women, and the type of violence experienced, it was found that
the women experienced violence at two levels; a ‘localised’ level of
intimate relationship, family and community, and a more ‘structural
level’ of external revictimisation within the healthcare and justice
delivery system.
At the level of intimate relationships, the violence experienced by
the women includes extreme forms of physical and emotional violence,
which fits in with what (Johnson, 1995), describes as ‘patriarchal
terrorism’, as opposed to common couple violence. In contrast,
‘patriarchal terrorism’ tends to be perpetrated by men toward women,
shows a pattern of escalation in frequency and severity over time, and
includes not only physical violence, but also ‘economic subordination,
threats, isolation, and other control tactics’, and ‘is rooted deeply in
the patriarchal traditions of the Western family’ [Johnson, 1995:284]
Some of the statements of the women include:
• ‘My husband came out of prison and shot me, I have bullets
lodged in my body…’
• ‘My husband, who is a policeman, used to beat me up so much
my son would find me in a pool of blood…’
• ‘I was gang raped by a group of unknown men who broke into
our house; my husband blamed me for the incident…’
• ‘I was raped by my father’s friend (I think my father knew),
when I was twelve, I went to the priest to get help, he raped me
repeatedly until I decided to run away from home…’
There were also mentioning of implicit/unspoken ‘rules’ and 34 aLQ – June 2006
…unspoken ‘rules’ … around
sex that … violence is often
justified as ‘culture’…
…there is a sense of
hopelessness, blaming
women for spreading
HIV, and also a sense
of entitlement and
ownership of women’s
sexuality…
Gender and power relations
S
values around sex that create another form of violence that
revictimises survivors within families and communities; this form of
violence is often justified as ‘culture’. These cultural dictates and
traditional practices endanger both the survivor and the perpetrator,
particularly within the context of HIV and AIDS. These ‘rules’ and
values include that:
• Socialisation into sexuality is characterised by fear or modesty,
moral or religious judgment. It is considered inappropriate for
women to initiate discussion around sex and express their
pleasure related to sex. A woman who contradicts these ‘rules’ is
looked at as being ‘loose’, a ‘slut’ (‘letekatse’, ‘sefebe’)10 and as
a potential carrier of sexually transmitted diseases, including
HIV and AIDS.
• STI’s are transmitted by women.
• Women who have abortions are dangerous as they are carriers
of dirty blood that can infect men during sexual contact.
• Men are inherently knowledgeable about sex, they can
initiate sex.
Related to the above points is the naming of sexual organs
implying concepts of male = power and female = objects. The vagina
is called ‘kuku’, ‘koek’ which, when translated, means ‘cake’,
obviously something that one eats. The penis is commonly known
across most languages as ‘induku’ or ‘molamu’ and ‘pipi’. ‘Induku’ or
‘molamu’ refer to ‘sticks’, which are used in fighting and to inflict
pain, but also representing power and authority. In the era of AIDS, one
could argue that this type of language can powerfully influence male
perceptions to see a penis as being powerful to a point of being
immune to diseases, including HIV and AIDS.
It is within the family and community that the women suffered a
triple form of stigmatisation because of their HIV positive status, for
trying to leave the abusive partner and move to a shelter, and for
bringing the virus into the family.
Structural revictimisation: Justice delivery system11
In dealing with abuse one cannot avoid the role of the justice
system, with the police being the first port of call for most women.
However, many women reported that accessing justice was difficult,
particularly after a traumatic experience, such as rape. In addition to
the direct trauma of such a crime, a survivor must undergo the
harassment that has come to be associated with the law enforcement
agencies, and the medical and legal machinery in the course
towards justice.12
Examples of police revictimisation as
expressed by the women include:
• The police would encourage the
women to go and resolve the problem
with their abusive spouses or the
in-laws (‘bo mmatsale’).
• The police took sides with the
perpetrators by asking the question:
‘what did you do to the person’ (your
partner, the stranger who raped you etc).
This attitude often rendered the survivor
a possible liar and/or devalued
the person.
• Some women were told by the clerks
at the Maintenance Court to go and find
jobs and stop harassing their
husbands/partners for money.
• Magistrates openly sided with the
perpetrator by questioning the woman’s
credibility.
• Lack of understanding of the legal
process involved in child maintenance,
although there is a sound policy
framework in place.
Revictimisation within the health
delivery system
There is no question that the HIV and
AIDS epidemic has imposed new challenges
on all human institutions, particularly health
aLQ – June 2006 35
…language can powerfully
influence male perceptions to see a
penis as being powerful to a point
of being immune to diseases…
…perhaps the biggest
challenge on the
medical fraternity is
the absence of a
‘cure’ for AIDS,
considering a culture
where prescribing
medicine and
providing ‘cures’ for
illnesses is a big part
of medical practice…
Gender and power relations
S sectors, in most Sub Saharan countries. It has
been widely reported that health personnel in
these countries are over-stretched. Perhaps
the biggest challenge on the medical
fraternity is the absence of a ‘cure’ for AIDS,
considering a culture where prescribing
medicine and providing ‘cures’ for illnesses
is a big part of medical practice.
In terms of sexual violence, as argued by
D’Souza [1998]:
…the emphasis at the medical facility is
on collection of forensic evidence. Scant
attention is paid to the emergency and
long-term medical and psycho-social
needs of the woman.
Treatment and advice for sexually
transmitted diseases and pregnancy takes
second place. Often these aspects of medical
care are completely overlooked. The
examination of survivors of alleged sexual
offences is one of the most difficult tasks in
forensic medicine. The danger of allowing
true offences to go unpunished as well as the
injustice of wrong convictions make the
responsibility of the examining physician
very heavy.13
Whether or not these factors contribute to
some of the challenges in dealing with the
epidemic is a question that could be
interrogated and researched further. What is
clear, however, is that healthcare providers
(nurses, doctors) have a lot of power over
patients, and for many years, the practice is
that patients do not question their doctor
or nurse.
Some of the experiences of the participants in dealing with the
health system included:
• Isolation of women who were diagnosed with HIV in the
maternity or labour wards. This approach was in many ways a
forced disclosure, but most importantly it stigmatised HIV
positive tested people in the hospital or clinic.
• Giving away people’s HIV status to third parties without their
consent, testing without counselling, as well as providing results
in public and without post counselling. A poignant example was
of a patient, who nearly killed herself with rat poisoning, after
she was told by a health worker that ‘my girl you are going to die,
just know that you are going to die anytime, you’re in big
trouble’.14 This statement was supposed to be her blood test
results; she said she guessed that her HIV test results were positive.
• Diagnosis without a blood test. One of the participants
reported that a doctor told her that she was HIV positive without
giving her a test; she had been losing a lot of weight but she did
not understand why.
• Healthcare providers failing to help a rape survivor, who did
not want to keep the pregnancy after the rape.
These case studies are a clear indication that ‘gender-based
violence is not only about interpersonal relationships but is also
reinforced by laws, institutional structures, oppressive customs’ [Wood
& Roche, 2001:584]. It is important for interventions, or any strategies
on HIV and AIDS, to pay attention to external oppressive
conditions and help deconstruct oppressive self-stories internalised by
the survivor, to engage in radical listening and not see the person as
a problem.15
Carlson (2000)16 points out that these structures can ‘thwart’ a
person’s coping efforts. Furthermore, the dignity and personhood of
survivors of gender-based violence is taken away. Kidd et al [1998:73]
argues that:
…even though there is no omnibus definition of personhood,
there is no doubt that both the indigenous and the liberal legal
forms confer upon women in a variety of situations the status of
social and legal minors thereby diminishing their autonomy and
capabilities as persons.
The context of violence does seem to paint a ‘grim picture’ for
gender relations in South Africa. It gives a sense of a polarised
environment of ‘men as perpetrators’ and ‘women as helpless victims’.
This position has indeed received a lot of attention in the arena of
public debates on gender and received strong counter arguments
pointing out, that this approach is limited for a number of reasons,
including the way society defines, and links, concepts of gender,
masculinity, femininity, sexuality and HIV and AIDS.17
Conclusion
In summary, I will raise a few questions, as well as offer a few
thoughts regarding the remaining challenges.
An expanded approach should not only address gender ideologies
and patterned relations, but also the structural context (barriers) versus 36 aLQ – June 2006
…the context of
violence does seem to
paint a ‘grim picture’
for gender relations …
a sense of a polarised
environment of ‘men
as perpetrators’ and
‘women as helpless
victims’…
Gender and power relations
R
policies or laws that affect people at high risk of infection, especially
vulnerable and marginalised groups. Placing women within the HIV
and AIDS crisis is important in exploring, as well as understanding, the
implication of gendered power relations and how men are
‘endangered’ by certain ideologies of masculinity, with regards to
prevention and the spread of HIV and AIDS.
Some pertinent question in dealing with violence should include:
how can societies foster identity formation that rejects violence and
aggression in men; what is the roles of mothers and fathers,
particularly the role of heterosexual women, in recasting male
identities. Snider (1998)18 argues in this context that both
mothers and fathers, worry about their sons being ‘sissies’ or ‘wimps’
and subsequently may send mixed messages, when it comes to
aggressive behaviour, such as bullying.
In addition, questions could be raised as to the role of communities
in the occurrence and response to gender-based violence, including
infant rape; as well as whether or not communities perceive violence
solely as a problem of the criminal justice system, or as a problem that
can also be addressed by communities.
Rather than develop programmes that teach women to protect
themselves from men, interventions should strive to work with men to
understand and prevent violence, and to understand masculinities as a
key component in addressing gender, HIV and AIDS and unequal
power relations. There is much to learn from programmes that seek to
challenge and address gender roles and create more gender equitable
relations, in which society’s attitudes and behaviour in relation to sex
is mutually respectful. Working with perpetrators would be one of the
options for offering support to women, since, as one woman
pointed out:
…we (women) have been learning about HIV since it started but
no one is teaching our men, it does not help us.
REFERENCES
D’Souza, L. 1998. Collection of medical and forensic evidence, medical
treatment and psycho-social rehabilitation: A manual and evidence kit for
the examining physician. Mumbai: CEHAT (Centre for Enquiry into Health
& Allied Themes).
Ford, C. J. 2003. ‘Infant rape and the deconstruction of predatory and
impulsive masculinity’. Paper presented at the IASSCS International
Conference: Sex and Secrecy, 22 – 25 June, Johannesburg.
www.amnita.co.uk/princesstrust/infant-rape.htm.
Johnson, M. P. 1995. ‘Patriarchal terrorism and
common couple violence: Two forms of
violence against women’. In Journal of Marriage
and the Family,. 57, pp283-294.
Kidd, P.E. et al. 1998. Botswana families and
women’s rights in a changing environment.
Botswana: Women in Law in Southern Africa
research Trust (WLSA). Botswana: Lightbooks
Publishers.
Wood, G.G. & Roche, S.E. 2001. ‘Situations
and Representations: Feminist practice with
survivors of violence’. In Families in Society:
The Journal of Contemporary Human Services,
Volume 82, Issue 6, pp583-591.
FOOTNOTES:
1. The paper draws primarily from a study that worked with abused
women in the area of Gauteng; an action research that examined the
impact of a rights-based approach to HIV and AIDS at a local level.
2. See also Agenda; ‘Counting the Costs’. 1998. Issue 39.
3. D’Souza (1998).
4. Participant at the Centre for the Study of AIDS University of Pretoria
AIDS Forum Seminar, held in 2004.
5. Earl-Taylor, M. 2002. ‘HIV/AIDS, the stats, the virgin cure
and infant rape’. In Science in Africa, April 2002.
www.scienceinafrica.co.za/2002/april/virgin.htm.
6. ‘Aids murder suspect in court’. 12 January 2004.
www.news24.com/News24/South_Africa/News.
7. Children’s Institute. November 2003. Rapid Assessment: The
situation of Children in South Africa. Children’s Institute: University
of Cape Town
8. ThisDay. February 2004.
9. Collaborative Research Project: Department of
Psychology/Psychiatry and Epidemiology and Public Health at Yale
University; Centre for the Study of AIDS (CSA), University of Pretoria;
and People Opposing Women Abuse (POWA), an NGO that provides
training and support services to women who have experienced sexual
abuse and violence.
10. These are strong Sesotho terms, whose equivalent in English would
be ‘whore’, but more than that the terms are stigmatising and can
isolate women who are named as such from mainstream society.
11. Justice delivery system includes services provided by the police,
courts and the social welfare system.
12. D’Souza (1998).
14. Focus group discussion with people living with HIV and AIDS;
Centre for the Study of AIDS, University of Pretoria: A study to
examine the impact of a rights-based approach to HIV and AIDS at a
local level.
15. Wood & Roche (2001).
16. Carlson, B.E. 2000. Children exposed to intimate partner violence:
research finding and implications for intervention. In Trauma, Violence
and Abuse. 1(4), pp321-340.
17. For more information on emerging discourses on masculinity see
Rao Gupta, G. 2002. ‘Gender, sexuality and HIV/AIDS: The what, the
why and the how’. Plenary Address at the XII International AIDS
Conference in Durban, South Africa. 12 July.; Morell, R. 2001.
Changing men in Southern Africa. London: Zed Books; and Ford
(2003).
18. Snider, L. 1998. ‘Towards Safer Societies: Punishment,
masculinities and violence against women’. In British Journal of
Criminology, 38, Winter.
aLQ – June 2006 37
…rather than develop programmes
that teach women to protect
themselves from men, interventions
should strive to work with men to
understand and prevent violence…
Rakgadi Mohlahlane is the Project
Manager of the Siyam’kela Project at
the Centre for the Study of AIDS at the
University of Pretoria. For more
information and/or comments, please
contact her on +27 12 420 4411 or at
rakgadip@up.ac.za.
Gender and power relations
I
DEFINING HUMAN RIGHTS
AND DISCRIMINATION
Human rights are based on respect for
the dignity and worth of each and every
human being, both as individuals and
as members of society as a whole.
Human rights capture those qualities of
life to which everyone is entitled,
regardless of their age, gender, race,
religion, nationality, or any other factor.
The responsibility for making sure that
rights are respected, protected and
fulfilled lies primarily with the state, in
the form of the national government.
But it also has implications for all
elements of society from the level of
international institutions, through to
individuals in the family and community.
[Child Rights Programming, 2005:12]
In other words, human rights are a set of
values that in their most basic form set out
how a person should be treated, and, treat
others. And this is not merely an obligation
for the national government and its
representatives, but also an obligation for any
individual and interpersonal behaviour.
Section 9 of the Constitution1, therefore, states
that neither the state (Section 9(3)) nor a person
(Section 9(4)) may unfairly discriminate
directly or indirectly against anyone, thus, no
one has the right to discriminate against
another person or group of people.
It is important to note that the nondiscrimination
provisions are contained within
the clause on equality. One interpretation of
this is that equality is non-discrimination, and
that non-discrimination, therefore, means
treating each person with the same and/or
equal respect, regardless of any differences
that may exist between people. Hence, it
could be argued that discrimination is treating
people differently based on real and/or perceived differences, which
are often based not on facts, but on judgements and/or stereotypes of
these differences.
DISCRIMINATION REALITIES
Discrimination is not merely treating people differently.
Discrimination manifests itself in behaviour, ranging from indirect to
direct exclusion of people; in the inability to access services, because
of service providers’ prejudices2; in hate speech, as well as derogatory
and exclusionary language, such as ‘those AIDS people’. And, in some
cases, discrimination leads to violent behaviour.
Discrimination is also based on stereotypes and/or judgements, and
it often occurs on the basis of a perceived difference, rather than a real
one. Wetherall [1996:189] argues that
…the problem with stereotypes is their partial, biased and
inadequate nature…pictures or fictions people carry in their
heads which distort or muddy their perception of reality.
An example of this would be the assumption that thin or skinny
people must be infected with HIV, which may result in discrimination
based on an incorrect assumption.
Discrimination is often portrayed in language and the way that
various groups of people or individuals are spoken about. Van Dyk
[2001:95] states:
While saying ‘He caught AIDS’, as opposed to ‘He has AIDS’
may mean the same thing; the first sentence is loaded with
negative meanings that betray the implicit attitudes of the
speaker. (Such a negative meaning may be that AIDS is
something over which we (the innocent) have no control,
something that we ‘catch’ from ‘them’ – the contaminated
out-group.) People often say ‘He is HIV’ instead of ‘He is HIV
positive’ or ‘He is infected with the HI virus’. A sentence that is
constructed like this implies an identity with the virus, i.e. the
person is the virus, instead of the person.
Gender-based violence and violence against people living
with HIV and AIDS are only two of the examples of violence based
on discrimination, some of which lead to murder.3 The consequences
of belonging to a vulnerable and/or marginalised group, who are
often subjected to discrimination, can be dire. While this article
focuses primarily on the context of HIV and AIDS, it is important to
recognise that discrimination persists based on a variety of factors
including HIV and AIDS, gender, race, age, sex, sexual orientation,
class, job, status, nationality – to name but a few. 38 aLQ – June 2006
Excuses, Excuses, Excuses…
A facilitator’s reflection on discrimination
Human rights in South Africa are constitutionally guaranteed and said to govern
not only legislation, but behaviour too. Yet, the principles of the Constitution
seem to be rarely translated into reality. This article examines some of the
common ‘excuses’ used to justify continuing discrimination, both broadly, and
specifically in the context of HIV and AIDS.
Emma Harvey
Excuses
C ‘REASONS’ FOR DISCRIMINATION
Recognising the gaps between the constitutional guarantee not to
be discriminated against and the reality of persistent discrimination,
there are, arguably, various questions that need to be raised. Why, in
spite of constitutional guarantees, does discrimination continue to take
place? Why do people treat people who are different ‘unfairly’? Why
is a person who is tested positive for HIV treated differently? Why are
women treated differently to men? Why are young people treated
differently to older people? While the specific questions could go on,
since the factors used to ‘reason’ discrimination are so many and
varied, there are, however, a number of responses that are common to
these questions.
It is due to culture; it is due to tradition; it is part of religious practices
or personal beliefs; it is due to how people are brought up; it is natural,
human beings do it all the time; it is because of peer pressure; it is just the
way society works – are only a few of the recurring ‘reasons’.
Most of these ‘reasons’ are raised as absolute and unchanging.
Culture, tradition, religion, upbringing, society, nature, and people are
presented in the context of justifying discrimination as being static and
unchanging. Since things always happened this way, they will
continue to happen this way.
REASONS OR EXCUSES?
Culture, tradition, religion and society are not static, change
happens constantly, as society adapts to its changing environment.
While, for example, culture and tradition govern the way people dress,
clothing, as well as the understanding of what is ‘acceptable’ to wear
changes constantly. Many traditions and cultures call for women to
wear skirts and yet, many women are choosing to wear trousers. It is
argued, that this is but one of many examples indicating that people
seemingly have the tendency to pick and chose which one of the
cultural and traditional practices are changeable. Thus, if it is possible
for traditional or cultural practices to change, then it is also possible to
‘change’ and not to use culture or traditional thoughts as excuses
to discriminate against the ‘other’.
Similarly, the wide variety and ever-changing religious inter
pretations and practices indicate that religion is not a static concept
either, but instead a value, norm and belief system that is constantly
modified as to respond to the changing environment. Once again, it
can be argued, that if religious practices are open to change, and
people are prepared to choose whether or not to obey certain
scriptures, then it is quite possible for people to ‘choose’ not to
continue using religious beliefs as an excuse to discriminate.
Besides, it has to be born in mind that while the South African
Constitution provides for freedom of religion, belief and opinion
(Section 15), the rights to use the language and participate in the
cultural life of one’s choice (Section 30), and
the freedom of cultural, religious and linguistic
communities (Section 31), these rights and
freedoms are limited, in that they may not be
exercised in a manner inconsistent with any
provision of the Bill of Rights (Section 31(2)).
This means that everyone has the right to
practice and enjoy the religious, cultural,
linguistic and traditional values of their
choice, as long as these beliefs, norms and
values do not promote and/or practice
discrimination. In addition, everyone has the
duty to respect the various belief, norm and
value systems that people may hold. Thus, the
freedom to choose one’s value, norm and belief
system does not include the ‘freedom to choose’
to exclude, marginalise and discriminate
against the one who thinks differently.
Commonly, ‘the way a person is brought
up’ is also used as a justification for
discrimination. Yet, studies show that during a
person’s growing up or development there are
stages in which presented ‘moral rules’ are
questioned and deliberated on. Subsequently,
people start making choices for themselves
whether or not certain kinds of behaviour are
acceptable.4 Van Dyk [2001:183] argues that:
Once adolescents develop some capacity
for principled moral reasoning, they
begin to see that absolutes and rules
may be questioned because such rules
may be based on someone else’s
subjective point of view – a point of view
that is open to various interpretations
and (therefore) disagreement.
Once again, what people learn as part of
‘upbringing’ is subject to change, and,
therefore, cannot be presented as static,
and thus, as a justification for continuing
discrimination.
In essence, that means that people have
the capacity to decide for themselves whether
or not particular kinds of behaviour are
acceptable, including the capacity to decide
whether or not discriminatory attitudes,
beliefs and practices are acceptable. It is
aLQ – June 2006 39
…if … people are prepared to
choose whether or not to obey
certain scriptures, then it is quite
possible … to ‘choose’ not to
continue using religious beliefs as
an excuse to discriminate…
…‘this is the way
society works, … as if
it absolves an
individual of any
responsibility to treat
people equally…
Excuses
A
within this context that even the notion of
‘peer pressure’, as a justification for
discrimination, can, arguably, be invalidated
and/or challenged, since people do have the
capacity to decide themselves what is and
what is not ‘acceptable behaviour’.
And then there is the excuse of ‘human
nature’ – that it is somehow ‘natural’ for
people to discriminate. Reynolds5 looked at
the question as to whether or not racism, as a
particular form of discrimination, is natural
and concluded that ‘human behaviour is very
obviously also a product of learning and
cultural conditioning’. The author further
argued that explanations for racism, using
human nature as a basis, cannot explain why
racism is an issue for some groups and not
others, or that it is a variable phenomenon that
takes specific forms. Based on this, the author
concluded that racism cannot be all ‘natural’
human functioning.6 If, as is argued, racism, as
a form of discrimination, is not ‘natural’, then
other forms of discrimination are not ‘natural’
and can similarly be defined as products of
learning and cultural conditioning. Therefore,
the argument that discrimination is ‘natural’
seems invalid and cannot be used to continue
justifying discrimination.
And finally, there is the argument that ‘this
is the way society works, discrimination
happens all the time’. Especially in the context
of South Africa, where ‘the way society worked’
for decades was based on institutionalised
discrimination, such an argument becomes
very questionable. If, for example, services,
such as healthcare, are to be delivered to one
group of people faster than to another, many
would argue that ‘society cannot work this
way’, since services need to be delivered
equitably, with no discrimination. Yet, when
asked to come up with a ‘reason’ why
discrimination occurs, the issue of society is
raised, as if it absolves an individual of any
responsibility to treat people equally. Once
again, the Constitution demands that the duty to promote, protect and
respect equality and non-discrimination is not only an obligation of the
state, but also a constitutional obligation for each and every individual.
The above clearly indicates that the ‘reasons’ provided as to why
discrimination occurs, become ‘excuses’ justifying the very same
continuation of discriminatory attitudes, beliefs and practices. In
addition, people using the above raised arguments often fail to take
into account that within the constitutional and legislative framework of
South Africa the principles of equality, non-discrimination and human
dignity are clearly laid out, and, thus, unfair discrimination is
unconstitutional and against the law.
THE ALTERNATIVE
As long as people hold on to ‘excuses’ to justify discriminating
against the ‘other’, the violation of fundamental rights and freedoms
will continue. Similarly, as long as discrimination based on, and in the
context of, HIV and AIDS persists, the access to services, including
prevention, treatment, support and care, will remain limited in
accordance with the prevailing ‘excuses’. Thus, as long as individual
choices are judged and people are discriminated against based on their
choice, instead of respected, no matter what their choice, the right to
equality and non-discrimination will not, and cannot, be realised.
In essence, what would create a society in which equality and
non-discrimination are a reality, is a society based on a ‘culture of
human rights’; a society, in which the dignity of each person is
promoted, respected and protected; a society in which people’s
differences and choices are treated with respect. This is not as alien as
some may see it, since
…the international system of human rights encompasses values
that can be found in all cultures and all religious, moral and
ethical traditions.
REFERENCES
Child Rights Programming: How to apply Rights Based Approaches to
Programming. Save the Children. Peru. July 2005.
van Dyk, A. 2001. HIV/AIDS Care & Counselling: A multidisciplinary
approach. Cape Town: Pearson Education.
Wetherall, M. 1996. ‘Group Conflict and the Social Psychology of
Racism’. In Wetherall, M. (Ed) Identities, Groups and Social Issues.
London: Sage Publications. London. pp175-238.
FOOTNOTES:
1. The Constitution of South Africa, Act 108 of 1996.
2. See ‘Disclosure’ on http://www.dayzero.co.za/steps/info/info_disclosure.htm.
3. The AIDS Law Project website highlights three major cases where discrimination based on a persons HIV
positive status resulted in murder. ‘Why are people with HIV or AIDS victimised?’, AIDS Law Project.
http://www.alp.org.za/modules.php?op=modload&name=News&file=article&sic=19. See also Isaack, W.
2004. Crimes of hate and prejudice against black lesbians’. In ALQ. November 2004 Edition, pp14-16.
4. van Dyk, 2001:163.
5. Cited in Wetherall, 1996:187.
6. Wetherall, 1996:187.
7. Child Rights Programming, 2005:2.
40 aLQ – June 2006
…as long as individual
choices are judged and
people are
discriminated against
… instead of
respected … the right
to equality … cannot
be realised…
Emma Harvey is the Trainer/Facilitator at the AIDS Legal
Network (ALN). For more information and/or comments,
please contact her on +27 21 447 8435 or at emma@aln.org.za.
Excuses
aLQ – June 2006 41
HIV and AIDS and domestic and sexual violence are
concurrently fuelling, and feeding into, each other.
Statistics indicate that South Africa has one of the
highest rates of reported domestic violence,
femicide and sexual abuse in the world. South
Africa also has one of the highest numbers of
people living with HIV and AIDS1. It is, arguably, one
of the dichotomies of South Africa to have, despite
all its available resources and infrastructure, as
compared to other African nations, the highest
statistics in both of the pandemics, sexual violence
and HIV and AIDS.
Sadly, these are also the two areas which show
the least amount of strong leadership by the South
African government. These two areas do not have
adequate legislation in place – while the Domestic
Violence Act lacks adequate implementation,
sexual offences lack adequate legislation. These
two areas also have no voice of unison from the
political, religious and/or traditional leadership of
the country. The Constitution2, providing for the
right to equality and the right not to be discriminated
against (Section 9), the right to have one’s dignity
protected and respected (Section 10), and the right
to be free from all forms of violence (Section 12),
appears to have little or no impact on the lived
realities of most South Africans. This is largely
due to the persistent patriarchal norms prevailing
in society.
The recent trial of Jacob Zuma is but one of the
examples highlighting the challenges, as well as the
attitudes towards HIV and AIDS and sexual
violence. This case not only highlighted a sample
opinion of one of the political leaders on issues of
HIV and sexual violence, but also seemed to have
strengthened, once again, the notion that the ‘word
of a man’ is taken over and above the ‘word of a
woman’, as well as the notion that the prior sexual
history of a woman seems to ‘explain’ whether or
not the alleged rape took place.
SEXUAL ASSAULT REALITIES: THE
GRIP EXPERIENCE
GRIP, an organisation based in Nelspruit,
Mpumalanga, is an intervention programme aimed
at empowering survivors of trauma and abuse. Prior
to 2002, GRIP faced three court cases. The charges
were based on the fact that GRIP subsidised and
paid for each survivor of sexual assault to access
Post-Exposure Prophylaxis (PEP), in an attempt to
prevent the transmission of HIV for survivors of
sexual assault. Years later, there are still areas in
South Africa, where the access to PEP to survivors
of sexual assault remains limited.
The increase in children being orphaned or left
vulnerable, due to the HIV and AIDS related deaths
of parents and caregivers, also impacts on the
growing incidences of sexual assault perpetrated
against children, as well as on the transference of
HIV. This is further exacerbated by the fact that
children are more likely to report sexual assault only
after the window period for accessing PEP
(72 hours) has expired, which is often due to
intimidation and the lack of family safety nets. In
cases of incest, there is the additional challenge of
‘sorting it out’ within the family – by payment of a
‘bride price’ – especially, when the perpetrator is
also the ‘bread winner’.
Factors fuelling the pandemics –
Experiences from
Nelspruit, Mpumalanga
Barbara Kenyon
Provincial view
The myth that ‘cleansing one’s blood, by having
sex with a virgin/child’ is not an African myth, but
actually originated in Scotland, and has been
evident with very large scale pandemics over the
centuries. In the late 19th Century, it was a
common practice that a man could be acquitted of
sexual assault, if he proved it was for medicinal
reasons. This myth, now said to be ‘African’, is, not
surprisingly, predominantly found in areas, in which
access to basic resources are limited.
Even though the impact of this myth is hard to
prove, or to disprove, GRIP has become aware of a
pattern of factors which leads us to suspect that
the myth of ‘cleansing the blood through virgin sex’
does indeed impact on the occurrence of sexual
violence. These factors include the perpetrator’s
relationship, both biological and through
relationship of power, to the child; the age of the
perpetrator; and the type of access the perpetrator
has to the child. These occurrences of sexual
assault usually get reported post the window
period of accessing PEP and often the child has
been sexually violated over a period of time – thus,
the increase in children presenting HIV for the
baseline HIV test, which is administered when
reporting sexual assault.
GRIP has also seen a shift in that the
perpetrators becoming younger and younger in
age, while concurrently the survivors also becoming
younger and younger in age. Some juvenile sexual
assault offenders say that they have sex with
younger children to ‘practice’ for their girlfriends.
Some of the offenders are survivors of sexual
assault themselves, and some commit sexual
assault as a ‘revenge’ for being ‘dumped‘ by their
girlfriend. Thus, sexual assault fuels the HIV and
AIDS pandemic amongst younger age groups.
Over the past six years, GRIP statistics have
shown children between the ages of 11 and 15
years of age to be the highest group of people
reporting sexual assault. One of the possible
aftermaths for a child, who is raped at this age, is
the possibility of becoming sexually promiscuous,
due to post rape stress syndrome, which, of
course, greatly impacts on the risk of HIV
transmission. GRIP statistics further indicate that
while in 2001, 59% of sexual assault survivors in
the reported cases were children below the age of
18 years, the number of child survivors of sexual
assault increased to 60% in 2005.
GRIP has observed a 60% reduction in adult
survivors of sexual assault presenting a positive HIV
test result at the baseline test from 2001 to 2005.
This is encouraging and may also be indicative that
HIV prevention messages are impacting on the
adult population. However, disconcerting is the
simultaneous increase in children presenting
baseline HIV positive test results when reporting
sexual assault, which has increased by 24% during
the same time.
Of all people raped, 25%, or one in four people,
will be a child between the ages of 11 and 15 years.
This is the same time when a child’s body is
developing physically and when self esteem and
world view is established. To destroy the very being
of a healthy body image, especially at this age will
have consequences for the rest of their lives.
In an effort to prevent abuse of women and
children, GRIP has implemented a three year
programme focussing on the boy child to
encourage gender sensitivity. In most areas, the
programme was successful in that it created some
change. However, boy children’s understanding of
HIV and AIDS, and its consequences, still seemed
to be a ‘foreign’ concept. Generally, boy children
still seemed to question the existence of HIV and
AIDS and to not believe that they are at risk of HIV
infection. What was also startling to find out is that
the boy children often said that it is the ‘girlfriend’
who resists using a condom. Furthermore, most of
the boy children portrayed the attitude that a ‘no’
generally means a ‘yes’, because the girl is trying to
play ‘hard to get’ and/or is too shy to admit that she
wants to have sex.
Consensual sexual coercion is also very evident
amongst the ‘brand conscience’ youth. This is not
42 aLQ – June 2006 Provincial view
aLQ – June 2006 43
necessarily only due to economic factors. Girl
children will ‘consent’ to have sexual relations with
older men – for the ‘status’ and ‘gifts’ that the man
can provide – without demanding the use of
condoms. It is argued that even though these
sexual relations often qualify as statutory rape, the
law, once again, is not applied consistently. A
recent trial of a soccer ‘star’, who had a sexual
relationship with a minor child and who was
acquitted of all charges is but one of the examples
of statute failing to protect the ‘victim’. In addition,
there is an increase in the phenomenon of ‘Taxi
Queens’, usually minor girl children, who ‘consent’
to sex in exchange for ‘goods’ – without the use of
condoms. Too often, these incidences are
discounted as sexual assault, since it is seen as an
economic transaction.
THE ‘DOUBLE-EDGED SWORD’
Women, in the reproductive cycle of their lives,
visit the clinics for check-ups during pregnancy and
many women choose to be tested for HIV. As a
result, women know their HIV status before their
partners do. This often leads to a situation, in which
women are blamed for the transference of HIV, as
well as to violence and abuse by their partners
and/or family members. It is then that women are
seemingly presented with the ‘double-edged
sword’ of ‘to know or not to know’.
It is a common perception in communities that
the person, who first tests positive for HIV, is the
person responsible for the transference of HIV,
irrespective of the initial transference, and more
often than not, it is the woman who is blamed. This
perception not only fuels domestic violence
incidences, but also impacts negatively on the
extent to which ‘infant’ PEP is accessed. Similarly,
the perception that women who live with HIV
choose bottle feeding over breastfeeding, as well
as the attached stigma towards women who do not
breastfeed their children, often further limits
women’s choices. Thus, women are often not in the
position to make an informed choice, due to
prevailing beliefs and perception, as well as the
subsequent stigma and discrimination.
CONCLUSION
For GRIP it seems apparent that HIV prevention
messages based on the ABC (Abstain, Be Faithful,
Condomise) approach, including LoveLife
messages, have no real impact on the realities of
HIV and AIDS. In addition, it seems that current HIV
prevention messages do not, and cannot,
adequately de-mystify and/or respond to prevailing
myths and beliefs which further the occurrence of
sexual assault and, thus, the transference of HIV.
And while GRIP, by no means, claims to have
found the answers as to how to provide the
necessary information and services for people to
make the much needed ‘different’ choices and
decisions, we will continue to respond to the
escalating pandemics of sexual assault and HIV
and AIDS.
Barbara Kenyon is the Operational Manager at
Greater Rape Intervention Programme (GRIP).
For more information and/or comments, please
contact her on +27 13 752 4404 or at
kenyons@soft.co.za.
Provincial view
Community-based VCT
research in rural Tanzania
Laurie Abler, Gad Kilonzo, Jessie Mbwambo
44 aLQ – June 2006 Regional view
Introduction to Project Afiki (Accept)
Voluntary counselling and testing (VCT) is at the forefront
of both prevention and treatment of the HIV epidemic in sub-
Saharan Africa and is becoming more available throughout
many regions in these countries. Uptake of testing services is
increasingly important with the ongoing boost to antiretroviral
therapy (ART) access in many countries throughout
the continent. Individuals worldwide have the right to choose
to know their HIV status and knowing one’s HIV status is
necessary to open the way to prevention and ART treatment.
Studies have been done to show the benefit of VCT access
for individuals in regards to accessing ART, reducing sexual
risk behaviour, and increasing disclosure, but little research
has been done to show the impact of providing VCT
services to communities.
With study sites in Thailand, Zimbabwe, South Africa, and
Tanzania, Project Accept is a research project that aims to
use evidence-based results to determine the effects of a
community-level VCT intervention, building on previous
research showing the efficacy of the provision of VCT at the
individual level. Reliance on the individual to foment behaviour
change is nearly impossible without a concomitant change in
the social norms of the community in which the person lives.
The design of the study’s intervention aims to avoid the
pitfalls of an individual level approach to VCT provision –
namely that VCT and knowledge of one’s status is not
normative in communities, that there is stigma attached to
HIV and, thus, to HIV testing, and that little support is
available to help people deal with the implications of their test
result, whether positive or negative. (At this point in time, this
study is not equipped to provide or to assess the impact of
ART access on these factors.) The assumption that
approaches aimed solely at the individual are ultimately less
effective lies at the foundation of this community-based VCT
intervention and inform the theoretical design of the study’s
intervention components.
Instead of using a medical intervention – such as
anti-retroviral therapy, circumcision or a vaccine – Project
Accept will measure a behavioural/social science intervention
on HIV incidence, as well as on behavioural and cost
effectiveness outcomes. More explicitly,
the three objectives of the study are to:
 1) test the hypothesis that
communities receiving 2.5 years of
community-based VCT (CBVCT),
relative to communities receiving
2.5 years of standard VCT (SVCT),
will have significantly lower
prevalence of recent HIV infection;
 2) test the hypothesis that
CBVCT communities, relative to
SVCT communities, will at the end
of the intervention period report
significantly less HIV risk behaviour,
higher rates of HIV testing, more
favourable social norms regarding
HIV testing, more frequent
discussions about HIV, more
frequent disclosure of HIV status,
less HIV-related stigma, and fewer
HIV-related life events;
 3) assess whether CBVCT is
cost-effective compared to SVCT, in
terms of cost per HIV infection
averted and disability-adjusted
life years.
In terms of implementing the
research intervention, what does this
mean practically? Whereas typically
access to VCT services is in a stationary
structure like a clinic – hereafter
referred to as ‘Standard VCT’ or SVCT –
this study aims to look at the effect of
bringing HIV testing services into
communities by providing free mobile
VCT services. Not only does Project
Accept provide mobile VCT services, it
also works to mobilise communities
around accessing VCT services, as well
as providing post-test support services.
aLQ – June 2006 45
This combination of mobile VCT,
community mobilisation and post-test
support services comprise the
intervention, hereafter referred to as
‘Community-based VCT’ or CBVCT.
Project Accept is a Phase III
community-randomised control trial, in
which the effects of CBVCT provision
are compared to SVCT provision; half of
the communities in which we work
receive CBVCT services, while the
other half receive SVCT services for the
sake of research comparison.
Description of the study
community: Kisarawe, Tanzania
Project Accept works in Tanzania
under the local Swahili translation of its
name, Project Afiki, a name decided on
in partnership with the communities in
which the research takes place. These
rural, impoverished communities in the
Kisarawe district are located from 50 to
150 km away from Dar es Salaam, the
largest city in Tanzania. There are
approximately 60,000 inhabitants in the
communities in Kisarawe in which the
study runs, ranging in size from
approximately 3500 to 7000 people.
The people predominantly live off
subsistence level agriculture and/or rely
on employed family members in Dar es
Salaam to send money back to the
rural home. By road, access to
Kisarawe is quite remote, but a major
transit route – the Trans-Africa railroad
heading from Dar es Salaam to Zambia
– runs through the centre of Kisarawe.
Ten communities throughout
Kisarawe have been selected for the
purpose of conducting the research.
The leadership in each of the
communities have agreed to work with
us and have welcomed us into their
community. These ten communities
were then matched into pairs based on
common features, such as population
size, access to health and social
services, HIV risk behaviours, and
social network profiles. Of the five pairs of communities, one
of each pair was randomised to receive SVCT, while the other
was randomised to receive CBVCT. Prior to the arrival of
Project Afiki, VCT services were only available in one
Kisarawe location at the district hospital and were typified by
a short supply of test kits and testing mainly limited to
antenatal women. The district hospital lies on the north
border of the district and is quite a long distance away from
the majority of the district’s residents and access poses quite
a considerable financial cost to pay for transport. Regardless
of the randomisation results, all communities stand to gain
from the additional VCT services that Project Afiki brings.
SVCT facilities are permanently attached to the existing
health dispensary in each of the SVCT communities; people
must travel to their local health dispensary, a distance
ranging from 0 – 7 km. CBVCT is provided in mobile tents
that move to each of the sub-villages in the CBVCT
communities; testing is brought to the people. In addition to
the mobile tents, post-test support services are provided in
the CBVCT communities, with a focus on copingeffectiveness
training, stigma reduction training, and income
generating skills, as well as information sessions for people
who are interested in learning more about VCT and referral to
other organisations for additional help. CBVCT communities
are also actively mobilised to test through community
meetings, staff and volunteer door-to-door household visits,
and distribution of Information Education and
Communication (IEC) materials.
Challenges and considerations of conducting
research in Kisarawe1
The project in Kisarawe has two and a half years to
accomplish a difficult, but not impossible, task, mainly to
facilitate changing social norms and behaviours in order to
affect HIV infection rates. For the most part, in order for Project
Afiki to be as effective as possible, it must be welcomed and
respected by the Kisarawe communities, which previously have
not been exposed to research studies. The necessary trust to
accomplish this has been developed together slowly, and not
without setbacks, and there is the need for clarifications
between the researchers and the community members.
Conducting a pilot study was immensely helpful in elucidating
some of the potential trouble spots.
Lessons from the Pilot Study
During the pilot study which was conducted in
preparation for the actual research study, mobile VCT
services were provided in a similar community just outside of
Kisarawe for a period of approximately three months.
Regional view
Post-test support services were beyond the scope of
activities that were offered as part of the pilot. A self-selected
group of 300 people voluntarily received testing and
counselling during the pilot activities, of which 7.7% tested
HIV positive.2
Concurrent with the pilot CBVCT activities, community
meetings were held in which project staff were informed by
various people that the community must be free from HIV.
This belief arose and spread in the community because
people expected Afiki testers to disclose. Everybody who
disclosed said that they tested HIV negative. It is not known
whether people who tested HIV positive refrained from
disclosing their status at all and remained completely silent,
or if they said that they had tested HIV negative instead, for
fear of the stigma attached to a positive disclosure. This
created the belief in the community that it was free from HIV
as rumours spread about all the people who tested HIV
negative. The pilot staff and volunteers worked hard to dispel
this myth while simultaneously maintaining and fostering
respect for testing confidentiality, reinforcing the presence of
people living with HIV and AIDS or the existence of HIV in the
community, and ensuring people that the project was
providing high quality VCT services which informed people of
their correct HIV status.
Another challenge that emerged out of the meetings
during the pilot activities was community leaders’ request
that Project Afiki disclose to them all the people who had
tested HIV positive, in direct opposition to the confidential
nature of the services the project provides. The leadership
wanted to know all the people who had tested HIV positive
so that they could warn the other people in the community to
avoid people living with HIV and AIDS, a highly stigmatising
attitude. The desire of the community leadership to publicly
identify all the people living with HIV and AIDS who had
tested is quite reactionary and would constitute a basic
violation of people’s rights, but is also understandable in a
community going through the process of first dealing with the
implications of accepting that people are tested HIV positive
without the adequate information to comprehend what this
means. The initial fear and misunderstanding of HIV was
pervasive, which begat stigma, often stemming from
misinformation about the true nature of the virus. Making
public judgments about the village leaderships’ request at
this point in time would not have been helpful for Project Afiki;
instead it would have distanced the project from the village
leadership and compromised the project’s ability to work
effectively in the community. Pilot staff worked hard to liaise
with the village leaders in order to work through this attitude,
by reinforcing the implications of Project
Afiki’s confidential testing policy,
assuaging the fear of people living with
HIV and AIDS that their status would
never be disclosed by an Afiki staff
member, and providing the community
with more information about HIV, how it
is transmitted, and positive living
with HIV.
In regards to both of these
challenges, valuable lessons were
learned which were then applied to the
community preparedness activities
prior to the launch of the intervention
and ongoing in the community
mobilisation activities in the Kisarawe
communities, where the actual
research study is taking place.
Other considerations for working
in Kisarawe
A number of other factors are
involved in conducting the VCT
research project in Kisarawe, some of
which built directly into the study
design. With any sort of implementation
of a community-based research
project, community input is essential.
Community here is defined as the
collection of study villages that
comprise the area of Kisarawe in which
we work. To this end, the project needs
a number of different community
members to work in various capacities
with the project. Three levels of formal
community involvement help ensure the
success of the project and have been
essential in helping to build trust and
gain entry into the communities. Also,
all the members of the following bodies
are encouraged to test for HIV. The first
body is the Community Working
Groups (CWGs) whose role on the
study is to give community-level
feedback in regards to testing locations
and any other aspect of service
provision. CWGs help inform Project
Afiki about issues in both SVCT and
46 aLQ – June 2006 Regional view
aLQ – June 2006 47
Regional view
CBVCT communities, and each
community has its own CWG to
address issues specific to the
community. The second body
is the Community-based Outreach
Volunteers (CBOVs) who are
responsible for helping to mobilise the
communities to test for HIV, by
providing condoms, IEC, and
advertising the CBVCT services. Since
they play such a direct role in
community mobilisation, CBOVs only
work in CBVCT communities. The
third body is the District Advisory
Council (DAC), which works to
provide the project with district level
feedback regarding the conduct of the
study. Representatives are gathered
from each of the ten communities in
which the project works and are
comprised of a mixture of elected
political leadership, people living with
HIV and AIDS, youth representatives,
and faith-based representatives.
In addition to needing the help from
these community-based bodies to
adequately liaise with the study
communities, Project Afiki aimed to try
to recruit and hire a number of people
from Kisarawe to work as staff
members. Unfortunately, it has been
difficult to find qualified people in
Kisarawe due to the high education
level requirements – a secondary or
tertiary degree – for the majority of the
project’s positions. Many people from
Kisarawe who fulfil this requirement
have already moved to an urban area to
pursue economic activity there. Most of
the staff come from Dar es Salaam and
only a few from Kisarawe, mostly to fill
positions having little or no education
requirement. Though, in terms of
confidentiality and community level
trust in the project’s VCT services,
having non-Kisarawe staff has proven
helpful in that they are seen by the
community at being more able to
maintain testers’ confidentiality. Many people have indicated
that they like services provided by Afiki, because of this
assurance of confidentiality and maintenance of clients’
anonymity.
Affecting client’s motivations and barriers to test
Since the launch of VCT services two months ago in
March 2006, approximately 800 people have tested at
CBVCT sites and 300 at SVCT sites. The study team has
been overwhelmed by the large number of villagers who have
turned out to be tested and we sometimes have to tell
people to return another time when the counsellors can
handle the demand. This was especially true when the
project first started offering services, but uptake has curtailed
recently. Physical proximity to testing facilities alone is not
enough to change social norms and convince more people to
test. Bringing CBVCT services to the communities in which
people live is just the start. Attention must be paid to special,
sensitive provisions in terms of the community mobilisation
and operations of the VCT tents in order to maximise the
accessibility of VCT.
Client-centred approaches to VCT provision
On a most basic level, VCT services are offered using a
client-centred approach and adhere to ethical standards.
Since it is a research study, informed consent is given to each
client accessing services in which the procedures of VCT are
explained; the potential risks, discomforts and benefits of
participation; and contact details to find study staff if it is
necessary to get more information. This study was reviewed
and approved by the Institutional Review Boards at Muhimbili
University College of Health Sciences and the Tanzanian
National Institute of Medical Research, as well as the
Committee on Human Research at John Hopkins School of
Public Health. The ethical clearance that the project has
received from these Institutional Review Boards only allows
for informed consent to be given to people who are aged 16
or older, and thus, our intervention services can only be
offered to people aged 16 or older. The project collects basic
data about gender, age, services received, and test results for
each of the clients who come to access SVCT or CBVCT
services, but can not be linked back to the client.
In addition to providing confidential services, the project
also aims to make the process of testing as accessible as
possible. The project uses rapid testing procedures that
provide a client with her or his results the same day of
testing. Both pre- and post-test counselling are given to the
client and uses the client-centred HIV counselling approach,
in which the nurse counsellor guides the client to develop a
personal risk reduction plan, instead of focusing on the test
results and/or judging the behaviour of the client. Though the
exact reason is not clear yet, a number of people like to test
in a CBVCT venue which is not in their direct
community. To that end, Project Afiki provides VCT services
to anyone who accesses the testing tents, regardless of their
community of origin.
Gender sensitive approaches to VCT provision
Any HIV intervention hoping to affect community change
must actively take gender issues into consideration.
Considering the different gender dynamics in all the different
Project Accept study countries, each site must actively
determine how to be gender sensitive within their particular
cultural context, while some gender issues are
operationalised study-wide. High quality couples counselling
and testing is one such study-wide provision that helps
create open disclosure between partners who come
together and test. In the Tanzanian context, this means that
each member of the partnership is consented and agrees
individually to participate in the VCT and that pre- and posttest
counselling, following the risk-reduction model, is
conducted individually first for each member of the
partnership, and if they both agree then they are brought
together to be counselled and share their results if they
desire. The same model holds true for polygamous families
who access counselling together. Each member is
individually consented, pre-test counselled, tested and posttest
counselled. Members of the polygamous partnership are
counselled and share their results together only if they all
agreed. Often we have seen that one member of a
partnership will come and test, go home and disclose her/his
results with the partner, and then return to Project Afiki to test
together again with the partner. Promoting couples
counselling is especially important for women; it helps to
alleviate the blame that is often put on the woman for being
the partner responsible for bringing HIV into the relationship,
evidence of which we found while conducting in-depth
qualitative interviews with women and men in the communities.
Site-specific adaptations relevant to gender issues at the
Tanzanian site have also been implemented. Men typically act
as the public face and voice of the community and represent
the communities’ wishes to the project in the community
preparedness and community mobilisation meetings. The
project staff actively recruit women to attend these meetings
and also hold meetings in venues and forums acceptable to
women, so as to increase their attendance. They also
reinforce with the men in the community the importance of
women’s active presence in the
meetings and work to maintain a
meeting environment that coordinates
the participation of both women and
men in informing the project. Not only
does Project Afiki actively work to hear
women’s voices in community
meetings, women are heavily recruited
and encouraged to participate in the
various community bodies that work
together with the study. Of the 14 firstwave
CBOVs that have been trained,
five are female. Of the 200 CWGs, 59
are women. There are 13 females out of
43 representatives on the DAC which is
chaired by the District Commissioner,
who is currently a female.
After two and a half months of
providing services in the field, it has
quickly become apparent that women
in Kisarawe have much greater barriers
to accessing VCT services than men.
Preliminary figures from VCT uptake
show this. Of the approximately 1100
people that have tested at both CBVCT
and SVCT venues thus far, overall only
36% have been women. When these
numbers are broken down between the
two testing venues, 32% of testers at
CBVCT venues and 45% of testers at
SVCT venues are women. Failure to
equally avail VCT services to women is
problematic, especially considering the
low uptake of testing in venues which
are brought directly to the communities
and are easily (physically) accessible to
the women in the communities. Yet
other barriers exist for women to
access the VCT services, especially in
CBVCT venues. It is socially normative
for women to leave their homes to visit
the health dispensaries where the
SVCT services are located. Here,
women access antenatal services while
they are pregnant and bring in sick
children for care. While women are
already there, it is easy to get
counselling and HIV testing at the same
time, while taking care of their other
48 aLQ – June 2006 Regional view
aLQ – June 2006 49
Regional view
health needs in a socially acceptable
manner. Women do not have as readily
an acceptable excuse to visit a CBVCT
venue outside of admitting the desire
to test, which in Kisarawe may be
seen as admitting culpability for HIV
risk behaviour.
On some level, Project Afiki is taking
a ‘wait and see’ approach to increase
the number of women who access VCT
services, relying on the theory of the
intervention that invokes change agents
and diffusion of innovation to create a
critical mass of people who have tested
which affects the community testing
norms and the likelihood that nontesters
will come forward and test.
Alone, it will not be enough for Project
Afiki to just wait for the numbers of
women testing to increase. The
purpose of the community mobilisation
component of the study is to mobilise
all facets of the community aged 16
and above to come and test. Concerted
effort by all project stakeholders must be
made to identify and then discourage
other factors deterring women from
accessing VCT services. This involves
not only identifying and dismantling
barriers to accessing VCT for women,
but also barriers for women to cope with
their test result. And outside of the
project identifying the problem of gender
disparity amongst testing rates, it will
ultimately be up to the Kisarawe
community itself to take ownership of
ways to decrease HIV-related stigma and
increase the likelihood that women test.
More active engagement with the
CBOVs, CWGs and DAC are needed
to develop culturally sensitive
mechanisms to increase the number of
women who test in a way that does not
further increase the HIV-related stigma
against women in Kisarawe.
What next?
The way the study is designed –
with elements of mobile testing,
community mobilisation and post-test support services – it
aims to reduce the levels of stigma in regards to testing and
HIV status with the hope of ultimately affecting
infection rates. At this point in time, mobile VCT and
community mobilisation services have only been provided for
two and a half months, which is a little premature to assess
the effects on the social norms in the community. Also, posttest
support services will only be rolled out in the next few
weeks, so up to this point in time, people who have tested do
not have a supportive, semi-public forum in which they can
start coping with their test result, be it positive or negative.
Once all three components of the intervention are running in
the community, it is expected that the predicted changes in
social norms affecting stigma will begin to occur.
Project Afiki VCT activities will continue in the SVCT and
CBVCT communities through September 2008, at which
point all intervention activities will be curtailed for the duration
of survey research conducted to measure the research
outcomes – the impact of providing VCT services in these
communities. After this break in service provision, to afford
the opportunity of all the people in our study communities’
convenient access to VCT services, CBVCT services –
including mobile testing, post-test support services and
community mobilisation – will be offered to the previously
designated SVCT communities for a duration of six months.
Eventually, policy change – i.e. large-scale uptake of the
CBVCT model – needs to be guided by research showing the
efficacy of results. Assuming that the hypothesis holds and
CBVCT is proved to be more efficacious and cost effective
than SVCT, district and national level buy-in is necessary to
hand-over the provision of CBVCT services with little to no
disruption. The foundation with district and national
stakeholders has already begun in regards to creating a
district level and a national level community advisory board
that have input into the conduct of the study. The on-going
relationship with these stakeholders must be continued to
hear their input on the study and to ensure an easy hand-over
of CBVCT services once the study is finished.
FOOTNOTES:
1. The purpose is to explore some of the actualities and logistics of providing VCT services
sensitive to the Kisarawe community members while adhering to a research protocol standardised
for implementation across five international study sites.
2. The 2004-2005 Tanzania Ministry of Health data estimates that the HIV prevalence in
Kisarawe is 11%.
Laurie Abler, Gad Kilonzo and Jessie Mbwambo
are part of the Project Afiki. For more information
and/or comments please contact Laurie on
+225 784 820 632 or at Laurie.abler@gmail.com.
50 aLQ – June 2006
The Constitution2 of South Africa guarantees
everyone the right to equality and nondiscrimination
(Section 9), the right to dignity
(Section 10) and the right to privacy (Section 14).
The Constitution also guarantees the right to fair
labour practices (Section 23). The Labour
Relations Act (No 66 of 1995), the Basic
Conditions of Employment Act (No 75 of 1997),
and the Employment Equity Act (No 55 of 1998)
specifically aim to translate these constitutional
provisions into a reality within the workplace in
order to ensure fair labour practices for all. Along
with the NEDLAC Code of Good Practice on Key
Aspects of HIV/AIDS and Employment (2000), this
legislation should, theoretically, provide protection
to people living with HIV and AIDS in the
workplace. However, the question has to be
raised as to whether or not this legislation really
enables fair labour practices, dignity and nondiscrimination
within the workplace.
WORKPLACE REALITIES AND
RESPONSES TO HIV
The reality is that stigma and discrimination
against people living with, and/or perceived to be
living with, HIV and AIDS, remains rife within
society, including in many workplaces. In fact, a
number of studies3 have demonstrated that HIV is
still shrouded in stigma in many workplaces. One
study4, conducted amongst 383 companies,
found that approximately 30% of workers and
managers in these companies believed that
people living with HIV should not be allowed to
work, while more than 40% believed that HIV and
AIDS was a punishment for immoral behaviour.
Such stigma continues to result in many people
who live, and/or are perceived to live with HIV,
being subjected to various forms of discrimination
from both co-workers and managers. At times,
this takes the form of subtle and even overt verbal
abuse from both supervisors and co-workers. In
companies, where such practices take place,
workers living with, and/or perceived to be living
with HIV, often face social isolation and an
intolerable working environment. In fact,
Esu-Williams [2004:9] reported that over 65% of
workers interviewed feared that they would be
completely socially isolated in their work
environment, if they were perceived to be
infected with HIV.
Despite provisions in the Employment Equity Act
some companies still preclude promoting people
on the basis of their HIV status, gender and/or
race. This is often done in a subtle manner and,
thus, difficult for workers to prove. Power relations
within companies mean that employees that have
been subjected to such discrimination will rarely
take action, largely due to the fear of further
victimisation; the fear of losing one’s job; as well
as the fact that workers are often unaware of
their rights.
In reality, workers are still dismissed, because of
their actual and/or perceived HIV status, despite
making a point
Workplace approaches to
HIV and AIDS: Enabling fair
labour practices?
Shawn Hattingh1
comment: making a point
aLQ – June 2006 51
comment: making a point
legislation prohibiting discrimination.5 Versteeg
[2004:15], in a study conducted amongst
companies and business chambers, found that
employers still believe that companies could use
various means to essentially dismiss people living
with HIV, without getting penalised. Indeed, some
employers subject workers living with, and/or
perceived to be living with HIV, to unbearable
treatment in a bid to force the worker to resign.6 In
this way, employers hope to avoid the legal
ramifications of openly firing someone because of
their HIV status. Despite legal recourse, many
employees, who have been pushed into resigning,
select not to take any action. This is due to
various reasons: some workers are unaware of
their rights7; many workers, who are not union
members, cannot afford legal advice or a lawyer;
some workers select not to go to the CCMA,
because, in the case of ‘constructive dismissal’,
the burden of proof lies with the worker; some
workers are fearful of facing up to someone they
believe is powerful; and some workers, because
of the experience of being discriminated against,
might not even wish to disclose any aspect of their
HIV status any further.
In fact, it could be argued that, despite private
sector’s claim to the contrary, it is still relatively
easy to dismiss employees in South Africa – since,
in the case of someone, who is ill due to HIV, or
any other chronic illness, all that a company has to
do is to prove incapacity on the grounds of health.
And this can be done quite easy, if the person
misses more than 12 days of work a year, and the
company has made a token attempt to
‘accommodate’ the worker in another position.
In addition, confidentiality around medical
information is problematic in some workplaces.
Research has revealed that there have been
instances, in which supervisors, senior managers
and medical aids break the confidentially of workers.
Versteeg [2004:15] reported that in one of the
companies surveyed, supervisors revealed the
identification of workers living with HIV, without
their consent. Although, these may be relatively
isolated instances in large companies, amongst
the most vulnerable workers, such as domestic
workers, breaches of medical confidentiality, and
even forced HIV testing, are relatively common.8
Many employees also fear that confidentiality
around their HIV status would be violated, if they
were to become involved in HIV programmes or to
access voluntary counselling and testing (VCT)
services, made available directly by their
employers.9 It could be argued that the low level
uptake of many workplace HIV programmes is
indicative of the fear of stigma, discrimination and
the violation of confidentiality that exists.10
Some companies, however, do have a relatively
high uptake of VCT by employees. In fact, it has
been reported that some companies even
regularly schedule VCT sessions for employees.11
The question is, under such circumstances, how
voluntary is VCT? In name it might be voluntary,
but many workers would test, essentially against
their will, if employers placed pressure on the
worker to do so, due to unequal power relations in
workplaces, and the fear of the repercussions of
refusing the ‘suggestion’ to get tested for HIV by
someone in a position of power. In such cases,
workers’ right to security of person and the
freedom of choice may be completely violated.
It has been reported that in 2005, approximately a
third of large companies are offering ARVs to their
employees.12 The problem is that often ARVs have
to be directly accessed through the company, or a
clinic affiliated to the company. This means that a
person wishing to access ARVs, offered by an
employer, might have to disclose their HIV status
in order to do so. Hence, some workers essentially
have to forego aspects of their right to
confidentiality to gain access to treatment. The
52 aLQ – June 2006 comment: making a
point
reality is that most workplace environments are
not conducive to people disclosing their HIV
status. Added to this, many workers fear that if
their employer knew they are ill, even with a minor
illness, they will be retrenched or forced to resign.
Part of this fear stems from the reality that over the
last 15 years companies have been downsizing
their workforces. In such cases, it is often new
workers, or workers that are perceived as having
weaknesses – including older employees or
employees with chronic illnesses – who are the
first to be retrenched.
The above clearly indicates that stigma,
discrimination and fear of the violation of
confidentiality are major concerns in the
workplace. Indeed, it seems that the legislation
and Codes of Good Practice are filtering into far
too few workplaces. Hence, it seems that the
majority of workplace approaches to HIV are not
creating an environment in which equality,
non-discrimination, dignity, and fair labour
practices are guaranteed. The question now
becomes: Why have workplace responses to HIV
not created an environment enabling fair labour
practices and an adequate response to stigma,
discrimination and issues around confidentiality?
REASONS WHY WORKPLACE
RESPONSES TO HIV, IN MOST
CASES, HAVE NOT LED TO FAIR
LABOUR PRACTICES
Although, private sectors’ response to HIV and
AIDS has historically been slow, recently, within
the last five years, large businesses have, to a
greater or lesser extent, started offering a
response.13 In 2005, 90% of large companies
have HIV policies in place.14 However, large
companies only form a fraction of the employer
community in South Africa. Most employers take
the form of small and medium sized enterprises.
Unfortunately, only 19% of these smaller
companies even have HIV policies in place. This
means that the vast majority of workplaces do not
have any response to HIV. In such an environment,
it is not surprising that discrimination and unfair
labour practices towards people living with HIV
and AIDS continue. Indeed, it is the most
vulnerable workers, who are usually employed by
small companies or in the domestic service sector,
that are mostly subjected to discriminatory
practices. Added to this, more and more
established companies are also using brokered
labour or casual labour in an attempt to
circumvent labour legislation. As a result, workers
are subjected to extreme exploitation, receive no
medical benefits and are not covered by a
company’s policies, including HIV policies,
because, legally, they are employed by a broker
and not the company.
The fact that most large companies and some of
the smaller companies have HIV policies does not,
however, mean that all of these policies are
‘quality’ and/or ‘real’ policies. It has been found
that many companies simply ‘borrow’ HIV policies
directly from other companies.15 Thus, many
companies simply have generic policies that have
not been developed for the specific dynamics of a
particular company. Added to this, many of the
policies do not take workers’ human rights into
account, and far too many of the policies have
been developed solely by management, without
consulting trade union representatives or
workers.16 In such cases, it seems that managers
often disregard the opinions and possible inputs
of their employees. This is, arguably, symptomatic
of the power relations that exist between
employers and workers, and the disregard that
many employers have for workers as people. This
results in employees feeling that they have no
ownership of these policies. Indeed, it has been
shown that where top-down approaches are
favoured, very few workers will even be aware that
an HIV policy exists; let alone what is in it.17 Many
of the policies seem to be nothing more than
aLQ – June 2006 53
comment: making a point
pieces of paper that are never implemented and
therefore, have no impact on discrimination and
stigma in the workplace.
It must be recognised that some companies have
gone a step further. There are companies that
have developed and implemented HIV prevention
and awareness programmes. However, some of
these programmes lack adequate costing and
quality. In fact, it has been reported that the
majority of HIV workplace programmes are
under-resourced.18 Again, the effectiveness of low
cost HIV prevention campaigns is questionable;
since they only make the company look
reasonable, but have very little impact on the lives
of workers and their families.19 Most employers
tend to allocate very little working time towards
the implementation of these programmes. Indeed,
the extent of many HIV prevention programmes
does not go beyond a few boxes of condoms and
a lecture during the occasional lunch break. Many
of the programmes are driven by a limited number
of motivated people, and once they leave the
company, the quality of the HIV workplace
programme often suffer as a result. In addition,
very few companies monitor or evaluate the
effectiveness of their HIV workplace programme
and, thus, have very little data on whether or not
programmes in place are indeed effective.
Another issue is that HIV in the workplace has
often been seen as a cost-analysis issue, rather
than a human rights issue. Many employers
choose not to offer their workers benefits, such as
medical aid, or access to healthcare, on the basis
that it is too costly. Linked to this, some
companies, along with medical aids, have started
to shift the costs of healthcare and medical aid
policies more and more onto the worker, hoping to
avoid some of the material costs associated with
HIV and AIDS. Even in companies that do offer
workers access to medical schemes, it has been
found that the workers are often unaware of the
healthcare benefits that they are entitled to
receive.20 Hence, many workers, who may be
entitled to chronic illness benefits under medical
aid schemes, fail to take up such services, while
medical aid schemes and employers often do very
little to ensure that workers, with medical aids,
are fully aware of the benefits they are entitled
to receive.
It is further argued that workplace responses to
HIV and AIDS will remain to be inadequate and fail
to ensure fair labour practices, since the Codes of
Good Practice are not legally binding.21 As a
result, companies can choose not to do anything,
or very little, about HIV and AIDS in the workplace.
However, even if the Codes were legally binding,
and companies were legally obliged to develop
and implement HIV policies and programmes, it is
still not guaranteed that HIV policies and
programmes would be adequately applied
and implemented.
Perhaps, one of the main problems with HIV
workplace policies is that they often solely focus
on HIV and people, who live, and/or are perceived
to be living, with HIV. Thus, at best, HIV workplace
policies aim to address stigma and discrimination
based on, and in the context of, HIV and AIDS.
Broader issues, such as the fact that most
employers have very little regard for workers’
rights in general, regardless of workers’ HIV
status, are not addressed in most of the
workplace policies, despite the fact that
discrimination in workplaces do not just occur in
the context of HIV and AIDS. In reality, workers,
whether or not actual or perceived to be infected
with HIV, often face discrimination on a number of
other grounds, including race, class, gender, sex
and/or sexuality. Power relations prevalent in most
workplaces mean that the constitutionally
guaranteed right to equality cannot be realised.
Hence, it is argued that until workers’ human
54 aLQ – June 2006 comment: making a
point
rights are fully respected and protected,
discrimination, stigma and the violation of rights in
the workplace will continue and will not be
adequately addressed. Similarly, until workplace
policies do not address stigma, discrimination and
the violation of rights in all forms, HIV workplace
policies cannot and will not adequately address
stigma and discrimination based on, and in the
context of, HIV and AIDS.
SO WHAT IS TO BE DONE?
In summary, it is argued that HIV workplace
policies and programmes that exist, have failed to
adequately address stigma, discrimination and the
violation of rights, and failed to create an enabling
environment for fair labour practices, as
guaranteed in the Constitution.
As long as companies and their workers do not
develop and implement policies that address and
respond to all forms of stigma, discrimination and
violation of rights in the workplace, workplace
policies will continue to create an environment that
is neither conducive to fair labour practices nor to
the promotion, protection and realisation of
fundamental rights and freedoms.
In order to implement policies and programmes
aiming to create an environment for fair labour
practices, challenging and transforming the societal,
cultural and religious belief and value systems,
which lead to all forms of discrimination, has to
become an integral part of workplace policies and
programmes. This includes providing education
and training to workers about fundamental human
rights and freedoms, as well as equal access to
healthcare and other work-related benefits, as
much as it includes adequate inspection and
monitoring tools for companies, so as to ensure
fair labour practices, as well as the equal
promotion, protection and realisation of rights,
irrespective of employment status, sex, gender,
sexuality and/or HIV status.
REFERENCES
Esu-Williams, E. 2004. Gender-Related Aspects
of HIV/AIDS Stigma and Discrimination in the
Workplace. Johannesburg: Wits University.
Versteeg, M. 2004. A License to Choose?
HIV/AIDS Workplace Responses from South
African Profit-Making Companies in Context.
Johannesburg: Wits University.
FOOTNOTES:
1. An earlier version of this article has been presented at the AIDS Legal Network
(ALN) Public Debate ‘Workplace approaches to HIV and AIDS’ on 7 June 2006
in Cape Town.
2. Constitution of South Africa, Act 108 of 1996.
3. Stevens, M. 2004. Stigma and Discrimination: Barriers to Disease
Management. Johannesburg: Wits University; Esu-Williams, E. 2004. Gender-
Related Aspects of HIV/AIDS Stigma and Discrimination in the Workplace.
Johannesburg: Wits University; Versteeg, M. 2004. A License to Choose?
HIV/AIDS Workplace Responses from South African Profit-Making Companies
in Context. Johannesburg: Wits University.
4. Esu-Williams, 2004:9.
5. See also www.fedusa.org.za.
6. As cited in Versteeg, 2004.
7. Mapolisa, S., Schneider, H. & Stevens, M.. 2004. Labour Response to
HIV/AIDS in the Workplace: Can HIV/AIDS compete with Bread and Butter
Issues? Johannesburg: Wits University.
8. Peberdy, S. & Dinat, N. 2004. Domestic Workers in Johannesburg: Worlds of
Work and Health. Johannesburg: Wits University.
9. Mundy, J. 2004. Factors Affecting the Uptake of HIV Testing in the Workplace
Population. Johannesburg: Wits University.
10. Hassan, F. 2005. HIV/AIDS and Corporations: Meeting Human Rights and
Social Responsibility. Unpublished APRM submission to Parliament.
11. SABCOHA briefing in Parliament, February 2006.
12. See www.sabcoha.co.za.
13. Reed, C. 2004. Workplace Initiatives in South Africa: A Case Study
Approach. Wits University: Johannesburg.
14. SABCOHA & The Bureau for Economic Affairs. 2005. The Impact of
HIV/AIDS on Selected Business Sectors in South Africa. Stellenbosch:
Stellenbosch University. p22.
15. Vass, J. 2004. Policy versus Reality: A Preliminary Assessment of the SA
Codes of Good Practice on HIV/AIDS and Key Aspects of Employment.
Johannesburg: Wits University. p10.
16. Mapolisa, S. & Stevens, M. 2003. ‘Unions Fall Short on HIV/AIDS’. In South
African Labour Bulletin. Vol 27, No 6.
17. Mapolisa, S., Schneider, H. & Stevens, M. 2004. Labour Response to
HIV/AIDS in the Workplace. Can HIV/AIDS Compete with Bread and Butter
Issues? Johannesburg: Wits University. p165.
18. Dickinson, D. 2006. Report in Workplace HIV/AIDS Peer Educators in South
African Companies. Johannesburg: Wits University.
19. Grawitzky, R. 2002. ‘HIV/AIDS in the Workplace: Whose Responsibility is
it?’. In South African Labour Bulletin. Vol 26, No 1.
20. Mapolisa, S., Schneider, H. & Stevens, M. 2004. Labour Response to
HIV/AIDS in the Workplace. Can HIV/AIDS Compete with Bread and Butter
Issues? Johannesburg: Wits University. p166.
21. Dickinson, D. & Stevens. M. 2004. Understanding the Response of Large
South African Companies to HIV/AIDS. Wits University: Johannesburg.
Shawn Hattingh is the Assistant Editor at the
AIDS Legal Network (ALN). For further
information and/or comments, please contact
him on +27 21 447 8435 or at shawn@aln.org.za.
Feedback
aLQ – June 2006 55
Feedback…
Provincial Activities
Give people
informed choices…
Since the beginning of 2005, the AIDS Legal Network
(ALN), as part of its ongoing activities at a provincial
level, facilitated provincial networking meetings
focussing on sex and sexuality in the context of HIV
and AIDS (Oct – Nov 2005), as well as meetings
exploring core beliefs and underlying factors fuelling
the HIV pandemic (April to June 2006). Various social
and networking partners participated in these meetings
and its lively debates.
As a direct response to common issues raised
during the meetings focussing on sex and sexuality in
the context of HIV and AIDS, such as religion, culture,
socialisation, upbringing and gender as the factors
defining why women are disproportionately infected
and affected by the HIV pandemic, a decision was
taken to explore these ‘factors’ more in-depth. Thus, in
2006 the ALN began facilitating provincial networking
meetings exploring the very same underlying factors
and core beliefs that not only fuel the pandemic, but
also, unless adequately addressed and challenged,
prevent an effective response to the pandemic. A
response, that indeed impacts on HIV infection rates,
as well as on discriminatory attitudes, beliefs and
practices that seem to constantly limit the ‘success’ of
HIV prevention, treatment, support and care efforts.
The aim of these meetings was to discuss and
analyse the underlying factors and core beliefs that
continuously fuel the pandemic and render efforts to
address and respond to HIV and AIDS meaningless; to
explore the link of the societal context determining
choices and the realities and challenges of the
pandemic; as well as to collectively identify potential
advocacy and lobbying strategies and activities aimed
at addressing, challenging and transforming the
underlying factors and core beliefs that fuel and
perpetuate the pandemic.
Meetings with social and networking partners took
place in the Northern Cape (11 April), Mpumalanga (26
April), KwaZulu Natal (3 May), Eastern Cape (10 May),
Limpopo (22 May), Free State (14 June) and for the first
time in the North West (7 June). The meeting in the
Western Cape has not taken place at the time of print,
but has been scheduled for the 28 June 06.
The response to, and feedback from, the various
provinces on the underlying factors varied in
accordance with provincial realities and challenges.
However, there were a number of commonly raised
issues and concerns amongst all provinces, including:
 Lack of in-depth understanding of the impact of
value, norm and belief systems on HIV prevention,
treatment, support and care efforts
 Strong resistance to change cultural/religious
prescription of behaviour, including sexual behaviour
 Reluctance to take responsibility for own HIV
prevention
 Need for follow-up seminar/meeting to include
traditional healers and religious leaders in the
debate
 Need for strengthening provincial networking
activities to address issues collectively
The meeting clearly indicated not only the lack of an
in-depth understanding of the various realities, and its
correlation, of the prevailing challenges pertaining to
the HIV pandemic, but also of the role of prevailing
social, cultural and religious value, norm and belief
systems on the ‘success’ of current HIV prevention,
treatment, care and support efforts. In addition, the
meetings highlighted a lack of realisation as to how the
very same core beliefs and norms limit the access to
available services, and, thus, potentially perpetuate the
pandemic, including its discriminatory attitudes, beliefs
and practices leading to the exclusion, marginalisation,
stigmatisation and discrimination of the one, who is
actually, and/or perceived to be, living with HIV
and AIDS.
Gahsiena van der Schaff
aLQ – June 2006 56
DTP: MELISSA SMITH • PRINTED BY FA PRINT
Feedback
This publication has been made possible through the assistance of
the Joint Oxfam HIV/AIDS Programme (JOHAP) managed by Oxfam Australia
The meetings also showed the ‘capacity’, on an
intellectual level, to realise the role of core beliefs in
perpetuating the ‘status quo’ of prevailing gendered
inequalities, imbalances and injustices, as well as the
societal acceptance of the constant violation of rights.
The meetings, however, highlighted simultaneously the
‘lack of capacity,’ and/or preparedness to utilise the
‘intellectual capacity, to challenge, change and
transform the ‘status quo’.
…I will remember the cultural beliefs and how these
affect people on making choices and on equality…
[KZN Participant]
…vigorous and thought provoking discussions with
real life scenarios…keep up the good work… [Northern
Cape Participant]
…I will remember that we should give facts and not
judgements…HIV and AIDS is there…and most of the
people are dying, because of wrong education…
[North West Participant]
…thank you for giving us the chance to network
with others…the workshop was so informative… [KZN
Participant]
…the meeting/workshop has enlightened me and I
believe I will be able to apply the new approach when
giving health education talks in preventing HIV…
[Eastern Cape Participant]
…I’ll remember the way we spoke and the way
questions were asked in a way that we ended up
feeling guilty…I thank you guys, cause we will be able
to correct our way of thinking and do what is right for a
change… [Limpopo Participant]
…I’ll remember the dialogues we had as different
stakeholders on these issues… [Mpumalanga
Participant]
…what is important to remember is the choice that we
should afford every human being… [KZN Participant]
…the challenge I found myself faced with regarding
education on sex and HIV is my own beliefs and who
I am…the workshop was good, because it dealt with
our own fears rather than people outside… [North
West Participant]
…The workshop was very good because now we
can analyse and think broadly before doing things
concerning HIV and AIDS… [Limpopo Participant]
An additional challenge raised during these
meetings is the expressed need for further human
rights education and training; for follow-up sessions;
and for similar meetings focussing specifically on the
traditional, religious and/or cultural leadership in the
various provinces.
…I’d like to see ALN doing these workshops once
every month on different topics… [KZN Participant]
…what is needed is a summit addressing
challenges in churches, and with traditional leaders
and healers, and politicians on issues of HIV and
AIDS… [Mpumalanga Participant]
…No one must tell someone what to do or not to do
because everybody has the right to choose…may AIDS
Legal Network not stop giving us this information every
year… [Limpopo Participant]
…the workshop came at the right time and need to
be put into practice… [North West Participant]
…I learned so much…the most important thing is
that if we change the way we talk and teach people
about HIV…people have the choice… [Free State
Participant]
…we would like to see some changes by the next 12
months and we hope through the ALN support, we will
make it happen… [Mpumalanga Participant]
…thank you for sharing this information with us…I
think that if HIV education is non-prescriptive and nonjudgmental
we can go a long way in trying to reduce
infection rates… [North West Participant]
…I remember most how our religion and culture play
a role in increasing or decreasing HIV/AIDS…we must
not use our culture and religion to hurt others and to
ignore HIV… [Free State Participant]
So, after all these meetings the message seems
‘clear’. Until we provide information/education that is
‘facts-based’ and not ‘judgement-based’, core beliefs
and underlying factors will continue to fuel the HIV
pandemic and render our efforts meaningless. What is
needed, as stated by one participant in the North West,
we need to learn to give people informed choices…
Feedback… continued
Provincial Activities