Project Description

It is within the context of the persistent feminisation of the HIV and AIDS pandemic that this double edition of the ALQ focuses on gender, sex and sexuality in the context of HIV and AIDS. The various articles in this edition examine a broad range of realities as to the extent to which the gendered societal context, including the meaning and understanding of ‘appropriate’ and ‘acceptable’ sex and sexuality, indeed addresses and/or perpetuates the feminisation of the HIV and AIDS pandemic. The ABC prevention message, virginity testing, the meaning and understanding of sex and sexuality, adherence to PEP following sexual assault, the role of HIV and AIDS communication, and ethical considerations in narrative research, as well as proposed changes to the sexual offences legislation as it impacts on the criminalisation on non-disclosed sexual exposure to HIV and AIDS, and on the LGB community are some of the issues explored in this edition.

Sex and Sexuality
in the context of HIV and AIDS
South Africa has one of the most progressive constitutions in the world, yet the reality of life
in South Africa often does not live up to these ideals. Examples of continuing inequality and
discrimination are especially evident around issues of sex and sexuality in the context of HIV
and AIDS.
DEFINING SEX AND SEXUALITY
Sex1 in its simplest form is a physical act. In
sub-Saharan Africa it is also the most
common way that HIV is spread. Yet, how sex
is defined beyond these facts leads into the
realm of meanings and assumptions. Existing
sex education materials indicate that sex is
about vaginal, heterosexual, consensual sex
between two people. Many religious
teachings portray sex as a means of
procreation. Women’s magazines talk about
sex in terms of pleasure and orgasm with a
male partner. In addition, high prevalence of
sexual assault in South Africa also indicates
that for some, sex is not consensual and has
more to do with power. While these are only
a few examples of ideas and meanings about
sex and the purpose of sex, it highlights the
difficulty in defining sex.
Constitutionally guaranteed rights, such
as the right to be treated equally and not to be
discriminated against on grounds of
gender, sex and sexual orientation
(Constitution2, Section 9); the right to
freedom and security of the person,
including the right to bodily and psychological
integrity, the right to make reproductive
choices, as well as the right to security in, and
control over, one’s body (Constitution,
Section 12); and the right to inherent
dignity (Constitution, Section 10) arguably
indicate that everyone has the right to choose
where, when, how and with whom they
engage in sexual activity. Yet, Cornell, Reid
and Walker [2003:22] argue that in the South
African context
Sex is social – whom we have sex with,
how and where we have sex, our views
about sexual morality and even the
objects of our sexual desire are not
necessarily individual choices. The
environment in which we live influences
the extent to which we are able to
control these choices.
The societal context determining the
choices about why, where, how and with
whom to engage sexually, also defines the
understanding and meaning of sexuality. A
definition taken off a website specifically
geared towards teenagers exploring
questions around sex defines sexuality as:
…Referring to the interplay of physical,
psychological, social, emotional, and
spiritual makeup of an individual. It also
encompasses gender, gender role, gender
identity, sexual orientation, sexual
preference, and social norms as they
affect physical, emotional, and
spiritual life.3
This definition goes beyond common
assumptions and limitations that sexuality
merely refers to what some people call
Emma Harvey and Johanna Kehler
aLQ – November 2005 1
A Publication of the AIDS Legal Network November 2005
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 Sex and Sexuality in the context of HIV and AIDS
2 Editorial 7 Virginity Testing: In whose interest? 10 ‘ABC’: A gendered
look at HIV prevention 14 Sexual Offences Bill: Impact on the lesbian,
gay, bisexual and transgender community? 17 Post exposure
prophylaxis following sexual assault 21 Microbicides: A new weapon
in the war against HIV 23 Criminal liability for non-disclosed sexual
exposure to HIV and AIDS 26 The untold stories of women and AIDS
37 The Role of HIV and AIDS communication 40 Campaign on access
to social grants 41 Provincial view 43 Regional view
48 Comment 52 The fruits of democracy: Challenges for everyone
aLQ – November 2005 2 Editorial
I
The toll on women and girls…presents Africa and the
world with a practical and moral challenge, which
places gender at the centre of the human condition.
The practice of ignoring gender analysis has turned
out to be lethal. (Stephen Lewis, 2002)
It is the very ‘toll on women and girls’ that seems
to be the persistent challenge in addressing and
responding to HIV and AIDS realities. Infection rates
remain to be on the rise, prevention messages seem
to bypass the ones it is meant to ‘protect’, stigma and
discrimination experienced by people living with, and
affected by, HIV and AIDS prevail, instead of subside
– and it is women and girl children who remain, and
are increasingly, the ones who are disproportionately
impacted and affected by the pandemic.
It is within this context of the persistent feminisation
of the HIV and AIDS pandemic that this double edition
of the ALQ focuses on gender, sex and sexuality in the
context of HIV and AIDS. The various articles in this
issue examine a broad range of realities as to the extent
to which the gendered societal context, including the
meaning and understanding of ‘appropriate’ and
‘acceptable’ sex and sexuality, indeed addresses
and/or perpetuates the feminisation of the HIV and
AIDS pandemic. The ABC prevention message,
virginity testing, the meaning and understanding of sex
and sexuality, adherence to PEP following sexual
assault, the role of HIV and AIDS communication, and
ethical considerations in narrative research, as well as
proposed changes to the sexual offences legislation as
it impacts on the criminalisation of non-disclosed
sexual exposure to HIV and AIDS, and on the LGBT
community are some of the issues explored in this
edition. This issue also continues with the integral
features of the ALQ, introducing HIV and AIDS realities
and challenges from Zimbabwe, experiences from
Vulindlela, a village in KwaZulu Natal, and ‘making a
point’ about Christian responses to HIV and AIDS.
In this issue, Emma Harvey and Johanna Kehler
explore the meaning and understanding of sex and
sexuality, as well as various myths and realities of sex
and sexuality in the context of HIV and AIDS.
Recognising the moralisation and judgement of sex
and sexuality, the article argues that as long as sex
and sexuality is not de-moralised and free of judgement,
sexual choices, including the choice to prevent
HIV infection, will remain limited, whilst judgement
leading to stigma and discrimination, as experienced
by people living with, and affected by, HIV and AIDS,
will continue.
The proposal of the Children’s Bill to prohibit
virginity testing of children has caused heated debates
on the ‘pros’ and ‘cons’ of such practice with both
sides invoking the violations of rights, as well as
referencing the HIV pandemic. Carol Bower introduces
a rights based position to virginity testing and raises the
question as to why ‘virginity’ is such a ‘hot issue’. She
argues that virginity testing of children is not only a
gross violation of children’s rights, but also counterproductive
in that virginity testing exacerbates
children’s vulnerability.
Acknowledging increasing HIV infection rates,
especially amongst women, Rachel Elfenbein, examines
the meaning, interpretation and impact of the ABC
prevention message. She looks at the ‘A’, ‘B’ and ‘C’ of the
prevention message raising questions as to its
adequacy and argues that as long as gendered inequal
ties and imbalances are not taken into account, the ABC
prevention message will perpetuate the spread of HIV.
The potential of proposed sexual offences
legislation to address the persistent discrimination of
the LGBT community is discussed by Evashnee Naidu.
Examining various proposed changes to the current
legislation, she argues that while non-discriminatory
legislation might soon be in place, it can possibly not
impact on prevailing societal prejudices, and/or
application and implementation of the law, which
would, in reality, afford lesbians and gays equal
protection by the law.
Sadiyya Haffejee introduces research findings from
a study exploring factors that influence adherence to
post exposure prophylaxis following sexual assault.
She argues, that factors influencing adherence to PEP
are complex and thus, adherence is as much
dependent upon the skill, knowledge and attitude of
health facility staff, as it is dependent upon the
individual characteristics of the rape survivor and the
support received.
The extent to which the criminalisation of nondisclosed
exposure of HIV and AIDS, as proposed by
the Sexual Offences Bill, could assist in the diffusion of
HIV and AIDS, is examined by Johanna van Rooij. She
explores various arguments for and against such
criminalisation and argues that in light of HIV related
stigma, the criminalisation of HIV-related behaviour
might not only exacerbate stigma, but also would not
serve the purpose intended with such a criminalisation.
Editorial
continued on page 4
C
sexual identity, or sexual orientation, or identifying as lesbian,
gay, bisexual or transgender (LGBT). It defines sexuality as
encompassing the physical act itself, as well as perceptions, beliefs
and behaviours towards the physical act.
The above highlights the extent to which the societal context
largely determines the meaning of sex and sexuality. This very same
societal context further describes ‘appropriate’ sex and sexuality and,
thus, limits individual choices accordingly. However, the one common
factor amongst all the variety and diversity of understandings about
sex and sexuality seems to be the paradigm of patriarchy. A paradigm
that not only defines men as holding power in relationships, both on an
interpersonal and societal level, but also determines different
behavioural norms around sex for women and men and that defines sex
as heterosexual, resulting, amongst other things, in a gender bias that
is unfavourable to women. This patriarchal paradigm further
contradicts the understanding of equality as enshrined in the
Constitution that everybody is equal and therefore deserves equal
treatment, irrespective of one’s gender, sex and/or sexual orientation.
This unequal power between women and men is often expressed
in sexual relationships and is further related to the societal context
determining the extent to which individuals are in the position to
make sexual choices, and to enjoy the right to choose when, where
and with whom to engage in sexual activity. When gender roles are
determined by patriarchy, then it is mostly men who determine the
decisions about sex and sexuality. Thus, it is the patriarchal way of
thinking that largely determines gender norms and, subsequently,
defines the kind of sexual choices women and men can make.
MYTH VERSUS REALITY
In the context of manhood and its meaning, Cornell, Reid and
Walker [2003:26] argue:
How do men prove their manhood? A number of case studies
undertaken in Southern Africa identify dominant behaviour in
men. These include … exercising control over women, coercive
sex… Of course, not all men behave in this way.
It could be argued that ‘manhood’ is also largely defined by
sexual promiscuity, to always be ready for, and say yes to, sex, while
for the majority of girls and women what seems mostly valued is
‘purity’ and ‘virginity’, and girls and women are encouraged to say
‘no’ to sex as a way of remaining ‘good girls’. This seems to indicate
that issues of sex and sexuality are largely ‘taboo’ for women, while
for men sex and sexuality define their manhood, which is further, as
mentioned earlier, often based on dominating women both socially
and sexually.
The practice of ‘dry sex’ 4, where women
often use herbs to ensure that there is no
lubrication – a natural reaction to sexual
stimulation – during sex, is, arguably
another example of gendered definitions of
sex and sexuality. This practice seems to
indicate that women are not to show, or
have, any pleasure from the sexual
encounter. In addition, this also impacts on
women’s physiological vulnerability to HIV
infection, since ‘dry sex’ creates more friction,
more tears in the thin skin lining the
vaginal walls creating openings for seminal
fluids, that might contain HIV, to enter a
woman’s bloodstream.
Another example is the notion that men
have a ‘right’ to their sexual pleasure,
whenever and as often as deemed necessary.
One implication of this is the myth that
‘men just cannot control themselves’,
implying that ‘it is not their fault’ if they
‘force’ sex onto their partner. The unequal
power during these encounters does, however,
raise the question as to the ability to
negotiate condom use. In other words, as
long as beliefs, such as men have full rights
over the bodies of ‘their’ women, prevail,
women’s ability to negotiate safer sex
remains limited. While it seems to be still a
challenge for many men that a wife has the
right to refuse sex to her husband, it seems
to be equally challenging for many wives to
have the right to make her own decisions
about safer sex and reproduction. Or, as
stated in the 2005 State of World
Population Report [2005:45]: ‘Studies show
that married women would often rather risk
infection than ask their husbands to use a
condom’.
Cornell, Reid and Walker [2003:22]
argue that ‘sex is also about power – who
initiates sex, who makes the decisions…
these decisions are contested because
relationships between men and women are
unequal’. While this unequal power may
play out in encounters of consensual sex it
seems to be more often the case in nonconsensual
sex, since ‘non-consensual sex
is an abuse of power commonly rooted in
gender norms – societal assumptions and
expectations about what it means to be male
or female’ 5.
In South Africa, statistics on rape vary
from 52000 reported cases a year (police
records for girls and women only) to 1.69
million (SA Law Reform Commission)6.
The reality is also that the majority of
survivors of these assaults are women, and
aLQ – November 2005 3
Sex and Sexuality
in the context of HIV and AIDS
…still a challenge for many men
that a wife has the right to refuse
sex to her husband, it seems to
be equally challenging for many
wives to have the right to make
her own decisions…
The need for ethical considerations as the core of
narrative research with women who are infected and
affected by HIV and AIDS is discussed by Sunnette
Pienaar. She argues that while the narrative approach
to research facilitates a process for women, infected
and affected by HIV and AIDS, to speak out and tell
their stories, it also needs to facilitate a process of reevaluating
oneself, for the process to be ethical.
The role of HIV and AIDS communication as a
means of addressing and/or perpetuating the
feminisation of the pandemic is explored by Lene
Øverland. Analysing mainstream media as to how HIV
and AIDS is portrayed and as to who owns and who
accesses mainstream media, she argues that a twoway
communication, as provided by a few alternative
media interventions, not only opens the dialogue
between sender and receiver, but is also crucial to HIV
and AIDS communication aiming to address HIV and
AIDS realities and challenges.
Vulindlela, a rural community in KwaZulu Natal, is
introduced by Lilian Mboyi, through sharing challenges
experienced, both personal and professional. She
explores various challenges of the rural community,
discusses some of the core findings of research
conducted in the area and argues that there is hope for
the future, since HIV treatment is becoming a reality.
Miriam Madziwa introduces HIV and AIDS realities
and challenges in Zimbabwe. Looking at the economic
meltdown, Operation Murambatsvina, falling health
care standards and raising medical costs, voluntary
counselling and testing, sexual violence, and the role
of the media, she argues that it is women and girl
children who are disproportionately infected and
affected by HIV and AIDS in Zimbabwe.
‘Making a point’ about Christianity, Barbara
Schmid explores Christian responses to HIV
prevention and caring for people infected and affected
by HIV and AIDS. She raises questions as to the
adequacy of the Christian response and argues that
while a lot has been achieved, a lot more needs to be
done, especially pertaining to prevention, to stigma
hindering adequate prevention, and to orphans and
vulnerable children.
Looking into and exploring various gendered
realities, it seems, once again, confirmed that without
taking into account the persistent gendered inequalities
and imbalances, the ‘toll on women and girls’ will
persist, HIV prevention messages will continue to fail
the ones most vulnerable and at risk, and thus, the
feminisation of the pandemic will continue. The
recurring argument seems to be that the feminisation of
the pandemic manifests itself in all realities; that the
feminisation of HIV and AIDS is as much prescribed by
gendered behaviours, attitudes and practices, as it is
institutionalised; that the moralisation of sexual
behaviour and subsequent prescription of ‘appropriate’
sexual behaviour is not only further marginalising the
already marginalised, but also seemingly justifying the
‘exclusion’ of the ones who portray ‘inappropriate’
sexual behaviour; and that the feminisation of the
pandemic is not due to a lack of a constitutional
and legislative framework, but rather due to the
resistance and/or failure to challenge the gendered
societal context.
If we are to agree that gender is ‘at the centre of
human condition’, then ‘gender’ cannot be addressed
in isolation or in a vacuum ignoring, and constantly
failing to take into account, realities marked by
gendered inequalities, imbalances and injustices
leading to, and justifying, the very same feminisation of
the HIV and AIDS pandemic. Recognising the need to
challenge the gendered context of society, the status
quo, thus, implies that the very ‘centre of human
condition’ has to be challenged and transformed in
order to be in the position to begin the reversal of the
‘lethal’ outcome of the gendered nature of society.
Meaning, understanding and interpretations of
‘gender’ and its reflection in core beliefs of what is
‘appropriate’ and ‘good’ behaviour, including sexual
behaviour, seems to be the ‘human condition’ in need
of re-evaluating, addressing and challenging.
Thus, if we are to address the ‘toll on women and
girls’, the feminisation of the HIV and AIDS pandemic,
the societal gendered prescription of behaviour and
core beliefs, limiting not only individual choices, but
also the access and realisation of fundamental rights
and freedoms accordingly, needs to be challenged and
transformed into a concept based on equality and
human dignity, irrespective of one’s sex, gender,
sexuality and/or choice.
If we fail to challenge the status quo, the very same
gendered context of society will continue to prescribe
who, how, when, where and why people are vulnerable
to, and at risk of, HIV infection – and thus, prescribe
women and girls to be the ones who are most
vulnerable to, and at risk of, HIV infection, the ones
who are disproportionately impacted and affected by
HIV and AIDS realities, the ones for whom
fundamental rights and freedoms have little or no
impact in their lives – the feminisation of the HIV and
AIDS pandemic continues…
JOHANNA KEHLER
4 aLQ – November 2005 Editorial
continued from page 2
M
the majority of the perpetrators are men. Sexual assault clearly
violates a person’s right to be equal, their physical and psychological
integrity, their right to control what happens to their body, and their
inherent dignity, as much as it negates the possibility of negotiating
safer sex and, thus, plays a significant role in the spread of HIV.
The spread of HIV through sexual encounters, both consensual
and non-consensual, is further aggravated by gender-based power
imbalances. Gender roles limiting women’s ability to make sexual
choices also determine that girls and women are often more impacted
by HIV and AIDS infections. The 2005 State of World Population
Report estimates that 57% of people living with HIV in sub-Saharan
Africa are women. In South Africa, the HIV prevalence rates are
23.5% amongst women, as compared to 18.1% amongst men7. In
addition, patriarchal defined gender roles also place women in the
position of primary caregivers and, thus, girls and women are more
affected by the spread of the virus. In other words, the societal context
determining the extent to which women are in the position to take
control over, and make, sexual choices also defines women as the
ones bearing the brunt of the impact of the lack of choices and, thus,
the brunt of the HIV and AIDS pandemic.
Most of the beliefs and examples above seem to relate to sex as
heterosexual vaginal sex, an understanding further strengthened in
sexual education material, meant to assist in preventing the spread of HIV.
Prevention messages, such as ABC (Abstain, Be Faithful, Condomise)
are, subsequently, largely based on this narrow definition of sex, and
often emphasise the ‘A’ and ‘B’, creating the idea that sex is only safe
within marriage. Educational materials, based on such a definition of sex,
not only fails to take into account unequal gender relationships and
gender violence, but also, arguably, discriminates against people, who
engage in sexual activities other than the one described as ‘norm’. Such
narrow understanding of sex seemingly also fails to take into account that
marriages are not necessarily monogamous, especially in a societal
context in which multiple wives and/or sex partners are culturally and
religiously sanctioned8. In addition, commonly available educational
material aimed at preventing the spread of HIV through safer sex
messages are based on the assumption that the sexual encounter will be
one of vaginal penetration. Once again, this discriminates against people,
who choose to engage in sexual activities other than heterosexual sex
and/or vaginal penetrative sex.
The above clearly indicates that the societal context determining
sexual choices is the same societal context prescribing the ‘norm’ of
what sex is ‘supposed’ to be and the why, how, when and with whom
to engage sexually. Thus, individual sexual choices are, arguably,
limited to the choice of whether or not to ‘conform’ to the ‘norm’
and to be treated and ‘judged’ accordingly.
In other words, the societal context
defining sex and sexuality also seems to
define the ‘norm’ of sex and sexuality.
Further, the ‘norm’ seems to be not only
based within a moral context of ‘good’ and
‘bad’ and, thus, often leads to the perpetuation
of ideas that sex is ‘dirty’, ‘no good’ and
‘shouldn’t be enjoyed’, and that sex is
‘wrong’, ‘a sin’ and ‘punishable’. Again,
these ideas also contribute to the taboo,
secrecy and shame around sex and sexuality.
The moralisation and judgement of sex and
sexuality also create ideas about what is
‘good’ and ‘okay’ sex, and/or what is ‘bad’
and ‘wrong’ sex. These ideas of ‘good’ and
‘bad’ often differ between women and men
and are least favourable to people ‘outside’
the patriarchal paradigm, such as women,
unmarried sexually active people and/or
people who identify as LGBT, resulting,
amongst other things, in discrimination,
marginalisation and a lack of freedom to
make informed choices.
The moralisation and judgement of sex
and sexuality impact greatly on people who
are living with HIV and AIDS. Since the most
common form of HIV transmission is through
sex, and sex is seen as ‘shameful’, the
perception created is that HIV is a ‘shameful
disease’. This perception reinforces not only
the idea of sex as ‘bad’, when engaging in sex
could be life-threatening, but also the idea
that sexually active people, especially the
ones sexually engaging outside the ‘norm’, in
some ways ‘deserve’ to contract a lifethreatening
disease. In the context of HIV and
AIDS, added to the idea of ‘good’ and ‘bad’
sex, is the idea of ‘safe’ and ‘unsafe’ sex.
Often, the two are collapsed, ‘good’ sex is
‘safe’ sex, or no sex at all, and ‘bad’ sex is
‘unsafe’ sex, or sex outside the ‘norm’.
As a result, the most common assumption
seems to be that a person must have
contracted HIV through ‘bad’ sexual
behaviour, furthering the discrimination and
stigma that is all too prevalent for people
living with HIV and AIDS. And this
assumption prevails, despite the fact that
numerous research findings indicate that the
majority of women, who contract HIV,
contracting the virus within a marriage or
long-term relationship, where women have
not engaged in extra-marital sexual activity.9
Yet, the stigma and discrimination remain.
Stigma and discrimination might not be
mere judgements. Judgements can often
lead to action, and have potentially
life-threatening consequences. Mkhize10
aLQ – November 2005 5
Sex and Sexuality
in the context of HIV and AIDS
…the majority of women, who
contract HIV, contract the virus
within a marriage or long-term
relationship, where women have
not engaged in extra-marital sexual
activity.
T
In addition, it is the prevailing moralisation and judgement of sex
and sexuality, as well as assumptions about what is ‘good’ and ‘bad’
sex and sexuality within the patriarchal paradigm that need to be
challenged. Challenging the moralisation and common assumptions
about ‘good’ and ‘bad’ sex, may also lead to changing the models
and framework of sex education, encouraging people to make fully
informed choices about sexual activities and safer sex, in an
environment free from judgement and discrimination.
Unless the notions of sex and sexuality as ‘taboo’ and ‘shameful’
are challenged, the realisation and enjoyment of the right to like,
enjoy and explore sex and sexuality, the principles outlined in South
Africa’s Sexual Rights Charter12, will remain limited accordingly.
Lastly, challenging the discrimination, marginalisation and
inequalities, as well as the lack of respect for choices pertaining to
sex and sexuality will also help to diminish the stigma of people
living with HIV and AIDS and contribute to the realisation of the
right to equality for everyone, irrespective of one’s choices.
REFERENCES:
Cornell, M., Reid, G. & Walker, L. 2003. Waiting to Happen. Cape Town:
Double Storey.
‘Glossary of Sexual Terms’.
(http://www.coolnurse.com/sex_glossary/glossary_s.htm)
Margolis, J. 2003. O: The Intimate History of the Orgasm. London:
Arrow Books.
UN Population Fund. 2005: UNFPA State of World Population 2005:
The promise of Equality, Gender Equity, Reproductive Health and the
Millennium Development Goals. Geneva: UN Population Fund.
‘Youth lens: Gender norms underlie sexual coercion’.
(http://fhi.org/en/RH/Pubs/Network/v23_4/index.htm)
FOOTNOTES:
1. It must be noted that sex in this article refers to sexual activity and not sex as in biological attributes
that determine whether a person is a woman or a man.
2. The Constitution of South Africa, Act 108 of 1996.
3. http://www.coolnurse.com/sex_glossary/glossary_s.htm
4. van der Poll, L. 2003. ‘Formulating an appropriate legal response to dry sex and virginity testing
within the discourse on sexuality and human rights in Africa’. Paper presented at the Sex and Secrecy
Conference. 20 – 25 June 2003. South Africa.
5. ‘Youth lens: Gender norms underlie sexual coercion’. (http://fhi.org/en/RH/Pubs/Network/v23_4/index.htm)
6. 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.
7. 2005 State of World Population Report.
8. 2005 State of World Population Report.
9. Hamblin, J. & Reid, E. 1999. Women, the HIV Epidemic and Human Rights: A Tragic Imperative.
UNDP HIV and Development Programme, Issues Paper No. 8.
10. Mkhize, N. 2005. ‘Homophobia is supposed to have no place’. In ALQ, June 2005.
11. Cornell, M., Reid, G. & Walker, L. 2003. Waiting to Happen. Cape Town: Double Storey. p 28.
12. South Africa’s Sexual Rights Charter. Women’s Health Project.
discussed the various ways in which access to
appropriate health care is influenced by
sexuality and being identified as LGBT.
Judgements about who has the right to have
sex with who, can also lead to violation,
not only of the right to be free from
discrimination, but also the right to physical
and psychological integrity. Incidences of
black women who are raped and assaulted,
because they identify as lesbians; and a boy
punishing his girlfriend for alleged infidelity
by organising an ‘istimela’ or gang rape are
only two of the examples highlighting
consequences of judgements pertaining to sex
and sexuality.11
CONCLUSION
The underlying factor highlighted is the
extent to which the moralisation of sex and
sexuality violates fundamental human rights,
such as the right to equality and nondiscrimination
and the right to human dignity.
By judging what is ‘right’ and ‘wrong’
sexual behaviour, the right mostly violated is,
arguably, the right to be respected and to be
treated equally, irrespective of one’s choices.
The fundamental issue seems to be the
prevailing gendered inequalities and
imbalances, as well as discrimination on the
basis of one’s sex, gender, HIV status and/or
sexual orientation, limiting one’s space to
realise rights around sex and sexuality.
Social norms and the gendered societal
context determining women’s ability to
make their own choices, need to be
challenged, since, as argued in the 2005
State of World Population Report [2005:7],
‘the ability to make free and informed
choices in reproductive life…underpins
self-determination in all other areas of
women’s lives’.
6 aLQ – November 2005 Sex and Sexuality
in the context of HIV and AIDS
Emma Harvey is the Trainer/Facilitator and Johanna Kehler is
the National Director at the AIDS Legal Network (ALN). For
more information and comments please contact Emma
on +27 21 447 8435 or at emma@aln.org.za.
…marriages are
not necessarily
monogamous,
especially in a
societal context in
which multiple wives
and/or sex partners
are culturally and
religiously sanctioned.
D
The ones for and against the practice have engaged in heated exchanges
on the issue, and the range of arguments made on both sides of the
debate is broad. Both invoke the violation of rights in support of their
views and both reference the HIV pandemic. However, neither side pays
more than passing attention to the issue of WHY virginity is such a ‘hot
issue’. Yet, it is this very issue – the why of it – that is central to RAPCAN’s
position with regard to virginity testing.
It must also be noted that the ones who claim that ‘virginity testing
has been banned’ are incorrect – the Children’s Bill is relevant only for
children, which it defines as human beings under the age of 18. And it is
the Children’s Bill which has banned virginity testing of children.
THE RIGHT AND PROPER ‘PLACE’
FOR CHILDREN
South Africa, through the ratification of a number of international
treaties and conventions, is obliged to recognise and protect the rights of
children, and promote their realisation. Principally, these are the United
Nations Convention on the Rights of the Child (CRC), ratified by South
Africa in June 1995 and the African Union Charter on the Rights and
Welfare of the Child (the Charter), ratified in 2000. The rights to
survival, development, protection and participation, and the ‘best
interest’ principle, are considered to be fundamental to the CRC, and
there are many areas of congruence between it and the Charter.
The Constitution of South Africa 2 guarantees the rights of all South
Africans (including children), and Section 28 concerns the special
rights of children. Numerous pieces of domestic legislation also focus
on the rights of children, at least in sections. These include the South
African Schools Act (No 84 of 1996), the Domestic Violence Act (No
116 of 1998), the Choice on Termination of Pregnancy Act (No 92 of
1996), the Children’s Bill (2003), the Criminal Amendment (Sexual
Offences) Bill (2003) and the Child Justice Bill (2002). In addition, a
number of policies intended to give effect to the rights of children have
been developed.
Despite these various pieces of legislation and policy, the reality
remains that the rights of children in South Africa are in general
protected, neither in the homes nor in the communities in which they
live, and, it is our experience at RAPCAN, that there is a poor
understanding of the inalienable nature of children’s rights in
society at large. A common comment that
we hear is ‘the problem with children today
is that we have given them too many rights’.
Such a comment is arguably based on the
failure to understand that children are
bearers of rights in their own right, which
also lies at the heart of the virginity testing
debate (and others, such as that around
corporal punishment in the home). Notions
of children as owned by their parents and of
their virginity status as representing the
‘honour’ of their families, lie behind the
insistence of knowing whether or not the
hymen is intact.
It remains true in South Africa that
women’s status is largely determined by their
relationship to men – father, husband, brother
or son. For this system to work, it is
absolutely necessary to know to whom each
child born ‘belongs’ – i.e. who is that child’s
father? And the only way to be sure of that,
throughout most of human history, has been
to be sure of who has had the opportunity to
impregnate the mother. Which means she
must remain a certifiable virgin until her
husband claims her. Which is why her
virginity needs to be ‘tested’.
THE RIGHTS POSITION
Supporters of the practice of virginity testing
(mainly traditional leaders in the Eastern Cape
and KwaZulu Natal) have interpreted the ban
contained in the Children’s Bill as a violation
of the right to practice one’s culture
(Constitution, Section 31). The ones against
define virginity testing as a violation of the
right to protection (Constitution, Section
28(1)(d)), the right to privacy (Constitution,
Section 14), the right to dignity (Constitution,
Section 10), the right to bodily integrity
(Constitution, Section 12) and the right to aLQ – November 2005 7
Virginity Testing:
In whose interest?
Virginity Testing:
In whose interest?
The Children’s Bill1, read for the second time in Parliament on 22nd June 2005
and approved by the National Assembly on that date, contains one short
clause that has caused a furore. Section 12(4) states that ‘Virginity testing of
children is prohibited’.
Carol Bower
VaLQ – November 2005
identified as a non-virgin, is to be exposed to
stigmatisation and ridicule, both during the
ceremony and afterwards.
Both the public invasion of privacy
necessitated by the virginity test itself, and
the public humiliation which is often the
consequence of it’s ‘findings’ constitute a
violation of the right to dignity.
The right to bodily integrity [Section 12]
The ones who support the practice of
virginity testing claim that girls who are
inspected have consented to be tested.
Considering the expectation that girls must
‘willingly’ allow virginity testing, and if they
do not, they have something to hide, clearly
indicates that this is not really informed and
willing consent.
The common understanding is that a
refusal is construed as evidence of being
sexually active, while families are seen as
being ‘honoured’ by the virgin status of the
unmarried women and girls within their
household. The social pressure to undergo the
test mitigates any choice in the matter for the
girl or woman concerned.
Under these circumstances, the right to
security in and control over one’s body is
violated.
The right to privacy [Section 14]
Both the testing of virginity and the
communication of the results of the test are
very public events. Considering the significant
negative consequences of being identified as a
non-virgin, such public disclosure can place
the girl or woman at considerable physical and
emotional risk. It really is a ‘Catch-22
situation’ – if she refuses the test, she is
suspected of ‘improper’ conduct, if she takes it
and fails, she is guilty of ‘improper’ conduct.
equality (Constitution, Section 9). Both sides have invoked the
rights position.
The rights of all South Africans, including South African children,
are protected by the Constitution of South Africa. In general, the rights
outlined in the Constitution are not absolute, and provision is made for
the limitation of rights, in Section 36, which provides criteria for the
limitation of rights and guidance on decision-making in this regard 3.
Clearly, the rights of children and others to practice their cultural
traditions and participate in the cultural life of their communities need to
be balanced against the right to protection, to privacy, to bodily
integrity and to equality. However, at RAPCAN, we are of the opinion
that these decisions need also to be informed by an understanding of
WHY it seems so important that women are virgins until they marry,
and the underlying ownership, power and control issues that are
relevant here.
RAPCAN believes that a number of rights are violated by the
practice of virginity testing.
The right to equality [Section 9]
Given the underlying reasons for virginity testing (related to a degree
of certainty about the paternity of a woman’s children), it is not
surprising to find that it generally applies only to women. Advocate
Tseliso Thipanyane quotes a newspaper report which claims that there is
a virginity test for boys 4, and that the virginity of both young men and
young women is prized 5. However, the test for boys is entirely noninvasive,
unlike that for girls. Sanctions against men who engaged in
pre-marital sex are focussed more on whether or not the woman/girl was
a virgin at the time of the seduction, rather than on the virginity status of
the man/boy. For an unmarried man, an active sex life is confirmation of
his masculinity 6; for the woman, it reduces her ‘bride-price’. It can also,
and often has, threatened her life.
This clearly indicates that the practice of virginity testing violates the
right to equality.
The right to dignity [Section 10]
Virginity testing involves an investigation of whether or not the
hymen is intact. However, the presence or absence of the hymen does not
necessarily relate to whether or not one has engaged in penetrative sex.
The hymen can and does break because of tampon use, or physical
activity; some women are born without one 7. Thus, the presence or
absence of the hymen is not a fool-proof indicator of ‘virginity’. To be 8 Virginity Testing:
In whose interest?
…women’s status is largely
determined by their relationship
to men – father, husband, brother
or son. For this system to work, it
is absolutely necessary to know to
whom each child born ‘belongs’ –
i.e. who is that child’s father?
To be identified as a
non-virgin, is to be
exposed to
stigmatisation and
ridicule, both during
the ceremony and
afterwards.
C
Either way, she is publicly humiliated, devalued, and placed at physical
and emotional risk.
This public exposure violates the right to privacy, with frequently
devastating consequences.
The right to protection [Section 28(1)(d)]
The rate of rape in South Africa is alarmingly high and rising. The
rape of young children is a particular problem8. Government has committed
itself to combating the sexual abuse of children, and NGOs also
play a vital role in this regard. Much of the work being done to raise
awareness of abuse among children as a prevention strategy focuses on
recognising, rejecting and reporting touching of their genitals, even
when the person doing the touching is stronger and more powerful than
the child.
Virginity testing undermines this strategy and the contradiction
of the instructions to children for their protection can and will
confuse children. It, undoubtedly, also renders children more
vulnerable to sexual abuse.
Children, identified as non-virgins, are exposed to physical and
emotional danger, as has already been shown. Additionally, children who
have been sexually abused and who are identified as non-virgins face
increased risks of abandonment, rejection and violence9.
Children identified as virgins are also at risk. Given the premium that
most societies place on virginity, their ‘value’ in terms of potential
exploitation and possible trafficking is linked to their virgin status. In a
society with high levels of gang-related activities, where the rape, and
even murder, of a virgin forms part of the initiation of gang members,
public identification of virgins could become a death sentence.
Children and young girls who are at risk of not passing a virginity
test have been known to take steps which endanger their health to
convince the testers that they are virgins. These measures include the
insertion of meat and other foreign objects into the vagina10. There is also
evidence that girls resort to anal sex in order to preserve the hymen11.
Many virginity testers neither use gloves nor wash their hands between
‘testing’ – with the related risk of transferring infections between the
ones being tested.
Hence, it is argued that the practice of virginity testing not only
exacerbates vulnerability, but also violates the child’s right to protection.
CONCLUSION
It is RAPCAN’s position that virginity testing violates a number
of rights, and places girls at risk of physical,
emotional, and sexual abuse. These risks
outweigh the considerations related to the
right for communities and individuals to
participate in and practice their culture.
RAPCAN, thus, supports the ban on
virginity testing for people under the age of 18.
However, it is also RAPCAN’s position
that the underlying issues related to the
importance given to virginity in our society
should be confronted. In addition to the
prohibition on virginity testing, awareness
raising and education which confronts the
notions of ownership, power and control
implicit in the value placed on virginity should
form part of a strategy aimed at reducing the
vulnerability of women and girls to violence of
many kinds.
FOOTNOTES:
1. Bill 70 [B] 2003.
2. The Constitution of the Republic of South Africa, Act 108 of 1996.
3. Children’s Institute, UCT. 2005. Virginity Testing and the
Children’s Bill: Discussion Paper. Unpublished.
(http://web.uct.ac.za/depts/ci/plr/docs/Virginity%20Testing%20Discussio
n%20Paper%2010%20Oct%202005.doc)
4. Murphy, D.E. 1999. A time for testing for Virginity, The Los Angeles
Times –Thursday, July 15, 1999.
(http://ww2.aegis.com/news/Lt/199/LT990702.html) quoted in:
Thipanyane, T. 2005. Virginity Testing in South Africa:A Human Rights
Perspective. Submission to the Select Committee on Social Services,
National Council of Provinces, Republic of South Africa on 11th
October 2005.
5. Thipanyane, T. 2005. Virginity Testing in South Africa: A Human
Rights Perspective. Submission to the Select Committee on Social
Services, National Council of Provinces, Republic of South Africa on
11th October 2005.
6. Ciet research
7. ‘South Africa: Virginity testing – absence of a small tissue becomes
big issue’ (www.IRINnews.org ) quoted in Children’s Institute, UCT.
2005. Virginity Testing and the Children’s Bill: Discussion Paper.
Unpublished.
(http://web.uct.ac.za/depts/ci/plr/docs/Virginity%20Testing%20Discussio
n%20Paper%2010%20Oct%202005.doc)
8. Jewkes, R. 2003. Virgin Cleansing and HIV. Paper presented at an
NGO/CSIR/NDPP Consultation, February 2003.
9. South African Human Rights Commission, July 2005. Position
Paper: Virginity Testing. p 2.
10. Policy Update, September 2004. Virginity Testing: Increasing
Health Risks and Violating Human Rights in the Name of HIVPrevention.
Quoted in: Children’s Institute, UCT. 2005. Virginity
Testing and the Children’s Bill: Discussion Paper.
11. Hlongwa, W. 2005. ‘Teens turn to anal sex to keep virginity’.
(www.news24.com). Quoted in Children’s Institute, UCT. 2005. Virginity
Testing and the Children’s Bill: Discussion Paper.
aLQ – November 2005 9
Virginity Testing:
In whose interest?
In a society with high levels of
gang-related activities, where
the rape, and even murder, of a
virgin forms part of the initiation
of gang members, public
identification of virgins could
become a death sentence.
Carol Bower is the Executive Director
of Resources Aimed at the Prevention
of Child Abuse and Neglect (RAPCAN).
For further information and comments
please contact her on +27 21 712 2330
or at carol@rapcan.org.za.
T
In addition, young women (aged 15-24 years)
are more than three times more likely to be
infected with HIV, than young men.2 The
increasing numbers of people infected with HIV,
and women in particular, seem to indicate that
the success of HIV prevention strategies is
questionable. Looking at the gender
imbalances in these statistics, it could be
argued that HIV prevention programmes are
limited and problematic in whom they actually
target and whom they reach.
This article will examine the popular ABC
(Abstain, Be Faithful, Condomise) HIV
prevention strategy and its underlying
assumptions from a gender perspective. Such
analysis will explore the human rights violations
and challenges that the ABC message seems to
ignore and that fuel the spread of the HIV
pandemic. As Delport [2005] states:
It is only if the rights to equality and nondiscrimination
are violated that the virus
can take advantage of the social, political,
and economic vulnerability this creates to
flourish unabated among women. Far
from being merely a health issue, the
pandemic is now recognised as a human
rights and development crisis. Gender
inequality is at the root of this crisis.
THE ORIGINS OF ABC
The Abstain, Be Faithful, and Condomise
HIV prevention strategy originated in Uganda
in the early 1990’s. At the time, Uganda had a
30% HIV prevalence rate, the highest in the
world. Through multiple approaches to
preventing and treating HIV and AIDS, the
prevalence rate in the country decreased to a
current 6%.3 Uganda has been heralded as a
HIV prevention ‘success story’, with its ABC
programme often interpreted to be the key to such ‘success’. The ABC
prevention strategy has, subsequently, been exported to many countries
as a proven way to prevent the spread of the HIV pandemic.
A closer analysis of the ABC prevention strategy in Uganda,
however, reveals fundamental flaws in its ‘success’. Of the estimated
one million Ugandans currently living with HIV, 56% are female.4
While 97% of married women have abstained from sex until marriage
and remained faithful to their husbands, 32% of women are married to
men, who have multiple wives.5 This indicates that many Ugandan
women who have heeded the ABC prevention strategy and, especially
the first two focal points of the strategy, therefore, are the ones who
contracted HIV. These statistics, arguably, raise as much questions as
to the efficacy of the ABC prevention strategy in Uganda, as to the
adequacy of replicating this prevention strategy in other countries,
especially in Sub-Saharan Africa and in South Africa in particular.
ABC AND THE SOCIETAL CONTEXT OF THE HIV
PANDEMIC
The spread of the HIV and AIDS pandemic occurs within a
broader societal context in which women and men are not treated
equally and in which women often experience multiple forms of
discrimination. Prevailing gendered inequalities place women in a
position in which they are more vulnerable to HIV infection. Or, as
Piot [2005] states: ‘the link between gender inequality and death has
never been so direct as with AIDS’.
Even though, the ABC prevention strategy seemingly fails to take
into account the prevailing gendered inequalities and imbalances, this
approach continues to be the primary prevention strategy in Sub-
Saharan Africa. Furthermore, as argued by Hamblin & Reid [1991]
…these prevention measures are drawn from men’s physique and
lifestyle and should be directed at men. As means by which women
can protect themselves from HIV, they are hopelessly inadequate.
These measures also fail to respond to the fact that women are,
biologically, more susceptible to HIV infection, due to their genital
areas tearing more easily and, thus, become more exposed to the virus
during sexual intercourse.6 Moreover, the ABC prevention strategy
seems to be inadequate, since it ignores the gendered societal context,
defining women’s realities. Or as Hamblin and Reid [1991] argue:
…the social and cultural determinants of HIV infection in women
are very different from those for men because they relate to the role
of women within relationships, families, and communities which, in
turn, determines the nature and patterns of sexual activity that
place women at risk for infection. 10 aLQ – November 2005
‘ABC’: A gendered look at
HIV prevention
The Human Immunodeficiency Virus (HIV) is preventable. Even though it is
preventable, the number of people who are infected with the virus is growing.
In Sub-Saharan Africa, the number of women infected with HIV is
greater, than the number of men. Almost 60% of people infected with HIV
in Sub-Saharan Africa are female.1
Rachel Elfenbein
‘ABC’: A gendered look at HIV prevention
SSince persistent patriarchal systems and male dominance define
women largely as ‘inferior’, in both the public and private spheres,
women often depend on men economically for their survival and are,
therefore, left with little or no space to negotiate the terms of their
sexual relationships and to protect themselves from HIV infection.
And this is the same patriarchal system and male dominance in all
spheres of society that determines the extent to which women are in
the position to claim and enjoy fundamental rights and freedoms,
such as the right to freedom and security of the person
(Constitution7, Section 12), specifically the right to be free from all
forms of violence (Constitution, Section 12(1)(c)) and the right to
security in, and control over, their bodies (Constitution, Section
12(2)(b)). It is in this context that
…abstinence is meaningless to women coerced into sex,
faithfulness offers little protection to wives whose husbands
have several sex partners, and condoms require the cooperation
of men. [Bryjak, 2005]
Thus, it is arguably men’s sexual and gendered behaviour that, to
a large extent, places women at risk of HIV infection, since, as
argued by Bryjak [2005], ‘while men are driving the AIDS epidemic
in large degree, women become the victims’.
ENGENDERING THE ‘A’ IN ABC
Following the ABC prevention strategy, people are first and
foremost supposed to abstain from sex. The underlying assumption
seems to be that people are supposed to abstain from sex until
marriage. This prescription of abstinence is problematic for
several reasons.
Firstly, the meaning/principle of abstinence is not clearly defined
and, thus, leaves ‘room’ for individual interpretations. Abstinence,
as in not engaging in sex at all or until a specified time; abstinence,
as in not engaging in vaginal sex or any type of sexual activities;
and/or interpretations as to who is to abstain from sex and when are
only a few examples. However, any individual interpretation of
abstinence can, arguably, not be removed from the gendered societal
context in which this interpretation is made. It is within this
gendered societal context that ‘sex is usually considered a marital
obligation, so wives are at higher risk for HIV than their single
counterparts who can choose to abstain’ [Feuer, 2004] and that, due
to women’s economic dependency, ‘sexual intercourse is not a
question of choice but rather a question of survival’ [Hamblin &
Reid, 1991]. This seems to also indicate that while
…abstinence-until-marriage programs erroneously assume
that marriage is a protective factor against HIV… evidence
increasingly demonstrates that because women have few rights
within marriage, marriage may be a key risk factor for HIV.
[Sexuality Information and Education Council, 2004]
Furthermore, women’s realities, have to, arguably, taken into
account, since for many women, the ‘choice’ to abstain from sex
and, thus, not to expose themselves to HIV infection is often
characterised by poverty. High rates of poverty lead to a situation in
which many women engage in transactional sex in order to survive and
in order to support both themselves and their families.
For these women, sex work is not an occupation or even a
chosen lifestyle, but a pragmatic measure to overcome
transitory economic hardship. The risk of HIV transmission to
which they are exposed has to be tragically balanced by them
against need. [Hamblin & Reid, 1991]
ENGENDERING THE ‘B’ IN
ABC: MARRIAGE AS A RISK
FACTOR FOR HIV INFECTION
The ABC approach to prevention is most
commonly interpreted in such a way that in
order to prevent HIV infection, people must
abstain from sex before marriage and be
faithful to their partners once they marry.
Once again, this interpretation raises
questions, since the ‘instruction’ for married
partners to be faithful to one another occurs in
a societal context in which polygamy is not
only culturally and religiously sanctioned, but
also to a large extent socially ‘acceptable’.
Subsequently, it seems to be largely
‘acceptable’ for men to have multiple sexual
partners before and while married, yet the
same behaviour is ‘unacceptable’ for women.
Social constructs dictate that married
women have little or no power to
negotiate the basis upon which their
relationships with their husbands take
place. Once married, women are usually
expected to remain faithful to their
husbands but are unable to compel
fidelity in return… The tendency for men
to have sexual relationships outside
their marriage is reinforced by male
migration and mobility when men leave
the village to obtain work elsewhere.
[Hamblin & Reid, 1991]
It is further argued that even if men do
remain faithful once they are married, women
remain at higher risk for HIV infection,
because men often do not abstain from sex
before marriage. Once again, reality and
common social practices do not seem to
aLQ – November 2005 11
…since the
‘instruction’ for
married partners to
be faithful to one
another occurs in a
societal context in
which polygamy is not
only culturally and
religiously sanctioned,
but also to a large
extent socially
‘acceptable’.
‘ABC’: A gendered look at HIV prevention
I
12 aLQ – November 2005 ‘
ABC’: A
gendered look at HIV prevention
coincide with the principles of the ABC
prevention strategy. Furthermore, while
communities often accept and expect young
women to have relationships with, and marry,
older men, it is these very relationships that
place women at risk of HIV infection. One of
the reasons, argued by Delport [2005], is that
…marriage to an older man creates
significant imbalances between husband
and wife in terms of experience, authority,
and economic autonomy… Early
marriage often goes hand in hand with
violence against women.
The above seems to indicate that
abstinence and fidelity have neither prevented
the spread of HIV nor the disproportional
infection of women, since men seem to have
not heeded them.
As a prevention strategy, reducing the
number of one’s sexual partners is of no
help to the many women who have sexual
intercourse only with their husband
or regular partner. Having only one sexual
partner has been a tragic failure as
a means of HIV protection against HIV
for wives. [Hamblin & Reid, 1991]
Thus, marriage, the very institution that the
ABC prevention strategy holds to be sacred and
safe, becomes the one that places women most
at risk of HIV infection. Latest research
findings and statistics indicate that the
…majority of newly HIV-positive
women are contracting the virus within
marriage from their husbands.. These
women complied with the prevention
messages they were given, and yet doing
so fails to protect them. Promoting
abstinence or faithfulness will leave
millions of people without the ability to
protect themselves from infection.
[Sindig, 2005:38]
Indeed, as the pandemic spreads, the
proportion of wives to all infected women is
increasing.8
ENGENDERING THE ‘C’
IN ABC: WHO CONTROLS
CONTRACEPTION USE?
The ABC prevention strategy ‘dictates’
that people should first and foremost abstain
from sex, until marriage, and be faithful to
their partners once they are married. The ‘C’,
as in condomise, only seems to become part
of prevention as and when people cannot
abstain from sex or are not faithful in their
relationships. Thus, condom use, as a form of
prevention, seems to become marginalised,
due to the promotion of abstinence and being
faithful. Furthermore, the ABC prevention strategy often limits the
prescription of condom use to groups of people perceived to be at ‘high
risk’ of HIV infection, such as sex workers and truck drivers.9 The
isolation of ‘high risk’ groups not only misrepresents and displaces the
level of risk, as the current statistics outlined above show that the
largest group of people at risk for HIV infection are married women,
but also perpetuates the stigmatisation of people belonging to ‘high
risk’ groups.
In addition, many married women are not in the position to
exercise their rights to make decisions about their sexual relationships
and/or reproduction. ‘The autonomy needed by a woman in order to
negotiate safer sex depends on the realisation of her right to equality
in many different areas of life’ [Delport, 2005]. Gendered inequalities
and imbalances largely determine that women are not in the position to
negotiate and practice safer sex and, thus, prevent HIV infection.
Power imbalances and inequalities between men and women
render many women unable to negotiate safer sexual practices
with their partners… In unequal relationships, women
demanding safer sex may risk impoverishment or assault. Social
norms dictate that women should be passive and compliant in
sexual relations. The right to decide how and when sex takes
place is regarded as a male prerogative. [Delport, 2005]
It also has to be acknowledged that male condoms are much more
widely available, but female condoms – a protection method that
women control themselves and that, therefore, offers women a way to
take control over their own bodies – are not as widely available.
WHAT ABOUT GBV (GENDER-BASED
VIOLENCE)?
While the most common, and seemingly societal ‘accepted’,
interpretation of the ABC prevention strategy reduces HIV prevention
to three seemingly easy steps, in reality, preventing HIV transmission
is not as easy, especially as and when women live in abusive relationships
and/or in situations in which women are sexually violated.
The ‘ABC’ arguably fails to take into account prevailing gendered
inequalities and imbalances, including high rates of abuse and/or
sexual violence and, thus, fails to address and respond to women’s
needs. On the contrary, this prevention strategy seems to be based on
the assumption that everyone is treated equally and, therefore, can
equally negotiate and agree upon faithfulness and regular condom use
within marriage and/or sexual relationships. However, this is not
reality. The reality is that
…married, monogamous women are highly vulnerable to HIV
infection due to their lack of rights within marriage,
difficulties negotiating safer sex, extended partner abuse and
domestic violence. [Sindig, 2005:38]
…as long as the ABC prevention
strategy does not address
fundamental human rights… it
arguably perpetuates not only the
spread of HIV, but also the gendered
nature of the HIV pandemic.
R
Reality also shows, as argued by Auerbach [2004:A31] that
…a significant risk factor for HIV infection is violence, to which
all women are more susceptible. One South African study found
that women who were beaten or dominated by their partners
were 48% more likely to become infected than women who lived
in non-violent households.
In other words, violence and/or threats of violence severely limit
women’s ability to negotiate safer sexual behaviour, including condom
use, with their male partners.10
The apparent link between sexual violence and HIV transmission
also directly impacts on especially women’s risk of contracting HIV,
through sexual abuse and violence is not eliminated11, even if women
do follow the ‘ABC’, since
…transmission of HIV and other sexually transmitted infections
will persist – despite common STI/HIV prevention approaches
emphasizing ABC – as long as non-consensual sex remains
widespread.’ [Family Health International, 2005:4]
FROM ABC TO A HUMAN RIGHTS-BASED
APPROACH TO HIV PREVENTION
The above clearly indicates that the most common interpretation of
the ABC prevention strategy simplifies HIV prevention, since it fails
to take into account the gendered context of society. Or, as argued by
Hamblin and Reid [1991]:
Knowing what has to be done in order to protect oneself from
HIV is meaningless if one has no power to control the
circumstances that give rise to the risk or in which prevention
must occur.
Thus, as long as the ABC prevention strategy does not address
fundamental human rights of equality and non-discrimination, as well
as underlying factors of gender-based violence, it arguably perpetuates
not only the spread of HIV, but also the gendered nature of the HIV
pandemic. It is the very same interaction between HIV infection,
prevailing value and belief systems and the realities and needs of
women that need to be recognised in order to attain the fundamental
changes required to stem the pandemic.
In reality, the number of women infected with HIV relative to men
infected with HIV increases every year and women more and more
become the face of HIV and AIDS, due to gendered inequalities. HIV
prevention strategies, therefore, need to address and promote
everyone’s right to equality and non-discrimination, the right to be free
from all forms of violence, as well as the right to make sexual and
reproductive decisions and the right to security in, and control over,
one’s body, if the spread of the pandemic is to be halted. Or as argued
by Hamblin and Reid [1991], ‘prevention strategies will only ever be
effective in protecting women from the effects of HIV if they embrace a
recognition and active promotion of the human rights of women’.
Human rights must be used proactively in the prevention of HIV.
REFERENCES:
Auerbach, J. 2004. ‘The Overlooked Victims of AIDS’. Washington Post,
14 October 2004.
Bryjak, G. 2005. ‘Gender, Power, and Death’. In Z Magazine Online. Vol
18, No 3. (http://www.zmagsite.zmag.org/Mar2005/bryjak0305.htm)
Delport, E. 2005. ‘HIV/AIDS: A challenge to the successful implementation
of the protocol’. In Pambazuka News.
(http://www.pambazuka.org/index.php?id=29499)
Family Health International. 2005. Network. Vol
23, No 4.
Feuer, C. 2004. ‘Can PEPFAR Save the Most
Vulnerable?’. In AmfAR Treatment Insider.
(http://www.amfar.org/cgibin/
iowa/td/feature/record.html?record=119)
Hamblin, J. & Reid, E. 1999. Women, the HIV
Epidemic and Human Rights: A Tragic
Imperative. UNDP: HIV and Development
Programme. Issues Paper No. 8.
Sexuality Information and Education Council.
2004. ‘The U.S. Five-Year Global HIV/AIDS
Strategy: A Vehicle for Conservative Ideology’.
In Making the Connection— News and Views
on Sexuality: Education, Health, and Rights.
Vol 3, Issue 1.
(http://www.siecus.org/inter/connection/conn0
037.html)
Sinding, S. 2005. ‘Does ‘CNN’ (Condoms,
Needles, and Negotiation) Work Better Than
‘ABC’ (Abstinence, Being Faithful and
Condom Use) in Attacking the AIDS
Epidemic?’. In International Family Planning
Perspectives. Vol 31, No 1. Pp. 38-40.
FOOTNOTES:
1. Bryjak G. 2005. ‘Gender, Power, and Death’. In Z Magazine
Online, Vol.18, No.3.
2. Delport E. 2005. ‘HIV/AIDS: A challenge to the successful implementation
of the protocol’. In Pambazuka News. (http://www.pambazuka.
org/index.php?id=29499)
3. Feuer C. 2004. ‘Can PEPFAR Save the Most Vulnerable?’ In
AmfAR Treatment Insider. (http://www.amfar.org/cgi-bin/iowa/td/feature/
record.html?record=119)
4. Ibid.
5. Ibid.
6. Kistner, U. 2003. Gender-based violence and HIV/AIDS in South
Africa: A literature review. Johannesburg: CADRE. pp 49-50.
7. The Constitution of South Africa, Act 108 of 1996.
8. Hamblin, J. & Reid, E. 1999. Women, the HIV Epidemic and
Human Rights: A Tragic Imperative. UNDP: HIV and Development
Programme. Issues Paper No. 8.
9. Sexuality Information and Education Council. 2004. ‘The U.S.
Five-Year Global HIV/AIDS Strategy: A Vehicle for Conservative
Ideology’. In Making the Connection – News and Views on
Sexuality: Education, Health, and Rights. Vol 3, Issue 1.
(http://www.siecus.org/inter/connection/conn0037.html)
10. Kistner, U. 2003. Gender-based violence and HIV/AIDS in
South Africa: A literature review. Johannesburg: CADRE. p. 48.
11. Ibid.
12. Ibid.
aLQ – November 2005 13
Rachel Elfenbein is the
Trainer/Facilitator at the AIDS Legal
Network (ALN). For further information
and/or comments please contact
her on +27 21 447 8435 or at
rachel@aln.org.za.
‘ABC’: A gendered look at HIV prevention
aLQ – November 2005 S 14 Sexual Offences Bill:
Impact on the LGBT community?
Sexual Offences Bill:
Impact on the lesbian, gay, bisexual and
transgender community?
Evashnee Naidu
South Africa’s Constitution1, one of the most
progressive in the world, expressly includes,
as the first country, sexual orientation as one
of the grounds of non-discrimination 2.
However, despite the progressive
constitutional provisions, there are still old
laws, such as the Sexual Offences Act
(No 23 of 1957), and social prejudices that
discriminate both directly and indirectly
against lesbians and gays.
Previously, the common law crime of
sodomy prohibited consensual sex between
men. The law was silent on the issue of
consensual sex between women.
In 1997, the National Coalition for Gay
and Lesbian Equality (NCGLE) and the
South African Human Rights Commission
(SAHRC) challenged the common law crime
of sodomy as unconstitutional and the
Constitutional Court3 ruled it to be no longer
a crime for men to have sex with men.
The discriminatory prohibitions on sex
between men reinforces already existing
societal prejudices and severely increases
the negative aspects of such prejudices on
their lives. … But such provisions also
impinge peripherally on other harmful
ways on gay men which go beyond the
immediate impact on their dignity and
self-esteem. Their consequences
‘legitimate or encourage blackmail police
entrapment, violence (‘queer-bashing’)
and peripheral discrimination, such as
refusal of facilities, accommodation and
opportunities’…4
AGE OF CONSENT
The current Sexual Offences Act (No 23
of 1957) has a different age of consent for
heterosexual people and for homosexual people. Heterosexual
people may have sex with each other at the age of 16, while lesbian
and gay people can only consent to sex at the age of 19.
This means that it is still illegal for young lesbians or gay men to
have sex. Technically, same-sex couples consenting to sex below the
age of 19 could be prosecuted and sent to jail. This clearly indicates
that current sexual offences legislation discriminates against samesex
relationships and, thus, should be declared unconstitutional.
The unequal age of consent also increases the risk of HIV
infection amongst same-sex couples, as it adds to the prejudice
faced by lesbians and gays in South Africa and further hinders
adequate access to sexuality education, information and treatment
for sexually transmitted diseases.
17 year old Simon5 shares his story…
Being gay while still at school is not one of the easiest things
in the world. I have always felt ‘different’ from the other guys. I
was never really interested in the types of activities that guys my
age were interested in, such as sports or girls. I never had any
male friends. And as a result I felt alienated and alone.
The older boys used to beat me up and tease me with names
like ‘sissie’ or ‘faggot’! I was constantly humiliated in front of all
the other kids. I had no friends. I couldn’t tell anyone about my
feelings as I feared they would not understand. I was also afraid
that my family would no longer love me, and that they would
punish me for being ‘different’. I was afraid of not being accepted
and of being humiliated. I didn’t want to be labelled ‘abnormal’.
I was so confused and frightened. I thought that there was something
wrong with me. I thought I was the only guy in the world who
was attracted to other guys. I felt guilty about my feelings and
thoughts. No one was there to tell me that these feelings and
thoughts were both natural and normal and that homosexuals could
lead very healthy and fulfilling lives.
I kept waiting to hear something about homosexuality – but I
got nothing. I kept thinking this may be a phase, but it wasn’t. I
used to fear that gays were sinners and had absolutely no rights
at all. I wish there was someone I could have talked to or at least
something I could have read that could have helped.
Since then, the South African Law Reform Commission (SALC)
has held numerous discussions throughout South Africa on a new
draft Sexual Offences Bill (SOB). The SALC has also recommended
T that the age of consent should be 16 years for both heterosexual and
homosexual people.
Thus, the proposed change to the sexual offences legislation will
remove the discrimination based on sexual orientation pertaining to
the age of consent, which is currently defined differently according
to sexual orientation. In addition, it could be argued, that this
recommendation carries the potential to assist the lesbian and gay
community accessing material about sexual education, accessing
preventative measures, accessing treatment, but most of all assist in
addressing the stigma and discrimination associated with being
lesbian or gay.
COMMON LAW DEFINITION OF RAPE
The current common law definition of rape consists of a man
who has unlawful sexual intercourse with a woman without her consent.
This offence can only be committed by a man against a woman,
by the penetration of the penis into the vagina. This offence excludes
anal penetration, oral penetration or penetration by foreign objects.
The definition is not only gender-biased, but also fails to provide
for rape against a person of the same sex.
18 year old Johan6 was at a party with friends. They were all
drinking. Sadly, some of Johan’s friends took this opportunity
to ‘gang-rape’ him. When he went to the nearest police station
to report the matter, he was chased out of the police station
because he was drunk. He thereafter went to the local hospital
to be examined. After many hours he was finally attended to
and given a starter pack of PEP7. When he went back to the
hospital two days later to receive the rest of his treatment, a
nurse laughed at him and said to him that men could not be
raped, so he could not get access to treatment.
Technically, the nurse in the above example was correct, since
under the current definition of rape, Johan could not have been raped.
The ones who ‘raped’ him would, under current legislation, have been
liable to prosecution on charges of indecent assault,
irrespective of the fact that Johan was ‘raped’ and the violation, as well
as the emotional and physical trauma, experienced by Johan, is no less
than the one experienced by a woman who has been raped.
The charge of indecent assault in existing sexual offences
legislation is used for sexual offences, which are of a lesser degree
than that of rape. Classing Johan’s
experience as an act of indecent assault
derogates from the seriousness of the offence.
The proposed changes to the sexual
offences legislation broaden the offence of
rape, especially with regard to the aspect of
gender ‘neutrality’. This offence addresses
the unlawful and intentional penetration of a
person by the genital organs of one person
into the anus or genital organs of another
person. This clearly allows for the recognition
of the fact that both women and men can
be victims and/or perpetrators of the crime
of rape.
This proposed change would also
greatly impact on the gay community, in
that it allows for gay males who have been
‘raped’, and have experienced the same kind
of violation and physical and emotional harm
that women experience, to have the right to
equal protection and benefit of the law8.
Two further recommendations pertaining
to sexual violation and sexual penetration9,
is also very progressive, especially in
recognising the reality in which many of the
gay community are sexually assaulted by
members of the ‘straight’ public, inserting
foreign objects into their anuses. These
aLQ – November 2005 15
Sexual Offences Bill:
Impact on the LGBT community?
Heterosexual people may have
sex with each other at the age of
16, while lesbian and gay people
can only consent to sex at
the age of 19.
The ones who ‘raped’
him would, under
current legislation,
have been liable to
prosecution on
charges of
indecent assault, …
in existing sexual
offences legislation is
used for sexual
offences, which are of
a lesser degree than
that of rape.
L offences respectively provide for the
unlawful and intentional use of an object to
penetrate a person’s anus or genital organs,
and the penetration of a person’s mouth by a
person or animal’s genital organs.
While these proposed legislative amendments
are definitely more in line with the
Constitution, it cannot possibly impact on
prevailing societal prejudices, and/or affect
the application and implementation of laws.
SOCIETAL CONTEXT
In reality, and despite constitutional and
proposed legislative provisions, lesbians
and gays still experience a lot of prejudice
in their families, communities, workplaces,
schools, religious institutions, as well as in
public services.10
In 1990, the United States Department
of Health and Human Services published a
report on Youth Suicide. The report found
that ‘gay youth are 2 to 3 times more likely
to attempt suicide than other young
people’11. Up to 30% of completed youth
suicides annually involved gay youth.
The report12 concluded that
The root of the problem of gay youth
suicide is a society that discriminates
against and stigmatizes homosexuals
while failing to recognize that a substantial number of its youth
has a gay or lesbian orientation.
In South Africa, in 1994, a 16-year old lesbian contacted the
Centre for Applied Legal Studies for assistance. She regularly faced
harassment at school. At home, her divorced mother and mother’s
boyfriend physically assaulted her on a daily basis because she was
a lesbian. Her father and stepmother also harassed and threatened
her about her sexual orientation.
The Social Services were asked to remove her from her mother’s
custody. They delayed. Two weeks later, she stabbed her mother’s
boyfriend with a knife when he assaulted her again.13
Lesbian youth are raped in their townships every day in an
attempt to change their sexual preference.14 In areas in the Eastern
Cape and Northern Kwa-Zulu Natal, people suspected to be lesbian
or gay are considered to be practicing witchcraft and are attacked by
their local communities.15 These examples, arguably, also highlight
the lack of understanding around lesbian and gay issues.
CONCLUSION
It is well and good for South Africa to have constitutional
provisions and progressive pieces of existing and proposed
legislation providing for equal protection and benefit of the law,
irrespective of one’s sexual orientation. The above, however, are
only a few examples of the reality experienced by young lesbians
and gays indicating that the challenge remains to be the extent to
which, especially lesbian and gay youth, are equally protected and
are equally in the position to access justice.
FOOTNOTES:
1. The Constitution of South Africa, Act 108 of 1996.
2. Section 9(3) of the Constitution.
3. National Coalition for Gay and Lesbian Equality and the South African Human Rights Commission v
Minister of Justice and the Attorney-General of the Witwatersrand, 1998.
4. National Coalition for Gay and Lesbian Equality v Minister of Justice 1999 (1) SA 6 (CC), paras 20-1,25.
5. Simon (not his real name) is a former client of the Durban Community Centre.
6. Johan (not his real name) is a former client of the Durban Community Centre.
7. Post-exposure prophylaxis (PEP).
8. Section 9(1) of the Constitution.
9. Criminal Law (Sexual Offences) Amendment Bill (2003).
10. See also Mkhize, N. 2005. ‘Homophobia is supposed to have no place’. In ALQ, June 2005.
11. As quoted in ALP/ALN. 2001. HIV/AIDS and the Law Manual. Cape Town. p. 232.
12. US Department of Health and Human Services. 1990. Report on Youth Suicide.
13. As quoted in ALP/ALN. 2001. HIV/AIDS and the Law Manual. Cape Town. p. 232.
14. See also Isaack, W. 2005. ‘Crimes of hate and prejudice against black lesbians’. In ALQ, November
2004.
15. See also Mkhize, N. 2005. ‘Homophobia is supposed to have no place’. In ALQ, June 2005.
16 aLQ – November 2005
Evashnee Naidu is the Legal Advisor at the Durban Lesbian
and Gay Community and Health Centre. For more
information and comments please contact her on
+27 31 301 2145 or at gaycentre@mweb.co.za.
In areas in
the Eastern Cape
and Northern
Kwa-Zulu Natal,
people suspected to
be lesbian or gay are
considered to be
practicing witchcraft
and are attacked
by their local
communities.
Sexual Offences Bill:
Impact on the LGBT community?
F
This non-adherence in the face of the high rates of sexual violence and
the nature of the HIV pandemic in South Africa is cause for concern, yet
very few research studies have investigated this.
The Centre for the Study of Violence and Reconciliation (CSVR), on
behalf of the GDoH, addressed this issue in a study conducted in 2004.
The study was carried out at various PEP facilities in Gauteng Province
and looked specifically at factors influencing adherence to PEP following
sexual assault. This paper presents a summary of the most salient findings
from the study. 1
LITERATURE REVIEW
A review of the literature on post exposure prophylaxis found
unpleasant side effects, associated with the use of PEP, to be the
most common explanation for low adherence. Other factors posited
as influencing adherence included patients’ perception of their risk
of HIV infection; the (non)availability of counselling and support to
the survivor; the nature and quality of relationships between health
care staff and patients; patient knowledge and understanding of the
drug regimen and the necessity of taking it; and the stigma attached
to both sexual assault and HIV.2 Kistner (2003)3 identified additional
factors that appear to affect adherence, such as the extent of
patients’ access to reliable primary medical care, as well as their
ability to keep appointments for follow up consultations; and
finally, how able patients are to fit the medication into their daily
routine and to take it in front of others.
METHODOLOGY
To adequately investigate factors influencing patient’s adherence
to PEP, various methods of data collection that relied on both
quantitative and qualitative methods were employed. Primary
sources of data collection included observations at seven PEP
facilities in Gauteng, interviews with 37 health workers across these
sites, interviews with 67 sexual assault survivors and data collection
schedules tracking rape survivors’ adherence to PEP. A secondary
source of data was GDoH’s monthly reports. Employing multiple
sources of data allowed for triangulation of data.
Research sites
The seven sites included in the study
presented a mixture of urban and peri-urban
sites in Gauteng Province and varied with
regards to patient load, with some of these
sites being amongst the busiest in the
province and others less busy.
FINDINGS
In the following sections, findings from
interviews conducted at PEP facilities with
health care workers (HCW) at the seven sites
and with sexual assault survivors are presented.
Findings from facility observations
and interviews with health care
workers
Findings from the study revealed
disparate levels of training and knowledge
amongst health care workers responsible for
providing PEP. Of the 37 HCWs interviewed,
approximately 6 nurses and 1 doctor had been
trained on the medico-legal examination and
21 were unaware of the treatment protocol.
Training sessions varied from half a day to
three weeks. Interviews also suggested that
most health workers have a limited
understanding of the side effects of the
medication, as well as how to treat it.
It appeared that the best trained and most
committed staff were on duty during the day,
while less effective service appeared more
likely at night and over weekends, when
casualty staff were responsible for providing
services. Given that the majority of rapes are
reported at night and over weekends, this is
aLQ – November 2005 17
Post exposure prophylaxis
following sexual assault
Statistics from the Gauteng Department of Health (GDoH) reveal that less
then 27% of patients who take post exposure prophylaxis (PEP) after a
sexual assault complete the full 28 day course of treatment.
Sadiyya Haffejee
Post exposure prophylaxis
following sexual assault
D
F
likely to result in many rape survivors who
will have their first contact with less-trained
and less-knowledgeable health workers.
Staff shortages and limited resources also
appeared to be a constraint to providing an
effective service at some sites. In addition to
inadequate equipment for conducting a
thorough medico-legal examination, staff
across 4 of the 7 sites reported running out of
PEP drugs. Staff shortages at some of the
facilities meant that despite certain health
workers’ ability and motivation, they were
unable to spend as much time with patients as
was necessary. Thus, at least some patients
would have left the facility not fully
understanding the importance of the
medication or how to take it. This situation
was exacerbated by the fact that these
facilities appeared to have little or no
information materials on the drug regimen for
patients to take home and read later.
Furthermore, some health care workers
appeared to lack the necessary training and
the much needed skill to counsel survivors.
Social workers and lay counsellors were not
available on a 24 hour basis at all facilities
and, where available, appeared to have
disparate levels of trauma training.
Furthermore, judgmental attitudes towards
sexual assault patients were reported at some
sites. Once again, the situation was aggravated
by the fact that interagency referrals appeared
to be largely non-existent at some sites; four
of the seven sites had no referral links to rape
trauma counselling services.
Findings from rape survivor interviews
A total of 67 interviews were conducted with rape survivors. Of
these interviews, 15 were in-depth and 52 were shorter structured
questionnaires administered when patients returned for repeats.
Findings from the study show that patients failed to adhere to the
drug regimen, due to side effects, forgetting to take their medication
and not taking their medication properly.
Almost all rape survivors reported side effects, some of which were
debilitating and did not improve. Ineffective treatment of side-effects
was a key finding from this study, emerging from the rape survivor
interviews, the health worker interviews and reinforced by our
observations. While all health workers knew that the drugs caused side
effects, the interviews found that few knew how to treat such side
effects adequately. The study also found that in the majority of cases,
patients were not telling nurses about the side effects they experienced,
and nurses in turn were not asking. The limited interaction that health
workers had with rape survivors collecting their repeat medication was
not sufficient to enquire about patients’ well-being.
Another key finding affecting adherence was rape survivors’ lack
of understanding of the drug regimen. Three reasons for this lack of
understanding are suggested by the study. Firstly, some health workers
are unfamiliar with the drugs so it is possible that they provide patients
with either inaccurate or insufficient information. Secondly, while
other staff may be sufficiently knowledgeable, by their own admission,
they do not spend sufficient time explaining PEP to patients. Finally,
some patients are in no condition to absorb all this information in the
immediate aftermath of the rape.
Fear of contracting HIV emerged as a motivating factor in
encouraging patients interviewed to complete PEP. Interviews also
suggested that the support of others was crucial to helping many
women persevere with treatment. Because their motivation sometimes
fluctuated and they did not always remember their medication,
adherence was helped by supportive others (such as family, friends and
workmates) assisting patients to take PEP.
The practice of supplying weekly dosages of the PEP treatment also
appeared to assist patients in continuing treatment. The reduced number
of pills received at each visit appeared to be less overwhelming and the
weekly contact with HCWs appeared to motivate patients. However, it
was noted, that this arrangement was not suited to all patients, since the 18 aLQ – November 2005 Post exposure prophylaxis
following sexual assault
Ineffective treatment of side-effects
was a key finding from this study,
emerging from the rape survivor
interviews…
Of the 37 HCWs
interviewed,
approximately 6 nurses
and 1 doctor had been
trained on the
medico-legal
examination and 21
were unaware of the
treatment protocol.
Dones who work or attend school appeared to find it difficult to return
on a weekly basis.
The in-depth interviews in particular suggested that some patients
took pride in their sense of responsibility and would not have
welcomed calls from health workers. For one patient, such a call would
have been an unwelcome reminder of the rape, while for others such
calls suggested that they could not be relied upon or trusted to take
their medication. However, because these patients completed their PEP,
they are the exception rather than the rule and may well be a group for
whom being reliable is more important than it might be to others.
The interviews also highlighted other factors potentially
influencing adherence, such as transport difficulties, the belief that
PEP gives people HIV, health facilities’ reputation for (not) caring and
curing, not feeling ill (meaning that medication was no longer
required), and finally, fear, as a result of the trauma suffered, which
may prevent some patients from going anywhere at all.
DISCUSSION AND RECOMMENDATIONS
Findings from the study suggest that factors influencing adherence
are dependent upon the skill, knowledge and attitudes of health
facility staff, individual characteristics of the rape survivor, and the
nature of support they receive in their immediate environment.
To enhance the effectiveness of the service, the following
recommendations were made.
Increase understanding amongst survivors of how to take
the drugs
Findings suggest that patients taking PEP often do not understand
how to take the drugs, how the drugs work or how to treat the side
effects. This failure often results in patients defaulting or taking the
drugs incorrectly and, thereby, negating its effectiveness.
The first step in ensuring that survivors understand how to take the
treatment, is to ensure that all health care workers implementing the
PEP service are fully congruent with the drug regimen and are able to
communicate this information in an empathic manner. To this end, the
study recommended that all staff providing PEP services have a
minimum level of knowledge and skills to deal with rape survivors.
Following the training, staff should be assessed on their understanding
of the training material and on their suitability to work with sexual
assault patients.
Additionally, the study recommends that patients be provided with
easy to read information that they can take home and read when they
are less traumatised. Information should include a simple background
on the treatment and its purpose, instructions on how to take the
treatment and its duration. Information on side effects should also be
included, along with a reminder to patients that side effects must be
reported to health care staff. This insert should further tell patients
about available over-the-counter remedies for some of the side effects.
Written, as well as visual, information should
be made available in all the relevant languages.
Furthermore, the study recommended
that after each visit health workers should
enquire how the patient is doing. This would
provide an important opportunity to clarify
misinformation and provide treatment to
ameliorate side effects.
Strengthen health workers’ support of
rape survivors
At most sites it appeared as though health
workers’ primary focus was on providing the
drugs, with less thought and time spent on the
emotional needs of the survivor. It was
observed that health workers were not always
equipped with the necessary skills and
attitude to counsel rape survivors or to
facilitate support groups. Support for PEP
facility staff, some of whom appeared demotivated,
was lacking. Lastly, PEP facilities
also seemed to be functioning in isolation,
with relations between health, the police and
NGOs relatively undeveloped.
The study, therefore, recommends that
health care services for rape survivors should
not only be limited to the provision of PEP.
The emotional and psychological impact of
the trauma suffered should be acknowledged
and counselling expanded to include trauma
counselling as well. In addition to ensuring
that health care staff are equipped with the
necessary information on the PEP regimen, aLQ – November 2005 19
Post exposure prophylaxis
following sexual assault
…the study
recommends that
patients be provided
with easy to read
information that they
can take home and
read when they are
less traumatised.
S
efforts should be undertaken to ensure that
the quality, attitude and approach of staff are
suited to patients’ needs. Health care workers
should be closely evaluated for their
suitability; screening of all potential
counsellors should be undertaken by trained
professionals and supervision of the ones
providing the counselling service set in place.
To ensure that staff providing the service do
not suffer secondary trauma, regular debriefing
sessions with trained professionals is
suggested. Health care staff should be
encouraged to make trauma counselling
referrals to specialist rape crisis
organisations in the area. Whilst counselling
forms an essential component of the
treatment of survivors, it should be delivered
by skilled counsellors.
Furthermore, the feasibility of follow-up
calls should be investigated. Counselling
appointments and repeat visits need to be
co-ordinated for the same day wherever
possible to prevent patients having to make
two trips in one week to the hospital, thus
reducing financial costs.
Support from family and friends appeared
to be integral in assisting rape survivors and if
patients require such support, it should be
allowed and encouraged. It is recommended that materials also be
developed for family members around being a ‘treatment helper’.
Further recommendations suggested include:
 The practice of providing weekly packs be continued as it
appeared to motivate some rape survivors– although flexibility
should be exercised to accommodate the ones who cannot get to the
facility on a weekly basis.
 The location of facilities should be investigated, as evidence
suggests that the casualty department is unsuited to rape survivors.
 The possibility of dispensing a less complicated drug regimen,
like Combivir should be investigated.
CONCLUSION
From the research it was apparent that the factors influencing
adherence are complex, with no one factor emerging as the primary
course of non-adherence. Based on the findings, a number of
recommendations have been suggested, many of which are cost
effective and relatively simple to institute. In addition, recommendations
are not specific to the facilities investigated; they are instead extensive
enough to be instituted at all facilities offering PEP.
In conclusion, it is important to note that although the study
identified problems in the administration of PEP at the facilities
investigated, there are many motivated and highly skilled health care
workers at some of the facilities who are doing all they can to provide
a good service. These efforts should be commended and supported.
FOOTNOTES:
1. Vetten, L. & Haffejee, S. 2004. Factors affecting adherence to Post-Exposure Prophylaxis in the aftermath
of Sexual Assault: Key findings from seven sites in Gauteng Province. The full report can be
obtained from the Centre for the Study of Violence and Reconciliation.
2. Kachienga, M. 2004. Factors promoting or limiting adherence to post exposure prophylaxis (PEP)
regimes internationally and nationally. Johannesburg: Centre for the Study of Violence and Reconciliation.
3. Kistner, U. 2003. Rape and post-exposure prophylaxis in South Africa. Johannesburg:
CADRE/Department of Health.
20 aLQ – November 2005
Sadiyya Haffejee is a psychologist and researcher in the
Gender Based Violence Unit at the Centre for the Study of
Violence and Reconciliation (CSVR). For further comments and
information, please contact her at +27 11 403 5650 or
at shaffejee@csvr.org.za.
Post exposure prophylaxis
following sexual assault
Health care workers
should be closely
evaluated for their
suitability; screening
of all potential
counsellors should be
undertaken by trained
professionals and
supervision of the
ones providing the
counselling service
set in place.
C
aLQ – November 2005 21
Microbicides
Introduction
Microba-what? This is the general reaction from
people when asked, whether or not they have
heard of microbicides. Perhaps our ignorance
relates to the fact that information regarding the
topic has not been widely distributed. However, the
question still looms, ‘what do microbicides have
to do with us?’. The answer lies in the HIV and
AIDS pandemic.
Around the world, women’s health and lives are at
risk every day, because there are too few options in
STD protection. Scientists are presently
conducting research with the objective of
developing microbicides, which, if proven effective,
would give women the power to protect
themselves from contracting sexually transmitted
diseases (STD’s) and HIV.
Presently, 55% of women in Africa have HIV and
AIDS. In fact, 15,000 new infections occur everyday.
AIDS is ranked among the world’s most devastating
infectious diseases, which creates a greater need for
new and effective preventative measures. This is
where MICROBICIDES come in.
A microbicide is a chemical substance, which may
prevent the transmission of HIV and other sexually
transmitted diseases, when used properly. It can
take the form of a gel, cream, foam, suppository or
film, and is applied intravaginally before sexual
intercourse.
A rampant issue South Africa is facing, is empowering
partners to discuss each other’s sexual history in
an open, honest and comfortable dialogue.
Although, the microbicide shouldn’t necessarily be a
substitute for open discussion about such issues,
microbicide can be used without the knowledge of
one’s partner.
There are three phases in testing the efficiency of
microbicides. Phase 1 and Phase 2 aim to test their
safety. Phase 3 tests whether or not the product
works to prevent HIV. Although not yet available,
five products have entered phase 3 testing in
South Africa.
Microbicides would work in one of the following
ways:
 Killing the HIV and STD pathogens;
 Creating a barrier against infections and thus
enhancing the bodies’ natural defences;
 Preventing replication of the virus;
 Preventing infection from spreading.
Currently, prevention strategies that emphasise
mutual monogamy, e.g. the male condom, require
co-operation by the woman’s partner. Women may
influence, but cannot control a man’s sexual
behaviour. Additionally, violence, coercion, and
economic dependency can make it difficult for
women to ‘negotiate’ condom use or to leave a
partnership that places women at risk.
History
Microbicide research has been taking place for the
last ten years. Since 1990, a number of government
research agencies, private organisations and multinational
bodies, like the World Health Organization
(WHO), have recognised the great potential of
microbicides. Scientists and advocates quickly
recognised the importance of coordinating the
work globally, and in 1994, the International
Working Group on Microbicides was born.
Intensive lobbying in the US and Europe has raised
Microbicides:
A new weapon in the war against HIV
22 aLQ – November 2005 Microbicides
the awareness of microbicides, and, subsequently,
more funding has become available1. However,
despite enormous scientific and public health
potential, microbicide research has been underfunded
and politically marginalised.
The South African government has been silent on
the issue of microbicides to the extent that it has
failed to even mention microbicides in their
HIV/AIDS and STD Strategic Plan 2000 – 2005.
Although, the government does acknowledge that
microbicide research is taking place, it does not
provide any funding for such research. Thus,
advocacy campaigns in South Africa are currently
aimed at government providing funding for
research and subsidising microbicide availability.
Accessibility, availability and demand
Women have expressed a positive attitude toward
the use of microbicidal products. Accessibility
studies in India, South Africa, USA and Brazil have
confirmed the urgent need, women feel, for a
preventative method that they can control.
Although, scientists are now in Phase 3 of the
trials, microbicides will only, with sufficient
investment, be available within 5 years.
Barriers to microbicides development
So, given all the potential advantages, why have
microbicides not taken centre-stage in HIV
research? The answer may lie in society’s approach
to the disease. When the virus was first discovered,
people assumed that an effective vaccine will soon
be available, and in the meantime safer-sex
campaigns will hold the virus at bay.
In reality, how soon microbicides materialise, will
depend on how successful we are in tackling not
only the scientific challenges, but also the societal
issues especially the level of funding for
microbicide development, which needs to be
greatly increased.
Would a microbicide eliminate the need
for condoms?
Condoms would remain the option of choice,
because, when used consistently and correctly,
they are more likely to provide better protection
than a microbicide. But for people, who cannot or
will not use a condom, and particularly for women,
whose partners refuse to use condoms,
microbicides will provide an important ‘fallback’
that can save lives and have a substantial impact
on the epidemic.
Microbicides have the added advantage in that
they are within women’s control. Though,
microbicides may not have a 100% efficacy rate,
they could prevent up to 3.7 million infections in
three years.
Conclusion
The ultimate objective is to provide women with a
tool to empower themselves. A microbicide would,
thus, serve a dual purpose, in that it does not only
provide women with an additional preventative
measure against HIV and AIDS and other STDs,
but it would also give women a sense of control
over their sexual relationships.
Microbicides alone will not solve the immense
problem of HIV and AIDS, but together with
condoms, and eventually AIDS vaccines, they will
give people a wider choice of protective measures.
FOOTNOTE:
1. New Scientists. 2003. HIV Focus Protect & Survive. p 43.
For further information please contact the
Campus Law Clinic on +27 31 260 2446 or at
bernardr@ukzn.ac.za.
C
Since medical science today lacks the technology to cure or to stop the
spread of HIV, many are demanding that the law be employed for
protection. There are a broad variety of legal measures one could think of
in the fight against the diffusion of HIV and AIDS. In South Africa, the
debate focuses on one of the possible legal measures, the criminalisation
of non-disclosed exposure to HIV or AIDS. The present debate appears
to be in response to the Criminal Law Sexual Offences Amendment Bill
(2003), where such criminalisation has been suggested.
Criminalisation can be regarded as an efficient method, in that
society clearly shows its position regarding intentional non-disclosed
exposure to HIV or AIDS. It could also play the role of reparation to
the victim. However, criminalisation is a drastic measure, since it is a
direct tool of state power. It could, therefore, be argued that
criminalisation should only be used with great caution.
Besides general arguments against criminalisation per se, one
could also question such legislation in the special context of HIV and
AIDS, since the criminalisation of non-disclosed exposure to HIV
could only constitute one of several ways to address the spread of HIV.
But one also has to question if criminalisation can truly lead to its goal,
namely to prevent the further spread of HIV and AIDS. Many
representatives from civil society have suggested that this would not be
the case. Furthermore, some seem to believe that such criminalisation
would even be counter-productive and, thus, help to diffuse the HIV
virus. Before such legislation is enacted, it seems logical to take the
voice of civil society into account.
CRIMINALISATION AND
ITS GENERAL DIFFICULTIES
Criminalisation means that a punishment is prescribed for a certain
conduct. Behind the criminalisation lies a political statement that the
conduct in question is so repugnant that it deserves to be sanctioned
with a penalty. Criminalisation fulfils a normative and an informative
purpose. Through the legislation, the state creates norms to be followed
and at the same time informs the citizens of the existence of these
norms. Besides that, criminalisation constitutes a base for law
enforcement agents and the judiciary to, within the frames of their
authority, make sure a penalty and a sentence are delivered to the
person guilty of the criminalised conduct.
There is, arguably, a general agreement in most democratic
societies that criminalisation, as a method to prevent violations of
public norms, should be used with precaution. Criminalisation is
normally not the only, nor always the most efficient means, to
aLQ – November 2005 23
Criminal liability for non-disclosed
sexual exposure to HIV and AIDS
Johanna van Rooij1
Criminal liability for non-disclosure
obstruct non-desirable conduct in a society.
Besides, it is a fairly costly method. It could,
therefore, be argued that a society’s resources
should only be used for conduct that causes
considerable damage to the society and only
in circumstances where there is no other way
to regulate such activity.
To criminalise a certain conduct does not
automatically lead to a punishment of the
perpetrator, since there are a variety of factors
that need to be fulfilled, if criminalisation is
to function in practice. Firstly, the criminal
conduct needs to come to the authority’s
knowledge. Secondly, the state has to have
enough resources to investigate the crime and
to identify the perpetrator. Thirdly, it must be
possible to prove the crime before a court. And
finally, the state has to have resources to carry
out the sentence. Thus, there are a number of
factors to take into consideration, when
criminalising special conduct in a society. 2
SPECIAL DIFFICULTIES IN THE
CONTEXT OF HIV AND AIDS
To criminalise intentional non-disclosure
of HIV and AIDS raises a number of specific
difficulties. Objectively, to be able to judge
whether or not such a criminal conduct took
place, one would have to prove that the
defendant had HIV or AIDS at the time of the
commission of the crime. In addition, one
would further have to be able to prove,
beyond reasonable doubt, that the victim
acquired the infection from the act of the
perpetrator. In other words, one would have to
be able to prove causality between the
criminal act and the damageable effect. Even
though, there are scientific possibilities to
prove such causality (DNA tests can test if the
structure of the antibodies in the victim
resemble the ones of the defendant), this is a
fairly costly method.
There are also subjective difficulties in
Fproving criminalised non-disclosure of HIV
or AIDS. The prosecutor must be able to show
that the defendant was fully informed of the
risks and the consequences of unprotected
sexual intercourse whilst infected with HIV
or AIDS. The conduct would only constitute a
crime, if the defendant knew the risks, or
reasonably must have been aware, and still
engaged in unprotected sexual intercourse. It
must, thus, have been the intention to cause
the damageable effect.
Finally, criminalising such non-disclosure
of HIV also causes difficulties when it comes
to sentencing. Since the defendants in such
cases would themselves be victims of their
own disease, it could be argued that a
punishment would be rather meaningless.
One would also have to take the availability of
health care services in prison into account and
the extent to which such a sanction would
affect the defendant’s health condition. In this
context, it has to be noted, that a defendant’s
HIV infection has, until now, often been
regarded as a mitigating factor in South
African case law.
CRIMINALISATION THROUGH
COMMON LAW
The fact that the South African
government is planning to criminalise
intentional non-disclosed exposure to HIV or
AIDS, does not mean that this conduct has
not been regarded as criminal before. Possible
prosecutions for deliberate conduct, which
cause an exposure to, or a transmission of
HIV, include murder, attempted murder,
assault, assault with the intent to do grievous
bodily harm, indecent assault, fraud and
crimen injuria.3 The recent case State v. Nyalungu 4 shows that it is
indeed possible, to successfully prosecute HIV-related behaviour under
the existing common law, without a specific statutory law. The
defendant in this case was found guilty of rape and attempted murder.
The latter charge was based on the fact that the defendant was HIV
positive at the time of the crime and that he therefore intentionally had
exposed the victim to the risk of transmission of the virus through the
rape. It was uncertain at the time of the trial whether or not the victim
had become infected with HIV.
CRIMINALISATION THROUGH STATUTORY LAW
The current draft of the Sexual Offences Bill (2003)5 has created a
separate offence called Criminal non-disclosure of HIV or AIDS. The
definition states that ‘a person (A) who engages in intimate contact
with another person (B) and who intentionally does not disclose to B
that he or she has HIV or AIDS’ is guilty of the offence. ‘Intimate
contact’ is defined as ‘contact of a sexual nature that exposes the body
of one person to a bodily fluid of another person’. It is further
recommended that if the other party was aware of the fact that her or
his sexual partner was infected with HIV or AIDS and still consented
to sexual penetration; it should be regarded as a defence to the charge.
It is also suggested that prosecution of this offence could only be
instituted with a written authorisation from the National Director of
Public Prosecutions, and only if instituting the prosecution would be in
the interests of justice, with due regard to the circumstances surrounding
the offence and the personal circumstances of both parties.6
It is unclear at the moment whether or not the proposed changes to
the sexual offences legislation will be passed by the Parliament.
However, if these changes pass, there are a number of legal issues that
need to be addressed. Firstly, the question arises whether or not this
intentional crime should be interpreted to include dolus eventualis.
Should ‘intentionally’ only cover dolus directus (aim and object to
infect) and dolus indirectus (foresight of substantial certainty) or also
include dolus eventualis (foresees the possibility that the prohibited
consequence might occur, in substantially the same manner as that in
24 aLQ – November 2005
…one would further
have to be able to
prove, beyond
reasonable doubt, that
the victim acquired the
infection from the act
of the perpetrator
Since the defendants in such cases
would themselves be victims of
their own disease, it could be
argued that a punishment would be
rather meaningless.
In South Africa, the HIV positive
status is highly stigmatised and,
thus, criminalisation of HIV-related
behaviour might exacerbate
this stigma…
Criminal liability for non-disclosure
M
which it actually does occur, or the prohibited circumstance might
exist and accepts this possibility into the bargain)? An inclusion of
dolus eventualis could, however, imply imposing a duty on people to
undergo HIV testing.7 Secondly, the question arises whether or not the
common law crimes used to date for HIV-related behaviour, such as
attempted murder, are still to be used for this conduct. Since the
legislation does not say anything explicitly about an eventual
annulment, the problem of a future collision between the common law
and the statutory law seems to be imminent.
POSSIBLE SOCIAL OUTCOMES OF
CRIMINALISATION THROUGH STATUTORY LAW
Criminalisation of intentional non-disclosed exposure to HIV or
AIDS through statutory law could, besides legal difficulties, also give
rise to practical difficulties, and more seriously to non-desirable effects.
Firstly, one would have to investigate the possibility of the courts
administering and adequately implementing this new offence. Taking
cognisance of the high numbers of HIV infected people in South Africa,
the risk of an overburdened criminal justice system would, arguably,
have to be considered. If the resources of the judicial system are
lacking, the criminal penalties could be regarded as empty threats.
Another practical issue, against special legislation, is the lack of
flexibility that this method brings. To legislate is complicated and
time-demanding. If, for example, anti-retroviral drugs become more
available, or a cure for the disease is found, there would be a need to
adapt the statutory law. These changes could instantly be taken into
account through the common law system, which has an inherent
higher flexibility.
More importantly, the criminalisation of intentional non-disclosed
exposure to HIV or AIDS would possibly not fulfil its purpose, but
instead risk being counter-productive. In South Africa, the HIV
positive status is highly stigmatised and, thus, criminalisation of HIVrelated
behaviour might exacerbate this stigma, since all people tested,
or perceived to be HIV positive would risk being regarded as potential
perpetrators. Furthermore, such legislation could lead to a situation in
which fewer people would choose to be tested to avoid being
prosecuted for intentional criminal conduct. Subsequently, people
infected with HIV, who do not know their status, would also risk
alienating themselves from medical care. In the long run, criminalisation
could, thus, challenge the extent to which society is in the position to
control and manage the pandemic and to treat its citizens suffering
from the disease. Criminalisation through statutory law could,
therefore, potentially aggravate an already
critical situation.
Finally, the high number of NGOs, who are
against this criminalisation, should be taken
into consideration. The National Civil Society
Coalition on the Sexual Offences Bill8 has
formulated a fact sheet about the suggested
offence of Criminal non-disclosure of HIV
or AIDS. According to their views, such
criminalisation could have a disproportionately
negative impact on women, who are often less
likely to disclose their HIV status for fear of
violent recrimination, economic hardship or
social abandonment. The fact sheet also points
to the fact that most HIV transmissions occur in
circumstances where neither party knows their
HIV status. Criminalisation could, therefore, be
considered meaningless.
Taking all these factors into consideration,
it could, therefore, be argued, that under
current South African circumstances, the
criminalisation of intentional non-disclosure
of HIV or AIDS would not serve the purpose
intended.
FOOTNOTES:
1. In April 2005, I was awarded a scholarship from the Swedish
International Development Cooperation Agency to, within my law
studies, carry out a Minor Field Study in South Africa investigating
the issue of criminal liability in the context of HIV and AIDS. This
article is based on literature review, as well as discussions with various
NGOs and professors of law and political science at the
University of Cape Town.
2. Swedish Government Bill, 1994/95:23, p. 52 ff.
3. Burchell, J. & Milton, J. 2005. Principles of Criminal Law. 3d
Edition. Juta. p. 724.
4. State v Nyalungu 2005 JOL 13254 (T). Case number CC 94/04.
Judgment date 15/03/2004.
5. Criminal Law (Sexual Offences) Amendment Bill, Section 5.
6. Criminal Law (Sexual Offences) Amendment Bill, Section 5(4).
7. Burchell, J. & Milton, J. 2005. Principles of Criminal Law. 3d
Edition. Juta. pp 467 & 725.
8. The working group member organisations include: AIDS Law
Project; Childline SA; Centre for Applied Legal Studies; Centre for
the Study of Violence and Reconciliation; Concerned People Against
Abuse; Lawyers for Human Rights; Ngata Safety and Health
Promotion; NISAA Institute for Women’s Development; People
Opposing Woman Abuse; Port Elizabeth Rape Crisis Centre; Rape
Crisis Cape Town Trust; Resources Aimed at the Prevention of Child
Abuse and Neglect; Save the Children Sweden; Sex Workers
Education and Advocacy Taskforce; Thohoyandou Victim
Empowerment Project; Tshwaranang Legal Advocacy Centre; Western
Cape Network on Violence against Women.
aLQ – November 2005 25
Johanna van Rooij is a final year law
student at Stockholm University.
For more information and comments
please contact her at
johannavanrooij@yahoo.se.
…such legislation could lead to a
situation in which fewer people
would choose to be tested to avoid
being prosecuted for intentional
criminal conduct.
Criminal liability for non-disclosure
B
Black women in previously disadvantaged
communities in South Africa carry the burden of
triple oppression: (a) the social engineering
policies synonymous with apartheid have
marginalised women economically and socially;
(b) patriarchy, embedded in cultural and
religious discourses, has rendered women
voiceless and powerless; and (c) HIV and AIDS is
targeting the most vulnerable, namely women
and children. Not only are women carrying the
brunt of HIV infections, but they also carry the
extra burden of caring for the sick and the dying.
Ethical considerations should, therefore,
be at the core of doing research with women
in previously disadvantaged communities,
infected and/or affected by HIV and AIDS,
about care and/or the lack of care. The
methodology chosen should be accountable to
these ethical considerations. As a contextual
liberation and feminist theologian, the writer
argues a narrative approach to doing research
with marginalised women. The article
concludes with a reflection on the
implementation of some of the ethical
principles in the research.
You and I are close, we intertwine; you
may stand on the other side of the hill
once in a while, but you may also be me,
while remaining what you are and what I
am not. [Trinh, 1989a:90]
‘DEAR GOD, FILL ME WITH
YOUR HOLY SPIRIT FOR I AM
ONLY A WOMAN’
Ever since I could remember, I wanted to
be a ‘dominee’. A strange calling, it seemed,
given the fact the Dutch Reformed Church did not allow women to
practice theology then.
In retrospect, my mother contributed considerably towards my
calling by challenging power discourses in society. She reminded me
constantly that we are all human beings created equally by God.
Neither money, status nor gender made one person more important
than another. I, therefore, believed that I could challenge viewpoints
different from my own, no matter who speaks them. I was continuously
reprimanded for not being submissive to my ‘meerderes’.
These beliefs brought me into conflict with the ‘powerful’ in my
community since an early age. I challenged the principal in primary school
for the disrespectful way he addressed pupils and I refused corporal
punishment. I confronted the ‘dominee’ for expecting me to learn the
Ten Commandments by heart, as a prerequisite to be accepted as a
member of the congregation, and I challenged school rules fabricated
to strengthen patriarchal discourse. The ‘powerful’ assured my mother
that I was going through a phase of teenage immaturity.
Before enrolling for a BA (admission) at the Rand Afrikaans
University, I visited my ‘dominee’ to share the excitement of my decision
to study theology. He tried to convince me to change my study
direction, ‘…as this is no job for a woman’. The theology class of 1992
consisted of three female students and seventy-eight male students.
The top achievers throughout my student career were all women.
With its emphasis no longer on dogma, which focuses on the
rules and regulations of the church, but on the ethical implications
of such rules and regulations on the lives of human beings, postmodern
theology suited my beliefs well and I could reassure myself
of my sanity.
The ethical considerations of post-modern theology impressed itself
on my heart. Russouw [1993:903] uses the phrase ‘from being right to
doing right’, to describe this ethical aspect of post-modern theology. A
Christian understanding of the world can never be anti-human.
Christians of all denominations should, therefore, not only be sensitive to
suffering in general, but should be especially sensitive to the practical
consequences of theological perspectives and practises based on belief.
Dogmas have tended to marginalise and disempower many people, which
also means that these people’s voices have been silenced.
26 aLQ – November 2005
The untold stories of women
and AIDS
Ethical considerations in a feminist narrative research experience
Sunette Pienaar
The untold stories of women and AIDS
ERussouw [1993:902,903] writes:
Theology has a long and rich tradition from which it can draw in
its response to the challenge to care for the marginalized in
society. Liberation theology and the most recent research on the
historical Jesus are only two of the recent developments which
have again focused on the special concern displayed in Scripture
for the marginalized … God therefore reveals and illustrates
through the story of his people and the story of Jesus a special
concern for those whose human value and dignity is denied by
society – those in danger of dropping out of the care of society,
or who has been excommunicated from society.
Ethical considerations function very strongly in post-modern
theology. At this point, I want to mention Foucault1, because he is a
post-structuralist, who concentrates on ethical issues and relational
power. Parker [1989:61] writes about Foucault’s idea of relational
power:
What is spoken, and who may speak, are issues of power. As well as
organizing and excluding forms of knowledge, discourse relates
and helps organize social relations as power relations.
In a post-modern worldview, I think it is important to ask the
question raised by Parker [1989:61]: ‘What is spoken and who may
speak?’ I raise the question in order to ask about the ethical
implications of an action or discourse. Ethical considerations
involve a focus on power relations. Parker [1989:67] says: ‘Not only
are social relations stressed, and social relations as they are
embodied in discourse, but we may view these relations as power
relations.’ Foucault, as quote in McHoul and Grace [1993:39], argues:
Power is everywhere, not because it embraces everything but
because it comes from everywhere … Power comes from below; that
is there is no binary and all-encompassing opposition between
ruler and ruled at the root of power relations, and serving as a
general matrix – no such duality extending from the top down and
reacting on more and more limited groups to the very depths of the
social body. One must suppose rather that the manifold relations of
force that take shape and come into play in the machinery of
production, in families, limited groups and institutions, are the
basis for wide-ranging effects of cleavage that run through the
social body as a whole.
If power is everywhere, then women and
children have power to resist, although, they
have been silenced by discourses embedded
in patriarchy, sexuality, gender, culture &
ethnicity and race. Post-modern culture
insists that people with so-called expert
knowledge are not the only ones to whom
one should listen when decisions are made.
The ones who are affected by such decisions
also have a valuable and indispensable
contribution to make – even if they are
considered non-experts or non-literates in
terms of modern rationality. Expertise must
be enriched and informed by the experience
of the ones on the receiving side of expert
opinion. This post-modern emphasis
becomes especially clear in the concern for
the ones, who have been marginalised in
modern culture – the ones, who have been
socially rejected by modern society and the
ones, who are not fit to compete in modern
society.2
Post-modern theology is concerned with
the ethics of our day-to-day life, and not
with the dogma of ‘being right’. Patriarchal
discourse has involved, for many years, a
misapplication of dogma, resulting in a
negative influence on many people and a
marginalisation of many voices. Postmodern
theology leaves a door open to deconstruct
discourses embedded in patriarchy,
sexuality gender, culture & ethnicity and
race, because of its relational power and
ethical considerations, to ‘do right’ instead
of ‘being right’. Post-modern theology has
aLQ – November 2005 27
Dogmas have tended to
marginalise and disempower
many people, which also means
that these people’s voices have
been silenced.
Post-modern theology
is concerned with the
ethics of our
day-to-day life, and
not with the dogma
of ‘being right’.
The untold stories of women and AIDS
D
influenced my thoughts about dogma and
ethics, and opened my mind to listen to people’s
lived experiences, instead of the theories and
dogmas that I was taught, were the only way.
The ‘socio-economic pattern of contextualisation’
described by Bosch [1991:421] as
‘evolutionary or revolutionary’, converted me
to ‘doing’ theology. Contextual theology
claims to be an epistemological break from
traditional theologies designed to serve the
interest of the West. It is affirming justice
against oppression, shifting from the general
to the local; co-constructing a variety of
‘local theologies’ 3; and opposing a Western
theology claiming universal validity. This
necessitates self-other actions that go beyond
the luxury of merely thinking commitments,
to doing commitments. It is committed to the
poor and the marginalised, it has the notion
that theology can only be done with the ones,
who suffer. It emphasises doing theology,
since doing is more important than knowing
or speaking (hermeneutic of the deed)4.
Dr Beyers Naudé addressed the
theological students in my final study year
for obtaining the BD degree. It was only
then that I realised that as a white person, I
grew up in a different South Africa from the
one he described. He told us about the
atrocities of the ‘apartheid’ government
against the black people. He also shared his
own story of marginalisation in the church,
as a result of his beliefs and his stand
against apartheid. I was disillusioned by the
role the Dutch Reformed Church played in
the institutionalisation of ‘apartheid.’
Churchgoing became a tedious activity of
the scrutinising of sermons and voices of
church leaders, measuring them against the
same scriptures used to condone apartheid.
Liberation theology took on a new
meaning for me, as I read the life stories of
Nelson Mandela and his comrades.
Liberation is a process in which
oppressive groups acknowledges their
responsibility for structures of
domination and name the forces that lead to repentance
and conversion [Welch, 1990:157].
Feminist theology was introduced to me in the form of a single
assignment in my final year. It was only after two years, as a youth
pastor in the church, that I started to comprehend the necessity for a
feminist theology 5 that exposes the harmful effects of a hierarchical
model in religions, while enhancing an egalitarian model.
I came to understand that my sexuality could hinder and even shame
my ministry. The church council even reprimanded a female colleague of
mine for wearing trousers. The ‘tannies’ in my congregation warned me
to be careful in my conduct with boys, as I am a woman. My husband,
also a minister and youth pastor before me, was never reprimanded in this
way for dealing with the young girls in the congregation.
Gender stereotyping also caused friction with my colleagues (all
male) and their wives. My male colleagues would greet each other with
the hand and would wave an informal ‘hello’ to my side at meetings.
During tea breaks at meetings, all eyes turned to me for pouring tea.
Needless to say, I refused to do ‘domestic tasks’ at the church or greet
anyone who didn’t greet me properly. This stereotyped me as someone
who deemed herself better than the wives of the other ministers. They
are God’s servants, who would continue with the demeaning tasks I
refused to do.
I was asked to do a sermon on women’s day at our church one year
and never again. A few ‘tannies’ confronted me after my sermon for
preaching a heresy as the Bible stipulated that women have to be
submissive to their husbands. A female elder prayed before one sermon:
‘Dear God, this is only a woman. Fulfil her with the Holy Spirit to preach
your word’. Some others would walk out, as soon as I mount the pulpit. I
was in desperate need of feminist practices that seek ‘justice, peace, healing
and wholeness for all in partnership’ [Ackermann, 1991:96].
Feminist theology represents ‘a radical critique of patriarchal religious
and theological thinking’ [Isherwood & McEwan, 1991:61]. It is within
the community of feminist theologians where I found food for my soul.
Feminist theology also takes into account ethical considerations. Griffen
(1989)6 states, that post-modern theology is supportive of feminist or
post-patriarchal theology.
Contextual liberation and feminist theology motivated me to
found an organisation that would aim at alleviating the suffering of
the most vulnerable members of society being women and children,
by facilitating change in communities. I longed for women to have a
28 aLQ – November 2005
Not only are women carrying the
brunt of HIV infections, but they
also carry the extra burden of
caring for the sick and the dying.
The untold stories of women and AIDS
platform to voice their stories and to be given the chance to createA
their own alternative stories. Heartbeat, Centre for Community
Development, has become my vehicle for ‘doing’ theology.
I set foot in a township for the first time in 1999 as part of my
endeavours of initiating the activities of Heartbeat. I was twenty-nine
years old and this would be my first encounter with the township
community socially engineered by the apartheid government.
Women in this community were exposed to triple discrimination:
(a) the social engineering policies synonymous with apartheid have
marginalised women economically and socially; (b) patriarchy,
embedded in cultural and religious discourses, has rendered women
voiceless and powerless and (c) HIV and AIDS is targeting the most
vulnerable: women and children. Not only are women carrying the
brunt of HIV infections, but they also carry the extra burden of
caring for the sick and the dying.
Although a new peaceful democracy has dawned on South Africa in
1994, a handful of women ministers were appointed in parliament, and
although, a constitution that enshrines women’s rights were
adopted, the lot of most black women stayed unchanged and
unchallenged in their communities. Cultural practices embedded in
religious beliefs and hierarchical systems render African women voiceless
and powerless. This is exacerbated by their poor economic status.
AIDS adds an extra burden of care on their worn-down shoulders.
I was committed to research that would
…not only contribute to the transformation of our society through
care with the marginalised and disadvantaged, but also address
cultural discourses and societal practices that promote injustices
[Kotzé & Kotzé, 2001:viii].
I wanted to render women in previously disadvantaged communities,
infected and/or affected by HIV and AIDS, the opportunity to share their
stories of care and/or the lack of care. I aimed to ensure that I apply a
research methodology true to the ethical principles of post-modern-,
contextual liberation- and feminist theology.
LISTENING TO THE STORIES OF WOMEN:
ETHICAL CONSIDERATIONS IN THE CHOICE OF
A METHODOLOGY
Qualitative research
I strongly identify with the ethical principles inherent to qualitative
research, because qualitative research is a
form of participatory research, which
challenges the traditional notion of the
researcher as the expert and blurs the boundaries
between ‘researcher’ and ‘researched’ 7.
Attempts are made to acknowledge and
reduce the distance between the researcher
and the researched and so control the effects
of subjectivity.8 In qualitative research, the
researcher and participant are interdependent
in the process.9 My research became
‘co-research’10, or, as Dixon [1999:45]
prefers, ‘co-search’ in the real sense of the
word, as my beliefs, my preconceived ideas
and my personal feelings were challenged. I
realised that
…hiding the ‘I’ is a pretence, a fraud that
forces me to hide my passion, to deny who
I am, and to pretend that my words are
separate from me. Acknowledging the ‘I’
allows me to reveal myself and my feelings
[Dudley-Marling, 1996:36].
One implication of qualitative research for
the power-sharing between researcher and
researched or participant is that the participant
benefits from the research project at the time
that it is taking place. Furthermore, the
participant in the project is, from start to
finish, an owner and co-creator of knowledge.
aLQ – November 2005 29
Cultural practices embedded in
religious beliefs and hierarchical
systems render African women
voiceless and powerless.
…for a long time
minority and
disempowered groups
became research
populations in
projects, which
advantaged
academics, while the
ones being studied
enjoyed no
benefits at all.
The untold stories of women and AIDS
F This has several implications for the ethics of
research in that it addresses issues such as
accountability, deceit and informed consent.
Most importantly, it corrects the injustice that
for a long time minority and disempowered
groups became research populations in
projects, which advantaged academics, while
the ones being studied enjoyed no benefits
at all.
I am concerned with how the voices of the
women are to be heard, with what authority and
in what form. This concern was a central issue
to my research. Some quantitative research has
dismissed, marginalised or maintained control
over the voices of others by an insistence on the
imposition of researcher-determined positivist
and neo-positivist evaluatory criteria, internal
and external validity, reliability and
objectivity.11
Together with other feminist researchers, I
am highly conscious of the absence of
women’s voices, distortions, and the charge
that preparing an account in the usual social
science modes only replicates hierarchical
conditions found in the parent disciplines,
where women are outside the account.12
In Africa we do things together through stories
I chose a narrative approach to research encompassing the ethics
embedded in post-modern- contextual liberation- and feminist theology.
The narrative world view proposes that human beings are
interpreting beings and that we are active in interpreting our
experiences as we live our lives.13 According to White [1995b:14], a
narrative perspective proposes that we live according to the stories that
we have about our lives, that these stories actually shape our lives,
constitute our lives and that they ‘embrace’ our lives.
Freedman and Combs [1996:31] suggest that, when therapists (in
this case ‘researchers’) listen to people’s stories in order to ‘make an
assessment’ or ‘take a history of the illness’ or ‘offer an interpretation’,
they are approaching people’s stories from a modernist, ‘structuralist’
point of view. However, within a post-modern social constructionist
world view, it is important to attend to cultural and contextual stories,
as well as to individual people’s stories. I agree with McLean
[1997:17] that an individual’s stories have been influenced by the
social, cultural, political and economic environments in which the
individual has lived. Freedman and Combs [1996:32] quote Mair in
this regard:
Stories inform life. They hold us together and keep us apart. We
inhabit the great stories of our culture. We live through stories. We
are lived by the stories of our race and place.
The narrative approach is a comfortable way to be true to postmodern
social-constructionism in the following way described by
Müller, Van Deventer and Human [2001]:
For us, the aim of the research is not to bring about change, but
to listen to the stories and to be drawn into those stories. While
the structuralist researcher has objectivity in mind by trying to be
an observer from outside, and by trying to bring about change
from the outside, the narrative researcher has subjective
integrity in mind and strives for participatory observation.
All the research companions travel together in the scientific vehicle of
social constructionism, which Manaka [2001:5] summarises well by
explaining ‘in Africa we do things together through stories’.
The narrative approach is derived from a post-modern social
construction discourse. This has implications not only for the way in
which narrative researchers think about truth, but also for the way in
which we try to be truthful in doing research.
The ‘crisis’ of post modernity is not simply one of believing, but
of revolutions in patterns of work and leisure, use of technology,
the exercise of civic power, participation and citizenship, access
to resources, relationships to the environment, and the use and
abuse of scientific innovations. [Graham, 2000:107]
Narrative researchers, such as Müller, Van Deventer and Human
[2001:76-96], add to the above the use and abuse of research and the
30 aLQ – November 2005
…talk about the
intimate daily
struggles of women
infected/affected by
HIV and AIDS and their
experiences of care or
the lack of care,
without blaming or
rejecting women for
what the problem has
caused in their lives.
The untold stories of women and AIDS
A
importance to deconstruct the sometimes abusiveness of research
projects. Therefore, these narrative researchers choose not to use
language such as ‘research objects’ or ‘research population’, but
rather refer to ‘research participants’ or ‘co-researchers’.
White, following on from Foucault14, writes that power is knowledge
and knowledge is power. This implies that the ones, who have
power, also have knowledge and vice versa. Power and power relations
can be seen in everyday interactions, techniques and practises, such as
the hierarchising of individuals in relation to one another.15
Patriarchal, gender, sexuality, and culture & ethnicity and race
discourses, have all rendered power to men in our society, while
women and children have been subjugated by this power. These
discourses have become dominant narratives which have been
internalised by all people who were marginalised by it, because they
thought that this is the way things should be. By deconstructing this
power or discourses, space can be opened up for alternative understandings
or insights, and the speaking out of the ones, who have
been marginalised.
narrative approach offers useful ideas to facilitate a process in
which women infected and/or affected by HIV and AIDS, from disadvantaged
communities can speak out about their experiences of care
and/or the lack of care. White [1998:1] indicates that the primary focus
of a narrative approach is people’s expressions of their experiences of
life. Winslade and Monk [1992:2,3] say about a narrative approach:
We live our lives according to the stories we tell ourselves and the
stories that others tell about us. Narrative counselling is a
deceptively simple therapy. It is based on the idea that we all
generate stories to make sense of ourselves and of the
circumstances of our lives. However, we are not the sole authors of
our stories. Many of the dominant stories that govern our lives were
generated in our early experiences of childhood at home, at school,
at church, in the neighbourhood.
These stories constitute our dominant way of interpreting and
experiencing our lives. These stories also include experiences that do
not fit into people’s day to day lives. These experiences are sometimes
told, as if they are part of someone’s life. People experience themselves
as the problem, but, according to White
[1988/9:6], ‘the problem is the problem, the
person is not the problem’. Externalising the
problem opens up fresh ways to talk about the
intimate daily struggles of women
infected/affected by HIV and AIDS and their
experiences of care or the lack of care,
without blaming or rejecting women for what
the problem has caused in their lives.
Furthermore, it gives women a chance
to share the stories and experiences that
constitute their lives.
A narrative approach emphasises
transparency, reflexive conversations and
accountability. Multiple reflexive conversations
used in post-modern discourse act as ways of
deconstructing the power/knowledge
relation.16 In this way, the number of
interpretations are expanded and ‘subjects’
are made ‘participants’, co-producing
research, training and therapy [Kotzé &
Kotzé, 1997:37]. Through transparency, the
therapy is deconstructed, in such a way that
the participants can reflect on the process of
communication. It contributes to a context in
which people are more able to decide for
themselves how they might take the
therapist’s responses17. Thus, transparency
involves a deconstruction of the power of the
therapist, entering the therapy or research
equal to the clients or participants.
Accountability is about addressing power
differences. Accountability requires researchers
to confront the ethical responsibilities involved
in the work they are doing with regard to the
people they are working with.
LIVING WITH HIV AND AIDS: A
DAY IN THE LIFE OF THE UBISI
FAMILY18
Nkele greets Mpeki and myself friendly.
Her two-year old daughter’s face lights up
with a smile. The twenty-one year old Nkele
is a beautiful girl with stunning features. Her
dream is to enrol with the Western College of
Engineering later this year (2003). In tears,
aLQ – November 2005 31
Accountability requires researchers
to confront the ethical
responsibilities involved in the work
they are doing with regard to the
people they are working with.
The untold stories of women and AIDS
R
she once told me that it was very difficult
caring for her terminally ill sister all the time.
Rose calls on her day and night: to feed her,
to give her medicine, to turn her, and to
change the towels that she so often soils. ‘It is
too much’, she said.
On this warm February morning, she
looks like any other twenty-one year old in
Atteridgeville, a township on the west side of
Pretoria, dressed in a t-shirt and denim skirt.
She smiles at my interpreter’s (Mpeki) trendy,
blue sunglasses. I comment that Mpeki has a
different pair of sunglasses for every outfit.
We all laugh.
I have brought Rose her favourite chocolate
and a fruit juice. By now, I am familiar with
the smell of the bacterial infections that
accompany AIDS. It used to scare me off and
rush my visits to Rose. Rose says she missed
me. I realised that I missed her too.
The rash that covers her body is red and
swollen. She scratches herself without stopping.
The ‘special’ vaseline that the (ZCC)
Zionist Christian Church gave her doesn’t help
like it used to. Her father pays more than one
thousand rand quarterly for the medicines from
the church: a mixture of teas and coffees, an
aloe vera drink and the special vaseline. I start
scratching intuitively. She says she likes
Mpeki’s sunglasses. Mpeki breaks off a piece of
chocolate and hands it to Rose. She closes her
eyes as she slowly savours the taste.
Rose’s mother, MaRose, enters into the
room. She welcomes me as a family member.
‘You are one of the Radebe’s now’, she says.
MaRose walks from the informal settlement
everyday to come and wash her daughter. The
informal settlement is five kilometres away
from the house where Rose is staying. She is
also taking care of Rose’s six year old
daughter. I recall how desperate she was the
first day I met her. At the time she was
emotionally drained of taking care of Rose
and she longed for Rose to admit herself to
Kalafong Hospital, two kilometres from
where Rose stays, but Rose was afraid of
going there, she wanted to die at home, not in a strange hospital ‘where
nurses treat you badly’.
Mpeki told me that Rose was experiencing some family problems
and I asked Rose if she would like to share with me. Rose did not share
this story with me on her own account, but she did share it with Mpeki.
(During a later incident Rose told Mpeki in front of me that she needed
money for food and if she could borrow money from Mpeki. Her
choice was to share this story with Mpeki and not with me). The story
that Rose narrated is one of bewitchment and stigma. The house where
Rose is staying belonged to her grandfather. Her grandfather disowned
her uncle because of his relationship with a girlfriend. This girlfriend
was bewitching the uncle and he was given the choice either to leave
her or to move with her to Mashengu, the informal settlement in
Atteridgeville. There, the grandfather said, they could start their
own family.
After the grandfather died, the uncle and the girlfriend moved into
the house where Rose and her sister stay. The uncle tore up the title
deed and Rose’s mother did not know who the house belonged to.
The girlfriend now shouts to passers by: ‘Stop AIDS, stop AIDS!’
She also sings songs about AIDS, so that every one in the street can
hear. She stands outside Rose’s window saying that no one cares for
Rose. At night, the girlfriend switches off the main power switch. This
way Rose cannot see and when she turns she falls off the bed. She is
only flesh and bone and the pain with the falling is excruciating.
Because she is so weak, she cannot get onto the bed again. Rose says
the attitude of the girlfriend used to hurt her, but now she doesn’t
care anymore.
The uncle doesn’t want to take Rose to the offices to access the
child support grant for her six-year old daughter, who lives with her
grandmother. He doesn’t allow AIDS in his car, he says. MaRose has
to fetch a wheelchair from the community hall and Rose has to be
pushed up the gravel road to the grant offices two kilometres away.
Rose called on Nkele. She said she wanted to talk to her. She told
Nkele that she wished Nkele would sometimes just talk and laugh with
her. She rushes in and out, because she is always busy. Nkele said that
it is true, that she is always busy. The two sisters agreed on a ten minute
32 aLQ – November 2005
I thought of the way that enemies
of a nation were paraded naked
through the streets, so that
everyone could shout and
spit at them. Our situation bore
some similarities.
The untold stories of women and AIDS
Ttalk every day. An alternative preferred story has developed in the
relationship between Rose and Nkele today.
Today is the day of accessing the grant and Rose asks if I would
take her to the grant office. Rose first had to be dressed by her mom,
before we could take her. Nkele placed a towel on the back seat of my
car. Rose’s mother and uncle carried her to the car. She seemed heavy
despite her slight frame. I turned the radio and air conditioning on. A
market was operating from across the grant offices and many people
were hanging out at the market place. Everyone seemed to be eating
something.
I stopped in front of the gate where a heavily armed guard was
standing. He told me that I could park outside the gate and then push
Rose in a wheelchair to the offices. I thought of the humiliation of
lifting Rose in front of all these people into a wheelchair and parading
her through the crowd. Her legs were covered with open sores and she
was very frail. A man appeared with a wheelchair and lifted her
roughly and without much ado into the wheelchair.
I walked with Rose and Nkele. It felt as if eyes were piercing right
through us. I thought of the way that enemies of a nation were paraded
naked through the streets, so that everyone could shout and spit at
them. Our situation bore some similarities.
The guys at the payout point explained that the people at the
Welfare office had a backlog and, therefore, Rose’s fingerprint have
not yet been cleared so that her sister can access the grant on her
behalf. She will have to come back again next month. I see the disappointment
on Rose’s face and feel discouraged myself. The staff at the
payout point doesn’t look at Rose. They smile friendly at Nkele. I catch
a glimpse of someone staring at Rose and when I caught his eye, he
looked away. We journeyed back again through the staring crowds to
the car parked in front of the market place. Someone tried to sell refuse
bags to me and I scolded him.
When I opened the back door, I noticed that the towel had spots of
blood and pus on it. The man who helped us in the first place again
appeared. He seemed in a hurry and grabbed Rose under the arms. The
next moment she was screaming. Everyone stopped whatever they were
doing and stared at us. I rushed to the other door to open it as she was
halfway in and halfway out of the car. I realised she must be in intense
pain. The guy managed to get her legs into the car and she curled into a
foetus position. There were tears on her cheeks and her big eyes were
opened wide with pain. Tears of humiliation, anger and frustration burnt
my eyes. Nkele didn’t blink an eye when her sister screamed.
I asked Rose if she was OK and she managed a nod. On my way
back home, I asked her what hurt so badly and she explained that it
was the steel of the wheelchair against her bones. I realised that she
had little flesh covering her bones and that she must have
experienced intense pain.
As soon as we have carried Rose to the
bed, I told the family that I had to leave for a
meeting. I had only one wish, to wash the dirt
from my body.
CRITICAL REFLECTION
The fact that Rose chose to share certain
stories with Mpeki and not with me, probed
me to critically reflect on the reasons for her
choices. There is a definite difference in the
position between the teller, being Rose, and
the listener, being myself, as well as between
telling the tale and hearing it. I am a white,
middle class woman and Rose is a marginalised
poverty-stricken woman of colour. She
is telling her story in a post-apartheid South
Africa, where history will take its course in
creating new meaning from the discourses
synonymous with ‘apartheid.’ It is imperative
to pay attention to how our multiple identities
are construed and played out at any one time
in any one context.
Why did I want to listen to the story of
Rose? Was it a matter of entertainment, as
‘that voices of difference likely to bring us
what we can’t have and to divert us from the
monotony of sameness?’ [Trinh, 1989a:88], I
am asking a woman of colour to tell her
aLQ – November 2005 33
I am asking a woman
of colour to tell her
stories, while I am
doing the writing up of
it? I assumed that
because she is a
marginalised woman,
she wants to tell her
unheard story? What
about her right to
silence?
The untold stories of women and AIDS
Wstories, while I am doing the writing up of it?
I assumed that because she is a marginalised
woman, she wants to tell her unheard story?
What about her right to silence? ‘Silence as a
will not to say or a will to unsay and as a
language of its own has barely been explored’
[Trinh, 1989a:373].
I believe that ‘…alliances might then be
possible between white, heterosexual, ablebodied
and middle- class women and
women on the margins’ [Spivak, 1990:47]
when we, as researchers, are more secure in
our respective commitments to probing
beneath the surface of what we know, to
how we know.
When I started my research, I honestly
couldn’t claim that I was acting only, or
even primarily, in my co-researcher’s
interests. I wanted to do this research to a)
obtain credibility for myself and my
organisation in the HIV and AIDS care
field and b) obtain a doctorate degree. My
own self-interest, rather than the client’s
best interests, controlled the initial care
towards the research participant. However,
my interest has changed to such an extent
that my relationship with Rose has become
more important than my thesis. I realised
what started off as a selfish endeavour with
a stranger, ended up as a journey with a
friend. An alternative research story has
developed.
In this research project, there was only
partial sharing of power, because I identified the research problem and
I determined the research questions and aims. However, the coresearcher
determined the outcome of the questions and aims.
Although, there was only partial sharing of power between the coresearcher
and myself, I endeavoured to share power through
transparency, frequent reflection and accountability. My aim in powersharing
was to ensure that the co-researcher benefited from the
research project at the time when it was taking place.
Before even engaging with my co-researcher in conversation, the
relational power discourses already existed by the mere fact that I
am a white, middle-class, well-educated woman doing research with
a black, impoverished woman without any tertiary education. I knew
from my experience with my work in black communities the past
four years (1999 – 2003), that the expectation already existed that I
would bring some resources into the Ubisi family, as I am white. In
South Africa, white people, as the beneficiaries of ‘apartheid’, are
still perceived as ‘resourceful’ and black people as ‘resource-less’
even though, there is a rising class of black professionals.
Although, I realised the importance to account Rose’s story in her
own language, I was constraint by the fact that I could not speak
SeSotho. Rose had the opportunity to convey her story in her own
language, but the fact that I couldn’t understand SeSotho, hindered me
from capturing her story in her own words. To this extent, I was
incapable of allowing marginalised women’s voices to be heard, as they
tell their stories. I tried to be as accountable as possible by reflecting
on previous discussions before engaging in new discussions and
documenting the words of the translator. But this was not my coresearcher’s
own words, it was already an interpretation. I apologise in
this study for the ‘distortion’ of my co-researcher’s voice.
Is informed consent really possible in doing cross-cultural
narrative research with poorly literate people, who are marginalised
by society? Explaining the aim, methodology and notion of multiple
narrative meaning to educated people in their own language already
poses a challenge, as they are unfamiliar with the social research
jargon. I realised that my translator also didn’t have a clear understanding
of the aim of my research and she had to translate it into
another language to a poorly educated co-researcher. I am however,
not prepared to silence Rose’s voice by excluding her from the
project on the notion that she doesn’t grasp the meaning of multiple
narratives, as Gottlieb and Lasser (2001)19 suggest. As a feminist and
contextual liberation theologian, my ethical responsibility lies with
creating the opportunity for the voiceless to tell their stories. As an
alternative to once off informed consent, I acquired continuous
consent from my co-researcher as the narrative process unfolded, as
power discourses were deconstructed and as Rose shared more and
more of her story.
34 aLQ – November 2005
Explaining the
aim, methodology
and notion of multiple
narrative meaning to
educated people in
their own language
already poses
a challenge…
The untold stories of women and AIDS
R
I sensed unease with my co-researcher, when I initially
interviewed her through loosely structured interview questions. The
many questions stemmed her uneasy and seemed abusive to me. I
later adopted a purely conversational style and started to participate
in the daily activities of the family, as illustrated in the narrative
above. It was through this activity that power was deconstructed to
such an extent that Rose and her family started sharing family
problems and stories of stigma and abuse, as illustrated in the story
of the girlfriend, who turns off the main switch at night. I agree with
Oakley [1986:41] that
…the goal of finding out about people through interviewing is best
achieved when the relationship of interviewer and interviewee is
non-hierarchical and when the interviewer is prepared to invest his
or her own personal identity in the relationship.
I became an honoured member of the family through announcement.
This brought new ethical matters to the forefront. My opinion was
asked on family and community matters. I gave it only when asked
and assured the family time and again that this was only my opinion
and not necessarily the right one. In close family matters, as is the
case with the relationship between Rose and her sister, Nkele, I took
on the role of facilitating the outcome of an alternative story of care.
The discourse of the medicines posed, what I thought at first, an
ethical dilemma. Rose was not using the Western medicines prescribed
by the clinic, except for the Stopitch, but she was using the traditional
medicine of her church. I felt at first that this was adding to the
deterioration of her health and I tried to persuade her to abandon the
traditional medicines for the Western medicines that I believed were
effective. It was only after I experienced that the Stopitch proved
ineffective for her itching, that an alternative story developed in my
mind about the use of alternative, ‘spiritual’ medicines.
I could not hide the ‘I’ in the circumstances that I was working.
The smell of the bacterial infections affected me to such an extent
that after my first encounter, I got nauseas at food that smelled
strongly, for the first time in my life. When
Rose wanted me to look at her bedsores, I
changed the subject, because I could not
face it. There was a time that the family was
so depressed because of Rose’s illness, that
I prayed that she would rather die. I was
repulsed by the open sores on Rose’s legs
that oozed blood and pus. I went through a
phase of denial when I couldn’t ‘fix’ Rose’s
condition with Western medicines. I got
angry with the way she was exposed to the
community and the rough manner in which
she was handled by volunteers at the
community hall. I scolded the vendor, who
sold black plastic bags, while I was trying to
cope with the difficulties that Rose faced.
Rose also asked me about my family and
I shared many stories with her about
happenings in my life. She gave advice,
which I followed and which had a positive
outcome. A poorly educated woman,
according to westernised standards, who
was terminally ill and whose life story was
influenced by cultural discourses totally
different from my own cultural background,
who could not even speak my language,
advised me on my life. The discourse on the
expert possessing the knowledge in my
culture was challenged radically. A new
alternative story on expert knowledge
formed in my mind.
I could see the research participant
benefiting from the research. I reacted on
Rose’s definition of care. Care, according to
her, was to laugh and talk with her and to
give her to eat what she likes and not what
other people decide on her behalf. She
wanted chocolate and fruit juice and I
brought her chocolate and fruit juice. She
conveyed to Mpeki that she misses me. She
got upset when I skipped a visit.
Through caring for my co-researcher, I
deconstructed the discourse of race and
culture and I was accepted, as one of the
family. My friendship with the Ubisi family
has become part of my life and is no longer
aLQ – November 2005 35
A poorly educated woman,
according to westernised
standards, who was terminally ill
and whose life story was influenced
by cultural discourses totally
different from my own cultural
background, who could not even
speak my language, advised
me on my life.
The untold stories of women and AIDS
R
a research project only. It is not only
unethical, but also impossible for me to break
of ties with the Ubisi family. I am committed
to this family and this is true to a hermeneutic
off deed as described by Bosch20. I am indeed
‘doing’ theology.
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(Pastoral Family Therapy), Faculty of Theology,
University of Pretoria.
McHoul, A. & Grace, W. 1993. A Foucault
primer. Discourse, power and the subject.
New York: New York University Press.
Müller, J.C., Van Deventer W.V. & Human L.
2001. Fiction writing as metaphor for research: a narrative approach. In:
Practical Theology in South Africa. Volume 26(2). Pretoria.
Oakley, A. 1986. Interviewing women: a contradiction in terms. In:
Roberts, H (Ed) Doing feminist research. P 30-61. London: Routledge.
Parker, I. 1989. Discourse and power. In Shotter, J. & Gergen, K.J.
(Eds.), Texts of identity. Pp 56-69. London: Sage.
Russouw, G.J. 1993. Theology in a post-modern culture. Ten
challenges. In: Hervormde Teologiese Studies 49(4), 894-907.
Spivak, G.C. 1990. The post-colonial critic interviews, strategies,
dialogues. New York & London: Routledge.
Trinh Minh-ha, T. 1989a. Not you/like you: Post-colonial women and the
interlocking questions of identity and difference. In Gloria Anzaldua (Ed),
Making face, Making soul Haciendo Caras, pp 371-375. San Francisco:
Aunt Lute Foundation Books.
White, M. 1995b. Re-authoring lives. Interviews and essays. Adelaide:
Dulwich Centre.
Winslade, J. & Monk, G. 1999. Narrative counselling in schools.
Powerful and brief. California: Sage, Corwin.
Welch, S.D. 1990. A feminist ethic of risk. Minneapolis: Fortress Press.
FOOTNOTES:
1. See Gordon, C. (Ed). 1980. Power/Knowledge. Selected Interviews and other writings: 1972-1977. New
York: Pantheon Books. Fillingham, L.A. 1993. Foucault for beginners. New York: Writers & Readers.
2. Russouw, G.J. 1993. Theology in a post-modern culture. Ten challenges. In: Hervormde Teologiese
Studies 49(4), 894-907. p 902.
3. Bosch, D.J. 1991. Transforming mission. Paradigm shifts in theology of mission. New York: Orbis
Books. p 426.
4. Ibid, p 424.
5. Isherwood, L. & McEwan, D. 1993. Introducing feminist theology. Sheffield: Sheffield Academic Press.
p 87.
6. Griffen, D.R. 1989. God and religion in the post-modern world. Albany: State University of New York
Press. p 8.
7. Bishop, R. 1996. Collaborative research stories. New Zealand: Dunmore. p 228.
8. Ibid. p 27.
9. Steier, F. 1991. Research and reflexivity. London: Sage.
10. Epston, D. 1995. Constructing alternative knowledges. Workshop presented at the 3rd Australian and
New Zealand Family Therapy Conference. 30 August – 2 September. Wellington, New Zealand.
11. Bishop, R. 1996. Collaborative research stories. New Zealand: Dunmore. p 230.
12. Olesen, V. 1994. Feminism and models of qualitative research, in Denzin, N.K & Licoln, Y.S (Eds.),
Handbook of qualitative research, 158-174. Thousand Oaks: Sage. p 167.
13. White, M .1995b. Re-authoring lives. Interviews and essays. Adelaide: Dulwich Centre. p 13.
14. Gordon, C. (Ed) 1980. Power/Knowledge. Selected interviews and other writings: 1972-1977. New
York: Pantheon Books.
15. Parker, I. 1989. Discourse and power, in Shotter, J & Gergen, KJ (eds), Texts of identity, 56-69. London:
Sage. p 58.
16. Kvale, S. 1992. Psychology and postmodernism. London: Sage. See also Steier, F. 1991. Research and
reflexivity. London: Sage.
17. White, M 1995b. Re-authoring lives. Interviews and essays. Adelaide: Dulwich Centre. p 144.
18. The names are fictional.
19. Gottlieb, M.C. & Lasser, J. 2001. Competing values: a respectful critique of narrative research, p 31-36.
In Ethics and Behavior, 10508422, Vol 11, Issue 2. p 32.
20. Bosch, D.J. 1991. Transforming mission. Paradigm shifts in theology of mission. New York: Orbis
Books.
36 aLQ – November 2005
Sunette Pienaar is the Manager at Heartbeat. For more information
and comments please contact her on +27 12 803 3970
or at sunette@heartbeat.org.za.
The untold stories of women and AIDS
W
All forms of communication are important in shaping the social
environment in which HIV and AIDS exist. This article explores the role
of mainstream media versus alternative media productions. It argues
that both can play an important role in addressing the feminisation of
the HIV and AIDS epidemic. However, the potential of media messages
in addressing the feminisation of the HIV and AIDS epidemic depends on
how they are produced, by whom they are produced and on how they are
communicated. This article focuses on how the involvement of HIV positive
people in the production of media and in the facilitation of media messages
can contribute to effective HIV and AIDS communication.
HIV AND AIDS COMMUNICATION
In South Africa, large amounts of resources have been dedicated to
HIV and AIDS information and communication campaigns. The
content of these have primarily focused on prevention messages – ‘on
how to prevent the spread of HIV touninfected people’. The content
have further largely focused on the medical aspects of the disease and
singled out high-risk groups, such as sex workers and injecting drug
users, for specific attention.
This discourse has brought about a moralistic response to HIV and
AIDS, whereby ‘others’ are blamed for the spread of the virus through
‘risk’ behaviour. This has marginalised vulnerable communities, and
hampered the implementation of effective prevention strategies.
Women are especially vulnerable to HIV infection for biological
and socio-cultural reasons. Gendered imbalances and realities, such as
women’s limited ability to negotiate safer sex practices and women’s
social status mostly described as subservient to men have to a large
extent defined women’s greater vulnerability to HIV. Information and
communication campaigns often communicate statistics also proving
the extreme high levels of violence against women, including sexual
violence. However, the fact that violence places women at greater risk
of HIV infection is seldom addressed in ways that empower women.
Furthermore, accurate and relevant information that would allow
women to move away from ‘victim-hood’ and become ‘agents of
change’ are seldom communicated.
Prevention messages and campaigns, including the internationally
well known ABC (Abstain, Be Faithful, Condomise) prevention
message, have failed to take into account how existing gender
imbalances are impacting on individual behaviours and choices and,
hence, vulnerability to HIV infection. The ABC prevention message
gives no answers to questions such as ‘Should a woman who is
faithful to her husband condomise?’, ‘How can a woman negotiate
condom use with a man who is hesitating to putting his penis into a
‘plastic bag’?’ This message does not even answer the most
common everyday challenges and has done little else than failing
women and girls.
MAINSTREAM
MEDIA PORTRAYAL
The South Africa mainstream media
reports on the HIV and AIDS epidemic in a
highly politicised way1. Further mainstream
media carries dramatic reports that often
compromise the right to privacy and dignity
of people living with HIV and AIDS.
Most of the mainstream reports on HIV and
AIDS lack educational content and gender
awareness. Apart from sex workers, who are
often depicted as ‘vectors of disease’, women
are invariably depicted as ‘HIV-positive
mothers’ or as pregnant women who are of
concern only insofar as they may infect their
babies or leave their children as orphans.2
The mainstream media contains little, if
any, information targeted specifically at
people living with HIV and AIDS. Further,
the voices of people infected with HIV are
few and far between. When people living with
HIV and AIDS are portrayed, it is often as
‘patients’ in need of care and compassion.3
The mainstream media have also tended to
feature high profile people, rather than
ordinary people.
The mainstream media has to a large
extent made HIV and AIDS a woman’s issue
by both blaming women for the spread of
the disease and by giving women the
responsibility to ‘fix’ the problem, which
they, according to the most common
messages, can do by ‘behaving correctly’.
The content of HIV and AIDS mainstream
media portrayal can broadly and crudely be
described as sensationalist, and the media
thus, arguably, contributed to the feminisation
of HIV and AIDS. One example is how the
media portray sex workers as ‘vectors of HIV
transmission’ or more crudely as ‘bad
women’. Another example of how the media
portray women is as ‘victims’ of HIV and
AIDS. Finally, by ‘avoiding’ to provide
access to information that will make the
consumers think for themselves and make
informed decisions about their own lives, the
aLQ – November 2005 37
The Role of HIV and AIDS
communication
The feminisation of the HIV and AIDS epidemic
Lene Øverland
T mainstream media has contributed to the
feminisation of HIV and AIDS.
WHO OWNS THE
MAINSTREAM MEDIA?
Ownership, editorship and production
methodology are crucial agents in
mainstream message production. In South
Africa, the mainstream media is mainly
owned and managed by white males, several
of them with limited intellectual investment
in South Africa. Very few of these males
have taken the effort to develop and/or
implement gender policies in their
newsrooms, which could potentially
encourage gendered analysis of HIV and
AIDS. Further, most of the mainstream
media is produced by journalists who, I dare
say, write about HIV and AIDS without, or
at least not admitting to, any personal
experiences of HIV and AIDS, other than
when in contact with their interview subject.
Neither ownership nor management nor
production methodology encourages
reporting that addresses the gendered nature
of HIV and AIDS.
ACCESSING THE
MAISTREAM MEDIA
Gaining access to information through the
mainstream media is challenging. Many
South Africans, and especially women,
cannot afford buying a newspaper, a TV, a
radio or access the Internet. Further, many
South Africans, and again mostly women, are
not able to consume media in the preferred broadcast or print language.
Finally, many people, and again especially women, do not have the
time or the energy to critically engage with the mainstream media as a
woman’s day is filled with all sorts of domestic and other work related
activities. As a result, the media reaches the elite and the few others
who can afford gaining access.
FILM A TOOL FOR DEVELOPMENT
Access to alternative media, such as community media and media
produced by developmental organisations, is in many instances as
challenging as accessing mainstream media. However, there are a few
exceptions to the ‘rule’.
Day Zero, a film production company based in Cape Town,
launched the ‘Steps for the future’ (STEPS) project a few years
back, and produced 38 documentaries and short films, as part of a
media advocacy campaign intended to promote debate and
discussion around HIV and AIDS related topics. These films portray
unconventional stories that celebrate the strength of the people
represented, and individual characters reflect on, and share, their
experiences of HIV and AIDS. The characters of the films challenge
fears with stories of hope and dismantle discrimination and
ignorance through cultivating tolerance.
The characters of the STEPS films empower individuals and
communities through facilitating discussions following the
screenings of their films, and as such they provide access to
education and information and promote the belief that ‘actually life
is a beautiful thing’.
The most compelling success of the film series is the impact at a
grassroots level across Southern Africa. Films are screened regularly
using mobile cinemas in Lesotho, Zimbabwe, Zambia, Mozambique
and South Africa, as well as in communities and schools across the
region. Through these screenings it becomes possible to engage the
audience in dialogue.
The STEPS films achieve their optimum potential when shown to
groups and followed by facilitated discussions. This participatory
approach encourages people to think for themselves, and it contributes
to learning and working together to solve challenges at local, national
and regional level.
The films have also proven to have a life after the screenings.
STEPS has found that messages from facilitated screenings are being
shared in the communities where the films are shown. This means that
on average, each screening would impact upon at least ten times the
amount of people watching a given screening.4
MEANINGFUL INVOLVEMENT OF PEOPLE
LIVING WITH HIV AND AIDS
Sesotho Media & Development is a non-governmental organisation
based in Maseru, Lesotho. The organisation works in partnership with
38 aLQ – November 2005
In South Africa, the mainstream
media is mainly owned and
managed by white males, several
of them with limited intellectual
investment in South Africa.
The ABC prevention
message gives no
answers to questions
such as ‘Should a
woman who is faithful
to her husband
condomise?’, ‘How can
a woman negotiate
condom use with a
man who is hesitating
to putting his penis
into a ‘plastic bag’?’
O
STEPS and operates a mobile video unit. Sesotho Media &
Development combines the use of film and facilitators, who are living
with HIV and AIDS, guide discussions.
Thabo, Thabiso, and Malousi, who are all facilitators at Sesotho
Media & Development, are also the central characters in Dumasani
Phakati’s documentary film ‘Ho Ea Rona’ and in Theboho Edkin’s
documentary film ‘Ask me I am Positive’. These films are popular
among audiences in Lesotho for its depiction of men dealing with
their HIV status in an environment that is familiar to the audiences.
The most striking aspect of screening ‘Ho Ea Rona’ and ‘Ask Me I
am Positive’ in Lesotho is that the energetic characters in films
facilitate the discussions. For audiences, the reality of HIV and AIDS
is brought to life through the documentary viewing, and reinforced
through discussions with the characters. While this kind of
synergy is not always possible, it is important to note that in the
Lesotho context, the common response from audience members is that
‘seeing is believing’. The films are important because they make
people believe.
SO WHAT DISTINGUISHES THESE FILMS FROM
WHAT WE SEE ON TV EVERY DAY?
One crucial aspect that distinguishes the STEPS films from other
film series is the active and meaningful involvement of people living
with HIV and AIDS through the production and outreach process as a
priority element of the communication strategy. In other words, the
process offers an opportunity for a two-way communication process
whereby the audience of the films are offered a safe place to ask
intimate and difficult questions, and be given information relevant to
their needs – not according to the needs identified by HIV and AIDS
‘experts’ or health reporters.
The underlying philosophy of STEPS is that confronting the
indifference, irresponsibility and stigma that surround HIV and AIDS is
the first step towards taking responsibility for ourselves and for one
another. STEPS has documented that viewers throughout the region
empathise with the characters in the STEPS film collection. The films
give people a chance to look inside themselves and then to look at one
another in a new light.
These STEPS film screenings are not directed specifically at
women or men. The films do not provide all the answers to our
questions – they rather raise more questions and heat our emotions.
Their messages reach us, as human beings, and make many, both
women and men, realise and take responsibility for our own and other
people’s lives.
BRINGING IT ALL TOGETHER
Information about HIV and AIDS is
crucial in our lives. However, the potential of
HIV and AIDS communication to make a
change in our lives depends on how we
receive information and the extent to which
we are able to interact with the information
we receive. One-way communication, as
provided by the mainstream media, does not
allow the receivers of messages to ask
questions and receive answers. However, twoway
communication, as provided by a few
alternative media interventions, opens up for
dialogue between sender and receiver.
In my view, three key words are crucial
to HIV and AIDS communication
 A production methodology that both
involves and takes the target audience
seriously;
 A distribution strategy that involves
people infected and affected by HIV
and AIDS; and
 An intervention based on dialogue
rather than ‘instruction’ and a
moralistic approach.
At stake in this article is the feminisation
of HIV and AIDS. Before producing new
messages, we need to ask ourselves how we
can best address this issue: Do we need to
produce information specifically targeted at
men to reverse the HIV and AIDS epidemic?
Has time come to address HIV and AIDS as
an issue that affects us all no matter what our
identities are? Do we need to focus our
energies on mobilising women and men
collectively to develop capacity to improve
our abilities to change our own lives?
FOOTNOTES:
1. Øverland, L. 2004. Managing the Message. A baseline snapshot of
HIV and AIDS media coverage in Mozambique, Namibia, South
Africa and Zimbabwe in the context of governance.
2. Ibid
3. Gysae, M. & Øverland, L. 2002. Monitoring HIV/AIDS reporting
through a gender lens. Cape Town: Women’s Media Watch.
4. STEPS, Impact Study, 2003.
aLQ – November 2005 39
…a two-way communication
process whereby the audience …
are offered a safe place to ask
intimate and difficult questions,
and be given information relevant
to their needs – not according to
the needs identified by HIV and
AIDS ‘experts’ or health reporters.
Lene Øverland is an Independent
Researcher. For more information and
comments please contact her at
leneoverland@yahoo.no.
40 aLQ – November 2005
Approximately 60% (11 million) of children in South Africa
live in dire poverty, on less than R200 a month.
Approximately 30% of the country’s population
experience food shortage. For many children, this means
starvation. Recently, at a children’s workshop, a 15-year
old child said: ’for my side the biggest problem is food.
Sometimes we end up not getting any food at home
and don’t know what to do’. As of March 2004, over
4.3 million children were receiving the Child Support
Grant (CSG). However, an estimated 56% of children
below the age of 18 years still live on less that R215 a
month and receive no form of social assistance from the
government. Although, there is an improvement, more
needs to be done.
These are some of the problems faced by children today,
despite the South African Constitution1 providing in
Section 27(1)(c) that if a parent is unable to provide for a
child’s basic needs, then the State must do so. Section
28(1)(c) of the Constitution further guarantees children
the right to basic nutrition, shelter, basic health care
services and social services.
Social assistance is non-contributory money given by the
State to help persons provide for their needs, intending to
alleviate poverty. According to the Social Assistance Act
(No 13 of 2004), children are entitled to Child Support
Grants, Foster Care Grants and Care Dependency
Grants. The Child Support Grant is available to a primary
caregiver of a child under the age of 11, who qualifies in
terms of the means test. A primary caregiver is a person
who is above the age of 18 years. The maximum amount
payable for the grant is R170 per child.
The Foster Care Grant is payable to a foster parent
provided that the child has been legally placed in their
custody by a court. The maximum amount payable is
R530 per child. Children who have been orphaned by the
death of their biological parents are automatically
considered to be in need of care and, thus, eligible for
foster placement and the grant.
The Care-Dependency Grant is available for children
living with disability, under the age of 18 years, who
require permanent home-based care. Once the
child’s health improves, s/he no longer qualifies for this
type of grant.
There is a definite need for social grants for HIV infected
children, since such a grant could be used to provide
children with adequate nutrition and medication that will
strengthen their immune system. Currently, a child will
qualify for the Child Dependency Grant when HIV-related
illnesses render the child severely ill and in need of
permanent home-based care.
People experience numerous challenges when
attempting to access these grants. Firstly, many
applicants do not possess the required documents and
the costs of travelling to the offices of the Social Welfare
departments, to apply for grants and/or to obtain
photographs, identity documents and birth certificates
are excessive. The existing administration is underresourced
and welfare officers do not communicate
accurately and effectively with applicants. There are also
cases of abuse and misuse of authority amongst
administrative officers. The application-processing period
is lengthy and the means test is inadequate. Many
children in need do not qualify in terms of the current
means test threshold. The maximum earning rates
allowed are R800 per month in urban areas and R1100
per month in informal dwellings or rural areas.
As of April 2005, the Child Support Grant is available for
children up to the age of 14 years. There is, however, also
an increasing occurrence of households run by minors
below 18 years of age. These children are in need of the
grants available, but are unable to access them due to
their age.
Finally, most people do not have access to the grants, due
to the lack of knowledge of their right to access the grants.
In light of the above challenges, some of the possible
solutions include:
 Provide efficient administration to shorten the
application-processing period;
 Monitor the administration in order to prevent an
abuse and misuse of authority;
 Increase the amount allocated in the means test,
which would result in a greater number of children in
need eligible for the grant;
 Increase the age limit of the grant to 18 years; and
 Create public awareness by providing workshops
and distributing pamphlets.
The role taken by non-governmental organisations
such as ACESS (Alliance for Children’s Entitlement to
Social Security) and Black Sash is to assist the
caregiver in trying to obtain the documentation they
require in order to access these grants. We, at the
Campus Law Clinic, are developing a media campaign
to create awareness around the issue, aiming to target
and enlighten members of the public of their right of
access to these grants.
FOOTNOTE:
1. The Constitution of South Africa, Act 108 of 1996.
For any further information please contact the
Campus Law Clinic on +27 31 260 2446 or at
bernardr@ukzn.ac.za.
Campaign on access to social grants
Campaign
on access to social grants
aLQ – November 2005 41
Background of area
Vulindlela is a rural community situated about 150 km
west of Durban. There are seven Primary Health Care (PHC)
clinics that are nurse-managed public sector health centres,
providing comprehensive primary care. The clinics provide
family planning (FP) services, including male condoms,
syndromic treatment of STIs, antenatal care, early childhood
services, treatment of opportunistic infections and voluntary
testing and counselling services. The PHC clinics are linked
by ambulance to the regional referral hospitals, namely
Grey’s Hospital (about 30 minutes away), and Edendale
Hospital (about 20 minutes away).
There are approximately 60 organisations in the area,
representing a variety of civic interests, such as youth,
women, religion, politics, and housing. Several nongovernmental
organisations are currently providing HIV
prevention and home-based care services to the
community. In contrast to other rural areas in KwaZulu-Natal,
employment opportunities exist within Vulindlela through
extensive forestry projects. In addition, men seek
employment in Pietermaritzburg and Howick. These men
usually commute daily or live in Pietermaritzburg during the
week and return home over the weekend. Women are also
employed by the forestry projects and engage in communal
income-generating activities, such as gardening and sewing.
Inroads into the community
I joined the CAPRISA research station in Vulindlela at
the end of January 2004 with brimming excitement of
being away from the ‘hum-drum’ of urban corporate life
and to enter the gentle pace of a rural setting. It took a few
weeks to adjust to communicating in Zulu on a daily basis,
as opposed to English, and managing eight field workers.
There was a lot to learn about research and also about the
people I was going to be working with. I had to get used
to the culture of politeness, being captious and generally
tapping onto my long forgotten humble nature.
In the first field visit, I felt beaten, shocked by the
poverty. I had read about it, but nothing had prepared me
for the lived reality. At one home in particular, we found an
old woman with two grandchildren in a dusty and bare
hut. I could smell and touch the poverty. The children were
eating what seemed to be left over from the night before
and did not seem appropriate for breakfast. It was a very
cold day and the two children were barely dressed. There
was not even a warm fire in the huge round hut, but a few
dying cinders, probably from the night before. The woman
explained that the parents of the children were away
looking for work and not often home. The old woman
seemed like she had nothing to her name, let alone
enough to feed the children, and because the children
have no birth certificates, she had no access to the Child
Support Grant. Her meagre income came from working
on a contract, clearing the roadside.
This was a picture of what life was like in this village. I
realised, life was hard in this place.
Every morning on the way to work, I was greeted by
sights of women carrying heavy logs on their heads to use
as fire wood. The women always seemed to have walked
long distances, machetes in hands, into the commercial
forest to chop the wood. The forest provides casual
employment for a lucky few. Others are domestic workers in
Howick, some work in industry. This is few and far between.
Most women, and some men, are at home. Children do
attend school, and, fortunately, the attendance is high. But it
seems – school is something children do, but with not much
promise of a bright future. The education is mediocre with
not many facilities to prepare children for the future.
Prioritising at home draws children away from school work,
with no option for extra lessons. With the parents
barely educated, there are hardly any educational resources
at home.
In some of the households, there are so many young
children under the age of six, one could be forgiven for
thinking it is a crèche. This is also related to childhood
pregnancies and orphans. There are some child-headed
households as well. Income is in the form of Child Care
Grants, Foster Care Grants and there are some pensioners.
In some households, nobody works, and this was quite
familiar. Even though opportunities exist for many people to
apply for grants, these are very difficult to access, since
many people do not have birth certificates.
Death is a feature of this landscape, as evidenced by the
graves, fresh and old, in almost every homestead. There is
so much death – every weekend there is a tent for burial. By
the end of the week, there are always a few tents pitched
around the village. The deaths could be attributed to HIV, but
not necessarily.
Administering the study
This cross-sectional study was conducted from
February 2004 to July 2004. The household questionnaire
recorded data on the number of occupants at the selected
household; demographic characteristics of the occupants,
My two years in rural KwaZulu Natal
Facing the realities of poverty, navigating the complexities
of HIV and AIDS stigma and discrimination and embracing
the dawn of HIV treatment1
Lilian Benita Mboyi
Provincial view
including more detailed information on children under 18
years of age; the type of dwelling; source of water; latrine
facilities; number and types of appliances in the household;
religious and social affiliations; general health status of
occupants; and mortality rates and cause of mortality in the
past year.
The respondent survey also utilised a structured
questionnaire that included closed and open-ended
questions. The questionnaire included items on
socio-demographic characteristics of the respondent,
mental health, willingness to participate in HIV prevention
research, faith-based organisations and their response to
the HIV and AIDS epidemic, attitudes to people living with
HIV and AIDS, virginity testing and gender.
Between November 2004 and January 2005, after
analysing the results of the stigma and discrimination section
of the quantitative study, we supplemented our findings with
focus group discussions held with different groups in the
community. Some of the discussions highlighted the
difficulties people have with HIV testing and the actual
barriers that lay in seeking treatment early.
Some results worth noting
Although, at the beginning of this specific research two
years ago, we were already offering VCT, there was no
treatment offered at the time. It was, therefore, of note that
even at that stage, 28% of the respondents have had an HIV
test in the past. Of those who had not had an HIV test in the
past (n=429), the majority (63%, n=272) indicated that they
would like to have an HIV test, and 36% (n=156) would not
want to have an HIV test.
There are issues that came up in the survey and were
backed up in the focus group discussions indicating that
there were problems associated with testing. The feedback
from the field workers during the debriefing sessions
indicated that respondents were divided in their responses
to the stigma and discrimination questions. At one level,
respondents seemed understanding and accepting of the
people infected and affected, and, at another level,
respondents seemed to harbour fears of being stigmatised
and discriminated against, were they to be found to be
infected with HIV. Some of these fears stemmed from
witnessing instances where a family member who had AIDS
was isolated when they were sick or were not allowed to live
in the household. Factors influencing disclosure included
perception of limited knowledge of HIV test and/or disease
among family members and community, as well as fear
emanating from the understanding that HIV and AIDS is
fatal. Most felt comfortable about disclosing their HIV status
to family, but had concerns about disclosure outside of
the family.
Other factors impacting disclosure of HIV status
included concerns about adding to the emotional burden of
the family, particularly where a death had already taken place
previously. There was also the issue of embarrassment
stemming from fear and shame.
Accessing treatment
The CAPRISA research facility started offering treatment
to people infected with HIV and with a CD4 count of less
than 200, in July 2004. Uptake was very slow and reluctant
at the beginning. In the early days, we saw mostly people
who were close to dying and who were not strong enough
to start on the treatment regiments and largely needed to be
referred to Greys Hospital or Edendale Hospital for other
critical care. Several died in the clinic next door, either while
waiting for an ambulance or had just arrived too late. This
was emotionally a heavy time for the staff, because
generally people were beginning to feel the burden of the
AIDS epidemic translated into real time deaths on the door
steps of medical care.
However, by the end of the year, there were beautiful
stories emerging in the form of people, who had come to us
with very low CD4 counts, blossoming back into the people
that they used to be, before AIDS had struck them down.
When they first came here, some of these people had to be
carried into the consulting rooms to be attended to. This
was definitely a good sign to send out hope to the whole
community. Although, there were only ten such patients by
the beginning of 2005, positive messages were reaching
the community.
Hope for the future
As part of the CAPRISA AIDS Treatment (CAT)
programme, we have tested, between October 2004 and
September 2005, a total of 2469 people. Of these, 2172
were female and 297 were males. Of all tested, a total
number of 1265 (1011 females and 254 males) have been
registered on the CAT programme. Between October 2004
and September 2005, we have placed a total of 353 people
(261 females and 92 males) on ARVs. It is encouraging to
see these numbers increasing by the day, as we strive to
initiate as many eligible people on treatment as possible.
It, indeed, seems a long way from when I started
working in this community and people were still fairly
reluctant to talk about HIV and AIDS. Even though the
deaths are still occurring, more and more people are getting
up to seek help while it is still early. This is a very
encouraging signal for the future of this place, and many
others where AIDS treatment is becoming a reality.
FOOTNOTE:
1. The articles is on personal reflections and field notes, as well as data from the
CAPRISA AIDS Treatment programme (Oct 2004 to Sept 2005), from the
Demographic Health Survey conducted Vulindlela, in the Inadi area (Jan 2004 to July
2004), from the Respondent Survey conducted in Vulindlela, in the Inadi area (Jan
2004 to July 2004), and from the focus groups discussions on HIV and AIDS Stigma
and Discrimination held in the Inadi area of Vulindlela (Nov 2004 to Jan 2005).
Lilian Benita Mboyi is the Research Fellow (2004 –
2005) at the Centre for the AIDS Programme of
Research in South Africa (CAPRISA). For more
information and comments please contact her on
+27 33 260 6851 or at Mboyi@ukzn.ac.za.
42 aLQ – November 2005 Provincial view
aLQ – November 2005 43
ECONOMIC MELTDOWN
Inflation, which at the beginning of
October 2005 stood at 360 percent and
is projected, to have risen to 400 percent
by year-end, is making it difficult for
women to buy food and other basic
commodities. In instances where the
woman is infected, her ability to have a
balanced diet, as recommended by
health workers, has been eroded by
inflation. Consequently, women and
children are forced to survive on onemeal
a day comprising mainly of sadza
(thick mealie-meal porridge and boiled
spinach.) And, unless the country
imports more grain urgently, by the end
of the year, putting this single meal on
the table will be almost impossible for
most families.
In instances when commodities,
such as sugar, salt and cooking oil,
are available, consumers have to
queue for long hours and there is
often the threat of harassment by
police officers when anxious buyers
turn rowdy in the queues.
Women living with the virus, or
taking care of ill partners and children,
cannot spend the day queuing thus
their diets are further compromised.
The alternative is to buy the goods on
the ‘black market’, where prices are triple or even five times
more than the gazetted prices.
Most companies producing basic items, such as soap
and disinfectants, have closed down. The result is that
such products, essential in home-based care, are in short
supply and expensive when available. Without these
products, women who carry the major burden of homebased
care find it difficult to take good care of themselves
and the ones in their care.
In rural areas, care givers report that they often cut
down on the recommended doses, thus, exposing
themselves to HIV infection. The net effect of the economic
crisis is that women’s capacity and ability to take care of
themselves and their families has been severely
compromised. In desperation, some women are turning to
prostitution to look after their families and, thus, exposing
themselves to HIV infection and re-infection.
Strategies required would be political intervention and
commitment to a macro-economic turn around. At a
household level, women and children could be encouraged
and assisted to start gardening projects. The produce
would help families have balanced diets without spending
too much money. In arid areas, especially in the southern
region, some AIDS service organisations have started such
projects and are giving drip kits that maximise water usage
for the plants to participants.
A ‘stopgap’ measure is to resume food handouts,
especially for families and people living with HIV and AIDS.
OPERATION MURAMBATSVINA
In June 2005, the government conducted a clean-up
HIV and AIDS realities:
The Zimbabwean context
Zimbabwe’s continued economic meltdown spells doom for people living with HIV and
AIDS in the country, especially women and children. The economic crisis characterised by
shortages of basic foodstuffs, fuel and foreign currency, coupled with raising inflation is
making survival a challenge for most Zimbabweans. The challenges are even greater for
women infected and affected by the HIV and AIDS pandemic.
Miriam Madziwa
Regional view
exercise, code named Operation Murambatsvina (Drive Out
Filth). According to a United Nations report, the operation
left 700 000 people homeless and/or without a source of
livelihood.
With respect to HIV and AIDS, the operation erased the
numerous gains that AIDS service organisations had
recorded during the past few years. The displacement and
forced relocation of individuals from urban to rural settings
disrupted access to medical care. Women and children,
who were on public antiretroviral drugs (ARVs) programme,
were relocated to rural areas where there are no clinics and
access to ARVs is impossible. In such instances, the
women and children have been forced to stop taking the
drugs to the detriment of their health.
Additionally, support groups that had taken years to
establish, crumbled as members were scattered all over
the country. Some of the victims succumbed to
opportunistic infections, such as pneumonia, from
spending long winter nights in the open without warm
clothing. Others contracted tuberculosis from sleeping in
crowded church halls and holding camps alongside
sputum positive patients, who were no longer on
treatment. The opportunistic infections have gone untreated,
leading to an increase in the number of deaths.
Reversing the adverse effects of Operation
Murambatsvina will require AIDS service organisations to
remobilise communities and to resuscitate support groups.
The same organisations would also need to trace people
living with HIV and AIDS who are on ARVs and help them
continue taking their medication with the possibility of
putting some of them on second regime treatment, which
is not readily and cheaply available in the country. In
Bulawayo, churches, working with MSF (Doctors without
Borders), have started offering limited medical care to
some of the victims.
FALLING HEALTH CARE STANDARDS
VERSUS RAISING MEDICAL COSTS
The economic crisis, alluded to earlier, is causing havoc
on Zimbabwe’s health delivery system. Health care
standards are dropping while costs continue to rise, due to
the economic turmoil. Health workers, doctors and nurses
are leaving the country for neighbouring South Africa,
Australia and United Kingdom, where remuneration and
working conditions are better. The
remaining personnel are failing to
cope with the number of people
requiring treatment. In most hospitals,
an average of 75 percent of admitted
patients are suffering from HIV- related
illnesses. Besides human resources,
Zimbabwe’s health institutions lack
adequate and affordable drugs and
equipment.
The drug shortage is a result of
foreign currency shortages. The
country has several pharmaceutical firms
that are failing to produce badly needed
medicines, because they do not have the
requisite imported materials.
People living with HIV and AIDS
taking locally produced ARVs could
soon be forced to change
combinations, because the local
manufacturer, Varichem, has stopped
production, citing foreign currency
shortages. A month’s dosage bought
from public hospitals cost $50 000.
Comparatively, imported generic ARVs
are being sold for $1 500 000 for a
month’s supply. A number of people,
who were getting their ARVS through
private suppliers, are turning to public
institutions for survival. There is,
therefore, stiff competition for the drugs
and, consequently, women are the
worst affected.
Health workers are finding it difficult
to adequately monitor people living with
HIV and AIDS. Doctors report they are
unable to do CD4 counts, because
the necessary reagents are not
available. Complimentary tests, such
as viral load, are hardly done at public
hospitals. As a result, doctors are
putting patients on ARVs, based on
symptoms presented, as staged by
the World Health Organisation.
44 aLQ – November 2005 Regional view
aLQ – November 2005 45
Regional view
The majority of women on the
public ARVs programmes are
unemployed widows, who are struggling
to raise $50 000 for their monthly
dosage. Most of these women were
involved in low-income projects, such
as peanut butter, soap and candle
making and vegetable vending. These
income-generating activities have been
outlawed, since Operation
Murambatsvina started. Medicines for
opportunistic infections are also in short
supply, and when available, are
unaffordable for many people living with
HIV and AIDS. On the other hand, men
are better off, because the greater
majority are employed. They can afford
medical aid schemes that help to buy
the life-prolonging drugs while some
companies have started buying ARVs
for their employees. Companies are
being encouraged to include spouses
and children as beneficiaries of their
ARV programmes.
From the above scenario, it is evident
Zimbabwe will miss its 3 by 5 goals of
having 100 000 people on ARVs the end
of the year. Health and Child Welfare
officials have since revised the figure
downwards to 40 000.
It is hoped that the recently
approved Global Fund disbursement
of funds to Zimbabwe will be used
to buyARVs and materials needed in
combating the pandemic. An additional
strategy would be to establish more
donor funded ARV distribution points,
such as The Centre in Harare,
throughout the country.
VOLUNTARY
COUNSELLING AND
TESTING
Voluntary counselling and testing
is slowly gaining acceptance, as Zimbabweans overcome
fears of discrimination. Youths and adults are visiting
centres to determine their status for a variety of reasons.
Unfortunately for many expecting mothers, HIV testing is
still not voluntary. Testing is routine for all pregnant women.
Most of Zimbabwe’s statistics on prevalence are based on
results of pregnant women. Because the testing is not
informed, when most of the HIV infected women get to
know their status, they do not tell their partners, for fear of
rejection. As a result, the objective of testing is lost.
An added problem for women is the increase in
discordance among couples. There have been reports in
the media of women, who have tested positive and been
able to convince their partners to test and the spouses’
results come back negative. In most such instances, the
males have abandoned the women.
Affected women complain of inadequate counselling
and knowledge on why and how discordance occurs to
enable them to explain to their partners. Few women know
and understand how the physiological differences between
the sexes have a bearing on HIV infection. Being HIV
positive is still considered a punishment for promiscuity
and, if a woman is tested positive and the spouse tested
negative, the woman is labelled ‘loose’.
Women taking care of infected children have the added
burden of getting treatment for the children. Medication for
children is equally difficult to come by and with regards to
ARVs there are no suspensions available for children.
Instead, mothers have to break the adult tablets and coax
their children to drink the pills. Not an easy task.
To reduce suffering among women, more work has to
be done to encourage VCT workers to fully counsel clients,
especially expecting mothers. This would entail hiring more
counsellors. Organisations, focusing on HIV and AIDS as it
affects women and children, must detail and disseminate
information on infection as new research findings are
published. Such information needs to be translated into
local languages, for the majority of English illiterate women
to be informed.
Additionally, organisations, such as Padare Men’s
Forum, Africare and John Snow International, are running
programmes to try and get men and youths involved in
care and support of people living with HIV and AIDS to
lessen the burden on women.
SEXUAL VIOLENCE
Sexual violence continues unabated in Zimbabwe.
Women and girls are raped and abused by spouses,
relatives, guardians and strangers, without much effort
being made to bring the perpetrators to book. Marital rape,
although legally recognised, is not socially accepted. As a
result, married women continue to be exposed to HIV
infection from promiscuous husbands, who openly have
mistresses commonly known as ‘small houses’ and yet,
refuse to use condoms.
Mistresses who are financially dependent on rich male
partners also have little say in how and when to have sex. Any
suggestions could spell the end of the relationship with dire
consequences for the impoverished women. The
economic hardships are forcing many women to remain in
violent relationships that often expose them to infection and
re-infection to HIV.
Young girls are equally at risk from parents, guardians
and teachers. This year, the talking point among gender
activists is the sexual abuse and rape of over 50 schoolgirls
by a gardener and a teacher at a primary school in
Macheke. The frightening incident revealed how vulnerable
the girl child is to abuse, even in schools. What is also
equally disheartening is the light sentences that perpetrators
of sexual violence continue to receive from the courts.
One way of breaking the cycle of abuse is to help women
to be economically empowered, so that they can look after
themselves without depending on men. Women’s organisations
need to revive campaigns that emphasise personal
respect and pride, so that women are not easily tempted to
resort to prostitution as a way of earning a living.
The country also needs to come up with more safe
houses that abused women and girls can turn to while they
pick up the pieces. Too often, women and girls continue to
live under the same roof with their abusers, because they
have nowhere else to go. Gender activists need to step up
campaigns to encourage women to use existing legislation
that criminalises sexual violence.
THE ROLE OF THE MEDIA
In these strategies, the media, both electronic and print,
has a role to play. Essentially, in HIV and AIDS campaigns,
the role of the media should evolve to one of helping,
reduce stigma surrounding the pandemic, through easy to
understand and informative articles.
Sadly, the media in Zimbabwe has
not done much in this regard. Most
media articles on HIV and AIDS revolve
around statistics of deaths and
prevalence alongside pronouncements
by government officials about policy
issues. Some media have started
running advice columns on positive
living. These are, however, too technical
for the understanding of the average
readership. A further stereotype that
has emerged in the coverage of HIV
and AIDS is that this is a disease of the
poor. Undeniably, there is a link
between the two.
Most articles are based on what
health officials and activists say. There
is little interrogation of what is
happening on the ground.
Additionally, the reporting is not
engendered. An example is the issue
of condom supply. There are media
reports that condoms are in short
supply and government health officials
are quoted as saying this is incorrect.
The reports do not state that they are
talking of free condoms, because in
shops a variety of condoms are available.
But women are essentially excluded in
such stories, because few reporters
care to explore the availability of the
female condom. To most
journalists, issues of condoms refer
exclusively to the male condom. This
effectively takes away women’s only
tool to negotiate for safer sex.
Women and children are given
voices mainly as the ‘victims’ of the
pandemic. This runs contrary to
awareness campaigns that highlight
the fact that anyone can get infected.
This feminisation of the pandemic has
allowed men to take a back seat in all
46 aLQ – November 2005 Regional view
aLQ – November 2005 47
Regional view
aspects of care work and support
required by the ones infected and
affected. Women form the core of
home-based care and support groups.
It is women, who are involved in taking
care of orphans and vulnerable
children. In the few instances that men
are involved, they usually do not
participate actively and instead, are
often the secretaries and treasurers of
the organisations. Most of the work the
women do is unpaid and undervalued.
Journalists in Zimbabwe still tend
to rely on single sources for their
information so that readers rarely get
to hear all sides of an issue. For
example, there is a Moringa craze
sweeping across the country. A few
activists have pronounced that the
leaves, roots and seeds of the plant
that grows abundantly in the Zambezi
valley are good for people living with
HIV and AIDS. And, that is the line that
most reporters have been taking
without bothering to talk to
pharmacists or scientists to verify
whether or not such findings are
indeed true. In the stories, no mention
is made of possible side effects.
Frequently, one still reads and
hears of ‘AIDS sufferers’ in media
reports, a worrying indication that not
enough training is being done for
media practitioners to effectively
report on the pandemic. There is also
the added stigma for journalists, who
decide to actively cover HIV and AIDS
issues. Such reporters are often
stigmatised as being infected, thus,
the keen interest in covering the
subject. AIDS service organisations
are trying to correct the current setup
by offering HIV and AIDS training
sessions to journalists, as well as
annual competitions to honour those journalists that try to
break existing stereotypes in their reporting. The stereotyping
and lack of intimate knowledge about HIV and AIDS
goes right up to the editors, who still believe health issues
are not front page material. There is still the archaic belief
that only politics sells, yet, HIV and AIDS is a topic that is
close to the hearts and minds of the majority of
readers and listeners, as most are infected or affected by
the disease.
AIDS service organisations and media training institutions
need to team up and come up with comprehensive training
programmes on reporting HIV and AIDS. The training should
include medical professionals with detailed knowledge of the
disease and not just activist, so journalists have the basics of
the HIV and AIDS. Such training would also help reporters to
explore issues beyond prevalence rates and policy
announcements to include ordinary people’s voices and
experiences in fighting the pandemic. Media practitioners
must be encouraged to go for testing, so that when they write
they are writing from an informed position. A journalist, who
knows her or his HIV status, is likely to write a more informed
piece, than a colleague, who still holds the belief that the
disease is only among readers and listeners out there.
The picture that emerges when one looks at gender, sex
and sexuality in the context of HIV and AIDS in Zimbabwe is
one that is biased against women. Women form the majority
of the ones infected and affected and yet, they are in the
minority, when it comes to making decisions and giving input
into how best the pandemic can be tackled.
Culture, stereotyping and stigmatisation have combined
forces to ensure that Zimbabwean women and children
remain hidden from public views, when talking about HIV
and AIDS, while they stoically carry the burden of living with
the virus. A starting point is campaigns that make the
pandemic everybody’s concern.
Mariam Madziwa is a Zimbabwean journalist. For more
information and comments please contact her at
mmadziwa@gmail.com.
48 aLQ – November 2005
SINTRODUCTION
The HIV and AIDS pandemic gives rise to
three subsequent, but related waves, each of
which rises slowly at first, then faster, until it
eventually reaches a maximum, before it
begins to subside. The first wave is that of HIV
infections. It is followed, some years later, by
the wave of deaths from AIDS-related causes.
The last wave following on this is the wave of
orphaning.
Each of these waves requires a specific
response. I want to structure my discussion of
the way in which the Christian community is
addressing the pandemic in terms of these
3 waves.
A few general comments first:
 Churches were slow to take up the HIV
challenge. With the exception of the
Catholic Church and the Salvation Army,
15 years or more into the pandemic there
were few institutional responses.
 Most responses were driven by
passionate individuals, rather than the
denominational leadership. (There are
exceptions to this, such as the Anglican
Archbishop.)
 In the last five to six years, there has
been a huge shift. Many new initiatives
were started and HIV and AIDS has been
firmly established as a central concern for
churches, drawing growing commitment of
church resources.
 Even now, the response is still quite
fragmented, with groups/ denominations
preferring to do their own thing. Attempts
to collaborate (or at least to ensure that
they avoid duplications), with one another
and government are slow in coming about.
RESPONDING TO THE WAVE OF
INFECTIONS: PREVENTION
HIV Awareness
Prevention is one of the most common ways
in which churches have taken on HIV, with
churches most comfortable in promoting
Abstinence until marriage, and Faithfulness
within marriage. Since the focus is on youth,
most programmes aim at ‘abstinence only’.
There is little acknowledgement of the fact
that faithful married women in Africa are a risk
group for HIV infection and no attempts are
made to empower them!
There are, however, growing numbers of
Christian groups, who do promote and
provide condom use as one option; believing
that it is up to individuals to choose which of
making a point
Christianity:
Addressing or perpetuating
the spread of HIV and AIDS?1
Barbara Schmid
comment: making a point
aLQ – November 2005 49
comment: making a point
the prevention approaches works for them.
Often, these are NGOs, who have grown out
of congregational projects, but have become
independent, to be less constrained by
denominational dogmatics.
Jenny Trinitapoli has done a (as yet unpublished)
study in Malawi on how churches promote HIV
prevention. Her finding is that most churches
do preach on HIV-related issues, however,
most messages from churches would be
considered ‘conservative’. She warns against
imposing our norms on what is appropriate for
given communities. Surely, she says, the
question is, ‘does it work for them?’.
I have to accept that this is the crucial
question, yet, add a rider to it. Surely, ‘them’ is
not a homogenous group. We have to ask:
Who gets to decide and impose the norm?
And what about those who fall outside it?
Most importantly, the question is to what
extent, what is said translates into behaviour
change. And here, it seems, the success of
churches has been limited.
Counselling and testing
Some groups do promote and provide
voluntary counselling and testing (VCT). A
controversial issue here is the insistence in
some contexts that couples get tested before
the clergy will marry them.
Problems with Prevention – mostly related
to stigma
 Churches, through the initial responses of
a few Christian leaders to the emergence of
AIDS as ‘god’s punishment for sin’, have
been the source of much stigma surrounding
AIDS. While most Christians now aim for
‘compassion, not judgment’ very often the
language and responses are still stigmatising.
I am convinced that this is due to the fact
that people living with HIV and AIDS are not
involved!
 It is difficult to acknowledge that we are at
risk, that members of our congregation are
affected and infected by HIV. Churches here
have eagerly followed the medico-moral
discourse that identified risk groups – and
assumed themselves not be at risk: ‘we are
not gay, promiscuous, Black ….’ Many still
hold to the notion that HIV infects ‘others’.
 Churches find it difficult to address
sexuality and the taboos around it. Opening
this area for debate seems to imply an
admission that the own ethical standards,
upheld and ignored for centuries, are not
adhered to. The unfortunate debate around
the ABC prevention methods belongs here.
 There is a need to develop a new
‘Theology of Sexuality’. Some new trends
are emerging, but this is a slow process; and
filtering through to those who need to hear –
and live – it is even slower.
 Gender & Patriarchy: The structure of
churches is patriarchal, and while changes
are happening, ultimately men have the say.
Even in HIV responses, which are driven to
90% or more by women, men are in leadership
positions, taking decisions.
 Men are generally not addressed in
interventions (and this is true for our public
health system as well, not only for Christian
responses). This is untenable when it is
evident that it is men who are driving
the pandemic.
 Few groups seem willing to take on
prevention in ‘tainted’ groups: sex workers,
50 aLQ – November 2005 comment: making a
point
prisoners, men. Few seem aware how
stigmatising the choice of churches to work
overwhelmingly with ‘the most innocent’ is.
RESPONDING TO THE WAVE OF
AIDS RELATED SICKNESS AND
DEATH
Once people start becoming seriously ill and
dying of AIDS-related causes, churches
responded to this need. They had always
cared for the sick and dying. And they do so
for those dying of AIDS.
Caring for people living with HIV and AIDS
Home-based care (HBC) is one of the most
common responses to the AIDS pandemic
amongst churches. HBC provides basic health
care, emotional support, as well as material
needs to those sent home from hospitals,
because ‘there is nothing more we can do
for you’.
An extensive network of HBC groups exists,
many of them linked to faith-based
organisations (FBOs) or congregations/
denominations. Unlike many other religious
responses, these groups are usually wellintegrated
with each other and with the public
health system.
Spiritual needs of people living with HIV
and AIDS
Some specific questions arise for those dying
of AIDS for which they need spiritual care. This
includes preparing for death, dealing with guilt
of becoming infected or having infected a
partner or child.
ARVs
Only recently, some churches have ventured
into the provision of ARVs. There are a few
Catholic projects and one of the Moravian
churches in the Eastern Cape. As this is an
expensive intervention, requiring highly trained
staff, not many churches take it on. And as the
roll-out of ARVs in the public health system
reaches further, it is not clear what role these
projects will continue to have.
This is also seen as a crucial intervention into
orphaning. The best thing to do for children is
to keep their parents alive, so they do not
become orphans.
Challenges regarding AIDS care
 We need to offer care and support to
those involved in care giving, whether
HBC, medical staff, or clergy suffering from
funeral fatigue. Not enough support is
available.
 All these responses suffer from lack of
resources. They often rely on volunteers,
many of whom are desperately poor
themselves, and not adequately trained for
the challenges they have to take on.
RESPONDING TO THE WAVE OF
ORPHANING
Traditional institutional responses
A number of these existing orphanages and
shelters for street children have shifted their
emphasis, as increasing numbers of the
children needing their care are de facto
orphans, largely due to AIDS. Nazareth House
and Beautiful Gates are well-known examples
of homes caring for children orphaned by
AIDS or living with HIV. They receive all sorts
of support from the community and from
many churches.
aLQ – November 2005 51
comment: making a point
Some programmes focus on finding foster or
adoptive parents for orphans. It is clear that
with the enormous scale of orphans, such
homes are not sufficient.
Community-based responses
Foster2 did a study of orphans and vulnerable
children responses in six African countries
(Kenya, Malawi, Mozambique, Namibia,
Swaziland and Uganda). There are currently
around 5.8m orphans in these countries, with
close to half orphaned due to AIDS.
Faith-based responses to orphans and
vulnerable children are widespread throughout
Africa. (It has to be noted that this study
included all FBOs, not only Christian ones.)
FBOs are coping with the epidemic by adapting
traditional approaches and developing new
ones. Many of the FBO projects are small scale,
caring for a few orphans. Yet a total of 322
FBOs (out of 505 surveyed) supported about
140 000 orphans and vulnerable children. Most
FBOs do so by relying on volunteers.
Most common was the provision of material
support and school assistance, and most
groups offer children religious teaching and
spiritual support.
Challenges around orphans and vulnerable
children responses:
 Huge numbers of children are being
orphaned. Responses reach relatively small
numbers of these. The scale of the
pandemic is overwhelming, but we have to
see the bigger picture.
 It seems easier to take on the care of
babies and small children. A concerted
effort is needed to reach out to teenaged
orphans – they are an extremely vulnerable
group and will impact seriously on society,
if the only ‘home’ they find is on the street
and in gangs.
 Targeting AIDS orphans with responses
is often counter-productive. Due to stigma,
many who are eligible for the service do not
come forward. And those, who do, may be
resented by non-AIDS orphans. The trend
is to offer services for orphans, irrespective
of the reason for the death of their parents.
 The emphasis needs to be on
strengthening extended families and
communities caring for orphans, as well as
orphans themselves who live in childheaded
households, so they can provide
the care that is needed.
FOOTNOTES:
1. An earlier version of this article was presented at the AIDS Legal Network
(ALN) Public Debate on 19 October 2005. See also Parry, S. 2005. Responses
of the Churches to HIV and AIDS in South Africa. Geneva: World Council of
Churches. & Schmid, B. 2002. The churches’ response to the HIV/AIDS pandemic:
A case study of Christian agencies in the Cape Town area. MSocSci
Thesis, UCT.
2. Foster, G. 2004. ‘Study of the Response by Faith-Based Organizations to
Orphans and Vulnerable Children: Preliminary Summary Report’. Paper presented
at the World Conference of Religions for Peace & United Nations
Children Fund – UNICEF, 2004. See also UNAIDS, UNICEF & USAID. 2004.
Children on the Brink 2004: A joint report of new orphan estimates and a
framework for action. USAID.
Barbara Schmid is the ARHAP Research
Coordinator at Religious Studies at the
University of Cape Town.
For more information and comments
please contact her on +27 21 650 3457 at
Bschmid@humanities.uct.ac.za.
aLQ – November 2005 52
PRINTED BY FA PRINT
It is the dawn of yet another decade of democracy in
South Africa, since the first democratic election in 1994.
The democratic government was then, and still is, faced
with a critical challenge of mending a fragile society into
a new South Africa, based on values of human dignity,
the achievement of equality and the advancement of
human rights and freedoms (Constitution1, Section 1(a)).
South Africa made history when adopting its new
Constitution in 1996, a constitution which is based on the
will of the people and guarantees everyone the right to
equality and non-discrimination (Constitution, Section 9).
Many injustices of the past dividing the nation, have been
addressed by the Constitution. However, to make
constitutional provisions a reality seems to pose very
serious challenges for everyone.
Government, in an attempt to create an enabling
environment for everyone, provided for a legislative and
policy framework aimed at protecting everyone against
any form of humiliation, degradation and other forms of
violence. Even though, the legislation is in place,
communities are faced with numerous challenges in
accessing and enjoying their rights. One of the biggest
challenges, however, seems to be the paradigm shift
and/or changing of mind sets required. This shift is not
going to happen overnight, it will be a long process.
The apparent gap between rights and lived realities
raises questions as to how to ensure that the rights
and freedoms enshrined in the Constitution become
lived realities in communities and how to begin
sensitising and capacitating community members with
the knowledge and understanding of their rights and
freedoms.
Acknowledging the prevailing injustices, inequalities and
discriminatory attitudes and practices in the
communities, also raises questions as to when are we
going to treat people with dignity and respect. While
Section 10 of the Constitution guarantees everyone the
right to have their dignity respected and protected, the
extent to which people are respected often differs due to
their age, sex and/or HIV status. An all too common
example is a child who stays with the grandmother due
to the fact that the parent passed away. As and when it
becomes known that the parent died of HIV-related
illnesses, the treatment will change and be totally
different. In some cases, the family will even insist that the
child be tested, bringing to the fore ‘excuses’ that it is in
the best interest of the child. Subsequently, the child will
suffer and be treated differently, because the parent died
of HIV-related illnesses. This, arguably, is one of the
reasons why people do not disclose their status,
because immediately after they do, the child is suspected
to also be infected with HIV and treated accordingly.
Children have the right to be treated like all human
beings, as they are indeed human beings. And this
includes that children have the right to have their
dignity respected and protected. It is saddening to see
that an 8 year old child is not going to school, because
the child has a ‘rash’. A ‘rash’ has deprived a child of
her/his right to attend school, because teachers say ‘it’
(‘the rash’) will be carried over to other learners. Where is
justice and the right to equal treatment?
With the Apartheid government, one thing that divided
the nation was race; today the nation still seems to be
divided – by a disease. Is this just?
All in all, the challenges seem to be changing/shifting our
mindsets from the concept of different treatment for
different people to the concept of equal treatment for
everyone. Lets all treat one another in a manner as I,
myself, would like to be treated. Personally, I am looking
forward to a time where all people will equally enjoy the
benefits of democracy.
And we are moving forward. President Mbeki (15 April
2003) describes the journey:
The road we have travelled and the advances we
have made convey the firm message that we are
moving towards the accomplishment of the
objectives we set ourselves. They tell us that, in the
end, however long the road we still have to travel, we
will win.
FOOTNOTE:
1. The Constitution of South Africa, Act 108 of 1996.
Sipho Fakude is the Project Coordinator at the
Phaphamani Home-Based Care Centre.
For more information and comments
please contact him at +27 13 796 1624
or at sipho@phaphamani.com.
The fruits of democracy:
Challenges for everyone
The fruits of democracy
Sipho Fakude
This publication has been made possible through the assistance of
the Joint Oxfam HIV/AIDS Programme (JOHAP) managed by Oxfam Australia