The Means of Reproduction: Sex, Power, and the Future of the World (39 page)

Many people across the political spectrum agree that dealing with the pandemic is one of the great moral challenges of the current generation. What has been insufficiently understood, though, is that in sub-Saharan Africa HIV/AIDS has been feminized, and women’s lack of control over their own sexual lives has been enormously important in its spread. Trying to address the disease without reference to gender hierarchies is as counterproductive now as attempts to curb overpopulation without paying attention to the status of women were decades ago.

Women make up 57 percent of adults living with the virus in sub-Saharan Africa, and in some parts of the continent young women are three times more likely than young men to be infected.
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The reasons for these disparities have as much to do with patriarchy as biology. “The subordinate position of women and girls—politically, socially and in sexual encounters—is ingrained in every aspect of the pandemic,” wrote Alex de Waal in
AIDS and Power
.
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Stephen Lewis, the former United Nations special envoy for AIDS in Africa, went further, telling me, “The struggle for gender equality is the single most important struggle on the face of the planet.”

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daughter of Uganda’s elite, physician Lydia Mungherera knew, in a vague and academic way, how bad things were for many women in her country. Her mother, after all, was a feminist who attended the Beijing women’s summit. Yet it wasn’t until she discovered that she was HIV-positive that the depth of women’s suffering became visceral to her.

Mungherera was wracked with HIV-related dementia when she was brought home to Uganda from South Africa, where she’d been living and working, in 1997. Her CD4 count—a measure of immune system functioning that’s between 500 and 1,500 in healthy adults—was 1. Most people in her condition would have been dead the next day, but somehow Mungherera’s family nursed her back to health. She’d been so sick in South Africa that she was barely aware of her diagnosis, but in Uganda she learned to live with it, eventually going on antiretroviral drugs. Soon she joined the Network of People Who Are Living With HIV and AIDS, training others in the use of the drugs. She quickly noticed that the pandemic was hitting women harder than men, and not just for biological reasons.

“Culturally, in African countries, men dominate women, and so I found myself [asking], how can we tackle this disease if we don’t fight for women’s rights?” she said. “Women don’t have rights in deciding when to have sex, and how to have sex—whether to use a condom or not. Men can have as many partners as they want—there’s a lot of polygamy here, and women don’t have a choice. You find that women are locked up in marriages where they’re not happy, and they don’t have the financial and educational empowerment to leave those marriages. There’s a lot of domestic violence, and I believe that violence drives the pandemic.” When it comes to HIV in Africa, marriage is a primary risk factor for young women.
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At the same time, some poor single women, desperate for food, clothes, and school fees, find themselves forced into sex with older men in exchange for gifts, a survival strategy so common that billboards in Kampala, Uganda’s capital, warn against “sugar daddy” relationships.

Looking for a way to make a difference, Mungherera, herself a mother of two, decided to focus on HIV-positive mothers, the cohort she saw as most vulnerable, and in 2004 she formed a support group called the Mamas Club, which now has branches in several Ugandan cities. Today the club, based in Kampala, draws women every day to its two-room headquarters, where they practice money-making skills like tailoring and embroidery, pool their money to make small investments, and share their burdens with each other. They also learn about family planning and their legal rights regarding property and child custody. Despite all their unfathomable miseries, the atmosphere is jovial— some of the women sing as they work on their crafts, or make jokes and erupt in knowing laughter. It’s hard to spend time with them without being a little awed by their resilience. But their stories offer a microcosmic view of the systematic discrimination that is killing so many.

Annet, an astonishingly cheerful young woman with chin-length braids and a wry sense of humor, was fourteen when she was raped by a thirty-five-year-old, the brother of a friend. She got pregnant and, terrified about how her harsh father would react, she ran away to the only place she could—the home of her rapist, who became a kind of common-law husband. “I was so young, and every year I’d get pregnant, because I didn’t know any better—I didn’t know about family planning,” she said. The man had a safe, and Annet knew he kept his money there. What she didn’t know is that that’s also where he kept his antiretroviral drugs. He never thought to tell her that he was HIV-positive.

A widowed friend of hers who had moved to Kampala from Uganda’s remote northwest urged Annet to accompany her to get tested, but Annet was too scared to ever pick up the results. Then her friend passed away, and with nowhere else to go, her three kids went to live with Annet. When Annet’s sister died, her two children joined the household as well.

She finally found out she had HIV after giving birth to a baby who tested positive. Three months later her husband died. Four of her five children turned out to be infected. Now she’s trying to keep ten children healthy and fed, but the only income she has comes from the Mamas Club.

Her story sounds extreme in its desolation, but many of the women had similar ones. Some were pulled out of school when money ran tight and were forced into early marriages with men who beat them when asked to use condoms. Some, after being tested, were chased away from home by the men who had infected them. Their bodies were taxed by frequent childbirth, which wasn’t always voluntary. “The men continue saying that you must have children,” said Mungherera. “I have a number of mothers who say the men say they must have more and more and more until their eggs are finished.”

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nd yet, even as the AIDS crisis is fueled by the lack of women’s rights, some in Africa blame female promiscuity for the pandemic. One sign of this was the spread of virginity-promotion programs directed solely at girls. In 2001, the king of Swaziland decreed a five-year ban on sex for young women, which included a prohibition on women wearing pants, a garment said to incite men to rape. Virginity testing became a kind of craze in several countries hard hit by HIV/AIDS; one chain of factories in South Africa reserved employment for virgins only, a policy enforced with monthly tests. “Strictly monitoring and controlling women’s sexuality is being promoted as a solution to containing the growth of the HIV/AIDS pandemic,” wrote the South African anthropologist Suzanne Leclerc-Madlala. In many African societies, she added, “HIV/AIDS has meaning as a disease linked to the moral transgressions of modern women.”
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The kind of abstinence-only prevention policies promoted by the Bush administration were based on similar reasoning, as if the epidemic could be checked with an injection of spiritual fortitude. Under the President’s Emergency Plan for AIDS Relief, or PEPFAR (which was justly praised for its role in providing lifesaving medicines to Africans), a full two thirds of American aid for the prevention of the sexual spread of HIV went to abstinence and faithfulness programs, often run by religious groups. American money influenced Uganda to abandon its successful, home-grown approach to curbing HIV in favor of one that fit the preconceptions of the religious right, with deadly results.

Uganda’s initial response to AIDS encouraged people to limit their sexual partners, a policy called “zero grazing,” which was not the same as abstinence. Condoms played a role as well. “HIV infection rates fell most rapidly during the early 1990s, mainly because people had fewer casual sexual partners,” wrote journalist Helen Epstein in her groundbreaking book
The Invisible Cure: Africa, the West, and the Fight Against AIDS
. “However, since 1995, the proportion of men with multiple partners had increased, but condom use increased at the same time, and this must be why the HIV infection rate remained low.”
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American abstinence-only policies threatened these gains. “[B]illboards advertising condoms, for years a common sight throughout the country, were taken down in December 2004,” Epstein wrote. “Radio ads with such slogans as ‘LifeGuard condoms! Ribbed for extra pleasure!’ were to be replaced with messages from the cardinal of Uganda and the Anglican archbishop about the importance of abstinence and faithfulness within marriage.”
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“The policy is making people fearful to talk comprehensively about HIV, because they think if they do, they will miss funding,” Canon Gideon, an HIV-positive Anglican minister from Uganda who has been a leader in the clerical response to the pandemic, told me. “Although they know the right things to say, they don’t say them, because they fear that if you talk about condoms and other safe practices, you might not get access to this money.”

On July 5, 2007, Beatrice Were, the founder of Uganda’s National Community of Women Living with HIV and AIDS, stood before hundreds of other HIV-positive women in the vaulted city hall in Nairobi, Kenya, and denounced the Bush administration’s AIDS policies. “We are now seeing a shift in recent years to abstinence-only,” she said. “We are expected to abstain when we are young girls and to be faithful when we are married to men who rape us, who are not necessarily faithful to us, who batter us.” The women in the audience, several waiting to share their own stories of marital rape, applauded.

Were exhorted her audience to “denounce programs that are not evidence-based, that view AIDS as a moral issue, that undermine the issues that affect us, women’s rights. I want to be very clear—the abstinence-only business, women must say no!” Again, there were hollers and applause.

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f course, not all women reject the abstinence-only business—far from it. In Africa as well as in America there are always women among the staunchest social conservatives. The owner of the virgins-only factories in South Africa is a woman, and there are many women just as eager to police the behavior of their gender. Feminists worldwide are working to reform not just laws but deeply ingrained traditions and religious strictures as well, institutions in which many women
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men find the only security and meaning that they know. Sexual hierarchies are literally essential to how most cultures reproduce themselves. Traditional gender roles are being challenged at a time when so much of life is in flux and so many verities are slipping away. No one knows what a world of gender equality would really look like, and so with each step toward it, people move from comforting certainty toward the unknown. To some it no doubt feels like being pushed toward an abyss.

Yet as long as women don’t have control of their own sexual and reproductive lives, we’re all heading toward possible disaster. HIV/AIDS has added to the Everest of evidence showing how deadly sexism can be. It is not the role of outsiders, either Western governments or foundations, to dictate new sexual norms to others. It should be their role, however, to bolster those trying to make positive, responsible change from within. In almost every society on earth there are women doing heroic work to remake their cultures. They are every bit as authentic as the self-appointed guardians of tradition, and we all have an interest in their success.

“Right now, women are coming to realize that they’ve been vulnerable for some time, and they are trying to fight to get out of that vulnerability,” said Esther Kalule, a Ugandan midwife-turned-district councilor in heavily rural Nakasongala province. “Some women’s organizations have come up, to advocate for their rights. Women are trying to participate in politics like I did, to ensure that we fight for our own rights. Very many activities are going on.”

I first met Kalule at a conference about women and HIV held in Nairobi during the summer of 2007, and I later visited her in her village. She was forty-nine, a broad-shouldered woman with close-cropped hair and a radiant smile. The men in her village, she said, call her a “rebel woman” and try to keep their wives away from her, lest she turn them into rebels, too.

Having seen AIDS decimate her community, she was defiant about the need to reject old traditions, including polygamy and female economic dependence. “Right now we are in the modern world,” she said emphatically. “Some women have gone to school. When they come back and they look at certain things, they say, ‘I don’t think this is something that should be practiced in my community,’ so they try to sensitize others. They’re changing the community, changing the society. We need to change! Whether you want it or not, everything has to change.”

D
uring the cold war, solidarity inspired liberals in the West to support those trying to profess humanistic ideas in hostile countries. Some Western governments also backed foreign dissidents with liberal views, though they were motivated by realpolitik rather than idealism. Despite being driven by different agendas, both groups recognized a powerful moral and strategic interest in helping those who propagated values in line with their own. Today, everyone concerned with a more just, peaceful, and healthy future has a similar investment in the world’s largest and most critical human rights struggle, the struggle for gender equality. The work of Mungherera and Kalule—and of women like them all over the globe—is of epochal importance. From HIV/AIDS to overpopulation to sex ratio imbalances to declining birthrates, the health of entire societies depends on the liberation of women. Over and over again, we see that sexism creates deadly disequilibria.