South Africa has one of the highest HIV prevalence rates in the world. In terms of numbers, South Africa has the most HIV-positive people living inside its borders[1]. For South African HIV-positive women, “their sickness is a result of structural violence: neither culture nor pure individual will is at fault; rather, historically given (and often economically driven) processes and forces conspire to constrain individual agency. Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress.[2]” The conflation of structural violence and cultural difference has been present in both scholarship and anecdotal commentaries for decades. Structural violence against women has perpetuated the AIDS epidemic as is evidenced by rape rapes, discordant concurrent relationships, and inability to negotiate condom use. Furthermore, some of the humanitarian efforts present in Sub-Saharan Africa have done little to empower women. In confronting the HIV/AIDS epidemic many well-meaning conservative movements have inadvertently enforced the patriarchical undertones in societies like South Africa.[3]
Rape rates are a shocking indicator of the powerlessness of women. In South Africa a woman is raped every 26 seconds; 1 in 3 women will be raped during her lifetime.[4] Many of the victims are young children:
But here in this impoverished township, the small victims still totter home like broken birds, whispering about the grown men who rape with numbing regularity. A doctor at the shabby public hospital opens a battered binder and counts the names: in 2001, more than 200 child rapes, mostly girls ages 7 to 9[5].
In addition to being emotionally and physically traumatizing, these rapes imprison young girls in a cycle of inequality. Many of these rapes happen in schools, in order to protect themselves from sexual violence these girls stop attending school. Two representative cases have forced the world to confront rape in South Africa by bringing the issue into the public domain. The rape of Baby Tshepang[6] and the Jacob Zuma Rape Trial[7] brought national attention to the woman rights issues in South Africa. Baby Tshepang was a nine-month old baby who was raped by the mother’s boyfriend. The baby very nearly died as a result of the trauma. The nurses called her “Tshepang,” which means “hope.” Jacob Zuma, the former Deputy President of South Africa was charged with raping an AIDS activist. He was acquitted of the charges but there is much speculation about corruption and this verdict. Both of these cases alerted the world to the frightening brutality and fear that has become standard for South African women. Some of the perpetrators of these child rapes may believe the myth that having sex with a virgin will cleanse them from HIV, others are undoubtedly aware that this will do nothing to prevent the transmission of AIDS. Regardless, virgin, child, and infant rapes are violent acts that propagate the spread of HIV. Forced sex usually involves bleeding; therefore, HIV is much more easily spread to a rape victim[8]. In recent years the South African government has made huge steps towards equality, but “cultural practices that deny fundamental human rights cannot be wiped away by a constitution created by lawyers, academics, and politicians.[9]” The difficulty is analyzing the problem of rape without supplanting our ‘Western’ culture on top of the ‘non-Western’ context of South Africa, in a way that doesn’t provoke or suppose that our framework is inherently superior.[10] Immediately faulting “culture” does not elucidate the true cause of the structural violence in South Africa.
Women in relationships face similarly difficult challenges. Studies indicate that women in consensual relationships are unable to negotiate the terms of sex – specifically, the use of condoms[11]. To combat this problem there have been attempts to implement programs aimed at empowering women. Stepping Stones, originally developed in Uganda to train women in a series of workshops to be more assertive about their sexual encounters and to engage in open dialogue about sex, was adapted for and implemented in South Africa. However, the study did not show that the program decreased the incidence of HIV. Some evidence exists that this program may have decreased some of the risk factors associated with HIV/AIDS[12]. Ultimately, decreasing these risk factors are more about a woman’s ability to make choices about the risks taken, for some there are far fewer options[13].
Women whose husbands have migrating jobs are more likely to engage in sex with prostitutes, girlfriends, or other wives may pass diseases throughout the sexual network. One study showed that when one or both members of a partnership reported having concurrent relationships along with the partnership being studies, the studied partnership was 3.8 times more likely to have an STI than a partnership where concurrency was not reported[14]. Furthermore, higher STIs were independently related to discordant relationships, that is, when only one of the partners reported engaging in concurrent relationships[15]. The inability to negotiate condom use is especially problematic when seen in light of concurrent relationships. Studies show that couples in steady relationships use condoms less. Multiple concurrent, yet steady, sexual relationships show this same trend[16]. In this case, HIV is easily spread because of the lack of condom use and the breadth of the sexual network. Whether there is a mutual desire not to use condoms is unclear:
Many African women find it hard to ask their partners to use condoms. In one survey in Zambia, less than a quarter of women believed they had the right to refuse sex with their husbands even if they knew he was unfaithful and HIV-positive. And only one in ten thought she could ask him to use a condom in this situation[17].
The lack of efficacy of some intervention campaigns[18] is largely due to the difficulty associated with translating an inherently American program onto the culture of South Africa. Social and cultural identity is not easily generalized; it is a complex of relatively concrete factors and subjective aspects.[19] By labeling campaigns targeted at behaviors believed to be propagating HIV as cultural interventions it is inevitable that a certain amount of ‘selective labeling’ will occur.
This ‘selective labeling’ of certain changes and not others as symptoms of “westernization” enables the portrayal of unwelcome changes as unforgivable betrayals of deep-rooted and constitutive traditions, while welcome changes are seen as merely pragmatic adaptations that are utterly consonant with the ‘preservation of culture and values.[20]’
In many ways designing programs involves “challenges to widespread unreflective assumptions about what national “culture” and “values” are, how important institutions function, and how various groups of people fare as a result of existing arrangements of national life[21].” A woman’s relationship to political and power structures, interpreted as a result of her experiences, creates a distinctly personal narrative[22]. Until women are connected to other women, until they see the political connections between their experiences and the experiences of other women[23], a movement to improve the gendered health and human rights phenomena of HIV/AIDS has little hope of being successful. A feminist movement against HIV/AIDS should combat instances of structural violence – of rape, of women without power to negotiate condom use, of women with unfaithful husbands – without generalizing about cultural norms and values, without assuming a Western supremacy.
[1] The Economist, Vol. 362, Issue 8261, (23 Feb 2002), 49-51.
[2] Farmer, P. (1999). Infections and Inequalities: The Modern Plagues. Los Angeles: University of California Press, p. 78.
[3] Petchesky, R, (2003) Global Prescriptions – Gendering Health and Human Rights, London: Zed Books, 5.
[4] The Times of India (2008, November 19). “A Woman is Raped Every 26Seconds. Retrieved November 20, 2008, from The Times of India. Website: http://timesofindia.indiatimes.com/World/A_woman_raped_every_26_sec_in_South_Africa/articleshow/3729626.cms; Human Rights Watch: www.hrw.org/en/news/2008/08/17/costs-marital-rape-southern-africa
[5] Swarns, R. (2002, January 29) “Grappling With South Africa’s Alarming Increase in the Rapes of Children.” New York Times.
[6] Phillips, B. (2001, December 11). “Baby Rapes Shock South Africa.” BBC News, http://news.bbc.co.uk/2/hi/africa/1703595.stm.
[7] BBC (2006, February 15). “Zuma Case Reveals South Africa Rape Problem.” BBC News, http://news.bbc.co.uk/2/hi/africa/4713172.stm.
[8] Cornwall, A. & Welborne, A. (2003). Realizing Rights: Transforming Approaches to Sexual and Reproductive Well-Being. London: Zed Books, p. 100.
[9] Heywood, M. & Cornell, M. (1998). “Human Rights and AIDS in South Africa: From Right Margin to Left Margin,” Heath and Human Rights, 2:4, 70-1; Petchesky, 94.
[10] Narayan, U. (1997). “Contesting Culture: “Westernization,” Respect for Cultures & Third World Feminists.” In Dislocating Cultures: Identities, Transformations, and Third World Feminisms. New York: Routledge, p. 3.
[11] Castle, J., et al. (2001) AERC Proceedings. Retrieved November 22, 2008 from http://www.edst.educ.ubc.ca/aerc/2001/2001castle.htm.
[12] Jewkes, R., Ndunda, M., Levin, J., Jama, N., Dunkle, K., Puren, A., Duvvury, N. (2008, August 7). “Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behavior in rural South Africa: cluster randomized controlled trial,” BJM, 337.
[13] Cornwall, A. & Welborne, A. (2003). Realizing Rights: Transforming Approaches to Sexual and Reproductive Well-Being. London: Zed Books, p. 101.
[14] Gorbach, P.M., Drumright, L.N., Holmes, K.K. (January 2005) “Discord, discordance & concurrency: Comparing individual and partnership level analyses of new partnerships of young adults at risk of STI.” Sex Transm Dis, 32:1, 7-12.
[15] Gorbach, P.M, Drumright, L.N.
[16] Hearst, N. and Chen, S. (March 2004). “Condom promotion for AIDS prevention in the developing world: Is it working?” Stud Fam Plann 35:1, p. 39-47.
[17] Guest, R, Shackled Continent – Africa’s Past, Present, and Future (London: Macmillan, 2004), 100.
[18] The campaigns I speak of are any of a broad grouping of HIV/AIDS prevention campaigns, including, but not limited to: Abstinence Only, ABC (Abstinence, Be Faithful, and Use Condoms), Zero Grazing, Stepping Stones, etc. South African interpretations of these campaigns have had mixed degrees of success.
[19] Song, S. (November 2005). “Majority Norms, Multiculturalism, and Gender Equality,” Am Pol Sci Rev, 99:4, p. 474.
[20] Narayan, U., p. 23
[21] Narayan, U., p. 34
[22] Narayan, U., p. 10
[23] Narayan, U., p. 11
