Human Rights Reporting

Summer 2004 Student Work

Inside the Epidemic: Women's Experience of AIDS in Africa

By Melanie White

With 5.3 million people living with HIV/AIDS in South Africa, this country has the highest rate of infection in the world. And within the culture of secrecy and myth surrounding AIDS in Africa there is a second epidemic that fuels the spread of the disease: rape, not only of women but also of young children.

Rebecca Schleifer, an HIV/AIDS researcher at Human Rights Watch, says that over 50,000 children under the age of 18 have been reported as raped in South Africa during the past year, and that the number of actual child rapes is probably higher, since many children are raped by members of their own family and the abuse goes unreported. "Also, the South African police are not exactly trustworthy," Schleifer says, "so many people are reluctant to go to them about something so sensitive."

Rape can be a death sentence in many sub-Saharan African countries because of the high incidence of AIDS. In Uganda, despite the relatively progressive constitution and the fact that a woman is currently the country's vice-president, 51 women serve in Parliament, and 39 districts are represented by women leaders, women still have the lowest status in Ugandan society and bear the brunt of the socio-economic effects of AIDS. Beatrice Were, a co-ordinator for the National Community of Women Living with HIV/AIDS in Uganda, emphasizes the way that women are affected by the AIDS epidemic differently than men. "It is the man who determines sexual relationships and controls the woman's body. If she refuses sex, even if her husband has AIDS, she loses her economic security," and so many women have few defenses against infection. Many women contract the disease from their husbands and are then rejected because of the stigma of the disease.

Young women are disproportionately affected by the disease. Throughout sub-Saharan Africa, HIV infection rates among teenage women are more than five times higher than rates for teenage males, according to one 1999 United Nations report. Despite the high incidence of infection, anti-retroviral drugs like Post-Exposure Prophylaxis (PEP) - a short course of drugs to prevent HIV after exposure - is available only on a very limited basis in sub-Saharan Africa, although it is regularly provided to rape survivors in the industrial world.

Schleifer says that this is a travesty for women in countries like South Africa. There is a widespread lack of information about PEP in the countries that require it most. There are no training courses for healthcare providers and no significant public awareness efforts. As a result, "Sexual violence survivors don't know about the health risks after rape and don't know about the services that are potentially available to them," Schleifer says. This has proved deadly for many women and children, as a course of PEP must be started within 72 hours after infection.

The level of denial is so great that last fall, President Thabo Mbeki told The Washington Post that he knew of no one in South Africa with AIDS/HIV. He also questioned the link between HIV and AIDS, and argued that anti-viral drugs not only fail to fight AIDS but are poisonous. Such denial and misinformation serves to hinder rather than help deal with the epidemic.

The Eastern Cape Hospital is supposed to be one of the nine hospitals dispensing PEP in South Africa. However, Schleifer says that this hospital was scared of dispensing the drug because they thought it was against government policy. PEP actually is part of the government's health policy, but the lack of information and public awareness efforts mean that hospitals like the Eastern Cape did not know that they were allowed to distribute potentially life-saving medication. Perhaps hospitals' confusion is understandable, given the South African government's former attempts to fight court rulings requiring it to dispense anti-retroviral drugs to pregnant women.

Compounding the problems of rape, misinformation and HIV/AIDS, hospitals will not treat women if they have not reported rape to the police. Despite the fact that many women and girls are loath to report sexual violence out of a sense of shame - especially if the attacker is a family member - they have no recourse to medical treatment unless they do so.

South African law does address domestic violence (including sexual assault) relatively well, but the police tend to be inept at dealing with victims. Schleifer says that one teenage girl went to the police the day after she was gang-raped, but they turned her away, saying, "We don't deal with children's issues." As a result, the girl failed to get treatment or PEP in time. While Schleifer does not know whether this girl actually contracted HIV, "police inactions could have cost her her life," she says.

However, there has been some slow progress in recent years in how South Africa deals with the epidemic and the way it impacts women. The National Prosecuting Authority has set up sexual offense courts, which specialize in the rape of those under the age of 12 - which furthermore suggests the widespread nature of this problem. The development of such specializations means that some prosecutors will become more effective in their indictment of rapists who contribute to the spread of HIV/AIDS. Police are starting to represent a gateway to services. Some one-stop centers at hospitals provide both police and medical support on site.

However, cultural attitudes remain a barrier to prevention. A myth circulates in some African societies that sex with a virgin will cure AIDS, which leads to some rapes - even of infants. In circumstances of secrecy, traditional practices depriving women of control of their sexuality remain integral to many sub-Saharan societies. As Were says, "AIDS is not just about condoms, it is about power relationships."