Violence against women and virulent HIV infection: Each one is bad enough without the other. But a new Amnesty International report shows that in rural South Africa -- a country where AIDS has reached epidemic proportions -- the two are inextricably and toxically linked.
"Violence against women affects the spread of AIDS with dire consequences," said Maureen Greenwood, an advocacy director for Amnesty International USA in Washington.
How? Many of the 37 rural women interviewed for the report said their husbands, who may be infected from a first or additional wife, or from an affair, refuse to wear condoms. (In certain places condoms are thought of as a prostitute's accessory; that, or men don't like them. "Power and control disparities in relationships create a context for men to have multiple concurrent partners and fuel their reluctance to use condoms," the report says, citing "The HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011.") Where does the violence come in? If these women insist on condoms, many say, their husbands will beat them, or force them to have unprotected sex.
"He did not allow [use of condoms]. I did try. At the clinic I got them and took them home, but he said no. We quarreled. He did hit me. He overpowered me," said JA, a 48-year-old woman with HIV. [The women in the report are identified by their initials.] "I told the clinic that my husband beat me ... The clinic did not tell me what to do ... He was forcing me to sleep with him ... He was raping me and infecting me."
No, not every husband is like J.A.'s, but for women married to those who are, it's really that grim. "Women are afraid," another woman told Amnesty. "They will allow [their husbands] to sleep with them without condoms [because] they are afraid that their husbands won't maintain them or stay with them."
Right. Factor in extreme poverty, and you've got a perfect storm: desperately poor, un- or underemployed women are socially and economically dependent on their husbands. (Not that that always gets them so far: One woman, echoing many, described her social status in a polygynous family by noting that she was always the last one to eat. "I am at the lowest end of all," she said.) Almost all the women interviewed said "their greatest wish was to find work," very little of which is available. Twenty-eight-year-old P.Y. told Amnesty, "I most wish for a job, so I can build on my parents' house, raise my child and teach the community about HIV." Z.T., abused and abandoned by her children's father, said her hope was "to have a job, so that I will have money to maintain my children and to have my own place, without men." Several of the women, infected with HIV, had to give up the jobs they did have when they became too ill.
Once infected, rural women face serious barriers to healthcare as well: many required visits, no money, no transportation. (About 10 percent of the population is infected, according to Amnesty, making South Africa home to one of the highest HIV prevalence rates in the world. Fifty-five percent of those infected are women; women under 25 are up to four times more likely to be infected than their male peers.)
Many of the women interviewed also said they faced the threat of abuse for trying to get HIV-related healthcare. "When a woman's partner is in denial about his own HIV status, he may resent her going to the clinic or taking medication," said Mary Rayner, Amnesty International's South Africa researcher and author of the report.
"Women's lives in rural South Africa are scarred by persistent violence in their families, homes and in underpoliced, unsafe communities," said Michelle Kagari, deputy director of Amnesty's Africa program. "The co-existence of epidemics of both HIV and violence against women has raised the costs of violence for South African women and girls -- both physically and psychologically."
While the report praises the South African government's five-year plan to combat HIV and other sexually transmitted infections, more needs to be done, like, in the next five minutes. Amnesty -- noting that "South Africa has obligations under international human rights law, as well as under national law, to prevent violence against women and provide access to effective remedies and redress for women subjected to violence" -- calls on the government to ramp up policing and prosecution, to tackle the economic inequalities that allow AIDS to proliferate, and to expand health and support services for women in rural areas. Support services including how to talk to your husband about wearing a goddamn condom.
Amnesty International USA is currently campaigning in the U.S. Congress for passage of the International Violence Against Women Act, which would help support medical treatment, women's economic empowerment, and changes in both legal codes and social attitudes.
Meanwhile, says 24-year-old L.E., "we live in fear. There is nothing we can do to protect ourselves." A rape survivor, she lives with a sister; they don't get along. She told Amnesty that what she wishes for most is "a home and peace."