The Dual Feminisation of HIV/AIDS

Abstract

The feminisation of HIV/AIDS commonly refers to the feminisation of the epidemic: women are disproportionately infected and affected by the disease. This paper argues that there is a dual feminisation of HIV/AIDS; that of the epidemic and that of its governance. Women are at the forefront of HIV/AIDS governance from the leadership of global programmes, directing national and district HIV/AIDS councils in-country, forming influential women and HIV/AIDS non-governmental organisations, and organising local communities. Yet this feminisation of governance has not led to better outcomes for the feminisation of the epidemic. This paper argues that this is because of the misapplication of gender mainstreaming and the politics of presence, the sidelining of gender expertise and institutional bias, and wider systematic issues with processes of HIV/AIDS governance that are exacerbated when addressing the concerns of women.

La feminización del VIH/SIDA se refiere comúnmente a la feminización de la epidemia: las mujeres están infectadas y afectadas desproporcionadamente por la enfermedad. Este estudio sostiene que existe una doble feminización del VIH/SIDA; la de la epidemia y la de su control. Las mujeres están al frente del control del liderazgo de los programas globales del VIH/SIDA, dirigiendo concejos distritales e internos del país, formando a mujeres influyentes y organizaciones no gubernamentales del VIH/SIDA y organizando comunidades locales. Sin embargo, esta feminización del control no ha dado mejores resultados a la feminización de la epidemia. Este estudio sostiene que esto se debe al mal manejo de la integración de la perspectiva de género y a la política de la presencia, la marginación de la experiencia del género y el prejuicio institucional, y otros amplios asuntos sistemáticos con el control del VIH/SIDA, que se agravan cuando abordan los asuntos de las mujeres.

艾滋病问题的女性化指的是在传染方面的女性化：女性不成比例地被传染和受到该疾病影响。本文认为艾滋病问题存在双重的女性化：不仅是传染方面，还有治理方面。女性以全球性项目的领导地位处于艾滋病治理的最前沿，在国内她们指导国家的和地区的相关艾滋病委员会，组建有影响力的妇女和艾滋病非政府组织，并建立地方社团。然而治理的女性化并未对传染的女性化产生更好的结果。本文认为原因在于性别主流化的滥用和现存政治、性别专门知识的边缘化和制度偏见，以及艾滋病治理进程中解决妇女的关切时还在恶化的更为广泛的各种体系性问题。

Keywords:

• HIV/AIDS
• gender
• women
• feminisation
• governance

Acknowledgements

I am extremely grateful to Laura Shepherd for her editorial suggestions and the remarks and feedback of one reviewer in particular. These comments helped focus the paper's argument and have substantially improved its overall quality and readability.

Notes

The physiological factors that make women more vulnerable to HIV infection relate to the exposure area of female genitalia and timing; the physiology of male and female sexual intercourse; and the increased inflammation of mucosal surfaces through cross-infection with other sexually transmitted infections (STIs) and possible trauma.

While the physiology of female genitalia makes them more susceptible to infection, it is the socially ascribed gender roles to women and men in East Africa that increase women's infection rates. Gender difference is based on women as carers, mothers, and wives, with the burden of childcare; and men as principal earners, fathers, owners of property rights, with masculinity associated with sexual behaviour. These gender roles perpetuate notions of real maleness as men who engage in concurrent, extramarital relationships (see Epstein, 2007) and owners of property and family income, and women as dependent on men because of their lack of access to property rights by the fact of being women, and the need to marry and bear children to avoid social stigma and gain access to property and financial support.

This was evident when talking to home-based carers and peer educators in rural and urban communities in Kenya, Tanzania, and Uganda about their lives and responsibilities; experiences from involvement with Tanzanian-based NGO Trans Tanz; as well as discussions as to the role of home-based carers and the role of women in interviews with Lilian Gitau (Int. 2005) who ran the local branch of St John's Ambulance in Kisumu, Kenya and Pfiriael Kiwia (Int. 2006), head of Kimara Peer Educators in Dar es Salaam, Tanzania.

This is evident from the number of women involved in community initiatives and non-governmental organisations on the ground in Kenya, Tanzania, and Uganda. Women make up the majority of these organisations. This can also be seen by the prominence of women-specific HIV/AIDS organisations such as the Kenya Network of Women with HIV/AIDS and the Society for Women and AIDS in Africa Tanzania (SWAAT).

Further declarations to address the issue of gender and HIV/AIDS include: Goal 3 and 6 of the Millennium Development Goals, the World Education Forum, the Fourth World Conference on Women ‘Beijing’ Declaration and Platform for Action, the International Conference on Population and Development Programme of Action, the World Conference on Human Rights Declaration and Programme of Action, Convention on the Rights of the Child, Convention on the Elimination of all Forms of Discrimination Against Women.

This was made clear to the author when discussing femidoms on home visits with St John's Ambulance in Kisumu, Western Kenya.

The inclusion of women and children with ‘other’ categories such as men who have sex with men and drug users is particularly problematic here. It suggests that ‘women-and-children’ are to be addressed as an add-on issue, integrated with ‘problematic’ and ‘other’ issues that relate to the global response to the epidemic but are not a central concern to the state. Women-and-children thus become conceived of as separate, problematic, and an ‘other’ issue that is not central to the state's overarching strategy to combat HIV/AIDS.

UNAIDS' 10 co-sponsors are: United Nations High Commissioner for Refugees (UNHCR), United Nations Children's Fund (UNICEF), World Food Programme (WFP), United Nations Development Programme (UNDP), United Nations Population Fund (UNFPA), United Nations Office on Drugs and Crime (UNODC), International Labour Organisation (ILO), United Nations Educational, Scientific and Cultural Organisation (UNESCO), World Bank, and the World Health Organisation (WHO).