Women in South African AIDS Activism:
Towards a Feminist Economic and Political Agenda to Address the Epidemic
Introduction
South Africa has one of the highest numbers of H.I.V. cases of any
country globally, and an estimated 5.27 million South Africans are
living with H.I.V. (UNAIDS 2008; South Africa Department of Health 2007:
23). The country's AIDS epidemic is fundamentally gendered as it has
more women than men living with the virus. In particular, the 2005
Nelson Mandela/HSRC study estimated that 13.3 percent of South African
women were then living with H.I.V., compared to 8.2 percent of South
African men (Shisana et al. 2005: 33). Young women are particularly
affected by the epidemic: while H.I.V. prevalence peaks among men
between the ages of 30 and 34, it peaks in young women between the ages
of 25 and 30 (Shisana et al. 2005: 34). Owing to widespread cultural
stereotypes that women are "naturally" better at domestic tasks and
child-rearing, women also bear the bulk of the burden of the largely
unpaid work of caring for relatives and community members ill with AIDS,
and for children orphaned by the disease (Akintola 2004).
Women's greater vulnerability to H.I.V. relates to their subordinate
socioeconomic status. South Africa is a middle-income country with high
levels of income inequality, and unemployment is perhaps the country's
most serious economic problem (Nattrass 2003). In this context, it must
be noted that more women than men are unemployed. According to the South
African 2001 census, while 41.3 percent of men were formally employed in
that year, only 26.8 percent of women had jobs (StatsSA 2001: 52). These
findings have been echoed in the 2000-2007 Labour Force Survey, which
has consistently shown substantially higher female unemployment compared
to men (StatsSA 2009). Women are also placed at an economic disadvantage
because of slightly lower rates of enrollment in primary and early
secondary school education, and because of barriers to greater
educational achievement such as sexual harassment, gender-based violence
and social pressure to drop out of school following pregnancy (South
Africa Department of Education 2008: 12). In contemporary South Africa,
women are rapidly migrating from rural areas to informal urban
settlements where transactional sex—sex in exchange for gifts or
money—is one of the few livelihood strategies available to them. This
transactional sex places them at risk of H.I.V. infection as it is often
with multiple concurrent sexual partners (Hunter 2002; Parker et al.
2007; Epstein 2008).
In this context, I will discuss women's roles in AIDS activism. I
will address the challenge of sexism within AIDS organizations and set
out a tentative agenda for feminist AIDS activism in relation to
economic policy. I will first argue that, as in many other countries,
feminism is a contested concept in South Africa. Nevertheless, feminism,
understood as advocacy for women's rights, has existed for a long time
in the country, and the post-apartheid Bill of Rights in the
Constitution proscribes unfair discrimination on the grounds of sex (s9)
and protects reproductive rights (s12). In the post-apartheid period,
the challenge facing feminist activists has been how to press the
government successfully to progressively realize these rights through
the formulation of relevant policies and their implementation.
Drawing on the work of Denise Walsh, I proceed from the assumption
that an agenda to promote gender equality—one that promotes
gender-related constitutional norms—can only be credibly advanced by an
organization in which women are fairly represented within the
organization, and in which women can compete for leadership positions on
an equitable basis and can publicly challenge any modus operandi
when it is sexist (2009). Women constitute the majority of the
membership of AIDS activist organizations such as the Treatment Action
Campaign (TAC) and affiliated support groups and organizations. This is
hardly surprising, given women's disproportionate vulnerability to
infection and the fact that they have disproportionately absorbed the
social impact of AIDS, as expressed in care for those who are ill with
AIDS and for orphaned children. Since the late 1990s, activist groups
have challenged the ways in which unjust economic policies (including
trade policies, health policies and related budgets) have acted as a
barrier to universal access to antiretroviral medicines for chronic use,
to prevent the perinatal transmission of H.I.V. and to prevent
transmission of the virus following sexual assault. Yet women have only
recently begun to play visible leadership roles in South African AIDS
activist organizations.
My paper has two main arguments in relation to the development of
advocacy for women's rights in the AIDS crisis. My main argument is that
while women AIDS activists have challenged sexism in wider society in
the post-apartheid period, sexism has simultaneously acted as a barrier
to their ascent to leadership positions within AIDS activist
organizations. This has meant that inadequate funds are made available
for AIDS-related women's rights. My second argument is that much work
remains ahead in advocating for an economic policy in South Africa that
would permit a women's-rights approach to addressing AIDS.
I will first discuss the history of female involvement in AIDS
activism as it relates to that of the wider women's movement in the
country. I will also analyze the ways in which violence against women
has operated as a barrier to women's prominent involvement in AIDS
activism. Then I will explore how AIDS activists have challenged many
aspects of domestic and international economic policy in relation to
AIDS, and how this work could be extended to advance women's rights in
the context of the serious, entrenched global AIDS pandemic. Finally, I
will discuss the impact of the economic downturn on women's rights
activism around AIDS in South Africa, and argue that funding for H.I.V.
prevention and access to treatment should not be reduced since new
infections are increasing at a dramatic rate.
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