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.

1) Historical and political challenges for women's rights work in South Africa

Many of the challenges experienced by women AIDS activists in ascending to leadership positions within their organizations, and in effectively exercising authority there, are not unique to non-governmental organizations (NGOs) working on AIDS. Indeed, South African women in civil society and politics more generally face these challenges. The post-apartheid proportional representation system has led to more women entering the government. But once in government, women have not always put forward feminist agendas, as a demonstration of party loyalty is usually the highest priority for ambitious female politicians who desire to advance their careers. Therefore, women in government are often disconnected from feminists in civil society, and the latter have few effective channels by which to influence their counterparts in the country's legislature, executive branch and civil service. In addition, women leaders in AIDS-related organizations are often not taken seriously as spokepeople, which diminishes their political authority.

South Africa has a racially and culturally diverse population. This fact has always acted as a brake on the development of a sustainable, powerful, broad-based, multiracial women's movement since at least the early twentieth century. Forging feminist solidarities has proven particularly difficult because women in the country have historically experienced sexism differently depending on their racial and cultural backgrounds (Bozzoli 1983). During the apartheid period, racial privilege insulated white women from many aspects of sexism such as unpaid domestic labor, because they relied on the services of poorly paid black domestic workers to undertake such work (Bozzoli 1983). Nationalism, as by both Afrikaners and Africans, has long been a driving force in South African political life. In this context, the political allegiances of many South African women have historically cohered around their racial identity and nationalist political agendas perceived as serving the interests of their race (Walker 1991). Even when South African women have been involved in work promoting gender equality, they have not described themselves as being "feminist," a concept popularly derided being as a Western import (Walker 1991; Britton and Fish 2009).

Similarly, postcolonial feminists have noted that women of different races do not have identical interests, and that transracial (and transnational) feminist political solidarities have to be consciously constructed through constant dialogue about women's different experiences of oppression (Davis 1981; Mohanty 2003). In a postcolonial context, there are additional representational challenges in creating space for the voices of subaltern women to emerge in writing (Spivak 1988). These challenges are not, however, insuperable, and I try here to allow some of the voices of women AIDS activists, from a variety of racial groups, to emerge.

The South African women's movement achieved many significant gains in the period of the country's transition to democracy and in the early post-apartheid period under the government of Nelson Mandela. In the transition era, the multiparty Women's National Coalition (WNC) did vital work to ensure that women were represented at a relatively senior level in the different parties' negotiating teams (Hassim 2006). In the post-apartheid era, South Africa adopted a proportional representation system. In this context, women's representation in Parliament increased as a result of lobbying by the African National Congress Women's League (ANCWL) for the implementation of a gender-quota system in the construction of the parties' lists (Hassim 2006). The inclusion of the gender-related clauses in the Constitution's Bill of Rights; legislative reform around domestic violence, sexual assault and abortion; and the creation of the Commission for Gender Equality, have all been admirable. But these laws have often been inadequately implemented, and there is much room for improvement in the socioeconomic status of the country's women.

Shireen Hassim has argued that with the shift of many women activists into government after 1994, the women's movement has become broken into issue-based movements such as securing access to safe abortions and preventing violence against women (2006). She also noted that in the post-apartheid era, there has been a significant disconnect between women in civil society and those in government (Hassim 2006). There are women politicians in government who have proven responsive to feminist demands, such as Pregs Govender, but it is a glaring irony that it was a female minister of health—Manto Tshabalala Msimang—who for many years resisted government provision of the antiretrovirals so many women desperately needed, and her department that delayed implementation of the antiretroviral rollout.

In relation to South African AIDS activism, Ida Susser has lamented "the repeated disappearance of women's experiences from research and public discussion" (2009: 217). As Susser notes, the erasure of women's social experiences and agency in the public discourse about AIDS is paradoxical in a context where much of the data about the epidemic comes from women being "counted, monitored and tested," especially at antenatal clinics (2009: 217). Women's experience of "voicelessness" and their difficulties in effectively challenging the established patriarchal "rules of the game" are far from unique to AIDS activism. Denise Walsh has pointed out that the Congress of South African Trade Unions (COSATU) only elected Connie September as its first female national officer in 1993 (2009). Moreover, in 1997 the unions rejected the recommendation made by the Commission on the Future of the Unions, which September headed, that 50 percent of union leadership positions be set aside for women. Instead, the unions opted for a gender-training program to promote women in the unions' ranks and a declaration of union solidarity on gender equality (Walsh 2009: 60).

Walsh has gone on to convincingly make the case that the extent to which women meaningful participate in civil society can be assessed using three criteria: access, voice, and whether women can contest the sexism in an organization's rules and everyday practices (2009: 48). If we use these criteria to assess women's participation in AIDS activism, it is clear that many challenges remain to gaining gender equality within the movements that focus on addressing the epidemic.

In 2005, Cha-Cha Connor and I embarked on an ethnographic study in Durban of 50 women AIDS activists from all of South Africa's racial groups to discuss the barriers they faced in conducting feminist organizing around the epidemic (2007). Because of the activists' fears about negative consequences if they revealed their names, the study was conducted on the condition that its participants and their organizations would remain anonymous. Unsurprisingly, given women activists' fears of negative repercussions if their critiques of their organizations appeared openly in print, voicelessness was the key issue that emerged in the study. Women AIDS activists felt there was resistance to substantive discussion of gender issues in their organization. One activist told us that in her organization:

Gender had been identified, but they were just resisting [the inclusion of] gender. I mean, they would go so far as purchasing a T-shirt that had a "women in AIDS" message on it, and that would be about it. (Interview, April 27, 2005).

As we have seen, women make up the majority of those living with the virus in South Africa. They also make up the majority of ordinary members of AIDS-related movements and organizations. Yet their voices have not been prominent in AIDS campaigns, or in the local or international media. One woman activist told us:

Women have been participating in AIDS organizing since the beginning of the epidemic. But . . . a woman who does home-based care and a woman who's caring for orphans gets credited and thanked. And then a man . . . who speaks on behalf of everybody gets prestigious recognitions . . .. I think that needs to change, because women are doing similar kinds of work. It's like we are good if we are doing domestic and caring types of H.I.V./AIDS work . . . but then if you do political stuff, you get marginalised: no recognition whatsoever. (Interview, April 27, 2005).

It would appear that rhetoric about "women and AIDS" and "gender and AIDS," which is commonly deployed in the "AIDS world" of the Joint U.N. Program on H.I.V./AIDS (UNAIDS), the World Health Organization, scientists, donors and international NGOs, has not always translated into gender transformative practice in South African AIDS NGOs. These issues remain current in South African AIDS activism. For instance, in relation to the Treatment Action Campaign, Janine Stephen recently argued:

As with any organization, TAC's members reflect the society they live in; the organization is not immune to sexism. Changing attitudes towards women and promoting equality have become a vital focus. But changing mindsets is not something that happens overnight (2009: 165).

According to Stephen, although formal moves have been underway to improve the organization's commitment to gender equality in recent years, there have been setbacks along the way. In particular, in 2007 several senior women in the organization resigned, and in the absence of an official TAC press release about the issue, rumors were generated that the resignations were related to "the organization's lack of commitment to women's issues" (2009: 166). More recently, the organization has taken steps to demonstrate its commitment to gender equality, such as establishing a Women in Leadership program to develop the leadership skills of women activists, the appointment of a women's rights coordinator and the election of its first female national chair, Nonkosi Khumalo (Stephen 2009).

However, the example of the TAC demonstrates that the internal transformation of an activist organization does not automatically alter cultural perceptions of women leaders. Stephen has gone on to argue that the media often prefers speaking to the male leaders of the organization, and that male representatives from COSATU or the ANC sometimes state that "they don't want to talk to a woman or a child" (2009: 169). Similarly, the ANC-led government recently created a Ministry of Women, Youth, Children and Disability. The creation of this ministry has been critiqued by feminists as being patronizing to women, who are adults who can claim rights independently, compared to children, who deserve (and require) the protection of adults (Lowe Morna 2009). This automatic equation/association of female leaders with children (and women's interests with children's interests), and the assumption they are less knowledgeable or competent, acts to undermine their authority and ability to shape and implement feminist agendas. As I will argue next, an even more serious barrier to women's AIDS activism is gender-based violence, which is also a key social driver of new infections.

2) Violence against women: A driver of new infections and a barrier to women's leadership in AIDS activism

South Africa is a country with a very high rate of intimate partner violence. Kristen Dunkle et al. have demonstrated that women with violent or controlling partners are at a greater risk of H.I.V. infection (2004). Women AIDS activists have also been vulnerable to violent gender-based attacks for openly revealing their H.I.V. status; therefore, it remains a serious barrier to women's exercise of vocal public leadership in activism around the epidemic.

As has been well documented, in December 1998 a woman activist from the National Association of People Living with H.I.V./AIDS (NAPWA) named Gugu Dlamini was publicly murdered in KwaMashu, Durban, a month after revealing her H.I.V. status on Radio Zulu. A bungled investigation rendered a successful prosecution impossible; however, an inquest into her murder, which was held only after vigorous advocacy by the AIDS Law Project (ALP), revealed that the suspects were heard by neighbors to accuse Dlamini of being a prostitute who had infected people with H.I.V. shortly before her brutal murder.[1]

Dlamini's experience is far from isolated. For instance, Promise Mthembu, who is now the global advocacy officer for the International Community of Women Living with H.I.V. (ICW), has stated that she has also experienced gender-based violence as a consequence of her activism. Mthembu was diagnosed with H.I.V in 1995. Five months after her diagnosis, she joined the National Association of People Living with H.I.V. (NAPWA) and began to speak out about living with H.I.V. in public meetings. Because of her H.I.V. status, her first child was stillborn, and her partner blamed her for infecting him with H.I.V. (Mthembu, undated). He began to beat her, and her speaking out about living with H.I.V only compounded the abuse. Writing about her own story, Mthembu said that her partner:

became more and more angry with me for attending AIDS meetings and giving talks about my personal story. He was jealous of my meeting other people who are H.I.V-positive, saying that I cared for and supported other people at his expense. My life became an endless circle of beatings and unprotected sex, especially if he was drunk. I could not take it any longer and I left him, despite the cultural disgrace and shame that it caused (Mthembu, undated).

The gravity of the issue was also demonstrated when TAC activist Lorna Mlofana was murdered after revealing her H.I.V. status to her perpetrators following a multiple-assailant sexual assault in Khayalitsha Township, Cape Town, in 2003. The successful prosecution of the perpetrators of the murder only came about after vigorous organizing by the TAC in the community.

As Walsh points out, civil society has often been conceptualized in the theoretical literature as separate from the "private sphere" of the family. However, family obligations and gendered problems in the home, such as intimate-partner violence, can act as a barrier to women's public political participation (2009). In addition to outright violence, Walsh points out that the "private sphere" impacts women activists' performances of their "public" roles through their experiences of the following problems: sexual harassment within their organizations, the "double shift" of unpaid housework at home and paid work for civil society organizations, and inconvenient meeting times after hours when public transport is less safe for women (2009). This is in addition to the fact that organizational sexism means that women have more limited experience and skills to make them eligible for promotion, and there is frequently a lack of institutional support for them in the rare instances when they do ascend to leadership positions (Walsh 2009).

Ironically, given that AIDS activism is at least in part aimed at ending new infections, sexual harassment has occurred in AIDS activist organizations in South Africa. In 2005, one woman told us that in her organization, "To get a hired position, you must sleep with the male supervisor . . .. If you break the relationship, you will be harassed until [you have] to resign, leave the job and go back home to die" (interview, April 26, 2005). Such relationships are clearly coercive and unethical in a context where women are more likely to experience difficulties in finding an alternative livelihood, and where the power imbalances inherent in such sexual relationships could make it harder to negotiate consistent and correct condom usage.

3) Economy policy and women's rights

Violence against women is a key social driver of new H.I.V infections in South Africa. In turn, women's relative poverty is a factor that forces them to stay in relationships with violent and controlling men. The high cost of antiretroviral treatment limits access to it, thereby contributing to the extent to which AIDS is a major cause of death among women and increasing women's disproportionate burden of care. I argue in this section that a women's-rights agenda around AIDS must include steps to advance the goal of women's equality to men in the economic sphere. In addition to challenging barriers to universal access to treatment, AIDS activist organizations should advocate for specific government measures to address women's relative economic marginalization. Moreover, at the very least, civil society organizations should not perpetuate women's economic disempowerment through exploiting their unpaid domestic and care-based labor based upon the myth that they are "naturally" better suited to such work.

The feminist economists Marianne Ferber and Julie Nelson have noted that "men have dominated the community of scholars who have created the discipline" and that "certain activities that are historically of greater concern to women than men have all too frequently been neglected" (Ferber and Nelson 1993: 2). Similarly, women's needs and interests globally are often poorly represented in national governments' budgets. In post-apartheid South Africa, feminists in government and civil society have made various attempts to shape the budget to advance women's interests.

Perhaps the best documented of these was the Women's Budget Initiative (WBI), which was established in 1995 by two non-governmental organizations and Parliament's Committee on the Quality of Life and Status of Women (Govender, 2007). Pregs Govender, a member of Parliament who chaired the Committee on the Status of Women, and Debbie Budlender, a feminist economist and sociologist, were key to the establishment of the WBI (Govender 2007; Budlender 2004). The WBI analyzed the budgets of every national department, and of provincial and local governments, from a gender perspective (Govender 2007: 165). Budlender has argued that the work of the WBI was initially well received, because the Minister of Finance announced in his first budget speech that there was to be a reduction in the defence budget in favour of increased spending on "women and children" (2004: 9). However, both Budlender and Govender have linked the diminishing commitment to advancing gender equality through the budget to the adoption of the fiscally conservative Growth, Employment and Redistribution (GEAR) strategy in 1996 (Budlender 2004; Govender 2007). While the strategy has proved highly effective at reducing the deficit, in the absence of improvements to the educational system, the government has failed to meet its targets on increasing employment or redistributing wealth (Nattrass 2003). Indeed, in recent years, job shedding linked to tariff reductions has proven particularly disastrous in industries where most of the employees are female, such as clothing and textile production (Benjamin 2007: 190). Moreover, as Govender pointed out at the time, an ambitious rearmament program, launched in 1998, failed to address poor women's economic needs (Govender 2007). Govender later resigned from Parliament in protest of Thabo Mbeki's policies, showing that both Parliament and the political parties are forums where outspoken feminists are made to feel unwelcome (Govender 2007).

Government approaches to addressing the feminization of poverty are relevant to the country's H.I.V. epidemic because gender-based social drivers of new infections such as transactional sex (Hunter 2002) and violence against women (Pronyk 2006) are clearly related to high levels of female unemployment. A randomized controlled trial in rural Limpopo showed that there was a 55 percent reduction in the levels of physical and sexual abuse experienced by women who had participated for a year in a joint microfinance, gender and H.I.V. training program (Pronyk 2006). The expansion of such microfinance initiatives has not been taken up in public policy, or by potentially vocal advocates such as the large AIDS activist organizations or COSATU.

What has been promoted consistently across the ideological spectrum of civil society—from the center-right Democratic Alliance party (the official opposition), TAC, COSATU, the South African Council of Churches (SACC) and the South African NGO Coalition—is the introduction of a basic income grant (BIG) for all South Africans. The thinking is that with an increase in income tax for the top two tax quintiles and/or an increase in "sin taxes" on alcohol and cigarettes, a grant of 100 rand (approximately $12) could be provided every month to all South Africans, irrespective of their income (Nattrass 2003: 151). Wealthier South Africans would pay more in additional taxes than they would receive through the grant, while their poorer counterparts would benefit because of the greater bureaucratic efficiencies inherent in the universal provision of social security. In addition, Natrass has argued that in the short to medium term, this measure represents one of the few mechanisms to substantially address income inequality in South Africa (2003). As we have seen, women are overrepresented in the ranks of the unemployed in South Africa, and so any universal social security provision would certainly improve their livelihoods.

The Mbeki administration was resistant to calls to introduce a BIG owing to its fiscally conservative GEAR policy framework. At the time of writing, it remains to be seen whether the ANC's 2009 election manifesto promise to "work towards bolder expansion of unemployment insurance" will be implemented, and if so, in what guise (ANC 2009; Piliso 2009). More importantly, it remains to be seen whether it will be as universal as the BIG proposal, or will include the expense and bureaucratic inefficiencies that are associated with means-tested social security provision.

Drug pricing is an economic issue that has been taken up by AIDS activists. Over the past decade, AIDS activists internationally have been very effective in advocating for reductions in the cost of first-line antiretroviral regimens by pushing for change to global trade agreements, acting as amicus curiae in court cases and involving themselves in vocal popular protests. This popular pressure was most effective when it was combined with competition from generic drug manufacturers and negotiations for voluntary price reductions in branded medicines led by the Clinton Foundation's H.I.V./AIDS Initiative (CHAI).

However, these gains cannot justify complacency in this area. H.I.V. eventually mutates around antiretroviral drugs, a process that leads to the development of drug-resistant strains of the virus. It is estimated that 10 to 15 percent of people living with the disease require the newer, better-tolerated, second-line drugs after their first four to five years on combination antiretroviral therapy (AVERT 2009).

Second-line drugs such as Kaletra and Efavirenz are frequently ten times more expensive than older first-line regimens (WHO, UNICEF and UNAIDS 2008: 32-5). This is because the patents on second-line drugs remain in force. Patents enforce the exclusive legal right of a company to produce a drug, and thereby inflate drug prices by prohibiting generic production. The World Trade Organization's Trade Related Aspects of Intellectual Property agreement (TRIP) forces developing countries such as South Africa to move towards greater enforcement of patents. While the agreement allows for the issuing of compulsory licences where there are public health emergencies, many developing countries have been hesitant to take up these flexibilities for fear of actions that would jeopardize their ongoing trade negotiations with wealthier countries, such as being placed on the U.S. Trade Representative's "watch list," which happened to Brazil, Thailand and South Africa. Governments in developing countries have good reason to fear threats from Western multinational pharmaceutical companies that they will withdraw from their markets, as actually happened in Thailand (AVERT 2009). One way around this problem is for developing countries to collectively issue compulsory licenses to prevent individual countries from being punished, and to pool their resources for the sustainable production of generic antiretrovirals.

The need to reduce the price of antiretrovirals through such measures is critical to the realization of women's rights and gender equality in South Africa for two reasons. First, more women than men are living with H.I.V. in South Africa, and in this context a lack of access to affordable second-line antiretrovirals is a critical women's health issue. Second, it is mostly poor women who bear the social impact of lack of access to second-line antiretrovirals, because they perform most of the unpaid labor of caring for those who are ill with AIDS and the orphaned children many adults leave behind after dying from preventable AIDS-related opportunistic infections.

In this regard, it is important to note that just because the home-based care provided by many NGOs is free, through unpaid "volunteers," it is far from free for the women who undertake such work, as they are mostly poor and unemployed. The time such women spend caring for sick community members and relatives is time not spent developing their skills or seeking paid employment. Such "volunteerism" is not entirely voluntary, as home-based careers are usually driven by a woman's desire to keep their community and family members, and themselves, alive. In our 2005 ethnographic study, one woman activist described her experience of working as a "voluntary" home-based care worker as follows:

You wake up in the morning, you are hungry. You go to bathe a very sick person . . . you have nothing in your stomach. You have to feed that person. You have to wash them. And you even have to wash their clothes. But you don't get paid. And the government says it's because you are doing voluntary work, and that's not fair (interview, April 26, 2005; Mbali and Connor 2007).

Dr. Olagoke Akintola has pointed out:

The burden of caring for the sick weighs disproportionately on women not only because they are the main providers of care in homes, but also because many have lost their male partners or have never been married, and therefore have to bear alone the financial costs of caring for self and sick family members (2004: 4).

He has gone on to argue that men rarely assist in caring for the sick, both because they are often involved in formal or informal income-generating activities, and because it is not socially expected for them to do so (Akintola 2004: 4).

The problems experienced by home-based caregivers graphically illustrate how poor women bear most of the impact of insufficient social grant provision and the inflated prices of second-line antiretrovirals. While successful advocacy around these issues may take some time, in the interim, NGOs working on AIDS that are concerned about reducing new H.I.V. infections should avoid entrenching women's economic marginalization by disproportionately relying on their unpaid labor in home-based care programs.

4) Impact of the recession on women's rights work

As we have seen, because of sexism, women in South Africa are disproportionately represented among the ranks of the unemployed and experience various kinds of educational disadvantages. Similarly, in the absence of universal access to H.I.V. treatment, women disproportionately bear the burden of caring for those who are ill with AIDS. The global economic recession has already had an adverse impact on international development aid, including funds to broaden access to H.I.V. treatment and combat violence against women. The recession is also worsening the related economic marginalization of poor women in developing countries.

For instance, the Global AIDS Alliance has argued that President Barack Obama has already faltered in his campaign promise to fully fund the President's Emergency Fund for AIDS Relief (Gharib and Lobe 2009). Instead, AIDS activists have critiqued his new Global Health Initiative (GHI) as having extended the project for a year while only providing $3 billion in its final year, which represents a substantial cut in funding across the period for which it is provided (Gharib and Lobe 2009). The Global Fund to Fight AIDS, TB and Malaria remains severely underfunded, a crisis which is only being exacerbated by the recession (Pilitza 2009).

Universal access to H.I.V. treatment is a critical women's rights issue and a goal that appears to be receding into the distance in the context of the recession. At the time of writing, it is certainly clear that the commitment of the G8 countries to working toward universal access to treatment by 2010 will not be met. The TAC recently experienced delays in the dispersal of foreign donor funding because of the recession, and had to let go a substantial proportion of the treatment literacy staff who educate members of the public about H.I.V. treatment, which is vital to dispel common myths about antiretrovirals and ensure adequate adherence to the drugs (Rank 2008). Similarly, the programs, and the very existence, of more traditional women's-rights organizations, which are underfinanced even in times of economic growth, are being threatened as never before. For instance, Rape Crisis Cape Town already fears that its foreign donor funding will be cut (Womankind 2009: 5).

A fraction of the vast sums that have been used to bail out banks in the United States and United Kingdom would go a long way to ensuring adequate funds to halt new H.I.V. infections and ensure universal access to treatment for those living with the virus globally. As AIDS activists have eloquently argued, while there may have been a slowdown in economic growth in many countries, the same cannot be said in relation to the growing numbers of new H.I.V. and TB infections (TAC 2009). Moreover, the social and economic burden of even short- to medium-term reductions in the funding of programs to combat these diseases will be disproportionately borne by a group that can least afford to shoulder it: poor women in developing countries.

Concluding remarks

In this paper I have explored women's roles in AIDS activism in post-apartheid South Africa. I have discussed how women AIDS activists have addressed sexism, and I have set out a tentative advocacy agenda for gender justice in economic policy for a country facing a serious and entrenched epidemic. I have proceeded from the assumption that promoting a feminist political agenda is a precondition for promoting an economic agenda focused on gender justice in the context of a serious AIDS epidemic. Poor women's economic interests cannot be promoted by organizations that do not allow them to compete for leadership positions, or to challenge established modus operandi when those entrench sexism.

While women AIDS activists have contested the sexism in their organizations, sexism has acted as a barrier to their appointment to leadership positions within AIDS NGOs. I have made a call for the reform of economic policies that adversely impact poor South African women's lives as they have also disproportionately borne the impact of the epidemic.

I have described the historical and political barriers to women's rights work in South Africa such as the racial diversions in the country, how loyalty to an organization or party inhibits women's ability to mount feminist challenges to a political entity's mode of operation, and women's voicelessness in the wider culture. I have also discussed how violence against women inhibits their participation in public, vocal AIDS activism, particularly when women activists reveal that they are living with H.I.V. I have described the ways in which most women's relative poverty makes them vulnerable to social drivers of new infections such as rape and transactional sex with multiple partners. I have also called for a reduction in the cost of second-line regimens through the greater production and importation of generic medicines, because poor women in developing countries disproportionately bear the burden of caring for those who are ill with AIDS and for orphaned children. Finally, I have discussed how the global economic recession is already having an adverse impact on the financing of women's-rights work around AIDS and on programs to expand access to H.I.V. treatment. Feminist AIDS activists must point out that it is poor women who will bear the impact of these cutbacks, and that unpaid caregiving work is far from "free" for those who undertake it.

To some extent, the sexism in AIDS NGOs is a reflection of the persistence of the phenomenon in South Africa's wider political culture, economy and society. It is important not to portray women as helpless victims in the epidemic. South African women AIDS activists have successfully demanded the ability to contest fairly for leadership positions, and have increasingly asserted feminist agendas within the mixed-gender organizations they belong to, as the example of the TAC shows. In this context, the present moment in South Africa is one of great potential risk and reward for the advancement of women's rights in the midst of a serious gendered AIDS epidemic. While the new administration of Jacob Zuma has made proposals that may prove promising in terms of addressing economic inequality in the country in ways that could advance the rights of poor women, the recession and the persistence of sexism in South African political culture are potential threats to the advancement of a feminist agenda by the new administration. In the post-apartheid period, women AIDS activists have addressed the economic, political and social aspects of their oppression as they relate to the epidemic in changing ways. It remains to be seen how and whether they will successfully navigate a path to promote a feminist agenda within AIDS activist organizations through the waves of change caused by the global recession and the country's new political leadership.

Bibliography

African National Congress. 2009 Election Manifesto: Working Together We Can Do More. 2009. Available at www.anc.org.za.

Akintola, O. "A gendered analysis of the burden of care on family and volunteer care givers in Uganda and South Africa." Durban: Health Economics and AIDS Research Division, 2004.

AVERT. "AIDS, drug prices and generic drugs." 2009. Available at www.avert.org/generic.htm.

Benjamin, S. "The feminization of poverty in post-apartheid South Africa: A story told by the women of Bayview, Chatsworth." Journal of Developing Societies 23 (2007): 175-206.

Bozzoli, B. "Marxism, feminism and South African studies." Journal of Southern African Studies 9. 2 (1983): 139-171.

Britton, H. and J. Fish. "Engendering civil society in democratic South Africa." In H. Britton, J. Fish and S. Meintjies, eds. Women's Activism in South Africa: Working Across Divides. Scottsville: University of KwaZulu-Natal Press, 2009.

Budlender, D. Expectations Versus Realities in Gender-Responsive Budget Initiatives. Geneva: UNRISD. Available at www.gender-budgets.org/content/view/144/153/.

Davis, A. Women, Race & Class. London: The Women's Press, 1981.

Dunkle, K.L., et al. "Gender-based violence, relationship power, and risk of H.I.V. infection in women attending antenatal clinics in South Africa." Lancet 363 (2004): 1415-1421.

Epstein, H. The Invisible Cure: Africa, the West and the Fight Against AIDS. New York: Farrar, Straus and Giroux, 2007.

Ferber, M.A., and J.A. Nelson. "Introduction: The social construction of economics and the social construction of gender." In M.A. Ferber and J.A. Nelson. Beyond Economic Man: Feminist Theory and Economics. Chicago and London: University of Chicago Press, 1993:1-22.

Gharib, A., and J. Lobe. "Obama's global health plan disappoints activists." IPS News, 5 May 2009. Available at ipsnews.net/news.asp?idnews=46734.

Govender, P. Love and Courage: A Story of Insubordination. Sunnyside: Jacana Press, 2007.

Hassim, S. Women's Organizations and Democracy in South Africa: Contesting Authority. Scottsville: University of KwaZulu-Natal Press, 2006.

Hunter, M. "The materiality of everyday sex: Thinking beyond prostitution." African Studies 61. 1 (2002): 99-120.

Lowe Morna, C. "South Africa: Jobs for the girls or gender equality for SA?" 15 May 2009. Available at www.pambazuka.org/en/category/wgender/56307.

Mbali, M., and C. Connor. "South African AIDS activism: A feminist view." In C. Clark, A. Holmes, L. VeneKlasen and E. Win, eds. Women Navigate Power: Stories About Claiming Our Rights. Johannesburg: Action Aid International, 2007: 49-74.

Mohanty, C.T. Feminism Without Borders: Decolonizing Theory, Practicing Solidarity. Durham and London: Duke University Press, 2003.

Mthembu, P. Testimonials Project on H.I.V./AIDS-Related Stigma and Discrimination: Young Women Living with H.I.V./AIDS Have Rights Too. 2001. Available at www.abanet.org/AIDS/testimonials/mthembu.html.

Nattrass, N. "The state of the economy: A crisis of employment." In J. Daniel, A. Habib and R. Southall, eds. State of the Nation: South Africa 2003-2004. Cape Town: HSRC Press, 2003: 141-57.

Parker, W., et al. Concurrent Sexual Partnerships Amongst Young Adults in South Africa: Challenges for H.I.V. Prevention Communication. Johannesburg: CADRE, 2007.

Piliso, S. "Government to ease job seekers' plight." The Times 19 April 2009. Available at www.thetimes.co.za/PrintEdition/News/Article.aspx?id=983383.

Pilitza, K. "Global financial crisis leads to H.I.V. budget cut." IPS News 18 May 2009. Available at www.ipsnews.net/africa/nota.asp?idnews=46882.

Pronyk, P.M., et al. "Effect of a structural intervention for the prevention of intimate partner violence and H.I.V. in rural South Africa: Results of a cluster randomized trial." The Lancet 368 (2006): 1973-1983.

Rank, F. "TAC financial crisis means big job losses." The Times 30 Nov 2008. Available at www.aegis.com/news/suntimes/2008/ST081107.html.

Shisana, O., et al. South African National H.I.V. Prevalence, H.I.V. Incidence, Behaviour and Communication Survey. Cape Town: HSRC Press, 2005.

South Africa Department of Education. International Conference on Education, 25-28 November 2008: South Africa: National Report on the Development of Education. Pretoria: Department of Education, 2008. Available at www.education.gov.za.

South Africa Department of Health. Report: The National HIV and Syphilis Prevalence Survey, South Africa, 2007. Pretoria: HSRC Press (2007). Available at www.doh.gov.za/docs/reports-f.html.

Spivak, G. "Can the subaltern speak?" In C. Nelson and L. Grossberg, eds. Marxism and the Interpretation of Culture. Basingstoke: Macmillan Education, 1988, pp. 66-111.

Stephen, J. "Saints and Sinners: The Treatment Action Campaign." In K. Cullinan and A. Thom, eds. The Virus, Vitamins & Vegetables: The South African H..IV./AIDS Mystery. Sunnyside: Jacana, 2009: 157-174.

Statistics South Africa (StatsSA). Census 2001: Census in Brief. Pretoria: Statistics South Africa, 2003.

Statistics South Africa (StatsSA). "Labour Force Survey Historical Revision, September Series 2000-2007." Pretoria: StatsSA, 2009. Available at www.statssa.gov.za.

Susser, I. AIDS, Sex and Culture: Global Politics and Survival in Southern Africa. Malden, MA, Oxford and Chicester: Wiley Blackwell, 2009.

Treatment Action Campaign. H.I.V. Is Not in Recession! TB Is Not in Recession! Press release, June 5, 2009. Available at http://www.tac.org.za/community/node/2545?.

UNAIDS. 2008 Report on the Global AIDS Epidemic. Geneva: UNAIDS, 2009. Available at www.unaids.org.

Walker, C. Women and Resistance in South Africa. New York: Monthly Review Press, 1991.

Walsh, D. "Citizenship, gender and civil society in South Africa." In H. Britton, J. Fish and S. Meintjes, eds. Women's Activism in South Africa: Working Across Divides. Scottsville: University of KwaZulu-Natal Press, 2009.

WHO, UNICEF and UNAIDS. Towards Universal Access: Scaling Up Priority H.I.V./AIDS Interventions in the Health Sector. Progress Report 2008. Geneva: WHO, 2008.

Womankind. "Who pays the price? The impact of the global economic recession on women in developing countries." 2009. Available at www.awid.org/eng/Issues-and-Analysis/Library/Who-pays-the-price.

Interviews with key informants

Interview, April 27, 2005.

Interview, April 26, 2005.

Endnotes

1. Inquest No. KwaMashu CAS 375: 12: 98, p. 18. The AIDS Law Project kindly sent the author a copy of this inquest in 2004. [Return to text]