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.
