**What will be the impact of HIV-AIDS on women and children? Should we
expect a more prominent role to be taken by women in African politics
and economics? What will spark this?**

**The views expressed in this and other papers associated with the NIC
2020 project**

**are those of individual participants. They are posted for discussion
purposes**

**only and do not represent the views of the US Government.**

# Background

At the beginning many people thought AIDS was a disease striking mainly
men. A decade ago, women were less affected. But a terrifying pattern
has since emerged. All over the world women face higher risks of being
infected by AIDS as well as increasingly bearing the brunt of its
impact. This is especially true in sub-Saharan Africa, the region
hardest hit by HIV and AIDS. In this region, more than half of all
adults living with HIV and AIDS are women the map below shows the worst
hit countries. Infection rates are much higher than those of men. UNAIDS
estimates that 50% of new HIV/AIDS infections in 2003 were in young
people 15-24 years of age and that young women in this age group were
disproportionally affected.

![](media/image1.wmf)

The paper will expound the factors driving the HIV/AIDS epidemic in
Sub-Sahara Africa; focusing on vulnerabilities of young girls, women and
children and will attempt to discuss the steps that could be taken to
stem the rapid progress of HIV/AIDS infection in girls and women as the
scenarios for year 2020 are formulated.

**Infection rate of young girls**

HIV and AIDS is hitting the world\'s young people hardest. Girls are at
very high risk of infection. More than half of the 14,000 people newly
infected each day are under 25 years old; most of them are girls. In
this region, more than two out of three newly-infected 15-24-year olds
are female. For adolescents between the ages of 15 and 19, five or six
girls are infected for every boy in the worst-affected areas. Even
marriage, particularly for very young women, guarantees no protection
from HIV/AIDS infection.

**Infection rates among married vs single women**

Most sexually transmitted HIV/AIDS infection in females occurs either
inside marriage or in relationships women believe to be monogamous.
Young married women are at higher risk of infection than unmarried women
of the same age. Many women are unable to refuse sex. Across the world
between one fifth and half of the girls and women report that their
first sex encounter was forced. In Uganda and many other sub Saharan
countries men marry and women are married. Social and cultural systems
in many African countries dictate that women have no control over their
sex lives or their husband's sex lives outside marriage. Bridal
payments, or dowry as popularly known, perpetuate the idea that the
woman is her husband's property. Culturally, wives are not allowed to
refuse sex from their husbands or to use a condom even when a man may be
infected with AIDS. Evidence also suggests that a large share of new HIV
infections are due to gender-based violence in homes, schools, the
workplace and other social arenas. Forced or coerced sex renders a woman
even more vulnerable to infection, and the younger she is, the more
likely it is that she will contract HIV.

Women and girls are physiologically more vulnerable to infection, and
gender-based inequities compound their risks. They are more likely to be
poor and powerless, have less education, less access to land, credit or
cash, and to social services. 

**Influence of culture and armed conflict on women and AIDS spread**

It is widely recognized that the influence of negative aspects of
culture and tradition has exacerbated AIDS infection in women. Cultural
and social economic factors have played and still play a massive part in
the spread of HIV/AIDS. These factors include impoverishments and the
decline of social services and rapid urbanization and modernization; to
this gloomy picture add wars and civil conflict in many African states.
Conflicts -- and the attendant violence and poverty -- exacerbate
HIV/AIDS infection in women. Rape is a well-known instrument of war. And
women and children are often exposed to sexual violence in crowded,
unsafe camps for refugees or the displaced.

The situation of women is compounded by the dominance of strong
patriarchal authority where culturally sons rather than daughters are
given preference to inherit land and property. Economic dependence on
men and lower levels of education inhibit women from leading lives
independent of marriage. In summary the powerlessness resulting from
some of these cultural prescriptions has made women highly vulnerable to
HIV/AIDS transmission.

However, there are positive aspects of culture that needs to be upheld
in the era of HIV/AIDS. It is very common for families to raise children
who are not members of the immediate family. For example, it is
traditional in many east and southern African communities for the
deceased father's nearest male relative, such as a brother or a nephew,
to inherit the deceased man's wife and children. Similarly, if a mother
dies, the husband would then marry a close female relative of the
deceased, who would then be obliged to regard any of his children as her
own. Another traditional way in which children have moved between
households is through fostering. It is common for parents in many
sub-Saharan African countries to send their children to be raised away
from home by relatives. It is this extended family that is at the front
line in the orphan crisis.

**Worsening poverty**

As HIV/AIDS strikes the lifeline of society that women represent, a
vicious cycle develops. Most of the world\'s women are poor and most of
the world\'s poor are women. Women make up almost two thirds of the
world\'s illiterate people and are often denied property rights or
access to credit. Women\'s economic vulnerability and dependence on men
increases their vulnerability to HIV by constraining their ability to
negotiate safe sex. More catastrophically than elsewhere, the HIV/AIDS
epidemic has deepened poverty and exacerbated myriad deprivations in
sub-Saharan Africa. As a result of AIDS, poorer women are becoming
economically disempowered and less secure. They are often deprived of
inheritances or even adequate health services. In rural areas AIDS has
caused the collapse of the coping system that has been touted as the
redeeming mechanism for mitigating the impact of AIDS on households,
families and communities. The responsibility of caring for orphaned
children is a major factor in pushing many extended families beyond
their ability to cope. With the number of children that require
protection and support soaring -- and ever-larger numbers of adults
falling sick with HIV/AIDS -- many extended family networks have simply
been overwhelmed. Grinding poverty, along with a lack of education and
productive resources, multiplies the chances that girls and women will
sell sex as their only economic option thus fuelling more infections. In
AIDS-affected communities, survival sex has become common currency --
traded for food, cash, and shelter -- even for education.

**HIV/AIDS affects families long before parents die**

Household incomes plummet when adults fall ill from HIV/AIDS and can no
longer work full-time or at all. In rural Zambia, households where the
head was chronically ill reduced the area of land they cultivated by 53
per cent, compared to households without a chronically ill adult,
resulting in reduced crop production and lower food availability
*(USAID, 1999*). Research findings attest to the fact that on the
average monthly per capita income in households where at least one
person was known to be HIV-positive was less than half the income of
non-affected households.

The costs of treating illnesses caused by HIV/AIDS place a huge economic
burden on families. Studies in urban households show that when a family
member has HIV/AIDS, the household spends four times as much on health
care as unaffected households. This extra expenditure is particularly
onerous because household income was cut by more than half because of
working days lost to illness. Even after death, funeral expenses
contribute to the toll exacted by HIV/AIDS. Evidence has shown that
households with a HIV/AIDS related death in the past year spent an
average of one third of their annual income on funerals.

Households with orphans are more likely to become poorer. This is
primarily because of the increased dependency ratio, meaning that in
these households the income of fewer earning adults is sustaining more
dependents. In the worst-affected countries in sub-Saharan Africa,
households with orphans have higher dependency ratios than those with
children but no orphans.

**Children living with AIDS: which way forward?**

In 2003, some 800,000 infants were infected with HIV (600,000 through
mother-to-child transmission), and some 580,000 children died of AIDS
*(UNICEF/UNAIDS, 2003).* Every day, HIV infects some 6,000 young people,
yet only a fraction of them know they are infected. Today, some 3
million children are living with HIV/AIDS and the population of children
orphaned by AIDS stands at over 13 million and will top 25 million by
the year 2010 (*Children on the Brink 2002)*. The vast majority of these
children and young people live in sub-Saharan Africa, what does the
future bring for these children?

**The growing orphan crisis: an impending calamity?**

Among the most devastating effects of the HIV/AIDS epidemic it is
orphaning generations of children -- and now seems set to create more
orphan generations. Today, over 11 million children under the age of 15
have been robbed of one or both parents by HIV/AIDS; compared to 1990
when fewer than 1 million children under the age of 15 had lost one or
both parents to HIV/AIDS. It is important to understand that the
millions of orphans are perhaps the most vexing inheritance of the
pandemic. There are several African countries now, with more than a
million orphans: it is without historical precedent; no one quite knows
how to handle it.

Seven years from now, the number is expected to have grown to 20 million
*(UNAIDS/UNICEF, 2003).* At that point, anywhere from 15 per cent to
over 25 per cent of the children in a dozen sub-Saharan African
countries will be orphans -- the vast majority of them will have been
orphaned by HIV/AIDS.

Critically worrying is the fact that staggering as the numbers already
are, the orphan crisis is just starting to unfold as can be seen from
the three curves below. As today's young adults die in growing numbers,
they will leave growing numbers of orphaned children. By 2010, HIV/AIDS
will have robbed an estimated 20 million children under the age of 15 of
one or both parents, nearly twice the number orphaned in this age group
in 2001 (*Children on the Brink, 2002).*

![](media/image2.wmf){width="5.376388888888889in"
height="3.7604166666666665in"}

These millions of orphans wander the landscape of Africa. These lonely
under socialised youngsters are bewildered, angry, sad, frantically
seeking nurture and affection, often hungry, homeless, significant
numbers living with grandmothers or in child-headed households,
countless numbers unable to go to school, a school being the single most
valuable and supportive environment they could possibly have ... unable
to go to school because they can't afford the school fees or the
uniforms or the books. And when one loses parents, who then hands down
the knowledge and values from generation to generation? The orphan
crisis is a crisis without parallel, it is an impending calamity. As
scenarios are developed, the orphan crisis is certainly a key driver
that countries have to plan and strategise for.

**Children heading households**

Tragically, the number of orphans in sub-Saharan Africa will continue to
rise in the years ahead, due to the high proportion of adults already
living with HIV/AIDS and the continuing difficulties in expanding access
to life-prolonging antiretroviral treatment. By 2010, children heading
households will be the norm. The toll on children has become tragically
clear: illness, malnutrition and death among young children are on the
rise, school participation is declining, and the numbers of street
children are growing. A large and growing number of children are
experiencing the trauma and distress of losing their parents and are
being forced to fend for themselves. In the absence of adult protection,
love and support, these children have been made even more vulnerable to
illness, exploitation and abuse, and to HIV infection. In the near
future, some of these children will form gangs, will be on drugs. Some
will be exploited as child soldiers.

![](media/image3.wmf){width="5.001388888888889in"
height="3.7569444444444446in"}

**Is the extended family coping?**

The extended family is and will continue to be the central social
welfare mechanism in most parts of sub Saharan Africa. The vast majority
of orphans continue to be taken in by the extended family. In nearly
every country, extended families have assumed responsibility for more
than 90 per cent of orphaned children. But this traditional support
system is under severe pressure -- and in many instances has already
been overwhelmed, increasingly impoverished and rendered unable to
provide adequate care for children. Most worryingly, it is precisely
those countries that will see the largest increase in orphans over the
coming years where the extended family is already most stretched by
caring for orphans. Where one parent has died, the majority of orphans
stay with the surviving parent. There are, however, important
differences between (and within) countries. Here, the extended family
has historically formed an intricate and resilient system of social
security that usually responds quickly to the death of a mother or
father.

**Hope in the face of an epic disaster; mitigating the impact of
HIV/AIDS**

By 2020, full and complete development of any given country and the
welfare of the world require the maximum participation of women on equal
terms with men in all fields. Positive concrete change that will give
power and confidence to women and girls and transform relations between
men and women at all levels of society could be the answer to stem the
tide of AIDS. Change that will strengthen the legal protection of
women's property and inheritance rights and ensure they have access to
preventive options including microbicides. Change in the traditional
role of men as well as the role of women in society and in the family is
needed to achieve full equality of men and women. Men must assume
responsibilities whether ensuring that girls get an education,
abstaining from sexual behaviour that put others to risk, forgoing
relations with girls and young women or understanding that when that it
comes to violence against women, there are no grounds for tolerance, no
tolerable excuses!

**Women taking the lead: Mother Africa**

Twenty years of the HIV/AIDS pandemic has shown that women's issues in
all spheres are marginal in global response to HIV and AIDS yet they
need to be at the centre of the response. Yet, it is evident that women
are the resilient force that sustains the continent. Everywhere the
epidemic is taking a toll; there are heroic women in groups and
cooperatives engaging in prevention, care and support. It is among these
women that the real heroes of this war against AIDS are to be found. In
sub Sahara Africa, women as mothers, as primary care givers and economic
providers will continue to depend on subsistence farming, petty trading
and other forms of informal economy to support families and communities.
It makes sense then that by supporting these women and encouraging
others to follow must be the strategy for the future. Therein hope lies.
There has to be action on those factors which make women vulnerable,
action for economic empowerment of women, action on property and
inheritance laws, action on prevention, and action on care. By 2020 as
countries have to place focus on:

-   **preventing** HIV infection among girls and young women

-   **reducing** violence against women

-   **protecting** the property and inheritance rights of women and
    girls

-   **ensuring** equal access by women and girls to care and treatment

-   **supporting** improved community-based care, with a special focus
    on women and girls

-   **promoting** access to new prevention options for women, including
    microbicides

-   **supporting** on-going efforts towards universal education for
    girls

By 2020, to protect women from HIV infection ways of empowering women
must be found. This means implementing policies and programmes that
increase women\'s access to education and information and to productive
resources, such as land, income, and credit. It also means providing
women with HIV prevention technologies that they themselves can control.
Failure to do that will be threatening the future of households,
communities, and entire nations.

In Conclusion, men and women must work together to counter gender
discrimination and subordination of women. The time is now!! Central to
this is the participation of policy makers and other people in power who
need to recognize the link between women economic empowerment and social
status and their vulnerability to HIV infection. Empowerment of women is
at the centre of the response to build. How will this be achieved?
Stephen Lewis (2004) strongly asserts:

> "*Empowerment \[of women aimed at reducing HIV/AIDS infection\]... it
> is time country by country ...support the struggle for gender
> equality...women should call press conferences, demand audiences, with
> the political and religious authorities, form coalitions, demonstrate,
> boycott, ...the cause of women will have to be advanced. Gender
> inequality and AIDS is a preordained equation to deat*h"