South Africa: Rural women the losers in HIV response
Amnesty International today revealed the extent of the impact of HIV and AIDS on poor rural women in South Africa with a major new report about the overwhelming challenges facing rural women in the midst of the severe HIV epidemic affecting the country.
The report, based on interviews with rural women living with HIV, describes oppression faced by rural South African women in their relationships with male partners and within the wider community because of their gender, HIV status and economic marginalization.
“Rural women in South Africa are disproportionately affected by poverty and unemployment,” said Mary Rayner, Amnesty International’s South Africa researcher.
“They continue to experience discriminatory attitudes and practices -- particularly from male partners – and live in an environment rife with high levels of sexual and other gender-based violence.”
Despite gradual improvements in the government’s response to the HIV epidemic and the adoption of a widely-welcomed five-year plan, five and a half million South Africans are HIV-infected – one of the highest numbers in any country in the world. Fifty-five percent of them are women. South African women under 25 are three to four times more likely to be HIV-infected than men in the same age group.
Many women interviewed by Amnesty International said that they were often unable to protect themselves against HIV infection because they felt at risk of violence when they suggested condom use.
One woman told Amnesty International that her husband, a truck driver, spent much of his time on the road. On his days off, he would visit her but refused to use condoms when she asked him. After he abandoned the family, she became sick and discovered at the local clinic that she was infected with HIV. She has no knowledge of her husband’s health since he left the family.
Several other women interviewed by Amnesty International described being beaten and forced to have sex by husbands who actively refused to use condoms.
“Rural South African women's lives are scarred by persistent violence in their families, homes and in under-policed, unsafe communities,” said Michelle Kagari, Deputy Director of AI’s Africa Programme.
"The co-existence of epidemics of both HIV and violence against women has raised the costs of violence for South African women and girls – both physically and psychologically," said Kagari
While there are many good reasons to increase testing for HIV across South Africa, the situation is complicated in a context of gender inequality and violence, poverty and social stigma. Women are currently tested in greater numbers than men currently. When they receive limited psycho-social support, disclosing their status can leave them vulnerable to abandonment, threats of violence and other consequences of stigma and discrimination.
The great majority of rural women interviewed by Amnesty International said that their male partners were reluctant to test for HIV or refused to be tested –- even when there were strong indications the men might be HIV-infected.
Many of the women faced abuse from their partners when they tried to access health services for HIV-related treatment and care.
“When a woman's partner is in denial about his own HIV status, he may resent her going to the clinic or taking medication,” said Rayner.
"In the context of pervasive gender inequalities, stigma and violence facing women, particular attention must be paid by those providing HIV testing to anticipate and address possible adverse consequences for women once they disclose their HIV positive status and start treatment.”
Effective treatment for HIV and AIDS requires regular visits to hospitals and clinics for treatment and care. Women also need adequate daily food with which to take their medication. Rural women living with HIV in circumstances of poverty and unemployment face constant challenges in having regular access to food and often cannot afford transportation to health facilities accredited to provide treatment.
"Lack of physical access to treatment centres is tantamount to a denial of access to health care services, and the government must take more responsibility in ensuring this access," said Michelle Kagari.
Also hampering treatment in rural areas is the fact that South Africa's health system is currently facing severe shortages of essential medical and other staff necessary for providing a comprehensive service - particularly in these areas.
Amnesty International’s report offers specific recommendations to national and provincial authorities on how to tackle the challenges facing rural women living with HIV. It also makes recommendations to donor countries and institutions that support health initiatives in South Africa.
"It is only with considerable difficulty and great determination that rural women manage to continue their treatment and try to improve their health -- and the government has a responsibility to help them in this struggle.”
To see a full copy of the report “I am at the lowest end of all” – Rural women living with HIV face human rights abuses in South Africa, please click here.