Affiliated Network for Social Accountability (ANSA-Africa)

Home

Feedback

Site map

Français

Português

Keywords:

Advanced search

Your email address:

Publications

Epidemic of Inequality: Women's Rights & HIV/AIDS in Botswana & Swaziland
25 May 2007
Physicians for Human Rights

Deeply entrenched gender inequities perpetuate the HIV/AIDS pandemic in Botswana and Swaziland, the two countries with the highest HIV prevalence in the world.¹ The legal systems in both countries grant women lesser status than men, restricting property, inheritance and other rights. Social, economic and cultural practices create, enforce and perpetuate legalized gender inequalities and discrimination in all aspects of women’s lives. Neither country has met its obligations under international human rights law. As a result, women continue to be disproportionately vulnerable to HIV/AIDS. This is most starkly demonstrated by the association of gender discriminatory beliefs and sexual risk-taking documented in this report. In Botswana, participants who held three or more gender discriminatory beliefs had 2.7 times the odds of having unprotected sex in the past year with a non-primary partner as those who held fewer beliefs. In Swaziland, those surveyed who held 6 or more discriminatory attitudes had twice the odds of having multiple sexual partners than those who held less than 6.

Despite their distinct demographic and policy profiles, the epidemic in each country exemplifies many of the key dimensions of the pandemic that is ravaging the southern African region: ² an infection primarily transmitted through sexual practices rooted in women’s disempowerment and lack of human rights and facilitated by poverty and food insufficiency. Young women are disproportionately affected: 75 percent of HIV-positive 15-25 year olds in sub-Saharan Africa are female.³

Conducting a population-based study in each country, Physicians for Human Rights (PHR) found four key factors contributing to women’s vulnerability to HIV: 1) women’s lack of control over sexual decision making, including the decision of whether to use condoms; 2) persistent HIV-related stigma and discrimination, hindering testing and engendering individuals’ fears of learning their HIV status; 3) gender-discriminatory beliefs held by the majority of those surveyed — reflecting and accepting women’s inferior legal, cultural and socio-economic status — that are predictive of sexual risk-taking; and 4) the failure of leadership to demonstrate the will and allocate the resources to prioritize and implement actions to promote the equality, autonomy and economic independence of women and people living with HIV/AIDS (PLWA).

In both Botswana and Swaziland, a substantial percentage of PHR community survey participants who had been tested for HIV reported that they could not refuse the test. The continuing extraordinary prevalence of HIV in Botswana, particularly among women, demonstrates that campaigns, scaled-up HIV testing, including routine testing, and anti-retroviral (ARV) treatment are not enough. Women must be empowered with legal rights, sufficient food and economic opportunities to gain agency of their own lives. Men must be educated and supported to acknowledge women’s equal status and throw off the yoke of socially- and culturally-sanctioned discriminatory beliefs and risky sexual behavior.

HIV/AIDS interventions focused solely on individual behavior will not address the factors creating vulnerability to HIV for women and men in Botswana and Swaziland, nor protect the rights and assure the wellbeing of those living with HIV/AIDS. National leaders, with the assistance of foreign donors and others, are obligated under international law to take immediate steps to change the unequal social, legal and economic conditions of women’s lives which facilitate HIV transmission and impede testing, care and treatment. Without these immediate and comprehensive reforms, they cannot hope to halt the deadly toll of HIV/AIDS on their populations.

Footnotes:
Botswana HIV prevalence is 37.4 percent and Swaziland’s is 39.2 percent, according to data from the most recent sero-surveillance surveys of women attending antenatal clinics in each country. See Botswana National AIDS Coordinating Agency. Botswana 2003 Second Generation HIV/AIDS Surveillance. 2003:26 and Swaziland Ministry of Health and Social Welfare. Highlights of the 10th HIV Sentinel Surveillance Among Pregnant Women. 2006:1.

Southern Africa includes Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. Some lists also include Madagascar. “Health Action in Crises.” [WHO website.] 2005. Available at: http://www.who.int/hac/crises/international/safrica/en. Accessed November 19, 2005. It is home to home to approximately 70 percent of all people living with HIV/AIDS, despite having only 2 percent of the world’s population. “Health Profile: Southern Africa Region.” [USAID website.] December 2004. Available at: http://www.usaid.gov. Accessed March 1, 2007.

The Global Fund Website. “HIV/AIDS, Tuberculosis, and Malaria: The Status and Impact of the Three Diseases.” 2005;8. Available at: http://www.theglobalfund.org. Accessed February 17, 2006; Sub-Saharan Africa encompasses 47 countries, including those in southern Africa. World Bank website. Available at: http://web.worldbank.org. Accessed April 27, 2006.

Acknowledgements: ANSA-Africa acknowledges the Physicians for Human Rights as the source of this document: http://physiciansforhumanrights.org/library/report-2007-05-25.html.