In this class we have had an opportunity to look into some of the inequalities and injustices that woman all around experience in relation to their health. For my final project, I have decided to talk about women in South Africa and the health issue that I want to focus on here is the incidence of HIV in women, especially in younger women. To look deeper into this issue, I will look at the critical medical anthropological theory which looks at what inequalities and political, economic, or social power lead to better or worse outcomes for certain groups of people, in this case women. With this theory, I want to focus on the limited social power that women have and the ineffectiveness of the government to effect change for women in South Africa.
South Africa is seen as a destination spot for many due to the diverse cultures and topography that make up the country. South Africa benefits from a mixed economy that includes tourist attractions, fertile agriculture, and abundant mineral resources. There are actually three different cities that serve as the capital of South Africa and each represents a different branch of the government. Pretoria serves as the executive branch, Cape Town as the legislative branch, and Bloemfontein as the judicial branch. South Africa is aptly named as it is the southernmost part of Africa with a population of more than 55 million people. (https://www.britannica.com/place/South-Africa) Women have a longer life expectancy at birth than men, 67 and 60 respectively, which is a little lower than compared to other parts of the world. In the population, about 14 percent of people are living below the international poverty line, defined in the statistics as earning less than $1.25 a day. Along with have a higher life expectancy rate than men, women also have high adult literacy rates. While this data is not completely available or completely up to date, I believe that the data given has probably not shifted much. (UNICEF, 2013)
The general history of women in South Africa is similar to what history for women has been for women in America where we had very little voice and faced with much inequality. Over the years, women have gained more roles in their government and are continuing to fight for their equality. From my research, women are very mistreated in South Africa, suffering from domestic violence and the burden of HIV among other things like poverty, unemployment, and child abuse. There is still a long way for women to come in South Africa to end gender- based violence and they continue to fight for it every day. Just earlier this month, thousands of women protested gender- based violence in South Africa after statistics in June revealed that the murder rate for women increased 117% and the number of women who experienced sexual offences increased 53% between 2015 and 2017. (UN Women, 2018) With rates of violence against women continuing to increase in the area, it is appearing more and more as if this level of inequality and tolerance of violence against women is just part of the society that is accepted in South Africa. I bring this up because violence against women seems to be a big contributing factor to continuing incidence of HIV in young women, and one could not expect to see lower incidence in HIV if things as serious as violence against women continues to persist.
HIV continues to be a major global public health issue, affecting more than 35 million lives so far across the world. Globally, 1.8 million people became infected with HIV in 2017. The area that is most infected with HIV is Africa, with more than 25 million people currently living with HIV and accounting for over two- thirds of the new cases of HIV. (WHO) While there are many efforts being done worldwide to help prevent new infections of HIV, including more preventative measures and quicker diagnosis of the disease, there is still a long way to go, and caring for women, especially those of childbearing age, can be an essential key. Since only about 75% know their HIV status, women especially in places like South Africa, have more concern with contracting HIV through sexual violence or being with men with multiple partners. It is also important to look at HIV in women who are of childbearing age because they have the added risk of transmitting HIV to their child if they are not receiving treatment or they don’t even know that they are infected with HIV. (WHO, 2018) In one study, it was found that levels of unplanned pregnancy were significantly higher in HIV- positive women than in HIV- negative women, particularly among women not on antiretroviral therapy. (Iyun, 2018) Another study was done showing that in rural South Africa, women who experienced intimate partner violence and had high gender inequity in their relationships had increased incidence of HIV infection and the risk of incident HIV infection was not associated with rape by a non-partner. (Intimate Partner Violence, 2010)
An article I found from The Independent discussing the burden of HIV in women in South Africa. South Africa has the highest epidemic of HIV in the world with 7.1 million people currently living with HIV. According to the article, young women are four times more likely to get infected than men around the same age. This gap may be so large in part because many women are infected unknowingly, which can also lead to them unknowingly passing it on to their children. This article focuses on a woman named Sylvia Mdluli who unknowingly spread HIV to her daughter due to lack of HIV testing in antenatal care visits. Upon finding this out, her husband was upset and blamed her for bringing HIV into the family when in fact he was the one who brought the virus by having another girlfriend who was HIV positive. Now she is working with groups like mothers2mothers which are attempting to educate mothers and children in hopes to help eradicate mother- to- child transmitted HIV. (Gray, 2018) Even women who are married have risk of infection, even though the risk remains higher for women who are victims of domestic abuse and rape.
This goes back to looking at the gender violence that exists for women in South Africa, which could be lessened if there was more involvement from the government in decreasing the amount of violence committed against women. The continued incidence of HIV in South Africa can also be attributed to some aspects of their cultures. Many women in South Africa fall victim to intimate partner violence, which including rape, can spread HIV to unsuspecting women who could end up contracting and further spreading HIV to others. Before Christianity made its way to South Africa, marriage was based on polygyny where men would have multiple wives. Even though this does not seem to be as common, there are probably still people who practice polygyny, which could lead to spreading HIV among a man, his multiple wives, and possibly even his children. Similarly, cohabitation without marriage is a very common domestic living situation where the people living together could bring HIV into the mix if they are engaging in sexual relations with multiple partners. (South Africa) Looking from a public health standpoint, addressing HIV in young girls can not only help to prevent more spread of HIV, but can also help us get closer to reaching several of the 17 sustainable development goals including: reduced inequalities, gender equality, and good health and well- being. Even though these goals have been adopted all over the world, there are still places like South Africa who have not successfully followed through yet. There are currently laws that are put in place that are supposed to protect women and prosecute crimes against them, but these justices are not really being followed through. This is evident as cases of what is considered femicide continue to be a problem with very little consequences to the offenders. The term femicide itself is defined as the killing of females, particularly by males, because of their gender. Based on the fact that there exists a term for this act means that it is happening in this world far too often. The article I read on the matter shares several different accounts of women being shot and even killed by ex- boyfriends and ex-lovers. Some of the reasons for this mistreatment of women that are mentioned in the article are failure of the male to navigate around rejection and a sense of power and entitlement that plays a role in why they won’t let go. In the article there are several statistics discussing violence in South Africa: “while women make up just 10 percent of gun homicide victims in South Africa‚ firearms play a significant role in violence against women – used to kill‚ rape‚ and to threaten and intimidate…83 percent of gunshot victims are killed‚ and of women victims of gun homicide‚ 68 percent are killed with a single shot‚ most often to the head and face”. The most frustrating part to read in the article was when the discussion of the lack of protection that women have against these men. Women who file protection orders still end up harassed and even killed because the perpetrators think nothing will happen to them, which seems pretty accurate according to the article. The article goes on to say that even if the perpetrator does get arrested, they can be out just a week later, free to commit the same crimes. (Masweneng, 2018) It is also important to have concern about young girls contracting and suffering from HIV because they are our future. Currently in the world, 50% of the population is under the age of 30 and there about 1.1 billion girls in the world, with a quarter of them calling Africa their home. What happens to these women plays a major role in the success of the future. (UN Women, 2017) Even though there are many diverse cultures, religions, and traditions in South Africa, stigma still exists for those who are infected with HIV as well as in many other places all over the world. Women who are living with HIV are treated similarly to other groups of people, including sex workers, lesbian women, and transgender women. The stigma that comes along with HIV often leaves women wanting to keep their HIV status hidden or wishing that they had. Some women recall being rejected by the families that they bought shame upon and the looks and whispers that they would experience going to clinics in order to receive treatment. Another problem that seems to exist within the culture is that generally women have the highest levels of acceptance of diversity as well as a higher sense of solidarity and support of other women. While it is great that many of these women support and accept each other, they can only do so much with the limited power in society and the government that they have. (ALN)
The unequal incidence of HIV in young women continues to persist in South Africa due to many different factors, some of which being the lack of support from the government, the unequal amount of women representation in the government, violence against women which continues to persist with lack of government support, the culture these women live in which can potentially put them at greater risks for contracting HIV from partners who may or may not know their status, and the stigma that exists for women who are HIV positive. There are many different factors here that play a role, but in general the biggest solutions seem to lie within the government and changing the culture in which these women live in. Neither of these things is an easy feat, but if women continue to fight for their equality and men begin to accept it more, many major changes can be made for women including improvement in their not only health, but education and employment as well.
Gray, Lucy Anna. “Why Women in South Africa Are Carrying the Burden of HIV – and How They Could Soon Eliminate It among Children.” The Independent, Independent Digital News and Media, 28 May 2018, 19:37, www.independent.co.uk/news/long_reads/hiv-aids-south-africa-women-mother-to-child-rate-infection-a8356926.html.
“HIV/AIDS.” World Health Organization, World Health Organization, July 2018, www.who.int/news-room/fact-sheets/detail/hiv-aids.
“In South Africa, Women Call for #TotalShutdown of Gender-Based Violence.” UN Women, UN Women, 3 Aug. 2018, www.unwomen.org/en/news/stories/2018/8/news-in-south-africa-women-call-for-totalshutdown-of-gender-based-violence.
Iyun, Victoria, et al. “Prevalence and Determinants of Unplanned Pregnancy in HIV-Positive and HIV-Negative Pregnant Women in Cape Town, South Africa: A Cross-Sectional Study.” BMJ Open, British Medical Journal Publishing Group, 1 Apr. 2018, bmjopen.bmj.com/content/8/4/e019979.
“Intimate Partner Violence, Relationship Power Inequity, and Incidence of HIV Infection in Young Women in South Africa: A Cohort Study.” Egyptian Journal of Medical Human Genetics, Elsevier, 16 June 2010, www.sciencedirect.com/science/article/pii/S014067361060548X.
Kehler, Johanna, and Dianne Massawe. We Have Our Rights! Women, Violence, and Diversity. KP Connect Programme, aln.org.za/wp-content/uploads/2018/02/ALNREACTReportElectronic.pdf.
Masweneng, Kgaugelo. “Femicide in South Africa: Why Men Kill Women.” Times LIVE, Sunday Times, 29 May 2018, 06:00, www.timeslive.co.za/news/south-africa/2018-05-29-femicide-in-south-africa-why-men-kill-women/.
“Speech: Two Sides of the Same Coin: Gender Inequality and Violence against Women.” UN Women, UN Women, 2017, www.unwomen.org/en/news/stories/2017/10/speech-ed-phumzile-five-days-of-violence-prevention-conference.
“South Africa.” Countries and Their Cultures, www.everyculture.com/Sa-Th/South-Africa.html.
“Statistics.” UNICEF, UNICEF, 31 Dec. 2013, www.unicef.org/infobycountry/southafrica_statistics.html.