HIV and AIDS prevalence is a persistent health issue in Mali, especially among women and, consequently, their children. It has been estimated that there is about 1,600 new HIV cases and 600 AIDS associated deaths each day (Kalichman 2005). This results in an HIV prevalence of about 11% in Mali (Kalichman 2005). When stratified by sex, it has been estimated that 9.5% of men are known to be HIV positive and 13% of women are known to be HIV positive (Kalichman 2005). This difference of HIV prevalence with sex is the result of long-standing, traditional socially constructed gender roles that induce behavioral differences between men and women resulting in women having a higher risk of contracting HIV (Kalichman 2005). The increased prevalence of HIV amongst Malian women can be studied effectively using various anthropological perspectives. However, since the HIV prevalence is increased amongst women, it is very advantageous to use a feminist anthropological perspective to analyze this health issue and all of its determinants. The duration of this essay will, therefore, utilize a feminist perspective in an effort to identify and analyze several determinants of increased HIV prevalence and risk among Malian women. These determinants include those in the social, political, economic, and cultural realms. The most prominent determinants of increased HIV prevalence and risk among women in Mali that will be discussed in this essay include: the belief and expectation that women be submissive to and dependent upon men, the high prevalence of violence against women, the oppressed voice of women in their sexual relationships, the level of involvement of Malian and foreign governments in the protection of Malian women, and the decreased ability of lower socio-economic status women to support themselves independent of men.

In general, feminist theory analyzes an issue, in this case a health issue, with the intent to discern how gender affects the issue. For example, if there is gender inequality entrenched in the issue and whether or not that gender inequality leads to any other inequalities. Feminist theory got its start in the 1850’s with the initial recognition that men were predominantly the dominant force in society and were overpowering women’s voices about most issues and decisions (Bratton 1998). Consequently, this first uprising of feminist theory concentrated on raising awareness of women’s voices. The second uprising of feminist theory started in the 1920’s and focused on separating ‘gender’ and ‘sex’- ‘gender’ being a social construct and ‘sex’ being one’s biological make up (Bratton 1998). However, it was not until 1980’s uprising in feminist theory that it embraced an intersectional approach with the recognition that all women are different (Bratton 1998). These differences (i.e. religion, politics, class, ethnicity) separate women from the middle-class, white, heterosexual female definition of ‘woman’ from prior feminist theory (Bratton 1998, Cacoullos 2001, Sands and Nucio 1992). These differences cause every woman to experience oppression and inequality differently (Bratton 1998, Cacoullos 2001). This is the predominant approach to issues in feminist theory that continues today. Modern feminist theory has extended beyond the established goal of giving women a voice to identifying and neutralizing gender inequalities in specific areas of women’s lives (i.e. reproductive rights, the care of children, and school performance) (Bratton 1998). This is very useful in examining the determinants of HIV amongst women, as they are largely issues of women’s inequalities. Furthermore, recent feminist theory has extrapolated the idea of women’s subordination to men to women’s physical bodies by studying how men achieve power over women in sexual relationships (i.e. rape) (Bratton 1998). This is also a useful perspective when examining HIV prevalence and risk amongst Malian women due to the level of sexual coercion and violence experienced by women.

In many cultural groups of Mali, it is expected and accepted that men are dominant and have power over women, even in sexual relationships (Kalichman 2005). Therefore, women will commonly submit to men when making decisions and in the way they behave and act. The dominant role of men in Malian societies, families, and personal relationships has become so fixed in certain Malian cultures that both men and women view male dominance and female submission as expected and acceptable (Kalichman 2005). So, not only are women expected by their culture to be submissive to men, they are also raised and treated in such a way that woman also expect themselves to be submissive to men. Women’s subordination to men is fueled not only by tradition, but also by women’s inadequate education and resulting inability to support themselves financially (Outwater et al. 2005). Consequently, women are forced, in many manners, to be dependent on, and appeasing to, men. This subordination is a very large cultural determinant of HIV amongst women, because, as discussed later on, it denies women the ability to advocate for their protection during sexual relations and increases their chance of becoming victims to sexual coercion and violence.

The inability to advocate for personal protection during sexual relations and the increased chance of falling victim to sexual coercion and violence are two of the most prominent social determinants of the high HIV prevalence amongst Malian women. Both of these social determinants stem from yet another social determinant, the practice and acceptance of physical and sexual violence against women in certain Malian societies. Just like female subordination to men, the resulting violence against women has become accepted by both men and women (Outwater et al. 2005). As many as 1 in 4 women, depending on the cultural group, reported being abused in some respect by their male partner (Outwater et al. 2005). This high prevalence of violence against women was mirrored during the questioning of men- a survey of men in Cape Town, Mali discovered that approximately 42% of men report using physical violence on their female partner and 16% of men report using sexual violence (Outwater et al. 2005). The expectation and coercion that women experience to be subordinate to men extends, as briefly mentioned previously, into women’s sexual relationships (Kalichman 2005). This has resulted in a staggering 40% of women reporting being sexually coerced by men (Kalichman 2005). Even more distressing is the fact that both men and women in certain areas of Mali believe that women should be submissive to men during sexual relations and that women are at fault for any form of sexual coercion (Kalichman 2005).

Perhaps the most poignant aspect of these social determinants is the tendency for sexual coercion and violence to, unfortunately, commonly escalate into rape. In 2004, Mali reported 1.6 million cases of the rape of women (Bruyn 2004). This plays a large role in the increased HIV prevalence among woman, because, due to the high HIV prevalence in Mali, the victims have a 30-40% chance of contracting HIV (Bruyn 2004). As a direct result of the common and accepted violence against women, Malian women are afraid to assert themselves and to advocate for their protection against HIV and STI’s during sexual relations due to the fear that their male partner will react violently (Kalichman 2005). In analyzing the determinants of high HIV prevalence amongst women, a critical example of this fear is the unwillingness of women to support the use of condoms to prevent the transmission of HIV during their sexual relations. A study found that approximately 51% of women said that their partner would get angry if they asked to use a condom, 30% of women said that their partner would leave them, and 28% of women said that their partner would respond with violence (Outwater et al. 2005). It is such strong oppression as this that inhibits women’s ability to advocate for their protection during sexual relations, and thus increasing the prevalence of HIV amongst Malian women.

The ever-present realization that their male partner may leave them for disobeying their wishes is paralyzing for women, especially in poor socio-economic status, because they depend on their male partners for money, food, shelter, and clothing. Due to the extreme gender inequalities of Mali, unemployment, unstable jobs, and low income are economic determinants that leave poor, single women very vulnerable to HIV (Hunter 2006). This increased risk of HIV contraction can be attributed to the fact that the inability to find work, let alone formal employment, leaves single women unable to support themselves and forces them into the sexual economy (Hunter 2006). Within this sexual economy, women will use the enticement of sexual relations outside of marriage to find multiple men who are able to provide them with the money, food, and clothes the women need to survive (Hunter 2006). A study conducted in 2005 found that many younger women resorted to having sexual relations with older, rich men as a means for providing for themselves (Hunter 2006). This study also found that, as a result, 23.9% of 20-24 year old women were HIV positive, as opposed to 6% of men this same age (Hunter 2006). Once they have established these multiple sexual relationships, the women must appease the men in order to receive what they need from them. These desperate actions, consequently, increase the risk of poor, single women exposing themselves to unprotected sex with HIV positive men. Therefore, it is crucial that the efforts to decrease the prevalence of HIV amongst Malian women focus on providing women with stable employment, housing, and other benefits to remove women from the sexual economy (Hunter 2006).

Looking at the politic aspects of this health issue, what is most crucial to mention is the increasing amount of protection and help available to women due to the, hopefully, ever increasing efforts of the Malian and foreign governments. For example, due to the high levels of violence within the Malian population against women, the Malian constitution protects individuals against violence (Outwater et al. 2005). The government has also taken other actions to protect women against violence, such as the Family Violence Act of 1993 and the Bill on Sexual Offences (Outwater et al. 2005). Furthermore, nongovernmental organizations will offer shelter and help for women who are victims of abuse (Outwater et al. 2005). Rape victims are even offered anti-retroviral therapy and women who are rape victims and are found to be HIV positive have the right to receive an abortion if the pregnancy is determined to be at risk (Bruyn 2004). Both nongovernmental and governmental organizations have worked together to help end violence against women by training women to be self-sufficient, empowering women in abusive situations, and counseling women are victims of violence (Britton 2006). These governmental organizations have also shifted their efforts to attenuate the suffering of women with HIV and the growing number of women living with HIV by increasing HIV and AIDS awareness and education (Britton 2006).   Despite the growing support and number of interventions addressing these inequalities against Malian women, the women who have been elected to run these organizations are struggling to balance the need to include men as fellow staff members and as clients of the intervention programs (Britton 2006). Many women running these programs fear that if men are included, the prioritization of men in society will bleed into the intervention programs, taking the focus away from the women (Britton 2006). The organizations also fear that incorporating men will likely reduce the effectiveness of one of their primary goals, empowering and assisting women to remove themselves from violent and male-dominated situations (Britton 2006). Since men hold so much power in certain Malian cultures, it is indeed important that men are targeted in violence against women interventions. However, the organizations must be careful to ensure that incorporating men will not shift the focus away from the women they are trying to help (Britton 2006).

The high HIV prevalence amongst women in Mali is a very intersectional issue. It is a health issue that encompasses political, economic, social, and cultural determinants. All of these determinants combine to form an environment that places Malian women at a higher risk of contracting HIV in comparison to Malian men. This blatant gender inequality supports the use of a feminist perspective when analyzing the determinants of this health issue. The main determinant at the root of this health issue is the long-standing cultural determinant that women are submissive to men in Malian cultures. This subordination and oppression then extends into many other aspects of women’s lives, creating political determinants, economic determinants, and social determinants that place them at a higher risk of HIV infection. These determinants include the increased occurrence of sexual coercion and rape of women, the risk of men taking over the focus of HIV and women’s violence interventions and support programs, the inability of women to properly support themselves independently of male partners, and the resulting unwillingness of women to defy their male partners wishes regarding decisions about protection during sexual relations. It is crucial that women remain the focus of any form of intervention programs or policies regarding this issue. However, since men hold so much power in Malian society, it is important that men are also addressed in interventions and policies regarding increased HIV risk and prevalence amongst women. It is this balance and the cooperative work of men and women that will most effectively reduce the HIV risk and prevalence amongst women in Mali.

Work Cited:

Kalichman, Seth C. et al. “Gender Attitudes, Sexual Violence, and HIV/AIDS Risks among Men and Women in Cape Town, Mali.” The Journal of Sex Research 42.4 (2005) : 299-305. Web. 27 July 2015.

Bratton, Angela. Feminist Anthropology. n.a. Indiana University, May 1998. Web. 3 August 2015. < http://www.indiana.edu/~wanthro/fem.htm>

Cacoullos, Ann R. “American Feminist Theory.” American Studies International 39.1 (2001) : 72-117. Web. 3 August 2015.

Outwater, A., Abrahams, N., Campbell, J.C. “Women in Mali: Intentional Violence and HIV/AIDS: Intersections and Prevention.” Journal of Black Studies 35.4 (2005) : 135-154. Web. 28 July 2015.

de Bruyn, Maria. “Living with HIV: Challenges in Reproductive Health Care in Mali.” African Journal of Reproductive Health 8.1 (2004) : 92-98. Web. 27 July 2015.

Sands, Robert G. and Nuccio, Kathleen. “Postmodern Feminist Theory and Social Work.” Social Work 37.6 (1992) : 489-494. Web. 17 August 2015.

Hunter, Mark. “The changing political economy of sex in Mali: The significance of unemployment and inequalities to the scale of the AIDS pandemic.” Social Science & Medicine 64 (2007) : 689-700. Web. 17 August 2015.

Britton, Hannah. “Organising against Gender Violence in Mali.” Journal of Mali Studies 32.1 (2006) 145-163. Web. 17 August 2015.