You are viewing : Vol. 5, Issue 3 Oct - Dec, 2008

Gender, bargaining power and HIV

Robert Lutaaya

The other day, as I sat down in the comfort of my chair to relax from a hard day’s work and a long bumpy ride, my mind wandered off to a topic that even I was surprised to be contemplating. It was this man/woman power relation. The empowered female prefers to call it gender relations! Now there’s one term I didn’t know existed till the mid 90s following the onset of the famous women emancipation movement. But that aside, this gender relations’ issue has pre-occupied my mind particularly because of a disturbing revelation by a friend. In one of our man to man talks, Andy, as I like to call him, hinted that one of the reasons HIV has taken root in our society is because of the gender question.

Some of you might be wondering what I’m talking about. Gender simply put refers to the socio cultural constructs that define how a male and female should behave. Most people confuse gender for sex. But these are two different things. We have for instance heard some of our parents say; a man should never be seen in the kitchen, the kitchen is a woman’s place or that girls never climb trees. All these are examples of socially constructed roles that are put in place by society to differentiate males from females. So when Andy began breaking these down for me and how some of these constructs are contributing to the ever-increasing HIV incidence rates, it got me seriously thinking. Culturally, men are considered superior. Most of the women in our society have been brought up to believe that a good woman should never deny her “man” or husband sex and because of such a belief, many have become infected with HIV. These women do not feel confident to demand that their spouse/partner remains faithful to them, let alone use condoms for protection. They do not feel empowered to suggest HIV testing with their spouse/partner. In many cases, some who are daring enough to make such demands, end up either being beaten, humiliated in public (especially among the man’s friends or relatives), or worse still being forced into sex!

The concept of marital rape does not even exist legally in Uganda. This puts many women in doubt of their capacity to rightly demand protection from HIV infection and stand by these demands. They therefore end up submitting to their spouse/partner’s sexual demands even when they are certain that their health and life is in danger. Some men use the defense tactic of branding the woman the unfaithful one instead and thus throw them out of the home. In such a scenario an economically dependent woman cannot take the risk of seeking an HIV test, let alone revealing her HIV status to her spouse because she needs him to continue supporting her and her children financially. If her husband wants more children, she will go ahead and have them, despite knowing that her child will be at risk of HIV infection.

The matter is even worse where young girls relate with mature men. The girls are physiologically more susceptible to HIV infection and yet they have little or no bargaining power on protection.You may advise such a woman to seek Prevention of Mother to Child Transmission (PMTCT) services. This may not be possible because one, you need to test before you can access these services, and yet this woman is too scared of the repercussions to do so. Even if she did, she may not seek out Antiretroviral therapy when necessary because of the complications of keeping the drugs at home. This is a classic example of ‘between a rock and a hard place’. Inability to afford alternative feeding options makes mother-to-child HIV transmission a real possibility.As social workers in this field, what are we doing about this trend of events? A lot has been said about increasing access to HIV information. But I must say that for over two decades now since HIV was first isolated, no other country has done this better than Uganda. So why do we still see new infections occurring? The secret lies in not only disseminating HIV information but in promoting HIV combination prevention!

For a long time, HIV prevention and behavioral change messages were targeted at young people (15-19 years). We realized a decline in HIV incidence rates among this age group. Can the same work for the 34+, especially considering that this is where HIV is prevalent now? Promoting HIV combination prevention is not necessarily a new approach but an effort to massively promote the use of various prevention strategies concurrently. For instance, if a couple presented with HIV discordance, as social workers our role would be to promote disclosure, condom use and Anti Retroviral Therapy (ART) all at the same time.

I am sure some men out there are wondering why I’m making all this noise about women’s vulnerability to HIV as though the men (worst of all considering that I, the writer, am male) are not vulnerable. But let’s face facts; HIV is now globally referred to as an epidemic with a female face! To effectively address the current disparity in HIV infections, the issue of power inequalities between men and women has to be adequately addressed by HIV prevention stakeholders through mainstreaming gender into HIV programs. This can be achieved through sensitizing communities on the importance of open communication in relationships, and the impact of some cultural norms on the spread of HIV.