Combat AIDS in Africa with sexual equality

July 11, 2002|By Chalya Lar

BARCELONA, Spain - "One more day, please."

It's a plea I hear every time I return to Africa, a plea from mothers dying of AIDS who need time to find someone to care for their children after they die.

And it's a plea that should echo in the ears of each of the 17,000 delegates during this week's International AIDS Conference in Barcelona.

Regrettably, the voices of thousands of African women will be silenced forever as delegates mix discussion on AIDS with sun, Catalan culture and paella in Barcelona.

Over the six days of the conference, more than 49,000 people will die of AIDS, most of them in Africa - most of them women.

Solving the problem of AIDS will require action, starting with substantial increases in aid from governments, businesses and private donors.

With less than $1 billion a year set aside to fight AIDS, the United States is making the largest contribution to combating the disease overseas of any country. But it is failing to exert leadership in what has been conservatively estimated as a $10-billion-a-year war.

Fighting AIDS also will require medical advances and innovative solutions for the care of an estimated 13 million orphans worldwide. And, perhaps the greatest challenge of all, it will require the empowerment of women.

A decade ago, I was on the front lines of this war, practicing medicine and epidemiology at home in Nigeria. My efforts to coordinate AIDS education were met with denial, dismissal, even charges that AIDS education was an American political strategy to discourage sex and stop the overpopulation of Africa. The church did not want me to speak about AIDS prevention; it would encourage premarital sex or infidelity. I was scolded.

The leaders of my community and my country did not take AIDS seriously. Wedding vows or prohibitions against premarital sex were ignored. Bound by culture, women could not ask their boyfriends or husbands about other lovers, let alone their HIV status. While these attitudes created professional challenges, they also forced a profound personal decision. I saw only one alternative to the risk of AIDS: remaining single and celibate.

It was a high price to pay.

But I have met countless women paying an even higher price for their husbands' infidelity.

Africa, home to 70 percent of the world's 40 million AIDS cases, is the only region where women with AIDS outnumber men. In sub-Saharan Africa, 55 percent of people infected with HIV/AIDS are women, compared with 20 percent in North America.

Since men often have many more sexual partners than women, a single infected male can spread the disease to dozens of women, who are physiologically more susceptible to the AIDS virus. Teen-age girls are especially at risk, since their partners are usually more experienced and less monogamous. African women also are less able to dictate the terms of sex, including the use of condoms or other means of protection - a concept foreign to my American friends, who enjoy relative political, economic and sexual equality with men, a "peace benefit" of the sexual revolution and the women's movement.

Women's lack of power is a significant factor in Africa's AIDS crisis. So is poverty.

Husbands leave wives and children at home for work as truck drivers or miners. Away from their families, they find sexual release with prostitutes, who themselves are compelled by poverty to sell their bodies. When husbands return to their wives, they bring more than a paycheck; they bring home this deadly virus.

But African women are not helpless. HIV infection rates in Uganda have dropped from 31 percent in 1990 to 8.3 percent in 1999. And women played a key role. In response to an unprecedented public education campaign, women and girls practiced "zero grazing," or abstinence before marriage and faithfulness after. Girls are holding on to their virginity a full year longer. And among women age 15 and older, the number reporting multiple sexual partners fell from 18.4 percent in 1989 to 2.5 percent in 2000.

AIDS has brought political and economic devastation to Africa that will be felt for this generation and at least the next. Long-term solutions must be rooted in communities and, specifically, women in communities. Stopping the disease will require determined action by leaders and private citizens alike.

Chalya Lar, M.D., is the HIV/AIDS program specialist for World Vision, the international Christian humanitarian organization. She is based in Washington.

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