It is a much-repeated and uncontested fact that the burden of HIV and AIDS sits most heavily upon the shoulders of women, especially those in rural areas.

It is almost a mantra of HIV and AIDS activism that sub-Saharan Africa is the epicentre of the scourge, that the spread of the virus is driven by poverty and inequality, and that it can be driven back by investment in comprehensive health systems and provision of anti-retroviral therapy.

South Africa as a case study.

Rights, health and development are interrelated, as health services on their own cannot ensure a healthy population. The fulfilment of socio-economic rights – to employment, education, food, water and shelter – is critical to staying healthy (Singh et al, 2003:5). Social service provision savings from sexual and reproductive health (SRH) interventions can result in economic and social benefits (World Bank 1993; Singh et al, 2003).

The impact of a positive HIV diagnosis may be best understood when viewed within a social constructivist framework. In many instances an HIV diagnosis calls into question a number of issues that are commonly taken for granted, such as whether to engage in sexual relationships, the nature of these relationships, and disclosure issues and decisions about reproductive health and rights issues. This qualitative exploratory research found that young women living with HIV in two South African townships had different family planning needs. While those who did not have a child wanted to have a child of their own, others had experienced more than one unintended pregnancy, due to lack of information and access to affordable family planning services, among other reasons.

In Namibia

Forced and coerced sterilisation is synonymous with a paternalistic desire to control women’s reproductive capacity. It is a practice that has always targeted the most marginalised people in society, including mentally ill or disabled persons, racial minorities, poor women, and people living with specific illnesses. Throughout the early 20th century, countries passed laws authorising the coerced or forced sterilisation of those it deemed unfit to procreate.

A case for reproductive and sexual health rights.

To have sex or not to? To use condoms or not to? To have children or to be sterilised? These and many more are challenges facing women living with HIV and AIDS in Africa.  For a long time, there has been an assumption that People Living With HIV and AIDS have no sexual desires or reproductive health needs. This assumption has been strongly tilted towards women. Yet women living with HIV and AIDS cross many boundaries. Many are young, many are old, many are menopausal, some have disabilities, some are widowed, others are lesbians. But they are all women with one thing in common – they are living with HIV and AIDS.

Can mandatory HIV-testing of newborns improve the success of PMTCT?

Recent studies have shown that uptake of Voluntary Counselling and Testing (VCT) services in public sector antenatal settings in South Africa is low, with only half of all pregnant women consenting to HIV test.1 Out of those who do test, it is estimated that only 30 percent of HIV-positive pregnant women actually receive antiretroviral treatment to prevent HIV transmission during labour. Against this backdrop, arguments are currently being made in favour of radical interventions to reduce vertical transmission. This briefing looks at the proposed policy of mandatory HIV-testing of newborns and presents the case against such an approach, in the interests of women and their babies. 

Recognising the right to choose

One of the striking features of the HIV epidemic in sub-Saharan Africa is that it is increasingly feminised, with women comprising a growing proportion of those infected and affected. While access to HIV treatment has been an area of contestation in South Africa, women’s sexual and reproductive health has been neglected. Historically, the paradigm of Prevention of Mother-to-Child Transmission (PMTCT) led the way as a clear, evidenced-based method of prevention. Many HIV-positive women, after dealing with their initial diagnosis and stabilisation on treatment, express the desire to have a child.

Site of high-jacking within the AIDS discourse.

The female body, in addition to everything else it may be, is very much a socio-cultural ‘construct’, which has been culturally ‘performed’ upon for colonial, religious and other purposes. This article argues that the female body is also being high-jacked within certain popular discourses on AIDS, itself a socially constructed and gendered disease. The article seeks to contextualise, within the escalating HIV and AIDS epidemic, an exploratory two-month study with Anthropology students at the University of KwaZulu-Natal. The study examined, through questionnaires and interviews, how female students viewed the discursive field of virginity and practices of virginity testing.

Gendered discourses of out-of-school youth in a context of HIV and AIDS.

Out-of-school youth exist in a marginal, and often academically ignored, world that is bounded by poverty, gender and HIV and AIDS. This article explores those boundaries and the way out-of-school youth talk about the space between them as well as their sense-making of it. In order to access this hard-to-reach group and attempt to break down the boundaries between trained and untrained, researcher and researched, eight out-of-school youths were trained in basic research skills to carry out interviews with other out-of-school youth in their communities. In total, 32 out-of-school youths in the Lamontville and Shongweni Dam areas in KwaZulu-Natal were interviewed for this research study.

as therapy for older women confronting pain and suffering.

Amid sickness and suffering, women, and in particular older women, often engage in therapeutic oral strategies such as the performance of poetry. There is a specific solo dance poetry, peculiarly known as ukushoza or ukujoqa, within the community of Zwelibomvu. This is similar to what in most areas is referred to as izigiyo. While izigiyo is normally performed by both men and women, in this community, ukushoza or ukujoqa is performed only by women, in order to communicate their perceptions, experiences and feelings about the way of life in their families and communities. Ukushoza is said to be solo dance poetry because it is initiated by an individual who is joined by fellow women during its performance.

The extended family revisited

This focus explores the interplay between the escalation of HIV and AIDS and mounting child care pressures exerted upon women, and increasingly upon children. In the present phase of the AIDS epidemic in South Africa, women are playing a leading role in providing childcare in resource-poor communities, as cultural ideologies are tested and care structures are renegotiated at the local level. The focus highlights how, in a climate where macro structural forces and micro level care demands transect, the care challenges placed upon women have been intensified. At the same time, cultural cosmologies surrounding ideal care are redefined in response to changing economic and socio-cultural conditions.

And implications for women’s sexual and reproductive health rights.

Male circumcision is being vigorously promoted by some as a component of HIV-prevention strategies. While the evidence suggests that circumcision reduces the risk of heterosexually transmitted infection for the circumcised man, it does not appear to have any impact on transmission rates from HIV-positive men to their female partners. Given resistance to the use of condoms, on the basis that they reduce sexual pleasure, and the belief that, on the contrary, circumcision leads to enhanced sexual pleasure, this article explores attitudes to male circumcision from a gender perspective. It looks at the risks associated with it and its relationship with sexual health, including HIV and other sexually transmitted infections (STIs). The subject of circumcision is taboo for women in African communities, where it is practised for cultural reasons, and this perpetuates inequality between men and women.

Proposes ‘roadmap’ for action on gender violence.

All eyes were on Mexico City, as the XVII (seventeenth) International Aids Conference, the second largest of its kind, was held in August 2008. The conference theme, Universal Action Now, emphasised the need for continued urgency in the worldwide response to HIV and AIDS. The Conference highlighted the dramatic, negative impact that stigma and the denial of human rights, including gender inequality, continue to have on the scale-up and effectiveness of HIV prevention and treatment.

(b. 4 February 1974 – d. 27 May 2008)

South African Artist Gabisile Nkosi, whose work has featured in Agenda and graces the cover of this issue, was murdered in May. Witty Nyide pays tribute.

This is a tribute to a humility-filled life that possessed a charismatic ability to transcend the physical. A tribute to the massive role of the loudest visual voice that made audible many a suffocated voice. ‘I learnt that art and life’s experiences were intertwined and when combined with the power of a person’s passion and vision it can transform one’s own and other’s life.’