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PRIMA Volume 2, Issue 1

Women, Poverty, AIDS and The Non-Profit Sector

By Muna Musiitwa

“Macroeconomic conditions operating in a context of pervasive gender inequality have different effects upon the lives of women in different regional, class, and family circumstances. Different circumstances also produce different negotiating strengths among women as well as different HIV risks.” 

                                Brooke Scheopf, “Gender, Development and AIDS”[1]

The AIDS (Acquired Immune Deficiency Syndrome) pandemic in Africa is horrific.  At the end of 1999 sub-Saharan Africa had over 24.5 million people infected with HIV with the rate of infection for women slightly higher than that of men.[2]  Several countries especially in Southern Africa have close to a quarter of their population infected.  Women have been the most vulnerable in the contraction of HIV (Human Immune-Deficiency Virus) for several reasons.  According to Farmer, “women with HIV are more likely than their male counterparts to be living in poverty”[3] and poverty is the umbrella cause of other social circumstances that most put women at risk for HIV infection.  Gender inequity and cultural sex taboos discourage women from asking their partners to wear a condom; the dire poverty that leaves prostitution as one of the few income generating careers; the failing public health care systems; structural violence the contributes to the historical likelihood of women being forced to live in poor conditions; forced early marriage, etc, are a few of many factors that increase the likelihood that African women will contract HIV.  It has been found that “those people who – before HIV/AIDS arrived – were already marginalized, stigmatized, and discriminated against – become, over time, those at highest risk for HIV infection.”[4]  Many governments are trying to combat AIDS in Africa, but without the tireless efforts and pressure of local non-governmental organizations (NGOs), the fight against AIDS would have been further behind than it is.  Because of the large amount of work being done in various fields of socioeconomic justice, the organizations to be discussed are NGOs, mostly community-based organizations (CBOs), more specifically AIDS Service Organizations (ASOs). 

As time goes on, there is hope that all their efforts will eventually rid Africa of most of its problems. This paper will analyze the relationship the participation and the advancement of sub-Saharan African women have with NGOS in their fight against AIDS.  By fully involving women in this effort, the impact they can have on the lives of other women is tremendous.  This will also allow women to start formulating a base upon which they can fight for the rights, especially economic and sexual, that they see as crucial to have in the twenty-first century.  A problem that is occurring in most of the non-profit sector is the lack of a concrete way of evaluating completed work, and AIDS complicates the evaluation process even more.   Governments such as those in Uganda and Senegal have been successful in curbing HIV infection rates, but there is little to no guarantee from other countries that their governments will acknowledge the problem, or have the determination, money and manpower to act accordingly; therefore placing NGOs in the forefront of women’s economic and sexual rights campaign and the prevention of HIV.

The role of women in African society has changed over the years from the role of home keeper to second “breadwinner” for the home.  Though female employment is still highly restricted to the informal sector, women are continuing to revolutionize their roles.  According to Snyder,

During the years when the social and economic crisis deepened and the conditions of women deteriorated accordingly, African women were catalyzed into action to ensure the survival of their households and communities.  Their response explains why, despite a very hostile environment, and despite their fewer opportunities as compared to men, women today are still on the move.[5]

It is an advancement that women are still further striving to be fully incorporated into the better employment opportunities instead of giving up.  However, by “being outside the structures of power and decision-making, they [women] may be denied the opportunity to participate equally within the community and may be subject to punitive laws, norms and practices exercising control over their bodies and sexual relations.”[6]  This is important to consider in relation to AIDS because with increased economic empowerment, women will be able to eliminate some of the circumstances that increase their infection susceptibility.   Since the economic prosperity of the majority of Africa has decreased since the high time a decade after independence, women too have lost numerous potential opportunities and have fallen behind where they could have potentially been.  Though their role in the workplace has undergone some changes, the rest of African society expects them to continue abiding to cultural mores that are quickly changing with time.  Many of these prevent her from fully being incorporated into the formal employment sector. 

The role African women play in society is quickly changing because AIDS is beginning to challenge traditional attitudes, and men, especially those who are infected themselves or who have worked with AIDS organizations are knowledgeable and increasingly willing to take on the physical care of sick family members.[7]  Still, as the culture demands, the woman also cares for other sick people even though she too might be sick.  As in most of the world, the non-profit sector, not excluding the health care sector in particular, is a large employer of women: 

There are many reasons for women’s numerically prominent representation in the health work force.  A partial explanation is that health care jobs are perceived to be overwhelmingly “women’s” jobs…to encompass the following:  a) traditional housewife tasks; b) few or no strenuous activities and hazards; c) patience, waiting, routine activities; d) rapid use of hands and fingers; e) distinctive welfare or cultural orientation; f) contact with young children; g) sex appeal.[8]

This does not seem to have any directly visible negative effects on the sector.  It is an area that women can easily enter without much threat of gender discrimination as well as be able to learn from what they see and act on a personal level to disseminate HIV information.  Hopefully, this can be further exploited in other ways that help women’s plight toward increased sexual rights.  The notion that there are few strenuous activities and hazards, however, is debatable, especially in some African countries where the use of surgical equipment sometimes occurs without disinfections. 

In light of their role as home careers and child bearers, African women have been able to use what is often seen in the modern world as a disadvantage and made good use of it.  When AIDS was first publicized as “the world’s next plague” and international NGOs came to Africa’s aid, they were not sure what strategies could be used to effectively reach as many people as possible to prevent the further spread of the disease.  Instead of acting at the policy level, NGOs went to the grassroots level to first find out how this disease was spreading at its rapid rate.  They researched the factors of African life that increased susceptibility, such as poverty, cultural traditions that incite female sexual degradation (the lack of choice through early marriage, transfer to deceased spouse’s brother), failing public health systems due to mismanagement and the lack of money, etc.  CBOs then asked women how they could be of help in this situation.  Because of the general African taboo not to discuss sexual issues, many women initially dismissed the thought of joining an effort against a disease they did not even know how to address.  The fact that even hospital coroner’ still refrained from citing HIV as a possible cause of death caused still more women to dismiss the reality of AIDS.  The pretense that exists in African society that sex does not occur as much as it does is merely to keep up a façade of perfection; now that so many people are dying, it can no longer be hidden.   With the growing realization that AIDS is fatal, women started in small ways to help the effort.  In relation to the fight for women’s economic and sexual rights, many women were excited to join a movement they saw as being able to change their lives.  This allowed efforts from both movements to combine.

Due to the fact that women are more vulnerable to HIV infection than men, there has been an increased interest in providing more resources and services for women.  “Globally, 73 women get HIV per 100 men.  In sub-Saharan Africa, 110 women get HIIV per 100 men,”[9] therefore explaining the increased trend of aiding women.  Also “eighty percent of the world’s women live in Africa.”[10]  During the African summit on HIV/AIDS, tuberculosis and other infectious diseases, Secretary General of the UN, Kofi Annan, in Abuja on April 26, 2001, mentioned that, “At present, in sub-Saharan Africa, adolescent girls are six times more likely to be infected than boys.  That is something which should make all of us African men deeply ashamed and angry.”[11] As the women’s rights movement continues to increase in Africa, AIDS has been put on the agenda as a factor that is continuing to hinder the advancement of women.  In tackling AIDS, feminists are lobbying for more laws that will penalize a male if he commits any acts of violence towards a woman who suggests he wear a condom.  Many NGOs that work with eliminating prostitution work hand in hand with ASOs to form a base on which women can stand and demand at least minimal respect for both of their lives.   The women’s movement has helped cover the reality that this disease affects both sexes.  In light of the United Nations and the public health sector’s realization of the single gender based focus, they adopted “AIDS:  Men make a difference” for the theme of World AIDS day 2000; and for 2001, “Men and AIDS:  I care, Do you?” will be the theme.  The fact that men have been the focus for two years in a row shows the concern that men might be looked over.  It is important to realize that though that might be the case, women’s sexual health is still a neglected aspect of their lives, therefore, taking a few years to focus on changing the existing trend is progress in the right direction.  In order to effectively combat this disease “programmes aimed at reducing the spread of HIV/AIDS and STDs must also specifically target men, both to address problems relevant to men and to address gender relations issues that negatively affect the lives of women, particularly their reproductive and sexual health.”[12]  Issues like culture, religion, age and all come into play and have been taken into consideration, allowing organizations to work to the best of the ability in their location.

The attainment of greater human rights by way of attaining the right to information and the right to act on what is the best for the woman’s body would help alleviate the African woman’s susceptibility to acquiring HIV.  Gender inequality reduces women's control over their lives and increases their vulnerability to HIV infection.  They are often unable to refuse sex without a condom or with a partner whom they know or suspect engages in high-risk behavior.  According to the Botswana Human Development Report, “This systemic gender inequality is a crucial factor in the spread of HIV and AIDS.  Educating women on their rights within relationships should continue with added vigor"[13] in order to aim towards the reduction of infection and greater sexual empowerment.  Reproductive rights have not fully been given to women because in many societies, women’s health is not placed as a priority.  Abortion, the unavailability of medication and health care for pre-natal mothers, inadequate information on sexually transmitted diseases etc are some of the problems faced by African women.  Because women do not have much of a say when it comes to sexual matters,

…. There is a strong gender bias in HIV/AIDS-related stigmatization, discrimination and denial.  This double standard exacts a terrible toll on women as mothers, as daughters, as caregivers and as people living with HIV/AIDS.  HIV/AIDS-related stigma, and the discrimination to which it leads, therefore plays a key role in intensifying gender inequalities.[14]

Women are fighting a battle greater than many can conceive.  No longer can cultural hindrances on the discussion of sex be prohibited because this problem is stretch across more than gender lines.  AIDS is a social issue and women need to be helped to deal with their own social problems before problems related to HIV can be dealt with.[15] Many ASOs are working hard not only to teach STD prevention, but also help develop and overall knowledge and acceptance of the female body as it is.  For the people living with AIDS (PWAs) with whom they work, acceptance of their reality and living the best life they can live is the main focus, as well as realizing that life must continue despite their infection.  These organizations usually work in close contact with governmental ministries of health and international NGOs to provide as solid a foundation as possible to deal with the pandemic and its dire effects on women.

What makes the issue of women and AIDS more sensitive is the number of links it has to children.  Children usually have high possibility of being born with the disease; or lucky enough not to be born with it but unlucky to contract it through breast milk, because mothers do not have adequate resources to buy baby formula; or being left single parented or orphaned.  The result is the decreased likelihood of receiving health care, attaining an education, therefore, further reducing the likelihood of a prosperous and literate Africa in the future.  Many NGOs that work with women’s AIDS issues also work with closely with youth issues.   It is a highly sensitive topic because of its relevance to Africa’s sustainable development and its promise to improve.  Education systems have taken the initiative to incorporate HIV education into the curriculum so as to provide an early start. 

The web that the non-profit sector has developed is best visible in the AIDS arena where an organization dealing with sustainable development is connected to a women’s church group and also connected to an anti-hunger campaign in a school etc.  Different trends appear every so often as what is prescribed to work best circulates around the NGOs world, and because nothing in relation to AIDS has been an adequate precedent, many organizations join the new trend in hope of increasing effectively.  This has led to some widespread successes like in Uganda where condom distribution helped decrease the number of infections.  For the number of issues that NGOs have to deal with in relation to poverty and AIDS, it is helpful to compart mentalize.  The Women’s AIDS Support Network (WASN) in Harare, Zimbabwe, is an example of an ASO that has divided its organization into different parts to effectively deal with as many issues as they see relate to women in the Harare area.  The problem with this strategy is that some issues within the same area might receive more priority, crippling other aspects of the organization’s work.  WASN has put most of its emphasis on HIV prevention education for adolescent females.  Therefore, when the Davidson College chapter of Adopt a Country AIDS Campaign offered to twin with them, it was a pleasant surprise: because the ACAC consists of youth it made the campaign more personal for the Davidson students, as they dealt with issues that affect them too.  

Though there are many NGOs and they do tremendous work, they are usually small in size.  As Walt believes, “Because of their smallness, their ability to respond quickly to community demands, their relative lack of bureaucracy and their grassroots or field experience, NGOs are often willing to support or try out innovative ideas.”[16]  As much as that can be advantageous, it can be detrimental to follow almost all existing trends.  Another main problem affecting local African NGOs is the inadequate amount of funding they have.  In order to help remedy the problem, ASOs in the West decided to form a concept of partnership with organizations in developing countries to help deal with some of their problems.  For example, if an ASO in Port-au-Prince, Haiti does not have anyone specialized in advocacy, that has they are partnered with an ASO in the United States that has several staff members in the policy department.  They can either arrange for the American staff member to come train workers in Haiti, or they have someone from Haiti to come to the US to shadow in an organization dealing with AIDS policy and advocacy.  Because many NGOs are small, their life spans are usually short.  They exist for a few years, but once the monetary source is cut they tend to crumble.  Also, embezzlement of funds and nepotism in hiring practices regardless of skill are problems facing many African NGOs.                                                                                                                 

A question that lurks within the non-profit sector is how to determine true effectiveness of an NGO’s work, especially in the case of a disease caused by so many intangible factors.  There have been no studies on what impact women have had (education, care, advocacy etc) on the AIDS crisis, but the contribution they have made is immense.  ASOs/CBOs deal with everything from care provision to advocacy to HIV prevention education, at the grassroots level.  To a degree, it does not matter if his or her work can have a numerical figure for social return on investment; the situation is so terrible that any contribution anyone can make will be better than nothing.  There is no exact definition of success because most effects will only be visible in future infection.  Different types of AIDS-related areas must be evaluated individually; for example, in the case of family planning programs “progress” is dependent on several factors.  Program design and organization will be influenced by kinship and reproductive decision-making, which varies across regions, racial and communal divisions, and religions.  Davidson Warwick explains that

The implementation depends on four aspects of culture:  a) the understanding, acceptance, and continued practice of family planning by clients; b) the climate in the organizations responsible for field work, which affects the disposition to work and the tasks to be done; c) the ability and willingness to of field implementers to do their work; and d) the communities in which the clients live, including collective attitudes toward family planning and local pressures put on clients to participate.[17] 

In addition to the difficulty of measuring their success, it is not easy to compare NGOs that do different work.  One of weaknesses of NGOs (although it is also a strength) is that most are fiercely independent.  Even when they have similar functions, their work may be motivated by very different ideals; some can easily work with governments, while others are more weary of the perception that they areco-opted by governments.[18]  The positive aspect of NGOs in the fight against AIDS and the progression of women is that they have more advantages than disadvantages.  Once more solid forms of cooperation are established between governmental units and NGOs it will be easier to network and remove as many holes in the system as possible.

Despite the difficulties that NGOs have to face in the fight against AIDS especially in relation to African women, they are doing a good job.  Women are also doing a tremendous task in helping themselves advance economically as well as helping improve their health by taking advantage of opportunities to learn about sexual disease prevention.  The numbers of possibilities for female social advancement have increased over the years and women have capitalized well upon them.  CBOs have done a good job at going to the core of the community and helping galvanize women to continue to fight against AIDS.  Women, not only as a characteristically caring gender but also as concerned citizens, have joined and exercised their power to become an influential part of society.  NGOs face numerous administrative and funding problems, but they are still able to function reasonably well.  As we progress into the twenty-first century women are taking a more important role as wage earners and as community carers regardless of their own health.  Such commitment to other humans rarely receives the credit it deserves especially with the adversity they have to face; but African women, publicly praised or not, receive thanks under the continent’s breath whether they are conscious of it or not.

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Works Cited

Botswana Human Development Report.  Towards and AIDS-Free Generation, 2000.

DeCarlo, Pamela.  (1999).  “HIV Among Women in Developing Countries.” Harvard AIDS Review: Women and AIDS, Spring 1999.              http://www.hsph.harvard.edu/hai/publications/har/spring_1999/spring99-2.html

Europa:  Development- HIV/AIDS Action in developing countries.  “The gender  paradigm shift.”  http://europa.eu.int/comm/development/aids/html/n1060.html,  Issue 6 June 2000. 

Farmer, Paul et al.  Women, Poverty, and AIDS:  Sex, Drugs and Structural Violence.              Common Courage Press: Monroe (Maine), 1996.

Fee, Elizabeth and Nancy Krieger.  Women’s Health, Politics, and Power:  Essays on            Sex/Gender, Medicine, and Public Health.  Baywood Publishing Company, Inc:            Amityville (New York), 1994.

Gordon, April A and Donald L. Gordon.  Understanding Contemporary Africa.  Lynne Rienner Publishers:  Boulder, 1996. 

Health and Development Networks.  “UNGASS News and Events- UN Secretary General in Abuja.”  Break-the-Silence, May 5, 2001.

James, Valentine Udoh.  Women and Sustainable Development in Africa.  Praeger Publishers:  Westport (Connecticut), 1995.

Mann, Jonathan.  “The Future of the Global AIDS Movement.”  Harvard AIDS Review: Women and AIDS, Spring 1999.  http://www.hsph.harvard.edu/hai/publications/har/spring_1999/spring99-2.html.

Synder, Margaret C.  African Women and Development:  A History.  Witwatersrand
           University Press:  Johannesburg, 1995.

UNAIDS Best Practice Collection.  Caring for Carers:  Managing stress in those who care for people with HIV and AIDS.  Geneva:  2000.

UNAIDS Best Practice Collection.  HIV and AIDS related stigmatization, discrimination and denil:  forms, contexts and determinants- Research studies from Uganda and India.  Geneva:  June 2000.

UNAIDS. “New HIV Estimates.  http://www.unaids.org/epidemic_update/report/,  Geneva: June 2000.

Walt, Gill.  Health Policy:  An Introduction to Process and Power.  Witwatersrand            University Press:  Johannesburg, 1994.

Warwick, Donald P.  “Culture and the Management of Family Planning Programs.”              Studies in Family Planning.  Volume 19, Number 1, January/February 1998.

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