In December 2002, Kofi Annan, the Secretary General of the United Nations at the time wrote in the New York Times, "AIDS has a woman's face" (2002). Women constitute 57 percent of infections in sub-Saharan African countries that are experiencing HIV epidemics (UNAIDS Report 2004). "Furthermore in sub-Saharan Africa, young women aged 15 to 24 are more than three times as likely to be infected as young men" (UNAIDS Report 2004). In this essay I will argue, with an emphasis on sub-Saharan Africa that the feminised epidemic that is taking place is being exacerbated largely due to Gender Inequality. I will argue this is the case because this is because women are socially, economically, and culturally more vulnerable to infection than men. Prevalent issues such as women's financial dependence on men, both physical and sexual abuse from their partners and the fact that it is customary for males to have multiple partners are key gender aspects that are crucial to the spread of HIV/AIDS in the region. I will start by defining what is meant by Gender Inequality and why it is important in this context and then consider the reasons with an emphasis on notions of masculinity and femininity to explain why the proportion of women being infected is rising. However, although this essay will primarily focus on women, it is important to note the gender aspects relating to the spread of HIV amongst men, in particular the pressure to perform and satisfy multiple sexual partners. Throughout the essay I will relate the issue of gender inequality to the themes of globalisation, poverty and governance and leadership whilst giving reference to the examples of Nigeria, Uganda and South Africa to support my argument. So what exactly is gender inequality and why is it important? When talking about gender inequality in sub-Saharan Africa, the issue is clear. Tallis relates the term best, remarking that we are "analysing the position and status of women in relation to the position of men and the position of other women" (2000: 59). The importance of gender inequality cannot be underestimated as it is evident at all stages of the prevention-care continuum. Gender inequality is perhaps the main problem area impeding HIV/AIDS prevention (Tallis 2000: 60). Furthermore, reports by several non-governmental organizations such as UNESCO, the UNAIDS Inter-Agency Task Team on Education and the Global Campaign for Education "recognise that gender issues are key to the problem of HIV and AIDS" (Oxfam 2008: 11). It is undisputed in the specialist HIV/AIDS field that gender roles and unequal gender relations are fuelling the epidemic by rendering women vulnerable to HIV/AIDS. Gender inequality is most commonly seen in notions of masculinity and femininity across African societies. In South Africa, culture is generally male-dominated, with women traditionally given a lower social status. "Men are socialised to believe that women are inferior and should be under their control; women are socialised to over-respect men and act submissively towards them" (Health24 2009). In addition to their lower status, black African women generally have "less access to safe housing and are often dependent on their male partners as breadwinners for support" (Petros 2006: 72). Sex, for instance continues to this day to be defined "primarily in terms of male desire with women being the relatively passive recipients of these passions"(Seidel 2000).Dr. Seggasne Musisi, head of psychiatric consultation at Mulago Hospital relates effectively the psychology of sexual behaviour in Uganda. "Control of sexual relations is purely with men. Women have no cultural or legal power to either promote or control their sexual health" (Human Rights Watch 2003). In these male-dominated societies, the risk of HIV/AIDS is exacerbated further by risky sexual practise, both by men and by women (which will be discussed later). Traditionally men are accustomed to have multiple partners and practise sex outside of a relationship, yet even suspected infidelity on a woman's part is socially unacceptable and can easily result in violence or social exclusion (Ackerman and de Klerk 2002: 169). Misconceptions of prophylactic use in African societies only worsen the situation. Women are largely afraid to introduce subject of prophylactic protection for fear of domestic violence either for suspecting their husbands of having extramarital affairs or because they might be accused of adultery" (Human Rights Watch 2003). Margaret Namusisi, 25 years old from Uganda explains the response when she asked her husband to wear a condom. "When I tell him to use a condom he refuses. He accuses me of having other men." (Human Rights Watch 2003) There was also the concern from women that if they asked to use condoms during sex, it would lead to violence or financial abandonment (World Health Organization 2003). Namusisi comments on the reaction she faces when she refuses to have sex without protection, "He goes away and doesn't provide. So I have sex with him so that he can look after the children and won't fight" (Human Rights Watch 2003) Globalisation and national economic policies have played a major role in heightening existing gender inequalities, increasing the economic dependence women have on their partners. The World Health organization has repeatedly criticized the impact globalization has had in sub- Saharan Africa, forwarding Nigeria as an example. It argues that, in Nigeria, globalisation has benefited the rich (mostly men) but penalised the poor, less educated, low skilled or unemployed fall within this other group, which relate to women (1990). "What this equates to is that the average Nigerian woman finds it increasingly hard to leave abusive or risk based relationships because of increased economic dependence" (Zierler and Krieger 1998:). Heavy criticism has been levelled also at the Structural Adjustment Program that was incorporated into developing countries. Despite the many benefits that Structural Adjustment Programmes provide to developing countries such as building up economies and changing national legislature in order to create an environment more open to incoming investment from abroad; SAPs have many flaws. PrimarilySAPs the main flaw affects the supply and the demand for health services through health spending cuts and also by reducing household income, which leaves people with less money for necessary treatment. (World Health Organization). Yet many are denied access to appropriate preventive and curative services especially in parts of the world where their needs are greatest. "As the epidemic has progressed, women have taken increasing responsibility for those who are sick or orphaned by AIDS yet they have been allowed little influence over the relevant policy and planning decisions" (Doyal in Tallis 2000:87). It is important to note that this is not solely the case in Nigeria, but in the majority of sub- Saharan Africa where "poverty affects 315 million people and one in two of people in Sub Saharan Africa survive on less than one dollar per day" (Food4Africa 2011) What SAPs and the aforementioned factors produce a society where poverty drives "Women resorting to increasingly risky sexual behaviours as part of multiple livelihood strategies" (Ahonsi 1999) Entering prostitution is not a personal choice in many cases but the "last resort of women who have been structurally disadvantaged in every way and left with no other resource but their bodies" (Schoepf 1998: 65). It is widely recognised that men will pay more to have sex without a condom, which the sex workers find difficult to refuse due to their financial problems. Moreover, with the HIV/AIDS epidemic concentrated in the poorest parts of the world with 90% of HIV positive cases living in the developing world UNAIDS/WHO (1997); it is vital to have constitutional guidelines to safeguard the population from the growing epidemic. The lack of both extensive guidelines and implementation of procedures within national constitutions for extensive responses to HIV/AIDS leads to situation where gender inequality will inevitably worsen For instance the Nigerian Constitution legislates for the protection of human rights but "there is a need to create explicit benchmarks and guidelines to implement and develop effective rights-based response to gender inequality and HIV/AIDS" (Aniekwu 2002: 35). South Africa has brought in laws detailing measures on promoting women's rights in what had been a predominantly patriarchal society among whites as well as blacks, the ANC has legalised abortion, given women equal power in marriage, cracking down on domestic violence and banning gender discrimination amongst other initaitives (Economist 2010). On paper South Africa has one of the world's most commendable constitution containing an " impressive legal arsenals for protecting women's rights and is ranked 4th out of 53 countries" with regards to this (Economist 2010). "But the gap between principle and practice is often wide" (Economist 2010); with women still more likely to be unemployed and 40% admit that their first experience of sex was a rape" (Economist 2010). Furthermore intimate partner violence is associated with increased levels of HIV risk behaviour, examples being multiple partners, high levels of prostitution and excessive substance use. "A potential link between HIV status and domestic violence has also been recognized with studies from Africa showing an increased risk of violence when the man is HIV positive" (van der Straten in WHO 2003:54) or when the woman perceives herself to be at high risk of acquiring HIV from the man (Coker AL and Richter DL in WHO 2003: 54) Before concluding, it is important that the "Government is the responsible party under relevant international instruments to protect rights" (Aniekwu 2002: 35). But Presidents such as South Africa's Jacob Zuma are doing nothing but aggravating the controversial issue of gender inequality through their own actions. Zuma used traditional notions of gender roles within Zulu society to form the basis of his defence against rape allegations claiming sexual intercourse with his accuser was "demanded by his status as a Zulu male" and to deny a woman sex in Zulu culture when she is ready would be "tantamount to rape" (Andrews 2007: 44). The Zuma case not only exposed national concerns about a culture of violence towards women but also revealed the ways in which gender roles were related via cultural norms. To conclude, It is important to note that men do suffer also as a result of gender inequality. "For men, the pressure to perform sexually and with many partners places them at risk of HIV infection" (Tallis 2000: 58). The male-orientated culture present in sub-Saharan African societies means that many men won't seek HIV services due to a fear of stigma and discrimination and the perception of being labelled weak in such a male dominated society, which then has an impact on their wives or partners. Both Education and Health Programmes can improve access to services for both women and men by removing financial barriers, bringing services closer to local communities and tackling HIV/AIDS. In this essay I have shown the combination of their sexuality and gender disadvantage in terms of cultural, economic and social factors places women more at risk of infection than men." Gender inequality has undoubtedly been a driving force in the spread of HIV/AIDS and will continue to do so until traditional notions of the roles of men and women are overhauled. As whilst, the 'blame culture' placed towards women continues, the HIV/AIDS HIV/AIDS epidemic will be remain feminised and sub-Saharan African women will still find themselves faced with overt prejudice.
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