Charlotte's Web

Blogging my world since 2006

Women, AIDS and Poverty


I am writing a novel about AIDS in South Africa. God knows if it will ever sell, because it’s very depressing, but it’s also about love, hope and ridiculous self-belief so maybe there’s a small chance. The thing that angers me most about the AIDS epidemic in South Africa is that it affects the poorest, the most vulnerable, the least educated and of this group, the largest proportion is women. It’s as if for them, apartheid is happening all over again, but it’s an apartheid of rich versus poor, of haves versus have-nots, of those with sexual power and those without.

So, to mark this year’s Blog Action Day – which has poverty as its main theme – I want to talk about the place where poverty collides with gender inequality, and how both affect the AIDS epidemic in South Africa. When Thabo Mbeki became South Africa’s ex-president a few weeks ago, the one thing that stood out for me in the reams of press copy I read was this:

First his culpability in the death of hundreds of thousands of ­people in South Africa with HIV/Aids cannot be underestimated and its impact will be felt for generations. Death certification by Stats SA shows more than 1,5-million deaths in the ages 0-49 and more than two million new infections during his rule. The long-overdue roll-out of a comprehensive antiretroviral programme, compounded by state-sponsored pseudo-science, has left 524 000 people desperately in need of the life-saving treatment unable to access it. As a direct result life expectancy has dropped every year Mbeki has been in office.

(Zackie Achmat of the Treatment Action Campaign (TAC), writing in the M&G, 27 September. Whole article here.)

That’s 1,5 million people – children and their young, economically active parents – who are now dead. That’s another two million who have become infected, of whom a quarter cannot access the life-enhancing drugs. Of these people most were, and are, poor. What a legacy, Mr Mbeki. According to the TAC’s website, most of the people who are infected live in informal settlements. There are more women infected than men, and most of those infected are black South Africans.

As part of my research for my novel, I have read a book by Edwin Cameron, a judge who sits on South Africa’s Supreme Court and who is living with HIV. Called Witness to AIDS, the book is part autobiography, part analysis and it is gripping. In it he describes the guilt he feels in being able to afford, just barely, the anti-retroviral treatment he needs to stay alive when so many millions in the country were being denied access. Cameron also bravely decided to go public with his HIV status in 1999, in order to begin to counteract the negative stereotypes of people with AIDS. He says:

The external manifestations of stigma are horrific enough. At Christmastime 1998, a 36-year-old South African woman, Gugu Dlamini, was stoned and stabbed to death. The horror of her death has never been fully investigated, because her murderers were never held to account. The prosecution brought charges, but dropped them for lack of evidence. What is clear is that shortly before her death Gugu told Zulu-language radio listeners that she was living with HIV. Three weeks later, members of her own neighbourhood rounded on her. Her attackers accused her of shaming her community by announcing her HIV status … Three months after Gugu died I decided to announce publically that I was living with HIV.

One of the main topics in Witness to AIDS, and of vital importance to non-governmental organisations (NGOs) like the TAC is access to drugs. There are two types of patients in South Africa: those who are privately insured and who acquire their drugs from dispensing doctors or pharmacies, and those who use the public health system. Here they can expect long queues and inconsistent service. Also, they have to get there. If you are poor and sick with AIDS and live in a rural village, you still need to find someone to help get you to the clinic in order to get your drugs. Poverty impedes people from getting treatment.

So, how do AIDS/HIV and poverty affect women specifically?

  1. Women and girls will be expected to give up their jobs and schooling to tend the sick, thus fuelling a cycle of poverty.
  2. The poorest households are mostly female-headed. Very often grandmothers, having nursed and buried their children, are left to raise their grandchildren, many of whom are also ill.
  3. There are also orphan-headed households, where the oldest child or oldest girl, takes care of the younger children.
  4. Society and customs do not allow women to abstain from sex or insist on condom use, so they are at heightened risk of infection.
  5. Women and girls in poverty are often forced to sell sex to survive, which opens them up to more risk of infection.
  6. Fear of abuse, or community retribution, discourage women from getting tested and seeking treatment.
  7. Lack of respect, and the custom of seeing women as commodities, means they are at risk of sexual abuse, rape and thus infection.

According to a paper by the HIV and Development Programme on poverty and AIDS in sub-Saharan Africa, the HIV epidemic has its origins in African poverty and unless and until poverty is reduced there will be little progress either with reducing transmission of the virus or an enhanced capacity to cope with its socio-economic consequences (my emphasis).

And the that question remains, for those who care, is what to do? There are many small ways to help make a difference:

1. Donate to Oxfam or another reputable NGO.

2. Join the Stop AIDS in Children campaign (see my side-bar).

3. Join a global volunteer programme.

4. Volunteer your professional services (I edit for an NGO in South Africa, and am about to start doing the same for one in Kenya).

5. Become a fan of The Girl Effect and spread the word that girls are the future.

6. Help a family affected by AIDS. PACSA is an NGO in the heart of the South African AIDS epidemic. I can put you in touch with the director, Danielle Gennrich. Through her, I am sending money to the widow and children of Tony Shelembe, an AIDS worker who died last year.

Edited to add: Following the wonderful example of LadyFi, I will make a donation for every comment on this post today to Global Giving’s project to Fight HIV/AIDS and build lives in South Africa. Why don’t you go and have a look at the amazing work they are doing?

Author: charlotteotter

Novelist, feminist, crime writer

27 thoughts on “Women, AIDS and Poverty

  1. Well done for tackling this difficult subject, Charlotte.

    It really is a daily reality here – our daily help, who is coloured, was infected by her common law husband when he had an affair and passed HIV back to her. He is also alcoholic and has left her to bring up their three children, the youngest of whom is disabled. She luckily does have access to a clinic and ARVs but it is still very hard for her as sole wage earner and her teenage daughters to worry about, as well as all the demands of caring for her disabled baby. As you say transport is a huge problem, she has to get to the hospital and clinic for regualr check-ups 20 km away and this costs quite a lot, as well as needing a whole day off work each time. We do our best by keeping her job available to her even when she is sometimes away for a week at a time and giving her a flexible 4 day week, paying her an above average wage and giving her lifts when we can. Before the ARVs were available, we got her natural, immune supporting supplements that helped. But she is just one of many (and ‘luckier’ than many). The biggest problem here is gender inequality, that men feel they have a right to sleep around, without taking precautions and that the stigma attached stops them both from admitting they have HIV and from seeking treatment. Her husband is living with the other woman now, has refused treatment and is still drinking, but amazingly is still alive three years on.

    Sorry for writing a whole post in the comments, just wanted to share that story.

  2. Thanks for this post and for highlighting an important issue. I am also participating in Blog Action Day and am donating money for every comment left on my posts dealing with poverty this week at:

  3. Thanks for the visit! Yes – please do steal my idea of donating money for every comment received. Today’s post is number 3 (and the last one) and I’ll be donating money for comments on all three posts!

  4. hey charlotte –

    i’ve made a donation to the positive women’s network for hiv+ women in south africa, and am also posting myself to draw attention to “the girl effect” (which i didn’t know about before!) thanks for this.

  5. Charlotte, thank you for writing the post. It is hard to imagine how the ignorance of one man, one government, can play so tragically in the lives of millions. A more than sobering thought. May many be motivate to do something against this tragedy.

  6. Pingback: Jen’s Den of Iniquity » the girl effect

  7. I already posted a comment but must have not clicked submit – you’d think I wopuld know how to do this by now!

    Anyway, it basically said that this is such a great post – so informative about such an important issue. Thanks for the useful links. You are helping me achieve my five actions which I posted about.

  8. Really great post. Unfortunately, I think alot of people who would otherwise be willing to donate time and help create awareness are reluctant to admit that the gender inequality associated with HIV and poverty is a major factor, and thus stifle an essential part of understanding how it can be tackled.

  9. Thank you Charlotte. You write so eloquently about such emotional and difficult subjects. You’ve given a lot of informations here that I’m anxious to check out. I’m expecially curious about The Girl Effect. I’m off to see what that’s all about. Keep up the good work.

  10. This is a sad reality. Thank you once again for a well written and informative post. It highlighted for me that as an individual, one can make a difference! As you know the ANC has been going through changes over the past few weeks and the one beacon of light has been the appointment of Barbara Hogan as Health Minister for South Africa. She believes that HIV/AIDS needs to be treated with conventional medicine and not beetroots and garlic as stipulated by her predecessor Manto Tshabalala-Msimang. This epidemic is her top priority and appears to be very close to her heart. Lets hope that this ‘talk’ is put into visible action.

  11. Great post! I’m off to check out your links.
    I also posted for blog action day….

  12. Great post, Charlotte. And incidentally, I think depressing books can actually be quite uplifting because they show what it is to care about people / an issue. I think we South Africans try and numb out the horror of stories like those of Gugu Dlamini otherwise we would be permanently depressed. But you’ve reminded me that we need to take action in small and steady ways on issues of HIV drug access, tolerance towards foreigners and so on. One easy way is to become familiar with people’s stories (such as those of Gugu Dlamini) and to take an interest. We need to remind politicians that HIV and poverty and crime and violence are urgent priorities that need constant monitoring. (Sorry got on the soapbox there).

  13. Is it still today there? What a wonderful post, full of great advice on how to take action.

  14. Thanks, Charlotte, for an informative post about such an important subject. When I mention the UN’s Millenium Development Goals, I have had people ask me why the goals seem to focus so much on girls and women. Empowering women is the key to eradicating poverty and overcoming the AIDS epidemic. Thank you for the links in your post and for addressing this important issue.

    I wasn’t aware that today was Blog Action Day (inaction best describes my blog recently). Since I’m planning on watching the US Pres. debates in a few minutes, I don’t know that I will participate in this today, but I will write something about poverty & will follow your example regarding comments & contributions (sometime in the next few days).

  15. Good on ya, Charlotte. Every little bit helps.

  16. Wow.
    What a thoughtful and revealing post… terrible situations such as the plight of women and AIDS victims in South Africa can be so overwhelming that one feels hopeless. But I’m deeply touched and inspired by your determination to learn, educate, and take action on such a universal challenge.
    I recently resided in India for a year, and there too AIDS is devastating the country, especially its female residents. Arranged marriages are the most common form of nuptials throughout the nation, and many cases are documented in which uneducated country girls from “low” castes are married off to HIV-positive sons of wealthy families. The girls in turn contract the virus, but as they have been trained to be nothing but obedient to their husbands and new families, they will continue to care for him up until his or their own death.
    So the boy’s family gets a free nurse, his dignity is intact as he will die married, the girl’s family often makes a profit from the arrangement, and she is left as the casualty.
    Education can solve all of this, and that is exactly what you are providing with your blog and, eventually, your novel.
    I can’t wait to read it.
    Thanks again,

  17. Thanks for the post Charlotte. For some reason whenever you broach this subject I become annoyed by the apathy of people who I deal with every day who have jobs (not children or the poverty-stricken).
    I believe in tackling issues where you can directly make a difference. Every year, twice a year, we offer HIV/AIDS counselling and testing to all our employees and their families. Every year EVERYBODY declines. We are devastated. Every year numerous family members die. Everyone is devastated.
    Our staff live close to town, they have access to our transport (for free), we allow time off to go to hospitals whenever, to attend funerals (and there are many, it affects all productivity and morale) and yet we cannot force or even positively influence anybody to take responsibility for their own lives.
    The new government campaign is called “It Starts With You.” Ironic but there is a whole lot of truth in that. Of course, it shouldn’t need to apply to children but it is a reality of growing up in South Africa.
    It is easy for me to say. I live comfortably and am extremely well educated!

  18. Thank you for this post, Charlotte. When I read down to the part about Blog Action Day, I thought, oh maybe I could join in. But then I realised, rather humblingly, that I know nothing about poverty, apart from the fact that it must be the most grindingly awful condition. I admire very much what you’ve done here, in educating and informing us all.

  19. A great post Charlotte. Thanks for all the details. I’ve watched Thabo Mbeki in horror from afar, but hadn’t realised just how much negative difference his weird thinking about HIV and AIDS has made.

  20. A beautiful post and an outrageous tragedy! I am so looking forward to reading your novel. I don’t mind depressing as long as it is the truth. Keep up updated.

    Have you seen the film Yesterday? It was really about the gendered nature of the HIV epidemic. I think it took place in South Africa if I recall correctly.

  21. Excellent, Charlotte! Just was listening to a radio program on South Africa this morning (National Public Radio) and was thinking of you and Thomas. Good work. No need to donate on my behalf (unless you want to) – I’ll get some money over there.

    We had a very cool thing come through our neck of the woods here in Wisconsin, USA called “Step into Africa” which follows the life of children living in a world of AIDS in Africa. It was sponsored by World Vision. Very powerful stuff. You cannot read about that or experience these types of things and go unchanged. Thanks for bringing this to our attention.

  22. Charlotte, I’m sorry I missed this post on the day.

    We (in the US) can talk about high gas prices, lack of health insurance, and increasing unemployment all we want, but you know something is terribly, terribly wrong when life expectancy is decreasing.

  23. Great post.
    Just finished reading the news that there is a new Health Minister in SA, Barbara Hogan who has discredited the government’s policies on HIV/Aids and has stated that conventional medicine is needed to treat patients. A far cry from the ‘there is no such thing as Aids’ talk that the SA government has been spewing out in the past. There is hope!
    Good luck with your book. 🙂

  24. I will *absolutely* read your book, and in fact, if you need a set of eyes before sending it off to agents/editors, please keep me in mind 🙂

  25. What an outstandign post, Charlotte. I know my acquaintances here in the UK are kind of numbed to the whole African AIDS statistics story, but it is writing like this that makes the issues real and concrete for people who have never lived in South Africa and seen how people struggle. The fact that Thabo Mbeki has allowed so many of his own countryment to die should be a permanent blot on his record, and the fact that he did not fire his Minister of Health when she pushed ahead with her garlic and beetroot nonsense is a national disgrace. Long live Barbara Hogan! Zacchie Achmat is one of the most inspirational people I have ever encountered and I wish him and the TAC nothing but strength and success in their long and uphill battle.

    And I will be first in the queue to read your book. I remember reading and being profoundly affected by “And the Band Played On” in the 1990s. It was just such a terrible indictment of how the US Government and others decided that those being decimated by the disease were marginal members of society and therefore it wasn’t worth mobilising to try and find the cause or the cure. Until it was too late and the virus was loose all over the world.

    It seems as if it could not have found a more comfortable or more tragic home than Africa, where the combination of poverty, ignorance, social conventions and government ineptitude combine to create a perfect AIDS incubator.

  26. Pingback: Reading about AIDS « Charlotte's Web

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