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WOMEN AND AIDS IN AFRICA:

UNEQUAL EXPERIENCES, UNEQUAL REPRESENTATIONS

presented by

Teresa Ann Swezey

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WOMEN AND AIDS IN AFRICA:
UNEQUAL EXPERIENCES, UNEQUAL REPRESENTATIONS
BY

Teresa Ann Swezey

A THESIS
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS

Department of Anthropology

1993

#fl ‘ n__ 7"

ABSTRACT
WOMEN AND AIDS IN AFRICA:
UNEQUAL EXPERIENCES, UNEQUAL REPRESENTATIONS
BY

Teresa Ann Swezey

This thesis examines epidemiological and feminist
literature on women and AIDS in Africa. The two bodies of
literature reflect differing degrees of recognition or
denial, inclusion or exclusion of the socially constructed
nature of the AIDS epidemic in Africa. Feminist challenges
to the traditional epistemological foundations of
anthropology raise new questions and analyses. Feminist
theories and criteria are used to critique epidemiological
studies of women and AIDS in Africa, which create largely
decontextualized representations of the complex experiences
and meanings of AIDS in women’s lives. To understand the
multiplicity of factors affecting women’s ability to reduce
their risk for HIV infection and AIDS, there is a need for
research and analyses that are "context rich." Analyses
that recognize the embeddedness of gender, class, and
ethnicity and the role that culture plays in creating
differential meanings and experiences of the epidemic have

the most to contribute to AIDS prevention programs.

 

 

Copyright by
Teresa Ann Swezey

1993

To my parents, Mary and Donald Swezey

and to Dr. Lynn Beatty

iv

ACKNOWLEDGEMENTS

I am very grateful to the members of my MA guidance
committee, Dr. John Hinnant, Dr. Anne Ferguson, Dr. Lawrence
Robbins, and Dr. Maxine Baca Zinn for their guidance,
encouragement, and support.

Many thanks to Dr. Patricia Whittier for her editing
and formatting of this thesis.

Dr. John Kaneene has been very generous in making time
to discuss epidemiological research design and methods. I
have also benefitted from his ongoing encouragement of my
efforts to study the social and cultural contexts of the
AIDS epidemic in Africa.

I am deeply indebted to Dr. Maxine Baca Zinn, whose
work I frequently cite. I appreciate her encouragement and
support for developing an intersections approach in this
thesis.

Finally, I owe a great debt to the people in Uganda who
generously shared their knowledge, experiences, and insights
of the AIDS epidemic. Many people made time in their busy
personal and professional lives to meet during my
predissertation research. Insights about the impact of the

AIDS epidemic in people’s lives gained during discussions

 

Ti

 

and attendance at an AIDS conference in Uganda shaped both
the arguments of this thesis and the direction of future
dissertation research. I am especially grateful to the
families and friends who opened their homes to me during my

stay in their country.

vi

 

TABLE OF CONTENTS

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter
I. FEMINIST CHALLENGES AND CONTRIBUTIONS TO
ANTHROPOLOGY . . . . . . . . . . . . . . . . . . 6
Feminist Criteria for Evaluating Representations
of Women and AIDS in Africa. . . . . . . . . . 15
II. EPIDEMIOLOGICAL LITERATURE . . . . . . . . . . l9
Representations of Women as Prostitutes and
Reproducers in the Epidemiological Literature
on Women and AIDS in Africa . . . . . . . . . . 23
Transitional Representations of Women in the
Epidemiological Literature on Women and AIDS
in Africa . . . . . . . . . . . . . . . . . . . 39

III. FEMINIST REPRESENTATIONS OF WOMEN AND

AIDS IN AFRICA . . . . . . . . . . . . . . . . 48
IV. INTERNATIONAL AND UGANDAN AIDS CONFERENCES . . . 73
VIII International AIDS/STD Conference . . . . . 73

Mobilization Workshop for HIV/AIDS Prevention,

Control, and Patient Care for Women Leaders . . 82

V. SUMMARY AND DISCUSSION . . . . . . . . . . . . . 94

VI. FUTURE RESEARCH DIRECTIONS . . . . . . . . . . 100
vii

ii”.

 

 

APPENDICES

Appendix I. Statements: International

Pre-Conference Workshop, Women Living with

HIV/AIDS . . . . . . . . . . . .

Appendix II. Women Program Guide . . . . . . .

BIBLIOGRAPHY . . . . . . . . . . . .

viii

 

. . 110
. . 112

. . 117

 

 

 

 

INTRODUCTION

According to the World Health Organization (WHO), "more
than half the estimated [eight to ten million] AIDS cases
have occurred in Africa and the number of adults now
infected with HIV is estimated to be close to six million"
(United States Agency for International Development 1991:4).
Women comprise over one-half the AIDS cases in Africa. The
original pattern of male to female heterosexual transmission
rate "had by the end of 1989 changed to 1:1.5 with more
women than men who were infected" (Ankrah 1991:971). For
example, "in Zaire women have a higher infection rate until
age 35. In Ghana among those diagnosed with AIDS, women
outnumber men" (Bassett and Mhloyi 1991:146). Further WHO
statistics state that:

At the end of the 19805 about 2.5 million females

in Africa were infected with HIV and they gave

birth to about 2 million infants, of which 500,000

were estimated to have been infected with the

virus. By the end of 1992 about 4 million infants

will have been born to HIV-infected women and

nearly a million more are expected to be infected.

[Chin 1990:2231

Three key issues are evident in the statistics: (1) the
discrepancies between male and female HIV infection rates
and cases of AIDS in Africa; (2) concern for women’s role as

reproducers; and (3) concern for the high risk of perinatal

1

 

 

2

transmission of HIV. Yet, beyond the biological categories
of male and female and women's biological and social "roles"
as childbearers (and what is implied by concern over
perinatal transmission statistics—intimplication of women’s
"role" in transmitting the HIV virus to their infants) are
the gender and class relations contributing to the
discrepancies. Further, what is often obscured in abstract,
quantitative reporting of AIDS statistics is the fact that
the statistics themselves are based in human experiences of
the AIDS epidemic. In other words, strictly statistical
approaches to understanding the AIDS epidemic are not
enough—they strip the human experience of AIDS from its
social, cultural, political, economic, historical, and
personal contexts. Statistics without the addition of human
experiences of the epidemic limit our understandings of how
AIDS differentially impacts people’s lives.

In this thesis, I argue that in addition to asking how
HIV infection is transmitted and making recommendations
about how to slow its spread, AIDS reporting and
representations must ask why the gender differences exist.
The gender, class, and ethnic or cultural relations shaping
women’s multiple experiences of the AIDS epidemic in Africa
must be viewed as a valid starting point in AIDS research.
Women must be worthy of research efforts because of their
humanness—aufl:exclusively because of their reproductive

function within societies.

 

 

3

The title of this thesis, "Women and AIDS in Africa:
Unequal Experiences, Unequal Representations," is intended
to convey a sense of the socially constructed experiences
and representations of the AIDS epidemic in Africa. By
socially constructed experiences, I mean the ways by which
the epidemic is structured by gender, class, and power
relations. As discussed in a later chapter, culture, in the
form of ethnicity, also contributes to gendered differences
in socially constructed experiences of the AIDS epidemic.

By socially constructed representations, I mean the ways
these relations are articulated in the literature on AIDS in
Africa.

I examine mainstream epidemiological and feminist
analyses of AIDS in Africa in this thesis and show how the
two bodies of literature reflect differing degrees of
recognition or denial, inclusion or exclusion of the
socially constructed nature of the epidemic. Each is based
in a different set of assumptions or conceptualizations
about women and results in different sets of representations
of the epidemic. Each also results in different
implications for what should be the goal of any AIDS
research project—dfluadevelopment of AIDS prevention and
education strategies sensitive to the constraints and
challenges of behavior change as shaped by both internal and
external conflicting forces.

Chapter 1 presents a discussion of feminist

 

4

perspectives in anthropology, emphasizing the ways in which
feminist challenges to the epistemological foundations of
traditional anthropology raise new questions and analyses
within the discipline. In Chapter 2, I evaluate the ways
women are included in the epidemiological literature on AIDS
in Africa. I have divided the epidemiological literature on
women and AIDS in Africa into two sub-sections. The first
treats women as reproducers and prostitutes (and to a lesser
degree caregivers and producers). The second sub-section
encompasses research that I have classified as
"transitional." The transitional category encompasses
representations with varying degrees of recognition and
contextualization of the socially constructed aspects of the
AIDS epidemic. Throughout each of these subsections,
underlying and often implicit or unstated conceptualizations
of women in the epidemiological research are identified and
critiqued using the feminist criteria outlined in Chapter 1.
Chapter 3 presents feminist studies standing in
opposition to standard epidemiological treatments of women
and AIDS in Africa. The focus of this chapter is
comparative. My intention is to raise issues that will
highlight the implications for AIDS programs sensitive to
the challenges many women face in negotiating AIDS
prevention strategies. Identifying levels of recognition or
non-recognition of the negotiated basis of AIDS prevention

is key to analyzing epidemiological and feminist approaches

FHI

 

5

to AIDS prevention. Chapter 4 integrates the arguments

 

Hr; it

made within this thesis with my reflections on the discourse
on the sociocultural dimensions of AIDS research as
articulated at the VIII International AIDS/STD Conference in
Amsterdam and a conference on women and AIDS in Kampala,
Uganda.

The discussion in Chapter5_pffers comments on the ways
that feminist challenges to epidemiology as usual (to
paraphrase Harding [1991]) are necessary and vital to the
development of successful AIDS prevention programs. In this
chapter, I also discuss the question of whether there ;;;~«~
been a feminist revolution in regard to major paradigmatic
shifts in mainstream approaches to AIDS in Africa.

The concluding chapter incorporates ideasand
information gained during a five-week visit to Uganda in
JulyeAugust 1992. This serves as a means of contextualizing
how the experiences of the people I spoke with about AIDS in
Uganda reflect many of the arguments set forth in this
thesis. The insights gained during that period will also

serve as the basis for questions to be raised in my

dissertation research.

 

 

THE

 

 

CHAPTER ONE

FEMINIST CHALLENGES AND CONTRIBUTIONS TO ANTHROPOLOGY

Issues of representation have been central to feminist
scholarship in anthropology over the last twenty years.
This section is not intended as a comprehensive overview of
the literature on feminist challenges and contributions to
anthropology, but rather, as a brief review of some of the
issues raised by feminists and to show how feminists ask
different questions and produce different analyses. It also
sets the tone for the specific feminist critiques of
representations about women and AIDS in Africa that follow.
This section is not limited to contributions from feminist
anthropologists; feminist perspectives from other social
science disciplines that have or can contribute to new
questions and analyses in anthropology have also been
included.

Feminist challenges to the epistemological foundations
of traditional anthropology brought about a rethinking and
rewriting of both anthropological theory and practice (di
Leonardo 1991; Gal 1991; Moore 1988). As Micaela di
Leonardo notes, feminist anthropologists in the 19705 began

"rewriting anthropology as if gender really mattered"

7
(1991:9). Objections to the androcentric construction of
social experience and reality within the discipline raised
key epistemological questions. Feminists challenged non-
inclusive anthropological paradigms that presented knowledge
about women, as well as about other societies and cultures,
that was based solely upon the contributions of male
informants. Some of the questions raised by feminists that
are pertinent both to this thesis and more broadly to the
anthropological endeavor include: what constitutes knowl-
edge; how is it produced; what kinds of questions get asked
and by whom; and who controls access to and distribution of
knowledge?

The critical stance adopted by feminist anthropologists
has contributed to a "reconsideration of entire subdivisions
of the discipline" (di Leonardo 1991:8). For example,
feminists challenged basic theoretical tenants of kinship
studies, political anthropology, and Third World peasant
studies. They also contested the hegemony of culture as the
primary explanatory variable in constructing difference. As
Moore contends,

Feminist anthropology . . . formulates its

theoretical questions in terms of how economics,

kinship, and ritual are experienced and structured

through gender, rather than asking how gender is
experienced and structured through culture.

[1988:9]

Feminist-based revisions in anthropological theory and

practice contributed to new understandings of the concept of

personhood. Feminists critiqued definitions of "work"

8
based on a non-recognition of "women's subsistence and
domestic labor" (Moore 1988:43). In so doing, they drew
attention to the sexual division of labor and motivated a
redefinition of the concept of work to include women’s work
in social reproduction.

Feminist research has also challenged and contributed
to a deconstruction of the notions of sexuality and
reproduction through arguing against biologically
determinist approaches to these topics. Similarly,
feminists have deconstructed the concepts of sex and gender
and demonstrated that sex and gender, like sexuality and
reproduction, are not, in fact, paired identical concepts.
Feminist anthropologists and other feminist researchers have
shown the analytical error in naturalizing sex and sexuality
and in conflating sexuality with reproduction (di Leonardo
1991; Moore 1988; Rapp 1992; Vance 1991). In commenting
upon feminist anthropologists’ approaches to studying
sexuality, Rayna Rapp contends that:

the social space in which "biological" experiences

are constructed is intimately shared with other

social relations. . . . our new focus on sexuality

parallels our understandings of other power

domains which in many ways invent and constrain

both sex and gender. [1992:84]

Feminists have highlighted anthropology’s inertia in
situating studies of sexuaiity within the context of social
structure (Vance 1991). Carol Vance classifies the conven-

tional approach to sexuality studies within anthropology as

"the cultural influence model" (1991:879). This model does

 

 

 

9
not question the concept of sexuality nor the assumptions
made about it in anthropological theory and practice.
According to Vance, the cultural influence model naturalizes
sexuality. Moreover, it "recognizes variations in the
occurrences of sexual behavior and in cultural attitudes
which encourage or restrict behavior, but not in the meaning
of the behavior itself" (1991:879). While critiquing the
cultural influence model, Vance nonetheless recognizes that
it has moved the analysis of sexuality away from a strictly
biological approach and has contributed to understandings of
sexuality by challenging the "more mechanistic theories of
sexual behavior, still common in medicine and psychiatry"
(p. 879).

Social constructionism shapes many approaches to
feminism and, thus, the types of questions asked and
analyses offered (di Leonardo 1991; Vance 1991). Vance's
comments on the social constructionist approach to sexuality
are especially pertinent to the different sets of questions
raised and analyses produced in the literature critiqued in
this thesis and within anthropology as a whole. Vance
describes this approach as one that would:

. . .examine the range of behavior, ideology, and

subjective meaning among and within human groups,

and would view the body and its functions and

sensations as potentials (and limits) which are

incorporated and mediated by culture. [1991:879]

Vance notes that feminist anthropologist Gayle Rubin’s

separation of sexuality and gender into analytically

 

 

 

 

 

 

 

 

10

distinct phenomena resulted in a new approach in which:

. . . sexuality and gender are separate systems

which are interwoven at many points. Although

members of a culture experience this weaving as

natural, seamless, and organic, the points of

connection vary historically and cross-culturally.

For researchers in sexuality the task is not only

to study changes in the expression of sexual

behavior and attitudes, but to examine the

relationship of these changes to more deeply-based

shifts in how gender and sexuality were organized

and interrelated within larger social relations.

[p. 876]

This observation is especially important in understanding
the ways in which the women described in Chapter 4 of this
thesis view unequal gender relationships and lack of control
over their sexuality-inuihence increased risk for HIV
infection—through cultural (or ethnic) lenses.

Using a social constructionist framework, feminist
researchers in anthropology and other disciplines explain
gendered differences in experiences of social reality and
the pervasiveness of male dominance and oppression
throughout time and space. Dichotomous explanations such as
culture/nature and public/private have yielded to a
recognition that there is no single or universal explanation
for women’s oppression (di Leonardo 1991). Likewise,
feminist perspectives now contend that there is no single
definition of "women" or of "men" (Baca Zinn 1993). In this
regard, Moore states, "there can be no universal or unitary
sociological category ‘woman' and therefore there can be no

analytical meaning in any conditions, attitudes or views

ascribed to this ‘woman’" (1989:189).

 

THE

 

11
The plurality of women’s experiences as structured by
»social location and culture prompts Harding to state:

. . . women come only in different classes, races,

and cultures: there is no "woman" and no "woman’s

experience." Masculine and feminine are always

categories within every class, race, and culture

in the sense that women’s and men's experiences,

desires, and interests differ within every class,

race, and culture. But so, too, are class, race,

and culture always categories within gender, since

women’s and men’s experiences, desires, and

interests differ according to class, race, and

culture. [1987:7]

This feminist perspective needs to be kept in mind when
considering the gender, class, and cultural factors
contributing to differentiated meanings and experiences of
the AIDS epidemic in Africa. The forms that structural
inequalities such as gender and class inequality take are
influenced by culture. As highlighted by some of the
feminist researchers reviewed here, and more explicitly in
the discussion section, one of the most important cultural
factors in the context of AIDS in Africa is the role that
women’s perceptions of ethnicity or tribalism play in their
perception of cultural influences that increase their risk
for HIV infection.

Feminist research is thus context rich. It recognizes
the historical contingency and partiality of the
representations created through academic inquiry. As Moore
observes,

[t]he term patriarchy is similarly deconstructed.

This does not mean that women are not oppressed by

patriarchal structures, but it does mean that the
nature and consequences of those structures have

 

 

 

 

I'HI

 

12

to be specified in each instance and not assumed.
[1988:189]

Feminist scholarship, whether in anthropology or in
other social sciences, is not an uncontested terrain. Women
of color, and Third World women in particular, have
challenged feminist representations of social reality based
upon white, middle-class feminists’ experiences of the world
(Hill Collins 1990; Hooks 1984; Mohanty, Russo, and Torres
1991). It is critical to recognize a plurality of

feminisms. Women of color and Third World women "call for

 

the expansion of theory and practice [to create] a number of
feminisms that mirror women’s different realities" (Ferguson
and Gallin 1992:7).

Maxine Baca Zinn and her colleagues argue that "[t]he
integration of race and class into the study of gender
creates different questions and new conceptualizations of
many problems" (1986:296). Baca Zinn terms this integration
of race, class, and other structural axes of social
organization and stratification "intersections analysis."
Intersections analysis contends that race, class, gender and
other structural axes of stratification are interlocking
systems of oppression that must not be considered in isola-
tion from one another (Baca Zinn 1993). As Margaret
Andersen and Patricia Hill Collins observe, "race, class,
and gender are inextricably intertwined, and they compel us
to think about the structure of race, class, and gender

relations in society" (1992:48). This type of feminist

 

THE

 

13
framework has much to offer anthropology and, as I contend
in this thesis, is especially useful for understanding the
complex experiences and meanings of the AIDS epidemic in
African women’s lives.

Intersections analysis encourages what Baca Zinn (1993)
refers to as oppositional reading—that is, reading against
the grain. In other words, in the tradition of feminism, it
challenges the epistemological bases of conventional
assumptions and representations of social reality within the
academy. It conceives of gender, race, and class as "linked
systems of control, domination, advantage, and privilege
which are relational; that is, they are positioned and gain
meaning relative to one another" (Baca Zinn 1993).
Intersection analysis emphasizes the importance of social
relations and social structure in shaping individual
experiences of reality. It critiques approaches that
conceive of gender as an individual, socialized attribute or
set of social roles. Intersections analysis also questions
additive analyses that treat gender as a variable and
analyses that rank types of oppression in hierarchical order
(Baca Zinn 1993). In this sense, intersections analysis
argues against gender as the only axis of social
organization that creates differential experiences of
structural inequality (Baca Zinn 1993; Ferguson and Gallin
1992).

The feminist culture and political economy framework

 

14

within anthropology somewhat parallels intersections
analysis. Di Leonardo (1991) identifies five key points of
this framework. First, a "radical rejection of . . . social
evolutionism" and an explicit recognition of the historical,
cultural, social, and political-economic contingencies of
gender. Second, an emphasis on social constructionism.
This approach contends that gender, race, ethnicity, nation-
ality, and so on "are not immutable characteristics of
individuals but emergent and shifting social categories that
can and do become the objects of intense political struggle"
(p. 29). Third, the feminist culture and political economy.
framework emphasizes the "embedded nature of gender, both as
a material, social institution and as a set of ideologies"
(p. 30). Fourth, recognition of gender embeddedness leads
to the "proposition that all forms of patterned inequality
merit analysis" (p. 31). Finally, this framework stresses
the importance of social location—«fifboth the researcher and
the researched (p. 31). It also recognizes the ways that
the production of knowledge is a highly politicized,
historically contingent, and profoundly ideological process.

In summary, many of the questions and issues raised by
feminists—both anthropologists and others—provide a critical
framework for approaching issues of representations of women
and AIDS in Africa. As di Leonardo notes, "anthropology
stands at the crossroads of knowledge production, embracing

scientific, social scientific, and humanist modes of

 

15
interpretation" (1991:1). Using feminist frameworks,
anthropologists in particular have contributed to more

contextualized analyses of the AIDS epidemic in Africa.

Feminist Criteria for Evaluating Representations

of Women and AIDS in Africa

Feminist frameworks offer a means to evaluate and
critique representations of women and AIDS in Africa. They
also suggest alternative research strategies and analyses
that move beyond the decontextualized shortcomings of
epidemiological representations as discussed in the next
chapter. Feminist standpoint thinking (Harding 1987; 1991),
intersections analysis (Baca Zinn 1992; 1993), and the
feminist political economy and culture framework (Schoepf
1992) each contribute components of the criteria used to
critique epidemiological and feminist representations of
women and AIDS in Africa. I also refer to discussion of the
treatment of women as either mothers (i.e., "good" women) or
whores (i.e., "bad" women) (Carovano 1991) as providing a
useful basis for examining underlying conceptualizations of
women in both epidemiological and feminist literature. My
goal in synthesizing these feminist perspectives into a
coherent framework in this thesis is to demonstrate how they
might work together to locate people within the various
contexts that influence their ability to reduce their risk

for HIV infection and AIDS.

 

THE

 

 

l6
standpoint thinking (Harding 1987:9) emphasizes the 9
importance of grounding research problems in women's
experiences, conducting research for the purpose of
liberation or change, and locating the researcher and the
researched in the same social plane. Intersections analysis
somewhat parallels standpoint thinking but is more explicit
about viewing gender, class, and race as structurally based
interlocking systems of stratification that must be
considered relationally rather than as attributes of
particular individuals or groups of individuals. In the
context of AIDS in Africa, ethnicity as generated through
culture, needs to be incorporated as an axis of
stratification in relation to gender and class in
considering the impact of the epidemic in women’s lives. In
turn, the feminist political economy and culture framework
places greater emphasis on the political economic and
sociocultural contexts than on the interlocking nature of
race, class, and gender. Feminists using this framework
create analyses of AIDS "linking a macrolevel analysis to
microlevel studies of social interaction [to show] how
political economy, gender, and culture shape responses to
disease" (Schoepf 1992:53).

The differences between these feminist frameworks are
also a source of complementarity; when combined they have
the potential for creating a context-rich analysis of women

and AIDS in Africa. My conceptualization of context-rich

 

 

I'HI

 

1?
analysis is an expansion of Susan Hunter's (1990)
definition. Hunter stresses the importance of involving
indigenous researchers and people in the production of
knowledge generated through AIDS research and analysis
(1990:689). I use the concept of context-rich analyses to
denote an approach that recognizes the epistemological and
practical shortcomings of conducting AIDS research without a
consideration of the multiple and interlocking contexts that i
create differential meanings and experiences of the
epidemic. In other words, such an approach recognizes the
need for AIDS research that considers the relationship
between gender, ethnicity, class, and the political-
economic, historical, personal, and cultural contexts rather
than treating each of these related aspects of the socially
constructed nature of the AIDS epidemic separately.

The following chapter examines the conflicts and
complementarity between mainstream epidemiological and
feminist approaches to understanding AIDS in Africa. The
two approaches are not mutually exclusive. For example,
feminist studies of AIDS in Africa often begin with
epidemiological statistics, and some of the epidemiological
reports hint at an awareness of the socially constructed
nature of the epidemic. I contend, however, that feminist
studies take AIDS research several vital steps further than
current trends in epidemiology by grounding their analyses

in women's experiences of the epidemic as structured by

18
social location. Feminist analysis thus exposes the limits
of decontextualized approaches to AIDS prevention and shows
the need for an analysis that relates all the factors
affecting African women's experiences of AIDS and their AIDS

prevention choices and strategies.

CHAPTER TWO

EPIDEMIOLOGICAL LITERATURE

Epidemiology is defined as "the study of the
distribution and determinants of disease frequency in human
populations" (Hennekens and Buring 1987:3). Empirically
based epidemiological research of the AIDS epidemic in
Africa is essential for gaining understandings of such
determinants of disease frequency and distribution as HIV
seroprevalence rates, numbers of AIDS cases, rates of
perinatal transmission, and biological and behavioral vari-
ables contributing to the spread and distribution of the
disease. According to Jonathan Mann, former director of the
World Health Organization’s Global Aids Programme,
"epidemiological studies have created a coherent view of HIV
transmission, for application by those working to prevent
HIV infection . . . [however] a sufficient understanding of
risk behavior has not yet been developed" (1991:555).

Epidemiological literature on AIDS in Africa is largely
based on a biomedical, empiricist, quantitative approach to
researching, analyzing, and reporting (representing) the
AIDS epidemic. Models used to explain HIV transmission and

AIDS are linear and behaviorally deterministic (Mann

19

20
1991:555). Gender relations and systems of social
hierarchy are barely alluded to as possible explanations for
the higher HIV infection rates in women and their infection
at earlier ages. The challenges to negotiating AIDS
prevention strategies are rarely acknowledged. The
experiences of the epidemic that form the foundation of the
AIDS statistics reported in epidemiology are frequently
presented as decontextualized "facts" by the disembodied
observers/researchers. Women are included in the
epidemiological literature primarily out of concern for
their "roles" as reproducers of children and infectors of
men and children (Carovano 1991). This results in women not
being viewed as active agents of change but as passive
bearers of children and the HIV virus.

A survey of the epidemiological literature on AIDS in
Africa thus quickly reveals, as one might expect, that it is
not based in feminist conceptualizations of how gender,
class, and power relations (e.g., patriarchy, differences in
access to and control of resources) interact to create
multiple systems of oppression and inequality. Nor does the
epidemiological literature incorporate feminist challenges
to positivistic, "objective," impartial science that contend
that social location is central to creating socially
situated, partial knowledge(s), where the view from the
perspective of the powerful is more distorted than the view

from the perspective of the oppressed (Harding 1991). As we

21
shall see, this perspective offers important advantages in
studying the AIDS epidemic.

A feminist perspective is a critical perspective. As
Harding notes, "gender relations in any particular situation
are always constructed by the entire array of hierarchical
social relations in which ‘women’ or ‘men’ participate"
(1991:14). It is reasonable to ask whether it is fair to
apply feminist lenses or value judgements to a body of
literature that clearly never intended to incorporate a
feminist perspective, much less a feminist standpoint. In
answering this, it is important to emphasize that the use of
feminist lenses reveals what is not seen in epidemiological
understandings and representations of the AIDS epidemic. As
Dorothy Smith states, "a critique is more than a negative
statement. It is an attempt to define an alternative"
(1987:78).

A critique should thus not only criticize, but offer
suggestions for transformation or change. Feminist lenses
applied to epidemiological literature provide a mechanism
for this. Jane Flax’s remarks in this regard are
particularly salient, "a fundamental goal of feminist theory
is and ought to be to analyze gender relations: how gender
relations are constituted and experienced and how we think,
or equally important, do not think about them" (1987:622).
In other words, this type of analysis and critique offers

what Flax terms the opportunity to think about how we

22
think—or in this case—to speculate on how epidemiologists
think and how their ways of thinking shape their
perceptions, discourse, representations, and
recommendations.

This is especially important given that epidemiological
analyses are usually presented as complete understandings
and representations of the AIDS epidemic. Epidemiological
approaches alone, however, create incomplete and thus
inaccurate representations of the epidemic and are examples
of the authoritarian stance of science that fails to
recognize the "situated" nature of knowledge production
(Haraway 1988:583). According to Haraway, there is a need
to recognize the partiality of knowledge production and to
strive for what she terms "feminist objectivity." Feminist
objectivity "is about limited location and situated
knowledge, not about transcendence and splitting subject and
object. It allows us to become answerable for what we learn
and how we see" (p. 583). Haraway’s statement,

I am arguing for epistemologies of location,

position, situating, where partiality and not

universality is the condition of being heard to
make rational knowledge claims. These are claims

on people’s lives! I am arguing for a view from
the body. [1988:589, emphasis added]

 

is especially powerful when applied to the question of
formulating possible alternative approaches to standard
epidemiological representations of AIDS in Africa.

It is foolish to suggest that epidemiology be abandoned

in favor of more qualitatively based approaches; the hows

 

 

23
of the AIDS epidemic are as important as the whys. As
mentioned previously, however, most epidemiological
approaches are limited in their abilities to move beyond
decontextualized representations of hows (and sometimes
whys) to asking broader based questions of why. Further,
they seldom explore the social, political, economic, and
cultural contexts. Again, it must be stressed that
epidemiology provides an important starting point for more
contextualized accounts of the epidemic. Since estimates of
future patterns of HIV infection and AIDS cases are Vital to
policy making, epidemiology provides necessary baseline data
for developing impact analyses that are essential to the
structure of AIDS programs. As Mann comments, however,
epidemiology's ability to quantify behavioral risk factors
using standard practices "may have reached its limit"

(1991:555).

Representations of Women as Prostitutes and Reproducers
in the Epidemiological Literature on Women and AIDS in
Africa

In this section, I explore how women are conceptualized
in the epidemiological literature. The material presented
draws from the most recent epidemiological works on AIDS in
Africa. The articles critiqued were selected from a list of
100 to 150 journal articles generated through key word

searches (Africa, women, HIV, AIDS) in Core Medline and

24
Excerptis Medicus. In reducing the list to a manageable
number, I attempted to select a representative sample. Only
articles that included discussion of women in their analyses
were selected. The articles included research on two of the
five modes of HIV transmission in Africa—sexual and
perinatal—inuion the content and efficacy of AIDS prevention
programs. HIV transmission by blood, by unsterile
instruments, and by skin cutting or piercing are not
included in the discussion.

To structure my discussion, I have grouped and analyzed
the articles according to the extent to which they recognize
the socially constructed nature of the AIDS epidemic.
Specifically, how much recognition is given to the role of
gender, power, and class relations in shaping the AIDS
epidemic? In other words, I attempt to synthesize and
reveal epidemiological literature’s frequently unstated or
merely implied conceptualizations of women. As will be
shown, in most of the articles, gender is treated as a
variable and/or gender is treated in terms of roles.

The groupings presented here are not intended to imply
strictly bounded categories, for there are multiple layers
of overlap between them. They are: (1) epidemiological
studies in which women are treated as reproducers,
prostitutes, and to a lesser degree, caregivers and
producers; and (2) epidemiological studies that I have

classified as "transitional"; i.e., studies that

25
incorporate varying degrees of recognition and contextuali-
zation of the socially constructed aspects of the AIDS
epidemic. Concrete examples of epidemiological
representations of women and AIDS in Africa are provided and
critiqued using the feminist criteria outlined above.
Consideration is given to the ways that feminist researchers
might address and provide alternate explanations of the same
issues.

Throughout the section, I echo Susan Hunter’s statement
that "AIDS research cannot be context poor. To be ethical
and methodologically correct, it must be context rich"
(1990:9). Additionally salient is the insight provided in
Mary Bassett and Marvellous Mhloyi’s statement: "Just as
much as HIV is a requirement for the AIDS epidemic, so too
are the social relations that mold, and even determine, the
setting of each individual’s exposure and susceptibility to
infection" (1991:144).

Carovano’s (1991) essay, "More than Mothers and Whores:
Redefining the AIDS Prevention Needs of Women," provides a
succinct criticism of approaches to AIDS research that
categorize women in their "good" or "bad" sexuality and
reproductive roles:

throughout the world, women’s sexual identities

have long been defined on the basis of their

reproductive capacity, and to a lesser degree,

their involvement in commercial sex. Motherhood

legitimizes a woman’s sexuality—~and very often

her life—whilermpstitution provides women with a

means of survival, though with a heavy stigma.
Women in many societies have traditionally been

 

 

26

identified sexually as either mothers or whores,
‘good girls’ or ‘bad girls’. . . . [1991:1321

Carovano goes on to say that this dichotomy is used in AIDS
research to "identify the risks posed to and by women" (p.
132).

Epidemiological research on perinatal transmission
rates, on childhood survival of infants born to HIV positive
mothers, and on prostitutes conceptualizes women in this
good/bad dichotomy. The primary concern is not with women
themselves but with children.

For example, a study of perinatal transmission rates in
Brazaville, Congo, makes no mention of the impact,
experience, meaning, and consequences of AIDS on mothers but
chooses to focus on "the consequences for infants of
maternal seropositivity with emphasis on survival"
(Lallemant et al. 1989:643). Feminist researchers would
identify this goal as important, but make clear that it
neglects to consider the impact on women, who are reduced to
passive carriers of children and of the HIV virus.

This study also falls short of any meaningful or
contextualized analysis of women’s socioeconomic conditions
and social location. This is revealed through the
categories that are used to indicate women’s "occupations";
the choices are: "housewife," "student," and "active" (p.
644). There are several problems with this approach.

First, the choice of occupational categories ignores the

diversity of women's work in Africa. Second, the terms

27
"housewife" and "active" are not defined. Does housewife
mean unemployed or employed in the informal sector? Does it
reveal an underlying assumption that housewives do not work?
Third, the term "active" is also problematic. Does it mean
employed, or does it only refer to employment in the formal
sector? How does one make a distinction between active and
inactive? Finally, the three categories appear to be
mutually exclusive. Are students not also possibly
housewives or active?

The authors report finding no significant differences
between what they term social variables (occupation, marital
status, and pregnancy outcome) and children born to the two
groups studied (HIV+ and HIV— women). Aside from noting
whether women were single or married, and whether the length
of the sexual relationship was over one year, information
about the women's partners (such as socioeconomic status,
sexual history, etc.) that would help to contextualize the
results are also missing from the study. This results in
the blame for perinatal transmission being placed squarely
on the shoulders of the women themselves rather than a
recognition of the types of socioeconomic and cultural
conditions that put women at risk for HIV infection in the
first place.

A variety of additional questions might be asked from
feminist perspectives. How long, for example, had the women

been living in the city? If they had recently moved to the

 

28
city, had they been separated from their partners when they
were in the rural areas? Did their partners have a second
family or other sexual partners in the city? What are the
social, cultural, and historical conditions contributing to
male control over female sexuality and reproduction, and how
might that increase women’s risk for HIV infection?
Finally, no indication is provided of income levels or
education for the two groups of women. What role might
differences in income and education play in women’s
knowledge of HIV transmission and subsequent variation in
infection rates?

Another study that is limited by its shallow
exploration of socioeconomic factors in women’s lives
analyzes perinatal transmission in Zambia (Hira et a1.
1989). This article follows the trend of viewing women in
their reproductive function. Its depth of analysis is
revealed by the authors’ limitation of occupation to two
categories: working versus non-working. This raises the
question of what qualifies as work and reflects the same
failure to contextualize the experiences and meanings of
AIDS in women’s everyday lives as did the article mentioned
earlier (where women were regarded as "housewife" or
"active").

Socially situating the concept of "working" in the
experiences of women’s lives would mean developing a

perspective entirely different from that offered in this

 

 

29
study. Application of Harding’s criteria of beginning from
women’s experiences and using them as a "test of adequacy of
the problems, concepts, hypothesis, research design,
collection and interpretation of data" (1987:11) are
especially appropriate here.

The conceptualization of women as reproducers and
transmitters of AIDS to children is present in every study
of perinatal transmission reviewed (Braddick et a1. 1990;
Hira et al. 1989; Konde-Lule et al. 1989; Miotti et al.
1990). The studies differ in the extent to which they
recognize and include non-biological factors as contributing
to HIV infection in women, but they are consistent in their
insistence that women need to be counseled against future
pregnancies if they are HIV positive.

These studies are also consistent in their failure to
address the negotiated aspects of sexuality and
reproduction, including AIDS prevention. As an example, a
study conducted in Kinshasa, Zaire, found the following
variables

significantly associated with HIV infection:

unmarried status, age less than 16 years at the

time of first intercourse, more than one sexual

partner in the last 5 years, a history of

prostitution, receipt of blood transfusion since

1980, consumption of alcohol during pregnancy, and

travel to other African countries. [Braddick et

al. 1990:1002]

The authors note that the study participants were poor

women. They recommend that HIV positive women be educated,

counseled, and advised to avoid future pregnancies (p.

30
1005). They do not, however, address the multiple meanings
of children to women in African societies or the dilemmas
women are faced with in being asked to choose between
motherhood and avoiding HIV. As Carovano insists, "the
argument that HIV-infected women should receive ‘directive
counseling’ to avoid or terminate pregnancy denies the
complexity and real importance of motherhood in many women’s
lives" (1991:139).

An example of a study that fails to contextualize the
complex meaning of motherhood in Africa is "Impact of
Single-session Post-partum Counselling of HIV Infected Women
on their Subsequent Reproductive Behavior" (Temmerman et al.
1990). The authors report that a follow-up study conducted
with HIV positive women one year after they received their
test results and counseling against further pregnancies
revealed that very few of the women had informed their
partners of their seropositive status. Some awareness of
gendered relations is revealed in the researchers’ statement
that sexually transmitted diseases are usually blamed on
women. They observe further that "the majority of these
mothers therefore preferred to keep the information to
themselves. Most of them were in good health and not
prepared to worry unduly about future eventualities" (p.
251). There is a tone of paternalism in these statements
and no attempt to further explore why the women are

preoccupied with the present.

 

31

The failure of these authors to consider context is
evidenced in their statement that:

the majority of these women, when confronted with

the notion of a high risk of child mortality,

expressed the desire to have more babies to

increase the likelihood of uninfected children.

On being informed that the risk of perinatal

transmission may be as high as 30% or more, many

women drew attention to the 70% chance of having

an uninfected child. [p. 251]

Making this statement without exploring the reasons
women want more children is not only irresponsible, but also
carries the underlying message that women are ignorant and
unwilling to change, even when confronted with the fact that
they could infect their own children. There is no concern
shown here for the women. But there is evidence of what
Hunter refers to as a way of treating the "other in godlike
ways that assume authority over things we know little about
simply because we are not ‘the other’" (1990:689).

The correlation between being female and having a
higher risk for HIV infection is discussed in a study titled
"Knowledge, Attitudes, and Practices Concerning AIDS in
Ugandans" (Konde-Lule et al. 1989). This study found that

women were more likely to be infected than males

(12.5 % versus 8.8%, relative risk 1.42). Factors

significantly associated with HIV infection . . .

include multiple sexual partners, sexually

transmitted disease (STDs), injections, and being

female. [p. 513, emphasis added]

The authors go on to note that women are infected at an

earlier age than men. Since women’s period of higher risk

occurs "at the peak of their reproductive potential it has

 

32
profound implications for perinatal transmission and child
survival in Uganda" (p. 517).

Once again, women are conceptualized as reproducers.
Explanations for the fact that being female is a risk factor
for HIV infection are limited to the biological realm—that
is, a more efficient mechanism of transmission from male to
female, injections, or STDs. The question of why being
female is a risk factor is never addressed, much less
contextualized within a socially constructed framework
addressing hierarchical power relations, differential access
to and control of resources, and gender relations.

Another study by some of the same authors presents a
model of factors possibly contributing to higher rates of
infection in women. Especially interesting are their
speculations grouped under the rubric of behavioral
variables such as "females sexually active at younger ages;
prostitutes-one female infects many males; older/richer
infected males infect many females; and males have more sex
partners" (Berkley et a1. 1990:1240).

This set of variables is especially rich in what it
reveals or obscures about the authors’ ideas about gender
relations. A primary distinction between feminist and
mainstream epidemiological treatments of the topic is that
feminist approaches would probably raise different sets of
questions and thus provide different analyses. For example,

feminist anthropologists grounded in the culture and

33
political economic framework or in intersections analysis
would go beyond a mere listing of variables to attempt to
contextualize and explain their research in terms of
historically specific, social, economic, cultural, personal,
and political circumstances.

A blatant conceptualization of prostitutes as
reservoirs of infection (a commonly used term in the
epidemiological literature on AIDS in Africa) is revealed in
the researchers’ portrayal of prostitutes as infecting many
men. From a feminist perspective, the inclusion of a
variable indicating that older men are having sex with
younger women is important, but the question of why this
variable is epidemiologically, much less socially, important
is left unanswered by the authors of this study.

Also pertinent to an evaluation of this study are the
demographic variables identified by the authors, including
the possibility that "young men work[ing] in urban areas
share a limited pool of women" (p. 1240). The social
construction of the epidemic is hinted at in this model but
not fully developed. The statement that men share a limited
pool of women reveals the patriarchal nature of the
researchers’ conceptualizations about women and externalizes

and objectifies women by portraying them as objects to be

-r
/
‘-
./

shared. (Mr

The researchers also comment on women’s value as the

primary agricultural producers and caregivers in Uganda (p.

 

34
1241). Implications of the higher transmission rate in

women and the threat of a correspondingly large loss of
K

\ -~--~~.

producers is a valid point. It also can be viewed, however,
as reducing women to their "roles" as producers rather than
considering them as worthy of good health in their own
right. Women are doubly blamed in this study: first, they
are the carriers of the virus; and, second, they are the
caregivers of children. The authors note that an increase
in childhood mortality is expected even in children "who are
lucky enough not to be infected themselves" because mothers
sick with AIDS are unable to care for children (p. 1241).

Contrast the approach of Berkeley et al. with that of a
feminist anthropologist such as Brooke Schoepf. Schoepf’s
approach (19910), which is more fully discussed in the
section on feminist representations of AIDS in Africa,
emphasizes the sociocultural nature of gender relations,
notes the fact that epidemics arise in times of crisis (p.
14); and links the "macrolevel political economy with
microlevel sociocultural analysis" (1991c: abstract).
According to Schoepf, "gender focused research demonstrates
that epidemiology which ignores the social context of
disease spread cannot claim to be a scientific account" (p.
14).

As previously mentioned, the term "prostitute" is
included in nearly every study of AIDS in Africa. Yet, it

is very rarely defined. Prostitutes have been targeted in

 

35
AIDS prevention campaigns, and most studies include
questions about whether the males surveyed have had sex with
prostitutes (Adamchak et al. 1990; Berkeley et al. 1990;
Killewo et al. 1990; Wilson et al. 1989). Being a
prostitute and having sex with a prostitute are clearly
implicated in increased risk of HIV infection.

While the recent trend in the epidemiological
literature is away from the concept of high risk group to a
concept of high risk behaviors, the categorization of women
as prostitutes and consequent implicit blame placed on them
is an underlying theme in the literature. More informed
approaches incorporate a recognition that all people are at
risk for AIDS (Ankrah 1989; Bassett and Mhloyi 1991; Mann
1991). In this regard, Schoepf argues that:

the notion that AIDS can be contained among high

risk cohorts is illusory. It neglects the

socioeconomic conditions that oblige many women to

rely on sexual exchange for subsistence. It

avoids the fact that due to widespread infection

many spouses and other regular partners are at

risk. It neglects the social, psychological,

economic, and political motives for men’s

multipartnerism. [1991bz755]

The term prostitute is thus rarely problematized in the
sense that Dorothy Smith (1987) develops the concept, that
is, in the experiences of the everyday world. More situated
and meaningful representations might emerge if
epidemiologists made efforts to "develop a women’s analysis,

descriptions and understandings of their situation, of their

everyday world, and of its determinations in the larger

36
socioeconomic organization to which it is articulated" (p.
88) .

Feminist historical analyses also offer insight into
the social construction of commercial sex work. In writing
about prostitution in colonial Nairobi, anthropologist Luise
White defines it as a form of domestic labor, "that labor
which maintains and reproduces labor power that is consumed
daily in obtaining a wage . . . domestic labor exists only
in relation to wage labor" (1980:1). This definition, while
being entirely materialist, has the benefit of showing the
role of prostitution within the capitalist modes of
production and reproduction. As Sharon Stichter and Jane
Parpart point out:

The core question in the domestic labor debate had

been the relation of non-valoriosed labor to the

value of capitalist surplus value. The labor of

prostitution, on the other hand, is valorised

petty commodity production . . . . [1988:18]

Paola Tabet, writing about the economic determinants of
prostitution in Africa, draws attention to women’s
disadvantaged position in employment,{;tating few women have
enough education to access wage labor'(1988:204-226). In
the cities, women support themselves through petty commodity
production, beer brewing, or other small business
activities:2 Additionally, according to Tabet, "all women
can supplement their income or make a living entirely by

engaging in different kinds of sexual-economic exchange" (p.

206). Tabet stresses that this exchange lies along a

37
continuum from marriage to occasional or longer lasting
relationships and may or may not include domestic labor.
The utility of this definition, Tabet contends, is that "the
woman is giving sexual services and[;he man is paying, be it
in money, food, rent, clothes, or access to material
resources . . . :i](p. 206).

The preceding serves as a background for evaluating a
study titled "HIV Infection among Lower Socioeconomic
Prostitutes in Nairobi" (Simonsen et al. 1990) that found a
62% HIV seroprevalence rate among 418 womeE:1 This article
makes some good points and could be grouped in the
transitional category of epidemiological research. It
remains in this section, however, as an example of the
contradictions and challenges inherent in epidemiological
approaches to AIDS in Africa.(:The research is part of an
ongoing project to encourage peer education and AIDS
prevention campaigns among prostitutes in Nairobi that has
had some success in promoting condom usage among
prostitutes.fli

As inhmgst studies, the term prostitute is not defined.
The study does, however, m0ve beyond blaming prostitutes
(clients are now included as reservoirs of infection and in
need of AIDS prevention programs) to include the need to
recognize and change the conditions that result in women’s
engaging in sex work:

As prostitutes and their clients are probably a
major reservoir of infection and thus serve to

38

amplify the epidemic, strategies to decrease the
prevalence of prostitution in African cities and
to reduce HIV transmission among prostitutes and
their clients are urgently required. Such
strategies should include prevention education for
AIDS and STDs, STD treatment programmes, promotion
and distribution of condoms, and reduction of the
social and economic circumstances which create the
necessity for women to resort to prostitution. [p.
1441

One of the major risk factors for HIV infection
identified in this study was being from an area in Tanzania
that borders a high incidence region of AIDS in Uganda (p.
140). Unfortunately, the authors do not offer insight into
the role that migration plays in some women’s lives.

Contextualization of the possible connection between
being of Tanzanian origin and a significantly increased rate
of HIV infection can be drawn from feminist researcher,
Paola Tabet’s comments in an article subtitled, "Sexual
Service, Migration, and Repression in Some African
Societies":

fr _
'—//

{/Many women leave their villages because they are
i widowed, divorced or repudiated and have to find
some way to survive. Others go away because their
husband doesn’t provide for them. They migrate to
escape an intolerable marriage, to get out of the
control of their families, and/or to get economic

iautonomy. [1989:205] \

 

To summarize, this section has focused on the
representation of women in the epidemiological literature as
reproducers and prostitutes and, to a lesser extent,
caregivers and producers. An underlying conceptual thread
in this type of research is an image of women as passive

bearers of the virus, passive bearers of children, and

39

infectors of men and children. Very little attention or
concern is directed toward the multiply constructed and
socially situated experiences and meanings of AIDS in
women’s lives. Carovano (1991) argues that this splitting
of women into "mothers" and "whores" is based on women’s
relationships to others. Accordingly, "in the context of
AIDS these definitions reflect the needs of men and
children, and it is in their relationship to the
HIV-infected woman that she becomes a concern or a threat "
(p. 132). Much of the epidemiological literature on AIDS in
Africa supports Carovano’s suggestion that "efforts to
prevent AIDS among women have not been the result of a
concern for women, but rather a concern that is primarily
about protecting the health of men and children" (p. 132).

In contrast to epidemiological approaches that limit
their conceptualizations of women to their roles as
reproducers, producers, prostitutes, and caregivers, some
approaches may be classified as "transitional" in their

attempt to contextualize AIDS in Africa.

Transitional Representations of Women in the Epidemiological
Literature on Women and AIDS in Africa
Many challenges presented themselves during the process
of dividing the epidemiological articles into categories
based on what I interpret as their underlying

conceptualizations of women. I found myself constantly

40

referring to my list of feminist criteria and then searching
through the articles for any indication that the researchers
had even an inkling of how gender and class relations—amnfli
less, as Schoepf insists, macro and micro level political
economy—construct women’s experiences of the AIDS epidemic.

The articles included in this section also showI
evidence of conceptualizing women in their roles as
reproducers. A critical distinction, however, is that they
make an attempt to link women’s higher levels of HIV
infection and greater risk to the larger socioeconomic.
context. I choose to view this as an indication that the
social as well as the biological construction of the AIDS
epidemic is recognized by the researchers. The articles are
thus classified as transitional. By transitional, I mean
that they recognize, to varying degrees, the socially
constructed nature of the epidemic. Consequently, the
representations of women in these articles reflect at least
some awareness of the multiple experiences and meanings of
the AIDS epidemic in women’s lives as shaped by gender and
class relations.

I v The articles remain transitional because while they
satisfy one or the other of the feminist criteria, they
still retain the distanced, disembodied stance of the
observer. At times they report on women’s experiences of
the epidemic, but they do not start from those experiences

or work to transform and change the circumstances

41
contributing to the differential risks and challenges
confronting women in the AIDS epidemic in Africa because of
the intersecting inequalities of gender and class.

The first example of a transitional study is titled
"Human Immunodeficiency Virus Infection in Urban Rwanda"
(Allen et al. 1991). The authors treat gender as more than
a variable, focus their research on a group of non-high risk
women (that is, a representative sample of urban women as
opposed to a focus on prostitutes), and touch on the
importance of socioeconomic context. While relying on the
classic epidemiological paradigmatic tenet of classifying
women as "of reproductive age" (that is, in their roles as
mothers), the study reveals the importance of behavioral
variables attributable to women’s partners as well as women
themselves in creating risks for HIV infection.

Factors associated with higher rates of infection are
identified as: (1) not being legally married (common law
versus "legal" marriage); (2) sexual partnership of less
than seven years; (3) women having more than one lifetime
sexual partner; (4) a higher level of male partner income;
(5) higher levels of alcohol consumption in male partners;
(6) couples who had fewer than four children; (7) women who
had a history of venereal disease within the last five
years; (8) women who had received blood transfusions; and
(9) women who had non-menstrual bleeding with intercourse

(p. 1661).

42

The researchers speculate that the association between
decreased risk for HIV infection in women and legal
marriages and larger families "may be an indication that men
in legal partnerships and those having large families (the
average Rwandan women bears eight children) have fewer or
lower-risk extramarital partners" (p. 1662). No further
comment is provided on this observation.

Higher levels of male partner income correlate with
"[male] socioeconomic status as a strong predictor of
women’s risk for HIV infection" (p. 1661). Higher levels of
alcohol consumption are speculated to be associated with
"drinking done in bars where prostitutes are readily
available" (p. 1662). Unfortunately, this language
reinforces the image of prostitutes as dangerous reservoirs
of infection.

The authors offer the following explanation for the
correlation between marriages of less than seven years and
the increased risk of HIV infection for women:

Men in Kigali become sexually active several years

before taking a wife, and their sexual partners

during this time are a small group of "free women"

(often single mothers) who have many partners. In

this setting, men may acquire the infection before

marriage and transmit the virus to their wives.

[pp. 1661-1662]

They go on to note that the prevalence of HIV in a "pool of
‘free women’" in another Rwandan city was 88 percent in

1983. The authors conclude that given the patterns of male

sexual behavior prior to marriage and the incidence of HIV

43
infection in "free women . . . this would explain the high
prevalence of infection in wives whose partners had
premarital sex in 1982 or later" (p. 1662). This study
relied on women’s knowledge of their partners’ sexual
behavior. The depth of analysis and interpretation would
have been much improved if they had actually involved male
partners in the research.

While Allen et al.’s research offers important
insights, it is classified as transitional because of its
representational language and imaging depicting women as "of
reproductive age" and "pools of ‘free women’."
Additionally, it hints at, but does not fully explore, how
gender and class relations shape women's economic
vulnerability and consequent risks for HIV infection. The
researchers are cognizant of some of the socially
constructed aspects of the AIDS epidemic in Africa but
neglect to further explore them in their analysis.

A second example of transitional research is a study
titled "Knowledge of AIDS, Use of Condoms and Results of
Counseling Subjects with Asymptomatic HIV2 Infection in The
Gambia" (Wilkins et al. 1989). This study stands up well
under the variety of feminist lenses applied to
epidemiological research. It is classified as transitional,
however, for three primary reasons. First, despite a
clearer recognition of the socially constructed nature of

the AIDS epidemic than the majority of epidemiological

44

studies, gender is still treated as a dependent variable.
As Stacey and Thorne argue, treating gender as a variable
creates analyses in which "gender is assumed to be a
property of individuals and is conceptualized in terms of
sex differences, rather than as a principle of social
organization" (1985:307). Second, and more important, the
authors’ description of the research design indicates no
recognition of the different types of knowledge, and thus
analyses, that might have been produced had they chosen a
woman as well as a man as their interviewer/counselor of
both men and women. I am uncertain which of the factors
listed in the following quote determined the choice of using
only a male interviewer and counsellor in the project:
"married . . . practicing Muslim from a rural community with
4 years of secondary education and 10 years of experience as
a field assistant in epidemiological surveys" (p. 248)
Perhaps all of them were determinant. Thus, a third and
related point, is that while the authors identified the
interviewer/researcher’s social location, they failed to
comment on how his social location influenced his
interpretation of women’s experiences of the AIDS epidemic.

The study was conducted in a largely Muslim area of The
Gambia. Perhaps the researchers felt it would be more
appropriate for a male to interview and counsel women than
the reverse. Alternately, the interviewer’s level of

education and experience in working on epidemiological

45
projects could have been the deciding factor. It is also
possible that the gendered relations in The Gambia might
have limited the numbers of qualified female interviewers.

The researchers are especially sensitive to the
psychological stress (and its sequelae) experienced by
people upon receiving news that they are HIV positive.
Counseling techniques focused on "the need to try to convey
the information that was available rather than to be firmly
prescriptive about issues such as future pregnancies" (p.
248). While the counsellor suggested that partners be
notified of positive HIV serology, there was also a recogni-
tion of the possible adverse outcome of such a disclosure on
relationships (p. 248).

The authors clearly recognize the constraints not only
to negotiating AIDS prevention but also to carrying out
effective counseling strategies. They observe that:

the possibility of a free discussion of the

implications of seropositivity between subject and

partner(s) must depend on the nature and relative
importance of the economic, reproductive, sexual,

and emotional components of the relationship.

These are likely to vary between cultures as well

as between individuals in a given society. [p.

2531

Also articulated in the study are women’s fear of
rejection by their husbands and that, for some women, low
levels of education make them economically vulnerable
because there are "few economically viable alternatives to

marriage in many societies" (p. 255). The authors suggest

that even for women with higher levels of education,

46

the nature of society may sometimes make a

positive modification of behavior difficult; the

position of a single woman is such that

seropositive divorcees or the widows of men who

die of AIDS face very great pressures not to

inform a potential husband of their status. [p.

2551
This is also the first report I have encountered suggesting
that religious beliefs, in the sense of fatalism and
"acceptance of misfortune," might work against initiating
behavioral changes to reduce AIDS risk.

As previously indicated, the researchers’ attention to
gender and class relations is evident throughout their
report. In writing about and reflecting on their
representations of women I realize that this report
represents the most transitional approach of the three
articles included in this section. I am, however, troubled
by the authors’ concluding remarks that the lack of
behavioral change in couples with discordant serostatus
necessitates a rethinking of using counseling as a technique
in AIDS prevention programs because of counselling’s
"uncertain benefit" (p. 256). A feminist challenge to this
conclusion would be to further address the structural
factors that may mitigate against behavioral change and, in
so doing, suggest ways that women can reduce AIDS risk. In
addition, I am curious as to whether the results of their
study would have differed if both male and female

counsellors had been used.

Finally, a study titled "AIDS-related Knowledge, Sexual

47
Behavior, and Condom Usage among Men and Women in Zaire
(Bertrand et al. 1991) does an excellent job of recognizing
the importance of socioeconomic context, barriers against
women’s honest reporting of numbers of sexual partners, and
showing differences in women and men’s attitudes towards
perceived risk of infection (pp. 54-56). The authors make
several recommendations for AIDS prevention. For example,
they urge that AIDS prevention efforts "should reinforce the
idea that the two main means of protection from sexually
transmitted HIV infection and AIDS are total mutual fidelity
within monogamous couples and, where that is not possible,
use of condoms" (p. 57). As further discussed in the next
chapter, feminist approaches would emphasize that this type
of recommendation while biologically plausible is not always
sociologically plausible. Further, feminists using the
culture and political economic approach to anthropology
would stress the need to ground such recommendations in
analyses of the ways the socially constructed aspects of the
AIDS epidemic result in a multiplicity of experiences that
create challenges, but not absolute barriers to AIDS

prevention strategies.

CHAPTER THREE

FEMINIST REPRESENTATIONS OF WOMEN AND AIDS IN AFRICA

This chapter presents feminist challenges to mainstream
epidemiological approaches and representations of AIDS in
Africa. Some of the literature cited does not identify
itself as explicitly feminist. The question then becomes
what qualifies as feminist literature? I have not developed
rigid categorizations of feminist criteria. While some of
the criteria were presented in the introduction, they are
repeated here to remind the reader of the types of value
judgements I used in selecting material.

Literature included in this section had to first
satisfy at least one of Harding’s (1987) three criteria
(ideally all three) of what constitutes the best in feminist
literature. To review, these criteria include: (1)
recognition of and explicit representations of the socially
constructed aspects based in women’s experiences of the AIDS
epidemic; (2) locating the researcher and the researched in
the same social plane; and, (3) most importantly,
recognizing and making explicit the circumstances
contributing to women’s different experiences of the

epidemic and offer suggestions for change or transformation

48

49
of these circumstances. Second, implied in Harding’s
criteria is the requirement for an intersections analysis
approach to researching and analyzing AIDS in Africa.
Third, Schoepf’s (1992) feminist political economy and
culture approach of linking macro political economy to
gender and class relations at the micro level is an
additional criteria in looking for evidence of some
recognition of how these factors interact to create
different levels of experience and meaning in the AIDS
epidemic in Africa. Finally, Carovano’s (1991) insistence
that women need to be conceptualized in their own right
rather than being categorized by their sexual and reproduc-
tive capacities in relation to men and children provides a
further value-laden judgement.

One of the primary ways that these criteria are
addressed is through the evaluation of the types of
questions researchers asked. The previous chapter presented
a detailed critique of the epidemiological literature using
feminist lenses. That chapter focused more on the questions
epidemiologists failed to ask. My critique involved showing
how feminists might ask a different series of questions and
might search for different answers. Susan Hunter, in
writing about AIDS in Africa makes the observation that "the
way we define a problem and visualize solutions depends on
our world view, our political and social belief systems, and

our resulting purposes and motives" (1990:688). This

50
section presents selected examples of the types of questions
asked by feminist research on AIDS in Africa. Examples are
chosen to reflect the criteria outlined above.
Epidemiological literature that contextualizes the multiple
factors affecting women’s experiences of the AIDS epidemic
is included in this section along with explicitly feminist
approaches to the issue.

A rare example of an epidemiological study that
problematizes the AIDS epidemic and situates it in the
experiences of everyday life is an article focusing on AIDS
prevention and education for commercial sex workers in
Bulawayo, Zimbabwe (Wilson et al. 1990). What distinguishes
this research from other epidemiological studies on AIDS in
Africa is the authors’ attention to the socially constructed
determinants of the epidemic in the lives of commercial sex
workers. Unlike other studies, this one provides a
definition of commercial sex work and presents the
heterogeneity or demographics of sex work within the city.
Commercial sex work is described and analyzed within the
sociocultggal, economic, and historical contexts affecting
its production and reproduction. The study also describes
women’s economic vulnerability, as shaped by such factors as
labor migration and urbanization, that results in their
using sex work as an economic survival strategy. Rather
than classifying women as prostitutes and leaving it at

that, the authors ask questions about the women’s "life

51
histories," "the social organization of sex work," "motiva-
tion for behavior change," and "psychological responses to
the threat of AIDS" (pp. 610-615).

Salient examples of gender and class relations shaping
the AIDS epidemic include the fact that nearly one-half of
the women in this study were divorced, the majority had at
least one child, and that 98% of the women said that they
had started sex work to support themselves or their children
(p. 610).

The researchers’ awareness of social construction is
further revealed in their inclusion of occupational
categories reflecting the realities of poor women’s lives /
(e.g., whether employed in the formal or informal sector and
in what capacity). Further, women were asked whether they
would take another job if offered, and 91% responded that
they would (p. 611).

Feminist approaches of orienting research for women are
evident in the authors’ change of plan to include clients in
the study-flichange that was motivated by requests from the
women participants. As a result of this suggestion, clients
were interviewed and encouraged to attend AIDS education
focus groups. The authors note that research directed at
health interventions for high risk groups must include equal
attention to sex workers app their clients (p. 616).

The authors incorporate their recognition of the

negotiated basis of sexuality and AIDS prevention throughout

52

.w-MHIT‘“

their article. They identify the ultimate goal of AIDS
prevention as structural change ofwthe socioeconomic x/l
conditions putting certain groups of women at high risk (p.
615), but recognize the difficulty of implementing this goal
and offer a number of alternatives. Providing commercial
sex workers with the opportunity to work other part-time
jobs is suggested as a way of reducing women’s use of sex
work as a survival strategy. Income from another source
would enable women, in the authors’ view, to be less reliant
on clients and to have increased economic flexibility to
reject clients if they refused to wear a condom or had
visible genital ulcers. Building upon the strong social
networks among sex workers, the researchers recommend peer-
education counseling about HIV and AIDS risks. The authors
stress that encouraging all sex workers to insist that their
clients use condoms will, in essence, produce a united front
that will act against clients playing off sex workers
against each other. Reducing clients’ resistance to condoms
and involving sex workers’ boyfriends or partners in AIDS
prevention programs (sex workers frequently report not using
condoms with non-paying partners) also needs to be incorpo-
rated into AIDS programs. Finally, changing AIDS prevention
and education messages from those that instil fear (often
accompanied by feelings of "stigmatization, denial, and
fatalism") to those that empower is identified as crucial to

addressing the meanings and experiences of the AIDS epidemic

53
in this group of commercial sex workers’ lives (pp.
615-617).

An unusual opportunity to evaluate the types of
questions asked in an AIDS research project is provided by
the authors of a study titled "Knowledge, Attitudes, and
Beliefs about HIV Infection among Healthy Factory Workers
and their Wives, Kinshasa, Zaire (Irwin et al. 1991). The
questions asked in separate focus groups for men and women
are included in the article. The research was conducted as
a preliminary step in establishing an AIDS prevention
program at the factory. The authors’ awareness of gender
and class relations is evident throughout the article in
statements framing social, economic, and health care
inequities between men and women in this region of Zaire.

Particularly relevant to issues of social construction
are the questions asked about counseling of HIV-positive
individuals. For example, when asked "should the spouse of
the person with a positive test also be notified of the test
results?" (p. 921), more than one-half of the men stated
that they would not want their wives informed. Men are
reported as expressing fear of marital instability, which
they felt could be avoided by finding ways to avoid
infecting their wives. The majority of the women, on the
other hand, stated that they would want their husbands
informed of their test results. The authors explain this as

due to many women’s need for permission as well as money to

54
seek medical treatment. Most of the women indicated that
they would want to know if their husbands were positive "so
they could protect themselves from becoming infected,
initiate separation, or help their husband seek medical
care" (p. 921).

Questions asked under the heading "predicted social
dynamics of couples with discordant HIV serostatus" (p. 922)
are also revealing. When asked to predict potential changes
in a couple’s relationship if the husband was HIV+ and the
wife HIV-, the majority of women indicated that, "they would
stay with their husbands to care for him, but would refuse
to have sex with him or share the same bed" (p. 922).
Clearly, by predicting that they would abstain from sex, the
women surveyed express a fear of HIV infection. It is also
possible, in my opinion, that women’s unwillingness to
continue a sexual relationship with their husbands could be
interpreted as a sign of resistance to male control over
female sexuality and reproduction. The authors note that
not all women agreed that the couple would stay together.
Several women predicted that the couple would separate or
divorce. Reasons included the following:

the wife would not want to become infected, she

would believe her husband had been sexually

unfaithful, she or her husband’s family would urge

her to leave her husband, or she would want to

have children and could only do so safely with

another man. [p. 922]

When asked about the reverse scenario (HIV+ wife, HIV-

husband), men were evenly divided in their responses.

55

One-half stated that they would separate or divorce and the
other half stated that they would stay with the woman but
avoid sex. In contrast, a majority of women predicted that
the couple would stay together but abstain from sex.
Several women stated, however, that women might be accused
of having extramarital sex and be accused by the husband of
adultery, thus further underlining women’s vulnerability
through the "threat of being thrown out of the house, and
separated from her children or of being physically abused"
(p. 922) .

The patrilineal nature of many African societies means
that women are socially and economically dependent.
Further, in these societies, children belong to the
husband’s kin line. Many researchers (Bledsoe 1991; Schoepf
et al. 1991; Ulin 1992) stress that women express fears that
introducing the subject of a condom as HIV prevention into a
relationship is tantamount to risking divorce or rejection.
These fears are reflected in the responses of the men and
women surveyed as part of the research by Irwin et al. When
study participants were asked to anticipate what would
happen to children if a couple separated or divorced, most
people predicted that the children would stay with the
father or his family (1991:923). Answers to the questions
of how families would respond if they knew a couple had
different test results also reflect gendered differences.

In a scenario where the woman was HIV+ and the man HIV-,

56
most of the study participants predicted that the husband’s
family would react more strongly than the wife’s, including
"extreme anger, accusations of infidelity, demands for
divorce, and death threats" (p. 923). In contrast, there
was unanimous agreement that the husband’s family "would not
abandon him or refuse to care for him" if he were HIV+ (p.
923). A potentially important research direction that has
yet to be articulated in the literature is whether or not
(and how) women in matrilineal societies perceive the
relationship between risk of infection and risk of rejection
or divorce.

The study’s recommendations and implications for the
development of AIDS prevention programs emphasize the need
to empower both men and women in sexual negotiation skills.
The authors’ suggestions for further research demonstrate
their understanding of the complex nature of the AIDS
epidemic. As an example, they recommend research into the
possible conflict between the "high social value placed on
parenthood in Africa" (p. 927) and couples’ decisions to
have children even if one or both of the partners is
infected with HIV. Unlike the epidemiological report cited
in the previous section that fails to investigate the
connection between motherhood, potential economic security,
and women’s desire to have children, this study asks the
question: "would an HIV seropositive woman who relied on her

children’s father as her sole source of financial support

57
choose to have a child even if she knew the risks of
vertical transmission?" (p. 927).

This is a pertinent concern as shown in Carovano’s
(1991) essay. She cites the work of the AIDS Support
Network (TASO) in Uganda. TASO’s director, Noerine Kaleeba,
reports on one woman’s reasons "for not adopting measures to
protect herself from HIV despite recognizing her potential
risk" in the following manner: "Babies and condoms don’t go
together. Nonpenetrative sex is no sex at all for a man,
and it is a woman’s responsibility to bear a child" (cited
in Carovano 1991:135.)

The difficult challenges faced by women as a result of
the AIDS epidemic are also addressed by Marble Mageze in an
article titled "Against a Sea of Troubles: AIDS Control in
Uganda" (1991). Mageze is also associated with TASO, an
organization that has been instrumental in listening to,
involving, and empowering women as AIDS educators and peer
counsellors in Uganda. In asking the question of why women
are at greater risk for HIV infection than men, Mageze
argues convincingly that answers can be found in cultural
factors as well as gender and class relations. She points
out that "the social and economic status of women in a
male-dominated community means that they are more frequently
infected than men" (p. 305). She identifies this higher
rate of infection as linked to a variety of cultural factors

including prescriptions against women discussing sex in

58

public, imbalances in power relationships involving
negotiating changes in sexual behavior that might facilitate
AIDS prevention, and a double standard that allows men to
remarry but mandates that women should not remarry (p. 305).

The trend toward empowering women at all levels is
evident in Mageze’s statement that "the status of women
cannot be improved unless they are educated about their/
rights and empowered to use them" (p. 305). According to
Mageze, women who are HIV positive are faced with multiple
challenges. They are expected to be the family caretakers
and, as such, experience great concern for their children’s
future. Gender relations structure society in such a way i
that women are often economically vulnerable and their own i
and their children’s security is vested in the husband’s
family. Women whose husbands die of AIDS are at risk of
losing familial possessions through in-laws reclaiming them
after the husband’s death. Mageze notes that if a woman
dies first, the children are at risk for receiving
diminished care. The human side of the epidemic is
reflected in her statement that this combination of concerns
affects women both psychologically and physiologically.
Mageze identifies improvements in health care as an
essential prerequisite to effective AIDS prevention programs
and stresses the need for activism at the grass-roots level
to empower women to demand improved health and social

services (pp. 305-306).

59

Anthropologist Susan McCombie, in an article titled
"Beliefs about AIDS Prevention in Uganda" (1991), asks
whether it is only women who experience difficulty in
negotiating AIDS prevention. McCombie challenges the
portrayal of the woman as the only partner in a sexual
relationship fearful of introducing condoms as AIDS
prevention. When asked what they would say to a partner if
they wanted to use a condom and whether they felt it would
be difficult to do so, over one-half of the men and women
interviewed refused to answer the question, stating that
"they would never want to use a condom." McCombie points
out the importance of the fact that equal numbers of men and
women replied in this way. The same discomfort was revealed
by those who responded that it would be difficult to ask a
partner to use a condom. Both men and women, according to
McCombie, thus experience difficulty in negotiating AIDS
prevention.

McCombie provides excerpts from interviews with men who
"often state that it is women that do not want to use
condoms, because they see it as an accusation of infidelity
or an indication of lack of respect" (p. 7). I wonder about
the generalizability of these statements, but they are
germane to McCombie’s point and provide insight into
gendered relations in negotiating AIDS prevention.
McCombie’s inclusion of men’s voices is an important and

rare published example of situating men’s as well as women’s

 

60
experiences of the epidemic in the AIDS discourse.

The question of the need to empower men to change
gender perceptions and relations that encourage them to
treat women as subordinate is addressed by Maxine Ankrah
(1991) in an article focusing on the social aspects of
health and AIDS. In describing the disadvantaged position
of women in Africa, Ankrah states, "the multiple social,
economic, and cultural burdens carried by the African woman
of childbearing age, much more than her choice of sexual
behaviors, may pose the major threat to her health" (p.
971). Empowerment for women is a vital part of AIDS
prevention, but according to Ankrah, given the gender-based
inequities in social organization that put women at higher
risk, men too must be empowered to change. Ankrah argues
that there is a general level of fear in addressing African
men about their sexuality and attitudes towards women as
subordinate beings (p. 922). While the following excerpt is
lengthy, I include it in its entirety for its unusual
approach to suggesting that men as well as women must be
empowered and for its emphasis on the need for change of
gender relations in developing increased AIDS awareness and
prevention:

In understanding the family and male-female

relationships there is a need and an opportunity

to reorder perceptions and actions. In

particular, the critical problematic of

male-female relationship and its impact on the

spread and control of AIDS need to be re-examined.

Additionally, the concept of maleness which hinges
on the subordination of women must be exposed so

61

that the danger such subordination poses to

society in terms of facilitating the spread of

AIDS can be realistically investigated. Male

sexuality should be studied in depth as a matter

of priority for clues as how to best bring about a

more rapid change in male attitudes and behavior.

The concept of empowerment may be viewed as a

strategy to reinforce efforts of the African male

to new perceptions of his female partner—as an

equal and as a collaborator in a renewed struggle

to preserve life in the Africa region rather than

as an inferior person. The empowerment of men is

expected to be a function of enactment of laws; it

should result from new forms of education, defined

broadly as socialization. [p. 978]

In "Women and AIDS in Zimbabwe: The Making of an
Epidemic" (1991), Mary Bassett and Marvellous Mhloyi
question mainstream approaches to researching and
representing women and AIDS in Africa. Using an approach
they identify as "the political economy of family
structures" (p. 149), the authors trace historical,
political, cultural, and socioeconomic factors contributing
to the types of familial change that put women at higher
risk for AIDS. Here I attempt to outline their formulation
to demonstrate how it contextualizes the development of AIDS
in a significantly different manner than does mainstream
research.

The links between political economy and the gender and
class-based construction of the AIDS epidemic also form the
cornerstone of Brooke Schoepf’s arguments, which are
presented below. Like Bassett and Mhloyi, Schoepf presents
a description of the multiplicity of factors contributing to

poor women’s increasing economic vulnerability and to the

 

62
spread of AIDS in Africa. Here I will summarize these
changes, relying principally on Bassett and Mhloyi as a
reference point. While there are variations in the
description of change provided by Bassett and Mhloyi based
on historically, geographically, and cultural specific
factors, similar processes have been noted by many authors
(Burja 1986; Hansen 1989; Mbilinyi 1989; Obbo 1980; Parpart
1989).

According to Bassett and Mhloyi, colonialization
created forced male labor migration and a cash economy, as
well as a hut tax based on a cash payment. The authors note
that prior to colonization, patrilineal societies had a
standard dictating that while men did not necessarily have
to be sexually faithful to their wives, they were
responsible for financial support of women and children (p.
149) .

A woman’s economic security and rights were vested in
her husband’s family, although she did have the right to
remuneration for her "own handiwork, to plots on which to
grow family food, and to certain gifts of motherhood" (p.
149). The combination of enforced changes in family
structure as a result of colonization, European patriarchal
ideology, and existing systems of patrilineal organization
resulted in the reduction of women’s traditional rights.
Bassett and Mhloyi note that "[women] were reduced to

perpetual minority status in the guardianship of either

63
their fathers or their husbands" (p. 149). The authors
highlight the difference between ideology and reality in
observing that, in the early 19805, about one-half of the
rural households were headed by women (p. 149). They point
out, however, that "responsibility does not translate into
control" (p. 149) and that women’s access to and control of
resources in Zimbabwe remains limited. The separation of
families as a result of male labor migration resulted in
changes in sexual relations including men’s "form[ing] other
liaisons in towns" (p. 150). The impact on women left
behind in rural areas was profound, with the possibility
that town relationships "might even supersede the rural
wife, leading to divorce or a reduction in remittances" (p.
150). The loss of material support from town-based husbands
significantly increased rural women’s economic vulnerability
(p. 150).

Patterns of multiple relationships that emerged in
urban settings should be distinguished from traditional
polygamous relationships. What Bassett and Mhloyi term "the
artificial settlement of men without their families"
resulted in changes "in where both men and women live as
well as in their patterns of sexual interaction" (p. 150).
While women were initially prohibited from urban migration
both legally and by the lack of employment prospects, some
women in fact migrated to "meet the demand for sexual

services" created by the separation of families. Bassett

64
and Mhloyi connect the longstanding cultural stereotyping of
urban women, especially single or divorced women, as
equivalent to prostitutes to a contemporary focus on
prostitutes as a high risk group in AIDS control programs
(p. 150).

Given the historical conditions that have contributed
to women’s economic vulnerability and changes in family
structure, Bassett and Mhloyi contend that the "exchange of
sex for money or for other goods and services covers a broad
range of arrangements" (p. 150). The scope of reasons women
exchange sex for money includes mothers’ needs to pay school
fees and provide material necessities for themselves and
their children. Additionally documented is the pattern of
"younger, even . . . school age" women receiving money for
sex from older men, seasonal women laborers supporting
themselves in the off season by selling sex, and employed
women "forced to exchange sex for job security" (p. 150).
The authors point out that the exchange of sex for money is
not limited to urban areas. For example, rural areas at the
crossroads of major transportation routes are also the sites
of this means of survival strategies for women (p. 151).

As reflected by the above evaluation, Bassett and
Mhloyi build a strong argument for the connection between
women’s subordinate position in patrilineal African
societies and their correspondingly greater risks for HIV

infection. According to the authors, women’s subordinate

 

65

position makes it difficult for them to initiate AIDS
prevention. Consequently, they note that "for many women
faced with dire poverty on the one hand and the risk of HIV
on the other, the choice becomes one of ‘social death’ or
biological death" (p. 146). Bassett and Mhloyi also
question and challenge mainstream treatments of women as
vectors and vessels. They note that the emphasis on "high
risk groups" such as prostitutes has created the mistaken
representation that without women there would be no AIDS
epidemic (p. 146). Further,

if not depicted as a dangerous source of

infection, women are of interest to those

conducting AIDS research or designing

interventions mainly in their pregnant state . . .

the image of women becomes one of a contaminated

vessel bearing condemned babies . . . . This

reinforces the notion that the mother is solely

responsible for the child’s serostatus. [p. 146]

Bassett and Mhloyi move beyond stating the obvious
reality that women are caregivers in African society to
consider this social fact in the everyday experiences of
women’s lives. In other words, they do not leave it at a
simple statement of decontextualized "facts" or statistics.
They point out the strain that the role of caregiver places
on women not only in caring for others but in trying to care
for their own health as well. They ask the important
question of whether traditional coping mechanisms within the
family can be sustained under the pressures of having one or

both parents sick with AIDS and the possibility of sick

children. Women’s caregiving responsibilities take on a new

66
light when framed in this manner.

i

The authors argue that "efforts to increase women’s
options" must be built into AIDS prevention and education V
strategies (p. 147). One of these options must be the
recognition of the importance of motherhood in Africa and
the need for women-controlled AIDS prevention technologies.
The complexities of the motherhood-womanhood-economic
security triad, as well as the fact that many women want to
have children, creates the need for AIDS prevention methods
that prevent infection but also "possibly permit conception"
(p. 154). This is one of the few articles that identifies
the social location of the authors. In this instance, they
are involved in providing health care to women in Zimbabwe.
From this perspective, they observe that "no one involved in
the caring for HIV-infected women in Zimbabwe, and
presumably elsewhere, can fail to be struck by the limited
opportunities that women have in negotiating their sexual
relations" (p. 146).

As mentioned previously, Brooke Schoepf (and her
colleagues) have written extensively about the socially
constructed basis of the AIDS epidemic in Africa as shaped
by the interaction of political economy and gender and class
relations (1991a; 1991b; 1991c; 1991d; 1992; and Schoepf et
a1. 1991). This work strongly challenges and questions
mainstream research on AIDS in Africa, as reflected in the

statement that "the classic epidemiological paradigm of

67
interacting host, disease and environment provides a
part-truth which serves to obscure more complete
understanding" (1991a:754). As opposed to simplistic
recommendations that ignore the realities of women’s lives
that shape challenges to AIDS prevention, Schoepf et al.
observe that "increased knowledge is necessary but seldom
sufficient to change behavior" (1991:189). At every point,
she and her colleagues are involved in basing their search
for why women are at greater risk for HIV infection in the
experiences of people’s (most particularly women’s) everyday
lives. Schoepf’s work—alone and with her colleagues—is
presented as the last example in this chapter because it
satisfies the vast majority of the feminist criteria
established as evaluative judgements for literature reviewed
in this thesis. It is particularly strong in basing
research in the experiences of women and in working toward
transformation or change of socially constructed risk
factors for AIDS in women’s lives.

Schoepf identifies her research approach as "cultural
politics," meaning an approach "used to frame the context in
which a biologically and socially constructed epidemic is
endowed with meaning by actors variously situated socially"
(1991d:9). The research produced by Schoepf and her col-
leagues is based on research conducted by members of
CONNAISSIDA, an action-oriented AIDS research project in

Zaire over a five-year period from 1985-1990. This group
sought to develop a broad understanding of the

68

spread of HIV infection and ways that AIDS is

perceived and reacted to by the population--the

cultural construction of AIDS. In the process,
researchers worked with informants to develop
culturally appropriate means of limiting the

epidemic. [Schoepf et al. 1991:2]

Like Bassett and Mhloyi, Schoepf stresses the

reshaping of women’s lives differently from those

of men in the process of incorporation in colonial

capitalism . . . . Women’s poverty, their family

responsibilities, their lack of access to

resources and inability to negotiate in sexual

relations are central to HIV spread. [1991bz791]

Schoepf et al. (1991) expand on Bassett and Mhloyi’s
formulation of the political economy of family structure to
situate the AIDS epidemic in the word economic crisis. They
state,

throughout the continent, poor women and children

have experienced most severely the effects of

structural adjustment policies and the deepening

[economic] crisis. In Zaire as elsewhere in the

region, economic crisis and the structure of

employment inherited from the colonial period
contribute to the feminization of poverty and

consequently to the spread of AIDS. [p. 190]

Schoepf, as previously mentioned, links poor women’s
economic vulnerability and increasing inability to earn
income in the informal sector to their use of sexual
exchange as a survival strategy—«durum because of the AIDS
epidemic, has transformed into a potential "death strategy"
(1991d:9). Multiple partnerships are common in Africa for
both men and women, according to Schoepf and her co-authors
(1991). In this regard, they observe that "it is the fact
of multiple partners, rather than the type of relationship,

however socially categorized and labeled, which puts people

69
at risk" (p. 192).

Schoepf (1991d), uses case studies as "vignettes [that]
lend texture to epidemiological data" (p. 27). The use of
case studies eloquently reveals the many experiences of the
AIDS epidemic in women’s lives. At the same time, they also
reveal how the larger political economy constructs different
experiences of the AIDS epidemic based not only on gender
but also class. According to Schoepf (1991d), the
challenges to women negotiating AIDS prevention are "social,
psychological, and material":

Most women are at risk because their economic and

social powerlessness in the overall organization

of Zairian society and their subordinate position

to men circumscribes their options. Few are able

to practice safer sex. Some do not feel able to

open dialogue with sexual partners on the subject.

Others who have attempted to do so have

experienced rejection and retaliation. Those who

have reduced their risk are women with decision-

making power based on their capacity to support

themselves and their dependents without resort to

sex within or outside of marriage. [p. 28]

In an article titled "Gender, Power, and Risks of AIDS
in Zaire" (1991), Schoepf and her colleagues describe AIDS
risk—reduction workshops conducted by CONNAISSIDA in Zaire
as based on the concept of experiential training.
Experiential training is described as "begin[ing] with the
principle that people already know a great deal about their
situation" (p. 193). The focus is on empowerment, which is
situationally defined as "the capacity to control risky

situations" (p. 192). Two examples of workshops conducted

are provided—one with sex workers and another with a group

70
of churchwomen. Schoepf and her colleagues describe the
steps in the training process and the different, but
overlapping, experiences of the AIDS epidemic as well as the
empowerment needs among these two divergent groups of women.
Role playing, demystifying condoms (e.g., "demystifying what
is an unfamiliar, uncongenial, unnatural, unwanted foreign
technology"), and situating AIDS prevention in a broader
community and health context are key elements of the
CONNAISSIDA approach (pp. 194-196).

The collaborative nature of the action-oriented
research process is reflected in the fact that both the sex
workers and the churchwomen requested additional workshops.
The sex workers asked for peer counseling training. The
churchwomen asked for workshops for "husbands, adolescents,
and young adult members of their households" (p. 200). The
authors note that "the most pressing need identified by both
women’s groups is for income-generating activities so that
women who cannot depend upon men to support them and their
children can survive without providing sexual services to
multiple partners" (p. 200).

Finally, this study concludes with a classic feminist
statement:

AIDS prevention is both personal and political . .

. . In the final analysis, effective AIDS control

in Africa will require changing the economic and

social status of women. Women’s economic

independence, their personal autonomy, and their

control over interpersonal relations, including

the power to negotiate sex, must be increased in
order to stop AIDS. [pp. 202-203]

 

71

Schoepf’s work can be classified as standpoint
thinking, major conceptual pieces that give new explanations
and advance theory (Baca Zinn 1992). According to Baca
Zinn, feminist theorizing consists of integrating the
multiple hierarchical systems of inequality such as gender,
race, and class into explanations that: (1) open the concept
of gender to analyses of historical, cultural, and
structural differentiation; (2) see gender relations as a
part of the myriad of social relations in any society; and
(3) think about gender as being inseparable and
interconnected, that is, intersected with other forms of
inequality (1992). The work of Schoepf and her co-authors
satisfies all these requirements.

Further, the research of Schoepf et al. meets the

operating guidelines for feminist research used as criteri

I
in this thesis. They may not achieve the "ideal" of ’

reflexivity, that is, giving voice to her (or their)
experiences of the research process and how they are shaped
by and shape the interpretations achieved. They do
identify, although they do not reflect on, their own social
location. The research is collaborative, emphasizing the
redistribution of power and making the research relevant to
the communities studied. The research process of
CONNAISSIDA and the intent of their approach is summarized
by Schoepf as:

The process of constructing a contextual framework
to situate sexual behavior involves listening to

 

 

72

people in many different social locations.

Experience with participatory risk assessment

shows how ethnography can build upon local social

knowledge, concepts, and organizations to develop

a consensus in support of risk reduction. When

those who are at risk play an active role in the

research process, culturally constructed meanings

can be shared and changed. [1991d:15]

In summary, the approach of Schoepf and her colleagues
to community based action research can and should provide a
model for transforming current mainstream approaches to AIDS
research and prevention into approaches more inclusive of
the socially constructed realities of the AIDS epidemic in

Africa.

CHAPTER FOUR

INTERNATIONAL AND UGANDAN AIDS CONFERENCES

In 1992 I attended international and Ugandan AIDS
conferences and spent five weeks in Uganda as a part of
predissertation research. These experiences allow me the
opportunity to more fully contextualize the insights of this
thesis. My goal is to demonstrate whether and how the
arguments I have presented are reflected in the
international, national, and local levels of AIDS discourse
and praxis. The chapter is divided into two sections. The
first presents my reflections on information from the VIII
International AIDS/STD Conference in Amsterdam. The second
addresses issues raised at a conference on women and AIDS in

Kampala, Uganda.

VIII International AIDSlSTD Conference
The sessions at the VIII International AIDS/STD

Conference in Amsterdam in July 1992, were divided into four
tracks: (1) basic science; (2) clinical care and science;
(3) epidemiology; and (4) social impact and response. I
attended several of the epidemiology sessions and a large

number of the social impact and response sessions. As will

73

 

74
be shown below, there is a gap in the direction and content
of the research and analyses produced in these two tracks.
Speakers at the opening ceremony articulated a need for more
fully contextualized accounts of the AIDS epidemic. Despite
this, the epistemological differences in how knowledge is
produced and what counts as knowledge remains a profound
line of demarcation between researchers in the epidemiologi-
cal and social impact and response tracks.

Since I attended only a few of the epidemiology
sessions, my interpretation of the nature of the
epidemiology track as a whole is obviously very partial. In
the sessions I attended, the epidemiological context was
presented, but not the other range of contexts—social,
political, cultural, economic—identified in this thesis as
important to the construction of more representative
analyses of the AIDS epidemic. An important exception to
this, however, was the session on "Epidemiology of HIV in
Women", where a prominent AIDS researcher from Kenya,
Elizabeth Ngugi, and her co-presenters stressed all these
contexts as important to understanding the epidemiology of
the AIDS epidemic.

Women with HIV/AIDS, as well as women researchers and
activists from around the world, were very active both in
contributing to and being a presence at the conference. The
participants at the first international pre-conference

titled, "Workshop for Women Living with HIV/AIDS," developed

75
a list of statements concerning the needs of women living
with HIV/AIDS globally. The list of statements, which is
included here as Appendix I, reflects the diversity of needs
and concerns of women from both developed and developing
countries.

One of the most moving and powerful parts of the
international AIDS conference occurred when 33 HIV-positive
women from different countries filed in front of the eight
to ten thousand delegates at the opening ceremony. Each
woman identified herself by her country and by the fact that
she was an HIV-positive woman. Every third woman read one
of the statements on the list of needs developed by the
women living with HIV/AIDS workshop. I interpret the power
of these women’s actions as linked to their purposes of
making women with HIV/AIDS visible to the international
research community, speaking with their own voices, and
making their needs known.

At a follow-up session to the international pre-
conference, those attending agreed to raise the issues on
the pre-conference list of statements at each of the
sessions we attended at the larger international conference.
Our purpose was to alert the international community to the
differing meanings, experiences, and needs of women living
with HIV infection and AIDS. People attending the follow-up
session were given copies of the "Women Program Guide,"

which is included as Appendix II. The Women Program Guide

 

76
supplemented the official international AIDS/STD conference
guide and highlighted conference sessions devoted to women’s
issues.

An example of AIDS research protocol that was
challenged repeatedly by women attending the epidemiology
sessions was the non-inclusion of possible gynecological
manifestations of HIV infection and AIDS in women. At the
time of the international AIDS conference, the clinical case
definition of AIDS was based on the manifestation of
symptoms in men. This can, in part, be explained by the
fact that the clinical case definition is based on the
development of AIDS in homosexual men. In an
epidemiological session on "Gender-Related Variations in
Natural History," gender was repeatedly referred to only in
the biological sense (as in male or female) by all but one
of the presenters. All but the last presenter treated
gender as a variable; no gender-related differences in the
natural history were discovered because the researchers
relied on a male-based clinical case definition of AIDS in
their research of HIV infection. This approach does not
allow for recognition of gender-variations since the
research design itself precludes the possibility. In the
final presentation of the session, the social construction
of gender was acknowledged and made a central part of the
research design and analysis. The presenter of that paper

placed a great deal of emphasis on how variations in the

77
social construction and meaning of gender has the potential
for increasing women’s risk of HIV infection.

The question and answer portion of that session was
taken up by challenges from the women present (to all but
the last researcher) asking why gynecological symptoms, such
as cervical dysplasia (a pre-cancerous condition), have not
been included in either the WHO or the CDC (Center for
Disease Control) clinical case definition of AIDS. In
answer to the presenters’ circular reasoning that possible
indications of AIDS in women were not included in the study
because they are not part of the case definition, the women
who were posing questions asked whether the international
research community realized the implications of their
exclusionary practices. For example, if gynecological
symptoms that might be indicative of a progression from HIV
infection to AIDS are not included in the case definition,
then women are effectively excluded from AIDS research
programs. They can not receive government-sponsored
financial support for treatment of AIDS if they do not fit
the definition of what constitutes, in epidemiological
language, an AIDS "case."

This example demonstrates the epistemological drawbacks
to creating definitions of social (and physical) reality
based solely upon the experiences of men. Perhaps as a
response to the challenges brought by women at the

international AIDS conference, the CDC recently announced

78
that they changed their clinical case definition of AIDS to
include gynecological manifestations such as invasive
cervical cancer.

The majority of the arguments set forth in this thesis
were strongly reinforced in the presentations at the opening
ceremony and in the Social Impact and Response Sessions that
I attended. Many of the presentations stressed that
biomedical, socially decontextualized approaches to AIDS
research, care, and prevention are inadequate to the task of
responding to the epidemic. Jonathan Mann, former head of
the WHO Global Programme on AIDS and Conference Chairperson,
stated in his opening remarks:

It is necessary to change our current vision of

AIDS because it is outdated . . . . The basic

issue before us is . . . how we see AIDS, how we

understand it, what we think it is really about—-

determines both what we do about it and how

successful we will be. . . . societal inequity and

discrimination fuel the spread of the pandemic

. . . to be effective against AIDS we would have

to address these issues. [1992:5-6]

Mann went on to note the importance of situating AIDS
prevention and care efforts in lessons "grounded in the
experience, knowledge, and lives of people [living with
HIV/AIDS] worldwide" (p. 6). He did not explicitly frame
his comments in intersections analysis or the feminist
cultural and political economic framework. Nonetheless, the
following excerpt reflects aspects of these feminist

frameworks for approaching AIDS research:

HIV exploits societal weaknesses, and the major
fault lines in society along which it proceeds are

79

those of inequity and discrimination: belonging

to any marginalized or stigmatized social group

creates an increased risk for HIV infection as

well as an increased risk of receiving inadequate

care and support. Therefore, to approach the

individual as if her or his behavior was

independent of economics, culture and politics—or

independent of human rights and dignity—wouhibe

to deny the reality we know. [p. 6]

Women’s increased vulnerability to HIV infection due to
social, economic, political, and cultural factors surfaced
as a dominant theme at the conference. Eka-Esa Williams,
president of the Society of Women and AIDS in Africa, stated
in her comments at the opening ceremony that two out of
three people diagnosed with HIV worldwide are women. She
attributed this to social factors of poverty,
discrimination, and the subordinate status of women around
the world.

Many of the Social Impact and Response sessions focused
on factors that constrain or enable people to negotiate a
reduction in their risk of HIV infection and AIDS. The
authors of the Conference Summary Report of the Social
Impact and Response Sessions observed that the focus of AIDS
research is slowly shifting from the individual to the
societal level. Specifically, the "blame for HIV
acquisition and transmission [has been] shifted away from
the individual, onto the underlying structures that limit or
prohibit choice in decision making" (van den Boom and Gostin

1992:34).

The issue of women’s economic dependence was raised

 

80
repeatedly at the sessions, particularly by women
researchers and activists from the Third World. Considering
the "socio-cultural context as a possible risk context in
which people exist and have to survive" leads to a
recognition that women’s economic dependence and unequal
relationships of power between men and women put women at
greater risk of acquiring HIV (p. 35).

The multiple meanings and experiences of the AIDS
epidemic as structured by gender, class, race and so on were
reflected in the titles of some of the sessions: "Gender,
Power, and HIV; Barriers to Condom Acceptance; Prevention
Programs for Women; Making Choices: Women, Reproductive
Rights and HIV; Women’s Access to Prevention and Care;
Changing Male Heterosexual Attitudes and Behaviors;
Empowering Heterosexual Women; and Intravaginal STD/HIV
Prevention Technology Controlled by Women."

Participants in the session on prevention programs for
women stressed that current recommendations for reducing
risk of HIV infection—reduction in number of partners,
condom use, and asking your partner’s sexual history—eUJ.
ignore the reality of gender and power relationships.
Condoms, as was noted in this and other sessions, are a male
controlled technology; women have to rely on the cooperation
of their partners in order to reduce their risk of HIV
infection. Women activists and researchers thus called for

increased research into HIV prevention methods that are

81
woman controlled. The need for a viricide that is not a
spermicide was suggested as a possible solution to the
dilemma that many women face in choosing between HIV preven-
tion or contraception.

Finally, as in many of the feminist analyses and
critiques presented in this thesis, there was a call in the
Social Impact and Response Sessions for greater attention in
research and prevention programs to the many difficult
decisions that women are confronted with when trying to
reduce their risk of HIV infection. Researchers and
activists from both developing and developed countries
insisted that the meaning of motherhood in societies that
may only define women as women when they have one or more
children needs to be more explicitly recognized. As
previously noted, asking a woman to use a condom for HIV
prevention means that you also ask her to contracept. In
societies that place a heavy emphasis on women’s
childbearing, women who have been informed of the high rate
of perinatal HIV transmission may still choose to have
children. Papers presented on this topic stressed that
women’s decisions about HIV prevention have to be seen

within specific cultural contexts.

82
Mobilization Workshop for HIVlAIDS Prevention,
Control. and Patient Care for Women Leaders

In many ways, the conference that I attended in Kampala
on women and AIDS in Uganda addressed issues of the cultural
determinants of HIV risk for women more than the
international conference in Amsterdam. Sponsored by the
Uganda chapter of the Society for Women and AIDS in Africa
(SWAA), the conference was titled "Mobilization Workshop for
HIV/AIDS Prevention, Control, and Patient Care for Women
Leaders." Attended by women leaders of the 35 districts of
Uganda, as well as by other individuals and organizations
involved in AIDS research, the conference had a number of
goals. The first goal was improving education and awareness
about HIV, AIDS, and STDs with particular reference to
women. This goal was directed at improving attendees'
ability to communicate this information to people in their
respective districts. The second and third goals directly
reflected many of the issues highlighted in this thesis:
specifically, to "explore and discuss gender issues/roles
pertaining to HIV transmission and care of people with AIDS;
and to foster a more creative approach to community
participation and income generating projects" (SWAA 1992).
The fourth goal encompassed district leaders making plans
for community based care projects within their districts.

The tone and focus of this conference was substantially

different from those of the Amsterdam conference. While

 

 

83
there were many presentations by expert AIDS educators,
counselors, activists, and researchers, the organizers of
the conference stressed that it was the women themselves who
were the experts on issues of gender, power, and HIV/AIDS.
In this sense, the organizers followed the feminist
standpoint principle of doing research, for and with women.
A recognition of the different forms of knowledge and
knowledge production was also a key aspect of this
conference. Participants expressed and shared their
knowledge, creating a dialectical exchange and creation of
knowledge among attendees, presenters, and conference
organizers.

One of the most memorable examples of this dialectical
exchange occurred during a session entitled "Traditional
Practices that Put Women at Risk of HIV Infection." The
group facilitator, is an AIDS counselor and trainer with The
AIDS Support Organization. Rather than telling the confer-
ence participants what traditional factors increase risk for
HIV infection, he recognized the women’s expertise and
knowledge and proceeded within that framework. The
participants were first asked to define culture. A variety
of explanations were offered, but the following four items
were agreed upon: (1) group behaviors found among certain
people in a community; (2) behaviors accepted by the group;
(3) such behaviors were described as entailing practices,

beliefs, religion, values, customs, morals, and attitudes;

 

84
and (4) it was noted that different tribes in Uganda each
have different cultural behaviors.

Conference participants were then asked to name
cultural behaviors that put women at risk for HIV infection.
A very long list, with contributions from each district, was
developed. There was some overlap in the behaviors listed.
From an anthropological viewpoint, one of the most revealing
aspects of the process was the exclamations of surprise when
cultural behaviors identified by participants from the
different districts fell outside the realm of individual and
collective (as in being a member of a tribe with a
particular set of cultural behaviors) experience. For
example, rape—defined by a conference participant as women
having to "play sex" against their will—was identified as
occurring in her tribe or culture. This led to outbursts of
surprise by conference participants from other tribes. I am
using the term tribe, rather than other anthropological
constructs of ethnic and cultural identity, because it is
the term the participants themselves used to describe one
aspect of their social identity.

I am including the majority of the list developed by
conference participants to provide an example of how culture
(in the form of ethnicity), as well as gender and class
create different meanings and experiences of the AIDS
epidemic for women (and for men). Polygamy, wife

inheritance, ritual cleansing of widows, and the fact that

 

 

 

85
women do not have control over their own bodies or sexuality
were at the top of the list. The lack of control over their
bodies and sexuality was listed and relisted. As one
participant stated, "women are expected to play sex whether
they want to or not." Women’s lack of knowledge about HIV
and AIDS also contributes to increased risk, as do religions
that prohibit the use of condoms. Marriage rites among some
tribes that encourage the prospective groom to "play sex"
with a maternal aunt were euphemistically phrased as
"marriage initiation ceremonies." Ceremonies such as
funeral rites and twin ceremonies were identified as times
when many people "play sex."

Definitions of womanhood that define women as women
only if they have children were also characterized as
contributing to the spread of AIDS. Women who are unable to
conceive with their partners might engage in "child seeking
behavior" with other men, which puts them at risk for
infection. The fact that prevention of HIV means prevention
of births was agreed upon by all as "women's dilemma."
Forced marriages, in which there is no HIV testing prior to
the marriage, was also mentioned by several district
representatives.

The double standard that allows men, but not women, to
have extramarital partners, and women’s perceived inability
to control their partners’ behavior were identified as major

risk factors for infection. Some districts have

86
discriminatory divorce laws, preventing women from seeking
divorce to protect themselves. One conference participant
stated that in her district, men only have to prove adultery
in order to be granted a divorce, whereas women have to
prove cruelty and desertion.

According to several of the women’s leaders, women’s
lack of control over their own sexuality leads to limited
foreplay. The resulting vaginal trauma and tearing due to
"dry sex" increases the risk for HIV infection. An example
of how placing women at the center of research can lead to
new forms of knowledge was provided by one participant’s
observation that female circumcision also creates the same
effects and consequences for increased infection.

This contribution was particularly striking because in
all the reading that I have done on risks for HIV infection,
I have never encountered this observation in the literature.
Female circumcision is often identified as a risk factor in
terms of unsterile instruments, for example, but not in
terms of the ways that it changes women’s sexual experience
and thereby potentially increases the risk for HIV
infection. One of the conference participants brought up
the topic of oral sex as a cultural behavior that puts women
at risk for AIDS. This led to a long and frank discussion
about what oral sex is (many of the participants were
unfamiliar with the concept). Several participants asked

how oral sex was done. The participant who identified it as

 

87
a cultural behavior attempted to explain it, but was
interrupted several times by outbursts of disapproval by
other attendees. When the session facilitator explained how
oral sex is performed he described it as something that is
done between "two women having oral-genital contact in the
69 position". He did not include the possibility of women
and men having oral sex in his definition. This led to more
exclamations of disapproval and the ice-breaking question
from one conference participant of "if 69 is the number for
two women having oral sex, what is the number for two men
having oral sex?" To which another participant replied,
"99". I am including a detailed description of this
particularly contentious contribution to the list to show
the ways that sexuality is filtered through individual and
collective lenses that are structured by social relations.
It also challenges cultural stereotypes that contend that
Africans find it difficult to talk about sex. As
illustrated in this example, not only did the women at the
conference talk frankly about oral sex, they did so with
humor.

The issue of oral sex led to heated debate about what
constitutes cultural behaviors. There was disagreement
about whether oral sex, which most agreed is an imported
behavior, is really part of Ugandan culture. The conference
participants were fairly evenly divided between

acknowledging that it is a part of culture and arguing that

88

such an obviously imported behavior cannot be considered to
be a cultural behavior. This is an example of how people
View certain behaviors as part of their own cultures, as
part of other cultures in the country, or as so foreign that
they could not be part of the perceived larger indigenous,
or Ugandan culture. There are implications for AIDS
prevention of this dichotimization of behaviors into "part
of our culture"/"not part of our culture." For example,
people may engage in high risk behaviors and not consider
themselves at risk, because the behavior is not
conceptualized as part of a cultural or a sexual identity.

My position of otherness as a guest at this conference
was especially acute during this session. [I had joined
SWAA while attending the international AIDS conference in
Amsterdam.] I was one of the only non-Ugandans present and
certainly qualified as someone from another culture. In the
earlier sessions, I had shared some information about my
background, interests, and reasons for attending the
conference during the initial introductions. During the
discussion and debate about what oral sex is, how it is
done, and whether or not it is a part of culture, I observed
several of the conference participants looking my way. I
wondered what their expectations of the outsider were and
debated about whether or not to contribute to the
discussion. I was wary of appearing to be the expert and

also did not want to contradict the facilitator’s definition

89
of oral sex as limited to homosexuals. I chose to stay
silent, having gone into the conference with the aim of
learning from the people attending. After the session,
three conference participants asked me why I did not
participate in the discussion and expressed hopes that I
would share my perspective and knowledge about women and
AIDS.

Unequal power relationships between men and women were
frequently identified as a cultural risk factor that
increases women’s exposure to HIV infection. Manifestations
of these inequalities that put women at risk for HIV
infection were identified as women seeking favors (material
goods) from chiefs or employers. Student-teacher sexual
relationships, which were said to be pervasive at all levels
of education, also contribute to women's increased
vulnerability to infection. School-age girls, who are
especially economically vulnerable, may exchange sex with
teachers for money or material goods.

There was also a great deal of heated discussion about
the trend of older men having sex with younger women or
girls as a perceived means of protecting themselves against
HIV infection. The participants were outraged that this
practice in fact results in a high likelihood of older men
infecting younger women. Their observations are reflected
in the gender and age disparities in the AIDS statistics

from Uganda. Statistics from July 1992 show that there are

 

90
six times as many cases of AIDS among 15 to 25-year-old
women than among men the same ages. The pattern is reversed
in the 25 to 49-year-old age group, with more men than women
with AIDS (AIDS Control Programme 1992). These statistics
are grounded in people’s experiences of the epidemic. As
reflected in the comments by conference participants, they
show how the AIDS epidemic is differentially experienced
based along the axes of gender, age, class, and power. The
statistics reflect only diagnosed cases of AIDS rather than
overall prevalence of HIV infection. Since it can take up
to several years for HIV infection to progress to AIDS,
women who are represented in the AIDS statistics at age 15
were probably infected several years earlier.

At the close of the session, the facilitator shared his
perspective and posed some questions to those attending. He
stated that current approaches to HIV prevention, such as
using condoms, clearly are not working. Cultural behaviors
he stated, are learned behaviors; just as they are learned
they can be unlearned. He acknowledged the central role
that women play in promoting behavior change. At this
point, several conference participants challenged his
statement, arguing that while women in fact are changing
their behavior, the real power in sexual decision making is
with men. The facilitator then asked participants whether
women have a right to say no to unprotected sex with their

husbands. Participants responded in the negative, stating

91
that culturally, that right is conferred by men.

In closing, the facilitator asked a series of key
questions. First, does culture really exist? Second, what
does it mean to say that culture does not allow women to
control their own bodies and sexuality or that cultural
attitudes contribute to women’s economic dependence? Third,
if culture prevents AIDS risk reduction behavior, what does
this mean? Finally, if the cultural behaviors listed during
the session increase women’s risk for HIV infection, are
those aspects of culture worth protecting?

Two additional themes of this conference merit mention
in regard to the content of this thesis. The first is a
reiteration of the numerous times that women’s economic
dependence was raised as a major risk factor for HIV
infection in women. Representatives from all of the
districts stated many times over that women hesitate to ask
their husbands to use a condom for fear that they will be
rejected. Rejection in this case was identified as being
forced to leave their marriage, children, and any material
or economic security behind. Women, according to the
participants, often choose economic security over even
communicating concern about risk of HIV infection to their
husbands, much less taking action by insisting on a condom.
Everyone in attendance agreed that if women had increased
opportunities to earn and control their own incomes, they

would feel more economically secure. In turn, women who

 

92
feel more economically secure would feel more secure about
protecting themselves against HIV infection. This was also
a theme at the Amsterdam Conference on AIDS.

The women leaders attending this conference seemed very
committed to the conference organizer’s goals of
mobilization and action to empower women to reduce their
risk of HIV infection. All the representatives developed
action plans for educating women in their districts about
HIV and AIDS and for initiating income generating projects.
Most of the women leaders represented women in rural
districts, and while it appeared that many were probably
fairly well educated and not part of the rural poor, they
nonetheless took their mission of representing the needs and
concerns of low income women in their rural districts
seriously.

I present this information as a background to make a
final point about the importance of placing marginalized
groups at the center of knowledge production and analyses.
As previously noted, by placing conference participants at
the center of knowledge production, the conference
organizers showed an explicit recognition of the fact that
knowledge is produced in different ways, by different
knowers, with different results.

At the close of the conference, the conference
organizers announced that annual dues for membership in the

Society for Women in AIDS in Africa amounted to a 2,000

 

93
Ugandan shilling joining fee and 5,000 shillings per year
membership fee (a total of US$ 7.00). This is more money
than the great majority of poor rural women have at their
disposal to spend on something like membership fees,
particularly given most women’s economically and socially
disadvantaged position in Uganda.

The conference organizers were clearly hoping to reach
women in rural areas through mobilizing their district
representatives. A great deal of discussion and debate was
generated over the issue of the proposed fee, with many of
the women leaders arguing that it was too high for low
income women living in rural areas. This debate
illustrates the importance of using a context-rich approach,
grounded in social location emphasizing the relational
nature of gender, class, and race or ethnicity.

My description and analysis of the events at the
conference is obviously filtered through my own experiences
and social location. My location as an outsider and as a
graduate student familiar with feminist and critical
perspectives in anthropology shapes my analysis. In
reflecting on what I have written, I am very aware that it
is only a partial account. And, I am concerned about how
this account would compare with the interpretations of other
people attending the conference. I would expect that each
person would have a different interpretation based on her or

his social location.

 

CHAPTER FIVE

SUMMARY AND DISCUSSION

I have argued in this thesis that standard
epidemiological approaches alone are an insufficient
depiction of the AIDS epidemic in Africa because they do not
create socially contextualized representations of women’s
many experiences of the epidemic. As noted in the
introduction, statistics on the AIDS epidemic are rooted in
the human experiences they are drawn from. Standard
epidemiological reports tend to produce what Krieger and
Margo refer to as "numbing numbers" (1990:584). In
contrast, feminist approaches often take AIDS statistics as
their starting point, problematize them in the everyday
lives of women, and in so doing, reinsert experience into
AIDS discourse and representations.

At its best, feminist research is not only by and for
women, but also works toward the transformation of socially
constructed, interlocking systems of inequality. The
majority of the examples of feminist research on women and
AIDS in Africa met most, if not all, of the criteria set out
in the introduction. In contrast, all but the transitional

category of mainstream epidemiological literature failed to

94

95
meet the feminist criteria. As previously stated, however,
applying feminist lenses can be a tool to reveal what is not
visible as well as what is clearly visible. In this manner,
underlying, often implicit conceptualizations of women in
the epidemiological literature on AIDS in Africa are
revealed.

Epidemiological literature on AIDS in Africa tends to
conceptualize and represent women in what I have termed
their roles as reproducers and passive carriers of the virus
and children. Little concern is shown for women’s rights to
health care and AIDS prevention apart from their relations
to men and children. Researchers remain disembodied and
detached from the process and the results of research. This
is reflected in the objectifying of women as "reservoirs of
infection," "pools of free women," "women of reproductive
age," and other linguistically distancing images created in
epidemiological representations of AIDS and its impact on
women.

There is a profound need for contextualization on all
levels in epidemiological accounts of AIDS in Africa. Susan
Hunter offers suggestions about how researchers might go
about conducting what she terms "context-rich research":

A context-rich, self-conscious research programme

avoiding self-and other-alienation has some

necessary and simple dimensions: stay awhile;

teach, live, share; incorporate indigenous

researchers in your projects; facilitate them with

money and resources; work by their side; train

them during the project execution; take the pain
to transfer your skills; listen to their ideas,

96

their conceptualizations, their pain. [1990:689]

I classify Hunter’s approach, like that of Schoepf et
al., as grounded in standpoint thinking. Schoepf and her
colleagues and Hunter offer invaluable guides to conducting
participatory research that should, in an ideal world, be
incorporated into mainstream paradigms of epidemiological
research on AIDS in Africa.

The question of whether there has been a feminist
revolution in the sense that Stacey and Thorne (1985) set
out is debatable. There has certainly been an increase in
what I have identified as feminist analyses of AIDS in
Africa over the last three to four years. The driving force
behind this increase is unknown. One of Stacey and Thorne’s
criteria of a feminist revolution is whether or not there
has been a paradigm shift—that is, have feminist analyses
made their way into the mainstream discourse? I tend to
think that they have not. For example, Mann’s (1991)
criticisms of the weaknesses of mainstream epidemiological
approaches are almost mirror images of many of the feminist
arguments presented in this paper. Yet no feminist authors
are cited in Mann’s bibliography (1990). On the one hand,

this could be interpreted as a sign that there has been a

 

paradigm shift. It is more likely, however, the paradigm
shift is yet to happen. Additional support for this
perspective comes from the fact that none of the articles I

have identified as feminist in this paper have been

97
published in mainstream epidemiological journals. Social
Science and Medicine and the International Journal of Health
Sciences (a more radical publication) are the two richest
sources of feminist research on women and AIDS in Africa.
Thus, the lack of feminist representation in mainstream
epidemiological literature can be further interpreted as a
lack of paradigmatic shifting.

Despite what I interpret as the "missing feminist
revolution" in mainstream discourse, the benefits of
feminist approaches are obvious. I anticipate that
feminists’ emphases on the social construction of the AIDS
epidemic in Africa will gradually influence the ways
mainstream thinkers and researchers not only design and
conduct research, but will also change the ways women are
conceptualized. Feminist perspectives and standpoints will
lead to more informed, realistic, and socially situated AIDS
prevention campaigns sensitive to the many challenges women
are faced with in negotiating AIDS prevention in Africa.

Indeed, as the chapter on the international AIDS
conference and the conference on women and AIDS in Uganda
demonstrated, there is increasing recognition by some within
the international and national research communities of the
need for more fully contextualized accounts of the AIDS
epidemic. And, as reflected in the knowledge produced by
the women at the AIDS conference in Kampala, gender, class,

and culture all shape Ugandan women’s perceptions of their

98
risks of HIV infection and AIDS.

I have used Harding’s three criteria for feminist
standpoint thinking throughout this thesis. Harding states,
"one distinctive feature of feminist research is that it
generates problematics from the perspective of women’s
experiences. It also uses these experiences as a
significant indicator of the ‘reality’ against which
hypothesis are tested" (1987:7). There is a need for
research on AIDS in Africa that incorporates both women and
men’s standpoints, yet most of the AIDS literature reveals
that men are members of the oppressor group when it comes to
issues of sexual negotiation in AIDS prevention strategies.
Is it possible, then, for men to research the gender, class,
and cultural differences that create different experiences
of the AIDS epidemic in people’s lives based on social
location? Harding writes:

if we start thinking and researching from the

perspective of the lives of oppressed people. . .

. [t]he understanding that they are oppressed,

exploited, and dominated—«anjust made miserable

by inevitable or social causes—reveals aspects of

the social order that are difficult to see from

the perspective of their oppressors’ lives.

[1991:126]

Harding thus argues that it is inaccurate to suggest
that men cannot conduct feminist research. However, men
claiming to conduct feminist research must meet the
following criteria:

Are women’s experiences used as the test of

adequacy of the problems, concepts, hypothesis,
research design, collection, and interpretation of

 

99

data? Is the research project pp; women rather

than for men and the institutions men control?

Does the researcher or theorist place himself in

the same class, race, culture, and gender-

sensitive critical plane as the subjects of his

study? [1987:11]

Feminist research tends to uncover and struggle against
hidden social structures contributing to oppression and
exploitation in social relations (Baca Zinn 1993). As shown
in this thesis, it is also critical to uncover the cultural
factors that contribute to exploitation and oppression.
Social science research that is not generated out of an
explicit recognition of the need to struggle "against
exploitation of women in everyday life [is] unlikely to
produce. . . research about any subject at all that is
undistorted by sexism and androcentricism" (Harding
1987:12).

An answer to the question of whether men can produce
feminist analyses and representations is contained in
Harding’s statement: "The issue here is not so much the
right to claim a label as it is of the prerequisites for
producing less partial and less distorted descriptions,
explanations, and understandings" (1987:12).

The final chapter addresses the need to consider the
relational nature of the factors influencing differentiated

experiences of the AIDS epidemic in Africa. It also

outlines future dissertation research directions.

CHAPTER SIX

FUTURE RESEARCH DIRECTIONS

During my predissertation visit to Uganda, in addition
to attending the conference on women and AIDS, I met with a
large number of individuals and organizations involved in
AIDS research. I also learned a great deal about the impact
of AIDS on people’s lives through informal discussions with
Ugandans. I had the privilege of accompanying an AIDS
counselor from The AIDS Support Organizations on home and
hospital visits to people with AIDS.

A theme in all of these meetings and discussions, as
well as in the two AIDS conferences, was a concern over low
income women’s economic dependence and their increased risk
for HIV infection and AIDS. It has been suggested that
income generating projects for women would provide increased
economic security and thus empower women to take the risk of
asking their partners to use a condom. Many researchers and
all the people I spoke with about this issue in Uganda
contend that when faced with the risk of HIV infection or
the risk of rejection, most women, because of their
economically vulnerable position, will risk infection rather

than rejection. Yet women’s economic dependence does not

100

101
occur in a social vacuum and must be contextualized along a
number of axes.

Noerine Kaleeba, founder and director of The AIDS
Support Organization (TASO), in discussing the relationship
between women’s economic dependence and HIV infection,
informed me that there is a need for research into this
area. She stated that TASO had conducted a very informal

and unscientific survey of some of their women clients.

 

Women were asked what factors would make them feel more
secure about asking a partner to use a condom in order to
prevent HIV infection. The majority of the women stated
that they would feel more secure if they had increased
economic security. They also expressed an interest in
income generating projects.

The issue of economic dependency and its relationship
to women’s risk for HIV infection is very complex. The
participants at the conference on women and AIDS framed
women’s economic dependency, women’s lack of control over
their own bodies and sexuality, and unequal power
relationships between genders in terms of cultural factors
that put women at risk for HIV infection. The relevance of
this perception in many women’s lives will guide my
dissertation research. As Schoepf and others cited in this
thesis argue individual behavior is embedded in social
relations. Harding summarizes this view in her statement

that:

102

All of us must live in social relations that

naturalize or make appear intuitive, social

arrangements that are in fact optional; they have

been created and made to appear natural by the

power of the dominant groups. [1991:286]

The knowledge produced by the women at the AIDS
conference in Kampala indicates that culture is the dominant
lens through which women attending the conference view their
risks of acquiring HIV infection. A number of feminist
researchers presented in this thesis point to the importance
of culture in the social construction of the AIDS epidemic
in Africa. While it is important to look at the wide range
of contexts influencing differences in the ways the epidemic
is structured by social location, it is also important to
avoid cultural determinism. As reflected in the discourse
of the women at the Kampala conference, culture takes on
particular structural manifestations in particular contexts.
For example, structural factors such as women’s lack of
control over their own sexuality and economic dependence
take on what the women see as cultural forms. Likewise,
other structurally-related aspects of social relations, such
as inheritance patterns, place of residence after marriage,
and what happens to women after they are widowed or
divorced, take on different shapes in different cultures.

My dissertation research will focus on women’s
perceptions of factors that either constrain or enable them

to negotiate AIDS prevention behaviors. I hope to

contribute to an understanding of how individual responses

 

103
to the epidemic are embedded in social relations. I believe
that feminist standpoint thinking, intersections analysis,
and Schoepf’s approach to "linking macrolevel analyses to
microlevel studies of social interaction [to show] how
political economy, gender, and culture shape responses to a
disease" (Schoepf 1992:53) provide the most productive
frameworks for producing knowledge and representations of
the AIDS epidemic in women’s lives. Combining these
feminist frameworks into a context-rich approach and
implementing such an approach in epidemiological research
has the potential to create the types of analyses that will
make a real impact on AIDS education and prevention programs
in Africa.

The hypothesized relationship between women’s economic
dependence and vulnerability to HIV infection raises a
number of interrelated questions. First, is the
relationship as simple and neat as it appears? Obviously,
the vast majority of the women in Africa are economically
disadvantaged in relationship to men. Yet, there are also
class differences among women. Do women who are
economically independent feel more secure in asking or
insisting that their partners use a condom? Is it an issue
of economic dependence or, rather, an issue of women’s
social dependence in terms of limited access to and control
of what Schoepf terms "strategic resources" (1992:69)? Are

there differences in the ways that women from matrilineal

 

104
versus patrilineal societies view the relationship between
economic security, HIV infection, and risk of rejection
(Ferguson, personal communication)?

What does economic security mean to women who express a
desire to be more economically independent? What does it
mean to AIDS researchers and activists who suggest it as a
possible approach to decreasing women’s risk for HIV
infection? How do perceptions of the need for economic
security before asking your partner to use a condom vary by
age or marital status? What kinds of income generating
projects will enable women to gain increased economic
security? Do poor rural women or women who are struggling
to survive in urban areas really have the time to engage in
income generating projects? If they do, will they be able
to control the income earned; if so, how will the income be
spent? If women use the income to pay for school fees or
the subsistence needs of their households, will they then
feel more economically secure? How will increases in
women’s income affect family dynamics? What kind of
resistance can be expected from husbands or male partners?
Does an increase in economic security necessarily translate
into an increase in control over the social and personal
realms? In other words, is income generation and economic
security enough of an answer? Few studies, aside from those
of Schoepf and her colleagues, focus on different classes'

sexual decision making and approaches to AIDS prevention.

105

The social expectations that women are women only if
they are wives and mothers creates difficult decisions for
women in regard to HIV prevention. The list of questions
presented above touches on the more practical relationship
between an increase in economic security and a hypothesized
decrease in risk of HIV infection. In societies in which
being a wife and mother are expected and valued social
statuses, will women, even if economically more secure, want
to leave a husband who refuses to use a condom? Do women
who may make this choice envision remaining single, or if
they decide to remarry, will they practice HIV prevention?
What are the possibilities of remarriage for women who make
these decisions?

Long term structural change is needed if efforts to
empower women to reduce their risk of HIV infection are to
be successful. This is very clearly not a goal that can be
achieved in a short time. Yet, as Schoepf states,
"empowerment strategies that incorporate a deep
understanding of local cultures and social group dynamics
have the potential to bring about changes in sexual behavior
and the social relations in which they are embedded"
(1992:68).

This thesis has focused on issues and representations
of women and AIDS in Africa. Unequal gender and power
relationships mean that women are less able to protect

themselves from HIV infection and AIDS than are men (Bledsoe

106
1992; Seely et al. 1992; Schoepf 1992; Standing 1991; Ulin
1991). Suggestions that women be empowered to reduce their
vulnerability to HIV infection run the risk of placing the
entire burden of responsibility for HIV prevention on
women’s shoulders.
Feminist perspectives and frameworks argue that gender

is inclusive of both women and men. There is a need for

 

research into the meanings and experiences of the epidemic
in men’s lives. Since condoms are a male-controlled
technology, men have more control over sexual and HIV
reduction decisions than do women. What explanations do men
who are resistant to using a condom for HIV protection
offer? How do these explanations vary by class or ethnic
group? How can men be empowered to change their approach to
HIV prevention? A barely explored area of AIDS research in
Africa is the potential relationship between ethnicity and
attitudes toward AIDS prevention. Do ethnic groups (or
tribes) that expect women to be more subservient have a
higher incidence of HIV infection?

The pervasive theme of this thesis, and one that
surfaced in the AIDS conferences in Amsterdam and Kampala as
well as in discussions during predissertation research in
Uganda, is the critical need for AIDS research and analyses
that are context rich. Anthropologists, particularly those
who use feminist frameworks, are at the forefront of

contributing contextualized analyses of how the AIDS

107
epidemic affects people’s lives. There is a need for more
analyses that incorporate an understanding of how gender,
class, ethnicity and culture (along with other factors)
intersect to create different meanings and experiences of
the AIDS epidemic. It is these types of analyses that have
the greatest potential for contributing to prevention
programs sensitive to the challenges that people face in

negotiating HIV and AIDS risk reduction strategies.

APPENDICES

 

APPENDIX I

Statements: International Pre-Conference Workshop

Women Living with HIV/AIDS

 

INTERNATIONAL WORKSHOP
PRE CONFERENCE WOMEN uvmc MH
1992 HIV / AIDS

STATEMENTS

 

TO IMPROVE THE SITUATION OF WOMEN LIVING WITH HIV/AIDS
THROUGHOUT THE WORLD , WE NEED :

l.

encouragement, support a funding for the development of self-help

. groups, local and international networks of women living with

2.

9.

HIV/AIDS

the media, not to stigmatize, but to realistically portray us

equitable, accessible and affordable treatments for and research
into how the virus effects women,
covering: psycho-social and medical aspects

complementary and allopathic treatments

funding for services and support for women living with
HIV/AIDS, to alleviate their isolation and meet their basic needs.
All funding directed to us needs to be evaluated and monitored to

ensure that we get It

the right to make our own choices about reproduction and to be
respected and supported in those choices. This includes the right
to have children and the right not to have children

recognition of the right of our children/orphans to be cared for
and the importance of our role as parents

education and training of health care providers and the community
at large about women's risk and our needs. Up to date, accurate
information concerning all issues about women living with HIV/AIDS
should be readily available

recognition of the fundamental human rights of all women living
with HIV/AIDS, with special consideration for women in prison,
drugusers and sexworkers

research into woman to woman transmission, recognition of and
support for lesbians living with HIV/AIDS

10.decision making power and consultation on all levels of policy and

programs affecting us

11.to provide economic support for women living with HIV/AIDS in

developing countries to help them to be self-sufficient and
independent

Members of the Steering Committee:

HIV Association Netherlands — ACT UP! Amsterdam - Bureau WOMEN and AIDS‘

Section Positive Women Predikherenkerkhon
Postbu515847 ' 3512TI< Utrecht
1001 NH Amsterdam TeIeIax (31) 30 334064

Telephone ( 31 )20 6644076 Telephone (31) 30 334064

APPENDIX II

Women Program Guide

Note: Shaded areas represent topics the conference

organizers thought of interest to women.

 

112

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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BIBLIOGRAPHY

 

BIBLIOGRAPHY

Adamchak, Donald, et al.
1989 Male Knowledge of and Attitudes and Practices
Towards AIDS in Zimbabwe. AIDS 4: 245-250.

AIDS Control Programme
1992 AIDS Surveillance Report June 1992. Entebbe:
Ministry of Health.

Allen, Susan, et al.

1991 Human Immunodeficiency Virus Infection in Urban
Rwanda: Demographic and Behavioral Change in a
Representative Sample of Child-Bearing Women. Journal
of the American Medical Association 226(12):1657-1663.

Andersen, Margaret, and Patricia Hill Collins
1992 Conceptualizing Race, Class, and Gender. In Race,
Class, and Gender: An Anthology. Margaret Anderson and
Patricia Hill Collins, eds. Pp. 47-53. Belmont, NY:
Wadsworth Publishing Co.

Ankrah, E. Maxine
1991 AIDS and the Social Side of Health. Social Science
and Medicine 32(4):967-980.

1989 AIDS: Methodological Problems in Studying its
Prevention and Spread. Social Science and Medicine
29(3): 265-276.

Baca Zinn, Maxine
1993 Personal Communication; lecture notes in file of
author from Race, Class, and Gender course, Department
of Sociology, Michigan State University.

1992 Personal Communication; lecture notes in file of
author from Sexual Inequality course, Department of
Sociology, Michigan State University.

Baca Zinn, Maxine, et al.

1986 The Costs of Exclusionary Practices in Women’s
Studies. Signs:11(2): 290-303.

117

 

118

Bassett, Mary, and Marvellous Mhloyi
1991 Women and AIDS in Zimbabwe: The Making of an
Epidemic. International Journal of Health Services
21(1): 143-156.

Berkley, Seth, et al.
1990 AIDS and HIV Infection in Uganda—Are Women More
Infected than Men? AIDS 4:1237-1242.

Bertrand, Jane, et al.
1990 AIDS-Related Knowledge, Sexual Behavior, and Condom
Use among Men and Women in Kinshasa, Zaire. American
Journal of Public Health 81(1): 53-58.

Bledsoe, Carolyn
1991 The Politics of AIDS and Condoms for Stable
Heterosexual Relationships in Africa: Recent Evidence
from the Print Media. Disasters 15(1): 2-10.

Braddick, Michael, et al.
1990 Impact of Maternal HIV Infection on Obstetrical and
Early Neonatal Outcome. AIDS 4: 1001-1005.

Burja, Janet
1986 Urging Women to Redouble their Efforts: Class,
Gender, and Capitalist Transformation in Africa. In
Women and Class in Africa. Claire Robertson and Iris
Berger, eds. Pp. 117-140. New York: Americana
Publishing Company.

Carovano, Kathryn
1991 More than Mothers and Whores: Redefining the AIDS
Prevention Needs of Women. International Journal of
Health Services 21(1):131-142.

Chin, James
1990 Current and Future Dimensions of the HIV/AIDS
Pandemic in Women and Children. Lancet 336: 221-224.

di Leonardo, Micaela
1991 Gender, Culture and Political Economy: Feminist
Anthropology in Historical Perspective. In Gender at
the Crossroads of Knowledge: Feminist Anthropology in
the Postmodern Era. Micaela di Leonardo, ed. Pp. 1-
48. Berkeley: University of California Press.

Ferguson, Anne, and Rita Gallin
1992 The Plurality of Feminism: Rethinking
‘Difference'. In The Women and International
Development Annual, Volume III. Anne Ferguson, Rita
Gallin, and Janice Harper, eds. Pp. 1-17. Boulder, CO:
Westview Press.

 

119

Flax, Jane
1987 Postmodernism and Gender Relations in Feminist
Theory. Signs 12: 621-643.

Gal, Susan
1991 Between Speech and Silence: The Problematics of
Research on Language and Gender. In Gender at the
Crossroads of Knowledge: Feminist Anthropology in the
Postmodern Era. Micaela di Leonardo, ed. Pp. 175-203.
Berkeley: University of California Press.

Hansen, Karen Tranberg
1989 Distant Companions: Servants and Employers in
Zambia, 1900-1985. Ithaca, NY: Cornell University
Press.

Haraway, Donna
1988 Situated Knowledges: The Science Question in
Feminism and the Privilege of Partial Perspective.
Feminist Studies 14(3): 575-599.

Harding, Sandra
1991 Whose Science, Whose Knowledge?: Thinking from
Women’s Lives. Ithaca, NY: Cornell University Press.

1987 Introduction: Is There a Feminist Method? In
Feminism and Methodology. Sandra Harding, ed. Pp. 1-
14. Bloomington: Indiana University Press.

Hennekens, Charles, and Julie Buring
1987 Epidemiology in Medicine. Boston: Little Brown.

Hill Collins, Patricia
1990 Black Feminist Thought: Knowledge, Consciousness,
and the Politics of Empowerment. New York: Routledge.

Hira, S.K., et al.
1989 Perinatal Transmission of HIV-1 in Zambia. British
Medical Journal 299(18):1250-1252.

Hooks, Bell
1984 Black Women: Shaping Feminist Theory. In Feminist
Theory: From Margin to Center. Bell Hooks, ed. Pp.
1-15. Boston: South End Press.

Hunter, Susan
1990 Orphans as a Window on the AIDS Epidemic in Sub-
Saharan Africa: Initial Results and Implications of a
Study in Uganda. Social Science and Medicine 31(6):
681-690.

120

Irwin, Kathleen, et al.

1991 Knowledge, Attitudes, and Beliefs about HIV
Infection and AIDS among Healthy Factory Workers and
their Wives in Kinshasa, Zaire. Social Science and
Medicine 32(8): 917-930.

Killewo, Japhet, et al.
1990 Prevalence of HIV-1 Infection in the Kagera Region
of Tanzania: A Population-Based Study. AIDS 4: 1081-
1085.

Konde-Lule, Joseph, Seth Berkley, and Robert Downing
1989 Knowledge, Attitudes, and Practices Concerning AIDS
in Ugandans. AIDS 3: 513-518.

Krieger, Nancy, and Glen Margo
1990 Introduction: Section on AIDS: The Politics of
Survival. International Journal of Health Services
20(4): 583-588.

Lallemant, Marc, et al.
1989 Mother-Child Transmission of HIV-1 and Infant
Survival in Brazaville, Congo. AIDS 3: 643-646.

Mageze, Marble
1991 Against a Sea of Troubles: AIDS Control in Uganda.
World Health Forum 12: 302-306.

Mann, Jonathan
1992 Opening Remarks: A Conference of Hope: A New
Beginning. In Conference Summary Report, VIII
International Conference on AIDS/III STD World
Congress. Pp. 5-8. Cambridge, MA: Harvard AIDS
Institute.

1991 Global AIDS: Critical Issues for Prevention in the
19905. International Journal of Health Services 21(3):
553-559.

Mbilinyi, Marjorie
1989 Women as Peasants and Casual Labor and the
Development Crisis in Tanzania. In Women and
Development in Africa: Comparative Perspectives. Jane
Parpart, ed. Pp. 209-256. New York: University Press
of America.

McCombie, Susan
1990 Beliefs about AIDS Prevention in Uganda. Paper
presented at the Annual Meetings of the American
Anthropological Association, New Orleans, November 28-
December 1, 1990.

 

121

Miotti, Paolo, et al.
1990 HIV-1 and Pregnant Women: Associated Factors,
Prevalence, Estimate of Incidence and Role of Fetal
Wastage in Central Africa. AIDS 4:733-736.

Mohanty, Chandra, Ann Russo, and Lourdes Torres
1991 Third World Women and the Politics of Feminism.
Bloomington: Indiana University Press.

Moore, Henrietta
1988 Feminism and Anthropology. Minneapolis:
University of Minnesota Press.

Obbo, Christine
1980 African Women: Their Struggle for Economic
Independence. London: Zed Press.

Parpart, Jane
1989 Sexuality and Power in the Zambian Copperbelt:
1926-1964. In Patriarchy and Class: African Women in
the Home and the Workforce. Sharon Stichter and Jane
Parpart, eds. Pp. 115-138. Boulder, CO: Westview
Press.

Rapp, Rayna
1992 Feminist Methodologies for the Science of Man? In
Revolutions in Knowledge: Feminism in the Social
Sciences. Sue Rosenberg Zalk and Janice Gordon-Kelter,
eds. Pp. 79-90. Boulder, CO: Westview Press.

Schoepf, Brooke Grundfest
1992 Gender, Development and AIDS: A Political Economy
and Culture Framework. In Women and International
Development Annual, Volume III. Anne Ferguson, Rita
Gallin, and Janice Harper, eds. Pp. 53-85. Boulder,
CO: Westview Press.

1991a Comments on Packard and Epstein: Epidemiologists,
Social Scientists, and the Structure of Medical
Research on AIDS in Africa. Social Science and
Medicine 33(7): 791.

1991b Ethical, Methodological, and Political Issues of
AIDS Research in Central Africa. Social Science and
Medicine 33(7): 749-763.

1991c Political Economy, Sex, and Cultural Logics: A
View from Zaire. Unpublished manuscript in files of
author.

122

1991d Theory and Practice in Anthropological Research on
AIDS with African Women: Case Studies from Zaire.
Unpublished manuscript in files of author.

Schoepf, Brooke Grundfest, et al.
1991 Gender, Power, and Risk of AIDS in Zaire. In Women
and Health in Africa. Meredeth Turshen, ed. Pp. 187-

203. Trenton, NJ: Africa World Press.

Seely, Janet, et al.
1992 Socio-Economic Status, Gender, and Risk of HIV-1
Infection in a Rural Community in South West Uganda.
Unpublished manuscript in files of author.

Simonsen, J. Neil, et a1.
1990 HIV Infection among Lower Socioeconomic Strata
Prostitutes in Nairobi. AIDS 4:139-144.

Smith, Dorothy
1987 The Everyday World as Problematic. Boston:
Northeastern University Press.

Society for Women and AIDS in Africa (SWAA)
1992 Mobilization Workshop for HIV/AIDS Prevention,
Control, and Patient Care for Women Leaders. Broad
Objective and Course Content Outline. Kampala: SWAA

Stacey, Judith, and Barrie Thorne
1985 The Missing Feminist Revolution in Sociology.
Social Problems 32:310-316.

Standing, Hilary
1992 AIDS: Conceptual and Methodological Issues in
Researching Sexual Behaviour in Sub-Saharan Africa.
Social Science and Medicine 34(5):475-483.

Stichter, Sharon, and Jane Parpart
1989 Introduction. In Patriarchy and Class: African
Women at Home and in the Workforce. Sharon Stichter
and Jane Parpart, eds. Boulder, CO: Westview Press.

Tabet, Paola
1989 I’m the Meat, I’m the Knife: Sexual Service,
Migration, and Repression in Some African Societies.
IQ A Vindication of the Rights of Whores. Gail
Peterson, ed. Pp. 204-226. Seattle: Seal Press.

Temmerman, M., et al.
1990 Impact of Single Session Post-Partum Counseling of
HIV Infected Women on their Subsequent Reproductive
Behavior. AIDS Care 2(3):247-252.

123

United States Agency for International Development
1991 HIV Infection and AIDS: A Progress Report to
Congress on the USAID Program for Prevention and
Control. Washington: USAID

Vance, Carole
1991 Anthropology Rediscovers Sexuality: A Theoretical
Comment. Social Science and Medicine 33(8): 875-884.

van den Boom, Frans, and Larry Gostin
1992 Summary Report on the Social Impact and Response
Track. Conference Summary Report, VIII International
Conference on AIDS/III STD World Congress. Pp. 33-43.
Cambridge: Harvard AIDS Institute.

White, Luise
1980 Women's Domestic Labor in Colonial Kenya:
Prostitution in Nairobi, 1909-1950. African Studies
Center Working Paper #30. Boston: Boston University
Press.

Wilkins, H.A., et al.
1989 Knowledge of AIDS, Use of Condoms and Results of
Counseling Asymptomatic HIV2 Infection in The Gambia.
AIDS Care 1(3): 247-256.

Wilson, David, et al.
1990 A Pilot Study for an HIV Prevention Programme among
Commercial Sex Workers in Bulawayo, Zimbabwe. Social
Science and Medicine 31(5):609-618.

 

 

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