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An examination of HIV/AIDS statistics by region and by gender reveals a
curious anomaly. In areas of the world where the primary means of
transmission is assumed to be heterosexual sex, such as sub-Saharan
Africa, North Africa and the Middle East, and the Caribbean, the majority
of HIV-positive adults are women. The United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization have recently called attention to this disparity in their AIDS Epidemic Update. In sub-Saharan Africa, for example, they report that 58 % of those who have HIV/AIDS are women.(1) In the younger age groups the disparity is even higher: “[O]verall about twice as many young women as men are infected in sub-Saharan Africa. In 2001, an estimated 6-11 percent of young women aged 15-24 were living with HIV/AIDS, compared to 3-6% of young men.”(2)

These results are surprising because they appear to contradict what we
know about human sexual behavior. Cross-culturally, men are more
promiscuous than women. They have more sexual partners before marriage and higher rates of marital infidelity. Moreover, some of their numbers patronize prostitutes, who are a prime vector for AIDS transmission. These are all behaviors which expose men to a greater risk of sexually contracting HIV/AIDS.

“Why do young African women appear so prone to HIV infection?” asks UNAIDS and WHO. Their answer (which of course assumes that HIV is sexually transmitted) is that African women are forced by circumstances to have sex with HIV positive men: “Women and girls are commonly discriminated against in terms of access to education, employment, credit, health care, land and inheritance. . . [R]elationships with men (casual or formalized through marriage) can serve as vital opportunities for financial and social security, or for satisfying material aspirations. But, in areas where HIV/AIDS is widespread, they [men] are also more likely to have become infected with HIV. The combination of dependence and subordination can make it very difficult for girls and women to demand safer sex (even from their husbands) or to end relationships that carry the threat of infection.”

This explanation—that African women are infected by rapacious men—may be convincing to the radical feminist mind, but it completely begs the question. Why does HIV in Africa disproportionately strike women?

The answer lies in the medical transmission of HIV/AIDS. The public health sector in many African countries has simply collapsed. African clinics are short of almost everything, from vaccines and malaria tablets to rubber gloves and needles. Little, if any, care is available to African men and women ill with malaria and other tropical diseases. Medical equipment, such as syringes, surgical instruments, and manual vacuum aspirators, cannot be properly disinfected before they are reused. The local blood supply is unreliable.

The one exception to the generally dismal state of primary health care in
Africa is Western-funded Sexual and Reproductive Health (SRH) programs targeting women. African medical workers are taught (and paid) to emphasize reproductive health procedures (contraception, sterilization, and abortion), often to the near exclusion of primary health care. Poorly equipped clinics are kept well-supplied with Depo-Provera, IUDs, and condoms. According to Dr. Stephen Karanja, the former Secretary of the Kenyan Medical Association, “Thousands of the Kenyan people will die of malaria whose treatment costs a few cents, in health facilities whose stores are stacked to the roof with millions of dollars worth of pills, IUDs, Norplant, Depo-Provera, most of which are supplied with American money.”(3)

Is it mere coincidence that the same groups that are targeted for invasive
procedures are disproportionately afflicted with AIDS? We think not. Women and girls account for such a high percentage of HIV/AIDS victims in Africa because they are infected during procedures designed to disable their reproductive systems and prevent them from conceiving or bearing children. Up to 70% of HIV infections in Africa, according to a recently published study in the peer-reviewed International Journal of STD and AIDS, occur as a result of substandard health care, primarily HIV transmission through reuse of needles.(4)

To paraphrase UNAIDS, it is the dependence and subordination of women to clinic personnel—often the only available source of health care for themselves and their families--that makes it very difficult to demand safe medical care, and to end medical relationships that carry the threat of infection.

Endnotes

(1) “AIDS Epidemic Update,” Joint United Nations Programme on HIV/AIDS
(UNAIDS)/World Health Organization (UNAIDS/WHO), December 2002, p. 6.
(2) “Ibid., p. 19.
(3) “Dr. Stephen Karanja: Health System Collapsed,” PRI Review
(March/April 1997), 7(2): p. 4.
(4) David D. Brewer, Stuart Brody, Ernest Drucker, David Gisselquist,
Stephen F. Minkin, John J. Potterat, Richard B. Rothernberg, and Francois
Vachon, “Mounting Anomalies in the Epidemiology of HIV in Africa: Cry the
Beloved Paradigm,” Int. J. of STD & AIDS 2003; 14:144-147.
David Gisselquist, John J. Potterat, Stuart Brody, and Francois Vachon,
“Let it be Sexual: how Health Care Transmission of AIDS in Africa was
Ignored,” Int. J. of STD & AIDS 2003; 14:148-161.
David Gisselquist and John J. Potterat, “Heterosexual Transmission of HIV
in Africa: An Empiric Estimate,” Int. J. of STD & AIDS 2003; 14:162-173.

© 2003 Population Research Institute. Permission to reprint granted.