Violence, Amnesty: Poverty And Discrimination Undermine AIDS Programs In Rural South Africa

For immediate release:

(New York) — Violence and extreme poverty in rural South Africa place women at grave risk of becoming infected with HIV, according to a new report by Amnesty International. They also undermine the ability of women who are HIV positive to seek and obtain treatment, thus worsening a national epidemic that is one of the worst in the world.

“Rural women in South Africa are disproportionately affected by poverty and unemployment,” said Mary Rayner, Amnesty International’s South Africa researcher and author of the report titled “I Am At the Lowest End Of All.”

“They continue to experience discriminatory attitudes and practices — particularly from male partners – and live in an environment rife with high levels of sexual and other gender-based violence.”

The South African government has gradually improved its response to the HIV epidemic through the adoption of the Department of Health’s widely-welcomed five-year plan to combat AIDS, HIV and other sexually transmitted diseases. Still, 5.5 million South Africans are HIV-infected (about 10 percent of the population), one of the highest prevalence rates in the world. Fifty-five percent of those infected are women. South African women under 25 are three to four times more likely to be HIV-infected than men in the same age group.

The report offers specific recommendations to the South African government to address the urgent needs of women with HIV in rural areas. The report calls on the government to urgently intensify efforts to prevent violence against women through stepped up policing and prosecution, and to address the economic inequalities that block HIV and AIDS prevention, treatment and care. Additionally, the report urges the government to widen access to health services for women in rural areas, and help them with the consequences of HIV, including safety concerns, when disclosing their status to male partners.

Many women interviewed by Amnesty International in South Africa said they were often unable to protect themselves against HIV infection because they felt at risk of violence from male partners when they suggested condom use.

One woman told Amnesty International that her husband, a truck driver, spent much of his time on the road. On his days off, he visited her but refused to use condoms when she asked him to do so. After he abandoned the family she became sick, and discovered at the local clinic that she was HIV positive.

Several other women interviewed by Amnesty International described being beaten and forced to have sex by husbands who refused to use condoms.

“Women’s lives in rural South Africa are scarred by persistent violence in their families, homes and in under-policed, unsafe communities,” said Michelle Kagari, Deputy Director of AI’s Africa Program.

“The co-existence of epidemics of both HIV and violence against women has raised the costs of violence for South African women and girls – both physically and psychologically,” said Kagari.

While there are many good reasons to increase testing for HIV across South Africa, the situation is complicated in a context of gender inequality and violence, poverty and social stigma. Women are currently tested in greater numbers than men. When they receive limited psycho-social support, disclosing their status can leave them vulnerable to abandonment, threats of violence and other consequences of stigma and discrimination.

The great majority of rural women interviewed by Amnesty International said that their male partners were reluctant to test for HIV or refused to be tested – even when there were strong indications the men might be HIV-infected.

Many of the women faced abuse from their partners when they tried to access health services for HIV-related treatment and care.

“When a woman’s partner is in denial about his own HIV status, he may resent her going to the clinic or taking medication,” said Rayner.

“In the context of pervasive gender inequalities, stigma and violence facing women, particular attention must be paid by those providing HIV testing to anticipate and address possible adverse consequences for women once they disclose their HIV positive status and start treatment.”

Effective treatment for HIV and AIDS requires regular visits to hospitals and clinics for treatment and care. Rural women living with HIV in circumstances of poverty and unemployment face constant challenges in having regular access to food and often cannot afford transportation to health clinics for treatment.

Also hampering treatment in rural areas is the fact that South Africa’s health system is currently facing severe shortages of essential medical and staff necessary for providing a comprehensive service.

To view the full report, go to www.amnestyusa.org.