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					                                                                       Reproductive Health and Rights—Reaching the Hardly Reached




Article 7
                                                                                             Naisiadet Mason is a compelling
                                                                                             advocate for the rights of women
Abused and Violated Women in                                                                 who are HIV-positive or
                                                                                             vulnerable to HIV and AIDS.
Africa: A Personal Story                                                                     Naisiadet was a faithful wife,
                                                                                             mother and homemaker whose
by Naisiadet Mason
                                                                                             life was irrevocably changed
                                                                                             when she discovered her HIV
I AM A WOMAN BORN AND RAISED IN KENYA, a beautiful country in East                           status. Now as an international
                                                                                             spokesperson, she appeals for
Africa, famous for its national parks and wildlife. Like many countries in sub-
                                                                                             greater attention to the issue and
Saharan Africa, Kenya reports a high incidence of HIV/AIDS. Women in
                                                                                             suggests some innovative
Africa and other developing countries are at high risk of HIV and sexually                   approaches for reaching women
transmitted infections (STIs) because of social and economic inequalities they               at risk.
experience.

These inequalities resulted in my becoming infected twice with gonorrhea, and not surpris-
ingly, with HIV infection in 1988. I was married through a traditional ceremony in 1984,
had my first child in May of 1985, and my second in April of 1987. I breastfed my daughter
for nine months; unbeknownst to me, a few weeks after I stopped breastfeeding, I would be
diagnosed with HIV. I am grateful every day that my daughter did not contract the virus.

As an African woman, I was raised to obey my husband, bear his children and provide him
with sex at his pleasure. The husband’s role is to provide food, shelter, clothing and other
basic needs for his family. Tradition dictates that once he has provided the basics for the fam-
ily, he has fulfilled his duties. If he decides to have an extramarital affair, as his wife I have
no grounds to complain. Even if I could complain, our traditional social infrastructure has
broken down, leaving no avenue for filing such a complaint.

Often my husband physically abused me when I refused to have sex without a condom, once
I found out he was having extramarital affairs. Several times I asked my parents-in-law to
intervene, and speak to my husband about his extramarital affairs. They responded by asking
me, “Does he provide shelter, food, clothing and other basic needs?” I told them, “Yes, he
provides those things.” They told me that I had no reason to complain, since I was not lack-
ing for anything. In fact, they felt I was nagging their son and could not understand my need
to spend time with him.

Not surprisingly, refusing my husband sex led to his raping me. Once, I decided to go to the
police to report that I was a rape victim. The police laughed and told me, “How does a hus-
band rape his wife? This is a domestic issue. Go back home and obey your husband.
Obviously you are not obedient and that is why your husband is disciplining you.”

                                                                                                                                    63
     Our African traditions may have worked well before colonization of the African continent.
     Unfortunately, European domination in Africa brought with it negative consequences,
     including the disintegration of our societal and cultural norms. Today, we have no recourse
     for wrongs of this kind committed by members of our community as we did traditionally. We
     no longer have answers within our cultural context to deal with difficult situations such as
     the constant physical and mental abuse African women experience.

     I thought of running away from home when I became HIV-positive, and I did in fact go to
     live with my brother and his family. However, this move opened my eyes to the negative
     social stigma associated with AIDS. My brother’s wife felt I was endangering her children
     because of my positive HIV status and that I should leave their home at once. Though my
     brother was equally ignorant about HIV and AIDS, he provided me with the support I need-
     ed. After a brief period I decided to leave my brother’s home, not because I had found sup-
     port elsewhere, but because my HIV status was causing conflict in his home.

     I went back to my home and my husband vowed he would change his behavior, but this was
     a short-lived promise. Hardly a month later he was back to his old ways—extramarital
     affairs, insisting on sex without a condom—and when I dared to refuse him, physical abuse
     would swiftly follow. I was desperate, isolated, dejected and in total apathy. I had nothing to
     look forward to, no hopes or aspirations. My dreams were shattered. I lived in a perpetual
     nightmare. My comforting dream was that since my husband had also been diagnosed HIV-
     positive shortly after my diagnosis, we would live together and help each other. I came to
     realize two years later that this was going to be a very short-lived comfort indeed.

     What I experienced is common for women in sub-Saharan Africa living with or without
     HIV. Because the issues underlying social and economic inequalities have deep roots in our
     culture, changing the balance of power will need a multi-faceted approach. Since the begin-
     ning of the AIDS epidemic, education has been a key intervention, which aims to change
     behavior and attitudes towards unsafe sexual practices. Unfortunately, for countries such as
     Kenya, behavior has been difficult to change, particularly among the male population. The
     escalating number of new HIV cases is indicative that interventions should adopt different
     approaches.

     Overcoming Obstacles through Innovative Approaches
     As we continue to provide HIV education to women like me, we need to develop supporting
     programs that will economically empower women. If I had possessed the financial means to
     support my children, I would not have tolerated the mental and physical abuse my late hus-
     band inflicted on me before and after I became HIV-infected. Income-generating projects
     have provided women infected with HIV, or at risk of HIV, with income for their families,
     reducing their dependence on an abusive partner.
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                                                                     Reproductive Health and Rights—Reaching the Hardly Reached




Kenya, Uganda, Tanzania, and Senegal are a few countries where these projects have had
great success. Income-generating activities need not be complex or demand a large capital
outlay. For example, Women Fighting AIDS in Kenya (WOFAK) is a non-profit organiza-
tion that provides HIV education and basic counseling to women who are infected with or
affected by HIV. WOFAK works with a group of 50 women leaders from the Luo tribe, in
Homa Bay, a small town on the shores of Lake Victoria in western Kenya. Some of these
women are living with HIV and AIDS; others have lost a partner, child or relative to AIDS.
They realize the deadly nature of AIDS through HIV education provided by WOFAK. They
have also been taught how to care for a person who is dying from AIDS, including providing
basic counseling. A majority of these women feel overwhelmed by the AIDS epidemic
because every other home in this area has experienced at least one death due to the disease.
Because of their strong cultural beliefs and practices, these women realized that they needed
more than HIV education to protect themselves from HIV infection or re-infection—a criti-
cal realization in the wake of negative cultural practices such as wife-inheritance.

Wife-inheritance is a practice causing more harm than good, especially in light of the
increasing numbers of HIV-infected individuals. When a married man dies in the Luo com-
munity, his brother or other designated person “inherits” his wife. The designated person,
who already has a wife and mistress, will marry the widow in a traditional ceremony. If the
man died of AIDS, and the woman is HIV-infected, then she is likely to infect the man who
inherits her, and through him, his other partners.

Luo women are fighting this custom, trying to educate the elders and men in their communi-
ties about the dangers of wife-inheritance and HIV. They feel especially challenged because
there is a belief among some Luos that causation of HIV is due to “Cira”, a curse cast upon a
person for a wrongful act, or for a wrongful act committed by an ancestor of that person in
the past. Women feel that the only way they can refuse to participate in this practice is
through financial empowerment and by accessing the necessary support within their commu-
nity.

WOFAK, in its attempt to financially empower this group of women, has initiated an
income-generating project that taps into existing skills the women acquired while growing
up. Most women learn how to make Ciondo, an African basket made out of sisal and yarn,
which is very popular among tourists. These baskets can be woven as the women walk to the
market, church or community service. The yarn and sisal are readily available and inexpen-
sive. Producing the final product does not take time away from a woman’s daily tasks, yet the
baskets will bring additional income that she controls.

Another area that needs attention is a support system enabling women to leave abusive rela-
tionships that put them at risk of HIV or STIs. I did not have support to leave a relationship

                                                                                                                                  65
     that was obviously unhealthy. Traditionally, communities provided a support system to which
     women had recourse if their husbands were abusive. For example, in a traditional rural
     African village setting, if a woman ran away from her abusive husband and went back to her
     parents, her parents could ask the counsel of elders to intervene on her behalf. With the
     widespread migration to urban areas, however, this kind of traditional support system is no
     longer available. The existing support systems need strengthening so women in similar
     predicaments can easily get help. Intensifying education among community members,
     including political leaders, churches and women’s groups will increase the existing but limit-
     ed current support system. Many churches in Kenya have women’s groups that meet after
     church services; such a group could provide needed support for at-risk women.

     Other women’s groups are found throughout Africa and other developing countries. Groups
     called Tontin in Burkina Faso, Chama in Kenya, Njangi in Cameroon, and Sousu in the
     Republic of Panama are examples of existing organizations, which if strengthened, could pro-
     vide support to women. These women’s groups act as a savings co-operative where women
     contribute a certain amount of money to one member of the group each month. The recipi-
     ent of the money alternates each month until the last member has received her turn. The
     rationale in collecting money for one person each month works on the assumption that it is
     easier to save in a group setting like this than on one’s own. When a member collects her
     share, she can use it as capital outlay for a small income-generating project. This group meets
     once a month for two hours to collect this money and discuss other important issues affect-
     ing the members. They also assist each other in times of crisis such as illness or family deaths.
     Group members can be equipped with skills to provide support to members who are in abu-
     sive relationships.

     A third key area that has been neglected for nearly 20 years in HIV education programs is
     men’s participation. Obviously if we intend to make changes in behavior and attitudes
     towards safer sex practices, we need to include our men. It does not make sense to develop
     programs that need men’s participation yet do not include their input. I believe we need to
     put more effort in allowing men to have ownership of programs that affect them, ultimately
     resulting in better outcomes. Experience has taught us when individuals have a stake in an
     undertaking, outcomes are bound to be more successful. Our lesson here is for women to stop
     fighting HIV and AIDS as if they are the only stakeholders, but instead ensure they include
     men in all aspects of developing programs that will ultimately affect both men and women.

     A final area too often forgotten is the dilemma of women infected with HIV, and their quest
     for motherhood. Earlier I mentioned that one of the key roles women play in African society
     is bearing children. In fact, motherhood validates a woman’s existence in the traditional
     African culture. Many men will divorce a woman if she is not capable of having children.


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                                                                       Reproductive Health and Rights—Reaching the Hardly Reached




With this kind of social pressure, which defines womanhood by her ability to reproduce,
what kinds of issues arise for a woman who is living with HIV? The message I have heard
preached in Africa is, “If you are HIV-infected, you should not have a child, because the
child will be born HIV-positive.” What options does this woman have if she wants to have a
child regardless of her HIV status?

Educating HIV-positive women in Africa and other developing countries on the feasibility of
having children has been low on the totem pole of needs. However, this needs to change
because our society judges women by their ability to bear children. Educational programs
that allow women to make informed choices on having children need to be developed.
Women will continue to have children anyway, so they should have relevant information
regarding precautionary measures they need to take to reduce the risk of HIV transmission to
the infant. Anti-viral drugs such as AZT and nevirapine have reduced mother-to-child trans-
mission significantly and women need to know this. Emotional support for women who
choose to have children will be essential, particularly if they are advised not to breastfeed. In
the African setting, women have breastfed their children in public since time immemorial,
so if all of a sudden a woman chooses not to breastfeed her child, what conclusions will be
drawn by her community? She will be “diagnosed” HIV-positive, and her nightmare of social
isolation will begin.

My Vision of Protecting Women’s Rights
As an African woman who has experienced a relationship that put me at risk of HIV/STIs,
the big picture I envision is one in which women control more resources. This means more
representation in the political arena, a crucial area in upholding women’s rights. In sub-
Saharan Africa, few women are in key positions in government, and so cannot initiate
change in government policies that protect women’s rights. Women need to place them-
selves strategically within their governments, thus giving women the voice to stand up
against the constant human rights violations they endure. I believe that involving women in
decision-making roles will improve women’s overall socio-economic standing because:

■   Doors will open for more girls in accessing education, leading to professional well-paid
    positions.
■   More financial resources will be allocated to women’s needs, such as support systems.
■   Greater respect for women’s rights will be fostered.
■   Greater recognition of women and their ability to perform at par with men will be real-
    ized.
My doctor once said, “HIV infection is directly related to an individual’s socio-economic
position.” In Africa, and other parts of the global developing world, women control very few

                                                                                                                                    67
     resources. In Africa approximately 50 percent of the adults infected with HIV are women,
     and women’s rate of infection is now higher than men’s is. This is why we need to develop
     innovative programs that go beyond HIV education to:

     ■   Empower women economically.
     ■   Provide a support system for women in abusive relationships and those living with HIV.
     ■   Include men in program development from the initial stages.
     ■   Provide HIV-positive women education on their reproductive rights, and available
         options.
     These interventions will reduce women’s rates of acquiring HIV infection, while changing
     the balance of power. Clearly, women must control more resources to reduce their risk of
     HIV infection and to take their rightful places as major contributors to their societies.


     Selected Resources
     Internet resources on women and HIV and               The National Association of Persons with AIDS
     AIDS, and women living with HIV and AIDS,             (NAPWA) in Washington DC provides educa-
     are extensive. These high-quality sites are a         tion, advocacy and a voice of support for those
     good place to start:                                  living with HIV and those affected by it. Its
     The Body: An AIDS and HIV Information                 international department—currently directed by
     Resource contains not only technical informa-         Naisiadet Mason—extends their programs glob-
     tion, but a wide array of topics, including reli-     ally. See: www.napwa.org.
     gion, wit and humor. Its extensive section on         The HIV and AIDS section of PATH’s
     women and HIV contains moving personal                Reproductive Health Outlook contains a tech-
     accounts of how people personally contend with        nical overview of HIV and AIDS, as well as an
     their own HIV and AIDS issues.                        annotated bibliography, program examples, and
     http://www.thebody.com/whatis/women.                  a comprehensive list of Internet links. This site
     shtml#pregnancy                                       is especially designed for reproductive health
     HIV InSite bills itself as the “gateway to AIDS       program managers and decision-makers working
     knowledge.” Its resources are broken down by          in developing countries and low-resource set-
     category: medical issues, prevention and educa-       tings. http://www.rho.org
     tion, social issues and policy international links,   WISE Words is the three-times yearly publica-
     and Spanish-language resources, among others.         tion of Project WISE, Project Inform’s interde-
     http://hivinsite.ucsf.edu/                            partmental program focused on HIV and AIDS
     The overall goal of the International                 treatment information and advocacy for women.
     Community of Women Living with                        The site includes extensive technical informa-
     HIV/AIDS (ICW) is to improve the lives of             tion on prevention of mother-to-child transmis-
     women with HIV and AIDS throughout the                sion of HIV.
     world. ICW’s core value is to be run by and for       http://www.projinf.org/pub/ww_index.html
     HIV-positive women. ICW aims to combat the
     isolation experienced by HIV-positive women
     and ensure that they have input at local,
     national and international levels.
     http://www.icw.org/index.html


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