AIDS, economics, gender and racism
A conversation with African women
by Pauline Muchina, Mabel Katahweire, and Lyn Headley-Moore

[Ed. note: Pauline Muchina is a theologian from Kenya who is currently working for the AIDS Resource Center in the Episcopal Diocese of Newark. Mabel Katahweire, an Anglican priest from Uganda, recently spent nine months doing AIDS ministry in Johannesburg, South Africa. Lyn Headley-Moore, the executive director of the AIDS Resource Center, a mission of the Diocese of Newark, facilitated a conversation between them in November.]

Lyn Headley-Moore: I thought we'd start with looking at the impact of AIDS in Africa. Why is southern Africa so severely affected?

Mabel Katahweire: AIDS in southern Africa is not worse than in other parts of sub-Saharan Africa. Southern Africans are waking up to the reality of HIV and AIDS after being in denial. Some people still think that it is a curse – that is why there is much killing and stigmatization of those who are known to be HIV-positive.

Pauline Muchina: You have to put it within the context of the whole continent, where you have 28 million people who are carrying HIV/AIDS and where you have 2.8 million people dying every year of HIV/AIDS. You have to look at the different factors that play a role, and some of them go back to the early stages of the disease. When the disease started in South Africa they were still under apartheid. I strongly believe that racism played a major role in the way HIV/AIDS was handled – in matters of assigning resources to combat it, education, providing knowledge for communities and how the media addressed it in black communities.

You look at a country like Angola, like Mocambique, like Zambia. And then you come to east Africa and you look at Kenya, Uganda, Rwanda and all these countries with very poor economies and with governments that are not even able to take care of their people in other areas – then you expect them to be able to take care of them on the issue of health and HIV/AIDS.

The other major part is the issue of urban migration. There is a lot of migration in southern Africa into urban centers.

Mabel Katahweire: When people migrate they are hoping to get a job. When they come to urban areas the reality is quite the opposite. They don't get jobs, so some young girls just end up selling their bodies in order to support themselves. And in the process they have children who become infected also. Because HIV/AIDS is more severe in poor neighborhoods, when people get infected they deteriorate very fast because they don't eat well and they have no medical care. So you end up burying more people every day.

Lyn Headley-Moore: Mabel, you've just been in South Africa. What did you see in terms of poverty, in terms of education, in terms of HIV and AIDS?

Mabel Katahweire: Many people are poor, but in ways that are different according to the country. In southern Africa, for example, the economy is mainly a money economy, so if you have no cash in your hand, you can't eat. Whereas in Uganda or Kenya you may not have cash in your hand, but at least you can grow fruit and you can put up a house. In southern Africa people are helpless if they have no job.

Pauline Muchina: When you think about the economy of South Africa and how they are tied up with the global market economy – and the way that none of the African countries today can operate without being tied up to the global economy – then you will begin to understand how globalization has been so devastating for us. Over 60 percent of the population of most African countries live below the poverty level of one dollar a day. They don't have access to proper housing, food, clean water, health care, education. Or if they do, it's very limited.

It makes me so angry because most of our African countries are also paying massive amounts of dollars in debt repayment because of the international debt. For example, a country like Kenya spent more money paying debt back than providing health services for citizens. When you look at the Structural Readjustment Program, which is implemented by the World Bank and the IMF, to try and help poor countries to repay their debt – those programs affect the poor, you know. They dictate to governments that they have to cut government spending, and so the first things to go are the resources that would be helpful to our communities, like health services, education. And women are the ones who are mostly affected, because they have to take on the burden of taking care of their families and they are the first ones to be cut off from their jobs.

Lyn Headley-Moore: What has been the role thus far of multinational pharmaceutical companies, and what are some of the things that could help that aren't happening yet?

Pauline Muchina: As you know, there have been a lot of advances of technology in countries like the U.S.A. and some countries in Europe, where drugs that help people with HIV/AIDS live a longer life are available, and where prenatal care and anti-retroviral drugs are available for mothers who are pregnant, and they are able to give birth to children who are not HIV-positive. But when you come to a region like Africa, those drugs are not available. Most people who get HIV/AIDS die within a period of six years. It's compounded by lack of good nutrition, poverty, but also lack of access to health services, medication and treatment. Pharmaceutical companies have been challenged to make those drugs available to poor countries. And some of them have said, okay, we're going to provide those drugs at a cheaper rate – but how is that going to help if it is being taken to a country where poor people who are infected are not even able to buy food? And at the same time, the World Trade Organization has this rule that local companies in places like South Africa, Brazil, India, cannot produce or manufacture generic drugs. If they were manufactured locally, they would be priced in a way that local people, poor people might be able to afford.

Lyn Headley-Moore: And government could subsidize.

Pauline Muchina: But that's impossible now, because of the World Trade Organization. Talk about globalization and imperialistic attitude! They are the owners of the knowledge of HIV medication and they will make some concession and lower the prices. But how are people going to buy anything? Let alone HIV medication, they can't even buy condoms. They can't even buy malaria tablets – malaria is the number one killer in Africa today and we're still wrestling with it. So the pharmaceutical companies have a moral obligation when it comes to sharing resources and sharing knowledge, and the international community needs to hold them accountable.

Lyn Headley-Moore: Why does HIV/AIDS have so great an impact for women?

Mabel Katahweire: One reason is poverty – women are poorer than men. And yet their families depend on them. They have to struggle to support the family and one of the ways they do that is to sell their bodies.

Another problem is that once a woman is married, she can't say no to a man even if she is aware that the man is infected. Also, when husbands die and widows have no income, they have nothing to support their children. And they will be forced into marrying some man who they know is infected in order that their children may get care.

Lyn Headley-Moore: What about women's choices within relationships, within marriage, about prevention options?

Pauline Muchina: We just had a meeting of African women theologians in Ethiopia in August to look at HIV/AIDS and African women and religion. And one of the things that came out so clearly to me was that marriage is not a safe haven for women. Most of the African women who are HIV-positive contracted HIV in marriage. You have to look also at women's rights in the whole society – and here you have to look at the three major religions that operate in Africa, which are Islam, Christianity and African religion, and how they view women, where women have no rights. Women's holdings do not belong to them, they belong to the man they are married to or to the men who are their fathers or their brothers. You have to look at this whole issue of their right to choose. That doesn't even exist in most communities in Africa, where sexuality is tied so closely with reproduction. That was the cultural perspective, but then Christianity encouraged that. You realize rape in marriages is very old, because a woman has no right to say no, she has no right to negotiate a condom. And if she does, she is subjected to violence by her husband and also condemned by the community, because her body belongs to her husband.

Mabel Katahweire: I came across a woman who knew that her husband had died of HIV/AIDS. The woman had known the husband was infected and she wanted to get out of that marriage, so she went to talk to her pastor and the pastor said, "You can't do that! You made vows in health or sickness, you have to stay with your husband." And this woman told me, "This was between life and death and I didn't want to die. I decided to get out of the marriage anyway. I got out of the marriage but I was stopped from having Holy Communion. I was punished for leaving my husband, for breaking the vows."

Lyn Headley-Moore: I heard a story when I was in South Africa last year about a woman who had been badly beaten by her husband because she had learned that a condom could be helpful. She knew that her husband was sexually involved with other people, so she had asked him to use a condom – which he took as meaning that she was sexually involved with someone else. Apparently that is not an uncommon experience.

Pauline Muchina: In Kenyan communities, a lot of men go to the cities to look for jobs. The women are left in the country where they take care of their families and work on their farms. When the husband comes back the woman doesn't know what he has been doing in the city. But it is possible that he engages in sexual activities with other women and especially prostitutes who are poor women trying to make a life. This man comes back to the village with HIV/AIDS and the woman cannot say no to him, and she gets infected. The next thing you know, the husband dies and she has to be inherited by the next of kin of the husband. So the cycle of HIV continues.

Mabel Katahweire: I wanted to go back to the role of the church, especially in Uganda, because the church's stand is that a condom is not to be used unless it is in a marriage setting. The church feels that it encourages immorality if you allow the use of condoms, which I really think is unfortunate.

Pauline Muchina: I agree with those who view the church as a movement capable of facing the challenge to contain the spread of HIV/AIDS through massive sensitization of communities. The church has been quite effective in teaching about the subordination of women. I believe they can undo the negative socialization by teaching respect and dignity, women's rights to choose, empowerment of women to be all that God intended.

Lyn Headley-Moore: What are the opportunities for being tested in most of Africa? Here in the U.S. a big part of the population that we're pretty sure is infected is untested even though there are opportunities for confidential testing. That's the hardest piece to break through, to get people tested.

Mabel Katahweire: Well, in Uganda we have been lucky, because the government has really spearheaded these programs to help eliminate HIV/AIDS. So testing is available. It used to be free. But today you pay for it and many people do go. And what education has done in Uganda is to get people to be open about AIDS. People are no longer ashamed. And that has been very helpful because people find out if they are infected. And they are not victimized through their jobs. There are many centers in the rural areas where people can go for treatment, and there are many people who go for testing, because they want to know their status and plan their future.

Pauline Muchina: That's so encouraging because my feeling has been the opposite – a lot of people don't go and get tested because they are afraid to know, because of the stigma associated with HIV/AIDS. But the government is saying, you have to go for testing. And they do provide a clinic. But that kind of testing is very limited where the health services are very poor. NGOs are the ones who are picking up the funeral costs in Kenya, especially in the Nairobi area, and it is NGOs that are leading the way in counseling, educating people and encouraging people to go for testing.

But I have known cases like my own cousin who died of HIV/AIDS about four years ago. He was tested by his doctor, and they didn't tell him he was HIV-positive. They were afraid of how he was going to react. So he didn't know until it was too late for him to take care of himself. But he, in turn, even after he knew he was HIV-positive, never told his wife. So everybody is implicated.

Mabel Katahweire: I think people are also afraid that when they are diagnosed with HIV, that's the end of their sexual life. They don't know that with protection they can still be sexually active. And most men will not go for testing because of that.

Pauline Muchina: And I think the church has to expect that people are sexually active outside marriage. Give young people a way to protect themselves, even if they are given knowledge to abstain or postpone sex. By not helping them to protect themselves, you are denying them abundant life which Jesus promised to us. I've been asking this question a lot – what does abundant life mean in the context of HIV/AIDS, especially in Africa? We talk all the time about abundant life, yet we as the church also stand in the way of people attaining abundant life by the rules and regulations that have been placed on people's sexuality.

Lyn Headley-Moore: Overall, do you have any idea how well educated people are about HIV and AIDS?

Pauline Muchina: I think people who have access to radios and TVs and newspapers hear more about HIV/AIDS than people who don't have access to that kind of knowledge. I think the problem with our whole system is we are not teaching about HIV/AIDS. They are afraid of addressing the issue of sexuality in school. In Kenya, the most educated people are dying of HIV/AIDS. I was talking to someone who was saying, do you know that even doctors are dying from HIV/AIDS? There is a group in Kenyan society which is dying not because they do not have knowledge of HIV/AIDS, but because they're in denial. They don't want to admit that they themselves are at risk. But I think the majority of the population are dying from the lack of knowledge.

Lyn Headley-Moore: I think that applies here, too. The populations being hardest hit currently with new infections are the poorest people, people of color, youth, seniors and women. Part of it is a lack of accurate, useful information. Part of it is a certain amount of denial of their risk potential, genuine ignorance of their risk, and ignorance on the part of doctors who are assuming that certain populations are not at risk, when in fact they are. It's not only men who have sex with men, it's not only injection drug users, it's women who are at risk of heterosexual transmission. And so doctors are very late recognizing the symptoms. Also, women still represent a very small percentage of clinical trials for treatment. And women are much later going for testing, getting a diagnosis and being available for treatment. So all of those things contribute to the death of women.

Pauline Muchina: You know, we all like to say that HIV/AIDS does not discriminate, but I've been just shocked working with the AIDS Resource Center and finding that most of the people who are affected are African Americans.

Lyn Headley-Moore: And now Latino numbers are rising.

Pauline Muchina: Right. But the face of HIV/AIDS is a problem of color. I know that initially it was primarily gay men, but now it is people of color who are the most affected. I mean, look at Haiti.You go to Asia, it's people of color. You go to South America, you go to Africa. Racism definitely has something to do with it.

Lyn Headley-Moore: Well, certainly racism has had a role in economic status, in opportunities for education and in choice. We're so aware these days – thank God – of the impact, for instance, in Africa. But people are not aware that in the state of New Jersey we still have six new infections every day despite the fact that we have some education. The infection rate is much higher than it should be and in the African-American community nationwide, it's one out of every 50 African-American men and one out of every 160 African-American women. In the city of Newark, though, we're talking like one out of every four to five people who are infected. It's impossible to stand at a bus stop with 20 people and find one person in that crowd who has not either been infected themselves, lost a close family member to AIDS, or who is at present a caretaker for someone who is living with HIV/AIDS. And although people are living healthier and longer, again medications are an issue for the African-American community. Partly because of the Tuskegee Syndrome [fear of racist medical experimentation], partly because of a general distrust of entire systems, and because poverty is a barrier to receiving the very services that are set up for you to access.

Pauline Muchina: A man from USAID was speaking to us at a conference in New Haven at the Yale Divinity School and he said that they went to the U.S. government to ask for additional money to fight HIV/AIDS, and they were told that there was no funding. And the same week, the U.S. government allocated two billion dollars to war. Are we missing something here? They need to look at their priorities much more.

Lyn Headley-Moore: And stewardship of resources. That brings me to another question. War is also an infection factor for people.

Pauline Muchina: I think a lot of women who live under war or have experienced war will tell you that their governments have spent millions of dollars fighting wars that were not helping them in any way. They were actually condemning them to death. Because the resources were taken away from things like shelter and the infrastructure of the country. They will also tell you that they have lost mostly all the males in their communities, either to death or they've run away and left them behind. And women are left with the burden of taking care of their children and that puts a lot of pressure on them to look for money in different ways. You know, the greatest number of refugees in Africa today are women and children, women running away from war and going to a country where they're left at the mercy of the local community that receives them, and that has not always been a positive experience.

Lyn Headley-Moore: And what about rape as a spoil of war?

Mabel Katahweire: Violence against women increases when people are at war. You know, women are raped to punish the men in the other communities. Women are raped by men who have been in the bush fighting war and have not had the opportunity to be with women in their own community.

Pauline Muchina: For example, Somali women were raped by Kenyan soldiers in a refugee camp in northern Kenya. Refugee women are also sold by the staff of some of these organizations that are working in refugee camps to exchange sexual favors in return for food. So war is a major factor in the spread of HIV/AIDS in Africa.