Women and AIDS in Africa: Strategies for Hope

The statistics on the spread of AIDS in Sub-Saharan Africa are staggering --nearly 30 million people living with HIV/AIDS, with 3.5 million newly infected in 2002. The images of human suffering in the media make the problem seem daunting, even hopeless. "Every time the news paints the misery, most people's reaction is, 'What can we do?' It's overwhelming," says Graduate Center Professor Ida Susser. "It's also de-humanizing. You don't see the daily humanity." In the midst of this atmosphere of despair, however, Susser--a self-described "activist anthropologist"--has been conducting research to define strategies for prevention and survival. She has chosen to focus on the plight of women, who are now contracting the disease at higher rates than are men.

Understanding the epidemic from the point of view of the people and communities affected by it has been the focus of Susser's research in Southern Africa over the past ten years. She has used her ethnographic methods in the field, interviewing people in Namibia, Botswana, and South Africa about sexual attitudes and practices, and perceptions of different methods of protection. This knowledge of local experience--how people in different communities are getting AIDS, what they think about it, and what preventative measures they are most likely to accept--is crucial to containing AIDS, says Susser.

"The issue in Southern Africa is that women now outnumber men with AIDS," she says. (According to UNAIDS, 58 percent of adults living with HIV/AIDS in sub-Saharan Africa are women, and more than two-thirds of newly infected 15- to 19-year-olds in the region are female.) "It's a gendered epidemic, so it's very much the opposite of how Americans think about it--where the majority of people with AIDS are men."

Not only do more women have AIDS than men, but they are getting it younger and dying sooner. "Men are dying in their 30s," says Susser, "but women are dying ten years younger. Many are dying at 20 or 22, and they already have children." Although the disease is horrible for everyone afflicted, the unequal odds of survival for women made Susser want to investigate what women can do to increase their life expectancies.

AIDS has reached beyond what were formerly regarded as the target populations of prostitutes and truck drivers. Married women are getting it from their husbands, who may have girlfriends on the side. (Some men use condoms but many do not, says Susser, and women are often not in a position to insist that they do so.) The strategies available to women are limited because women are subordinate in many aspects of marriages, says Susser, and often subject to domestic violence and rape. "Married women may be sleeping only with their husbands, and they'll be dying of AIDS," she says. In this scenario, the preventative measures that have been advocated in the West--distribution of condoms or the promotion of monogamy--have failed to protect many African women.

In her research, Susser concluded that the only barrier method known to prevent HIV that is a realistic option for many women is the female condom, a contraceptive that has largely been dismissed in the United States. Her report, "Culture, Sexuality, and Women's Agency in the

Prevention of HIV/AIDS in Southern Africa" (authored with Zena Stein), states: "Contrary to the view of African women as helpless victims, most of the women we spoke to saw themselves as active participants in the search for a way to protect themselves in sexual situations. Nevertheless, their methods of sexual negotiation are shaped by cultural and historical perceptions...In our interviews in these settings, both urban and rural, the women demanded that the female condom be provided to them...Woman-controlled methods of protection, such as the female condom are regarded as culturally appropriate among many men and women in South Africa and are crucial to the future of HIV/AIDS prevention." Susser believes that in this life or death struggle, the most important goal is providing African women with something they can use.

Her research has made a difference in promoting the female condom as a part of AIDS prevention programs. In Zimbabwe and South Africa, it has become an integral part of health services offered, according to the International Planned Parenthood Federation. Unsolved issues remain, however, such as lingering negative perceptions, high cost, and re-use among some people. Part of Susser's work has been to document the changes in Namibia, which is now moving towards widespread distribution and use of the female condom. "I think that the successes have to be publicized, because otherwise, people give up," she says.

She sees her work as part of a strong tradition of anthropology at The Graduate Center, where the point is not only to do research but to effect change. "You can't do work on AIDS without doing something about AIDS," she says. What anthropologists provide, in a situation such as the African AIDS epidemic, is a perspective on the real lives of people, in a global context.

"We're on the ground. We talk to people. We hear and listen and watch and observe....We must see the people as they are and hear them as they are." But it would be wrong to think of the interviews as just snapshots, says Susser. The anthropologist's job is to contextualize individual experience--in historical, geographical, and political terms--and draw connections between international relief efforts and what is happening at the local level.

Susser recently received a grant from the MacArthur Foundation's Program on Global Security and Sustainability to continue her studies on women in Namibia in 2002-2003. Another grant from the National Endowment for the Humanities and the National Institute of Health will allow her to write a book on this research during the following year.

Through her work, Susser has found grounds for hope: "In this difficult context, facing this tragic problem, the women do have strategies," she says. "They're resilient, and they're survivors."