The UNAIDS report on the HIV/AIDS pandemic highlights the growing rates of infection among women worldwide. Women now account for nearly 50% of all individuals living with HIV/AIDS worldwide. However, in Africa, the situation is more ominous. Almost 57% of all individuals living with HIV/AIDS in Africa are women. For Africans ages 15-24 living with HIV/AIDS, women account for 76% of all infections. In South Africa, Zambia and Zimbabwe, young women ages 15-24 have rates of infection that are between three and six times that of their male peers.

The so called feminization of AIDS appears to be in full swing in Africa. The key question is whether African leaders and elite are ready to make hard choices that would slow down the rate of infection among women. I briefly review these choices. The key is to focus on practical solutions to a problem that can only get worse if nothing is done.

First, are African leaders and governments ready to mount a comprehensive and sustained information, education and communication campaign against risk-behaving practices of men that put women at risk of HIV infection? I am not aware of any African country that is currently implementing a sustained, nationwide campaign against sugar daddies, the use of large sums of money by male clients to encourage sex workers to engage in unprotected sex, the rape of young girls by school teachers, the molestation of young girls by family members and the molestation of street children. African men who have disposable income are at the root of sexual networking in various communities that spread HIV, according to the UNAIDS.

Second, are African leaders and governments ready to address cultural practices that may put women at disadvantage in the fight against HIV/AIDS? These practices include lack of proactive opportunities for women to discuss sexual mores and risks with their husbands, cultural expectations of subservience in sexual matters, the culture of wife inheritance after widowhood, and, the lack of property rights for widows or single women even when they have to take care of small children.

Third, are African leaders and governments ready to invest for the long term on female education? According to latest data from the World Bank, 45% of women ages 15 and above in Sub-Sahara Africa are illiterate. While 94% of boys are enrolled in primary schools only 81% of girls are in school. For starters, primary and secondary school education should be free in Africa to allow young people, including girls, have a head start in life. It is also important for African women to have increased access to university education, especially those from poor families. However, to ensure quality education for African women, African governments and rich nations such as the United States and other Western democracies should provide increased, targeted development assistance for Africa. Rich nations and multilateral institutions such as the World Bank and the International Monetary Fund should provide comprehensive debt relief for Africa with a major condition that significant portions of the savings from debt relief should go toward social welfare programs such as financing of education initiatives for girls and young women.

Fourth, are African leaders and governments ready to create enabling environments for empowering African women? Limited economic choices and opportunities constrict the capacity of African women to negotiate safer personal behaviors, including sexual relations. Although African women are major sources of economic wealth in many rural parts of Africa, these women have limited control over their generated income due to cultural taboos and traditional practices. African governments should end cultural practices that deny women the right to benefit from their toil and labor. It is also important for African governments to create micro-credit facilities for enterprising rural women so that they could become stable, small-scale entrepreneurs and accumulate disposable income. Women with disposable income are likely to make better personal choices for themselves and their children.

Fifth, can African leaders and governments create political space for women? Unlike many official statistics that cite token numbers of national ministers and top government officials that are women, I believe that in order to fight AIDS, women must be in decision making organs in local and state governments throughout Africa, and also have leadership roles in key national government institutions such as the ministries of finance, national planning and justice. In addition, African women should be in decision making positions in civil society, local chambers of commerce and local youth organizations that directly interface with the grassroots. It is important to state without equivocation that female representation in national cabinets in Africa should go beyond the obligatory “Ministry of Women or Gender Affairs.”

Sixth, are African leaders and governments ready to create necessary legal climate and framework that protects women from discrimination and lack of due process? UNAIDS estimates that more than 50% of African countries do not have laws against discrimination of individuals living with HIV/AIDS. In Africa, according to the UNAIDS, the fear of a HIV test by women, including pregnant mothers, is the beginning of wisdom, since negative societal consequences and uncertain future may lie ahead if they test positive. For women living with HIV/AIDS, the prospect of dealing with family, community and government indifference and sometimes hostility, can be insurmountable. Legal reforms on rape, sexual molestations, domestic violence, favors-for-forced sexual relations, property rights, and ownership of business are crucial in the fight against feminization of HIV/AIDS.

Seventh, are African leaders and governments ready to invest in public health services that are friendly and accessible to women? National spending on public health services is low in Africa, about US$30 per capita, according to the World Bank. Women face formidable challenges in accessing public health services for conditions such as sexually transmitted diseases and tuberculosis that are important facilitators of HIV transmission. Privacy and confidentiality is rare in African health institutions, according to the UNAIDS. Societal stigma is common when women become linked to sexual transmitted diseases. In addition, fear of violence may keep women from utilizing HIV preventive services or even showing up for AIDS clinical care, according to the UNAIDS. It is important for the international community to support African nations that seek to implement female friendly health systems and programs.

Eight, are African leaders ready to position gender issues as a major priority of international development assistance? Declarations, statements and formal speeches about gender issues must be coupled with specific policy and program initiatives to end gender inequities in Africa. African leaders, continent-wide institutions and the civil society should make gender equity a cardinal feature of their relationship with bilateral and multilateral agencies. There is a tendency to point to token appointments of women to prominent positions as celebratory signs of progress on gender issues in Africa. While this is important, the focus should be on hundreds of millions of African women who toil away anonymously, unsung and uncelebrated despite their significant contributions to the economy of the continent. In particular, African governments should make ending gender inequity a top priority of their partnership with donor agencies. A good measure of serious commitment is the proportion of resources requested by African governments to deal with gender inequities in proposals sent to donor agencies. National budgets should also reflect increased resources devoted to ending gender inequities and creating income-generating opportunities for women.

Nine, can African leaders lead the fight against sexual violence against women? Official, societal and personal silence on sexual violence against women is deafening in many parts of Africa. In particular, perpetrators target female teenagers in some parts of Africa, thereby potentially setting off a chain of events that may leave the young women not only emotionally scarred for life but also the ever possible risk and danger of HIV/AIDS. To end sexual violence, African governments would have to deny perpetrators of sexual violence, political, economic, legal and social sanctuary. Zero legal tolerance against sexual violence should be enforced and perpetrators subjected to the long arm of the law. Women should be encouraged to come forward with cases of sexual violence and the society should treat them with compassion while the legal system runs its course.

Ten, African leaders and governments must win the battle against widespread poverty in the continent. Poverty is a major reason why individuals, including women, knowingly engage in high risk behaviors that facilitate the spread of HIV. Feminization of HIV/AIDS is closely intertwined with poverty and harsh living conditions. African leaders and governments should create opportunities for poor women to escape poverty through sustainable macroeconomic policies that improve their vocational skills, provide access to literacy programs, provide incentives for self employment and allow them to accumulate capital and properties. Rich nations, including the United States should work closely with Africa leaders in this regard. Comprehensive debt relief, increased access to trade for African farmers and businesses, and comprehensive micro-credit programs are also critical policy issues that rich nations can assist African nations as part of a comprehensive fight against poverty.

CONCLUSION
Efforts to end the feminization of AIDS in Africa must be African-based and African-implemented. For the African woman at the receiving end of HIV/AIDS, the solution lies principally in changing societal beliefs and practices within her family, community, country and the continent. The solution to gender inequities lies in the capacity of African governments to confront societal beliefs and practices that wittingly or unwittingly put women at risk of physical, emotional and mental harm. The HIV/AIDS epidemic in Africa is exposing deadly consequences of gender inequities. As the toll of HIV/AIDS mounts in Africa and the epidemic gradually assumes a feminine connotation, every policy maker in Africa should work toward the end of all practices that prevent African women from becoming full partners in the titanic struggle ahead. Any serious advocate for comprehensive AIDS remedial efforts in Africa cannot afford to watch from the sidelines the increasing feminization of AIDS in the continent.

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About the author: Chinua Akukwe is a member of the Board of Directors of the Constituency for Africa, Washington, DC and an adjunct professor of public health at the George Washington University, Washington, DC. He has written extensively on HIV/AIDS and development issues in Africa.

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BIBLIOGRAPHY
1. UNAIDS (2004). AIDS Epidemic Update: 2004. November. Geneva, Switzerland: Author. Available at the UNAIDS website, www.unaids.org This is the latest update on the global AIDS situation and is dedicated to the feminization of AIDS. Data used in this article are available in the PDF format of the update under the following sections and pages: INTRODUCTION, pages 2-6; WOMEN and AIDS, pages 7, 9-17 dealing on issues such as gender inequities, problems with accessing preventive and clinical care, power imbalances, fear of violence, lack of property rights, cultural taboo about discussing sexual mores and risks with husbands; SUB-SAHARAN AFRICA, pages 19, 23, 24, 27, 28, 29 on issues that affect women in Africa and how it impacts on the spread of HIV.
2. UNAIDS (2004). 2004 Report on the Global AIDS Epidemic. July. Geneva, Switzerland: Author. Available at the UNAIDS website, www.unaids.org This document released during the Bangkok AIDS conference in July 2004 contains series of information on the epidemic. The PDF format includes an executive summary that also discusses continued discrimination against women and the lack of enabling legislation that outlaws stigma and discrimination against individuals living with HIV/AIDS.
3. World Bank (2004). African Development Indicators 2004. Washington, DC: Author. This is widely considered the authoritative database on Africa’s development. Data cited in this article are found in pages 320, 322, 323 on healthcare expenditure per capita, illiteracy levels and primary school enrollment. The female economic situation in Africa is shown in page 330 of the document.
4. Chinua Akukwe, Melvin Foote (2001). HIV/AIDS in Africa: It is Time to End the Killing Fields. Foreign Policy in Focus, April.