By Per Kåks

How are gender roles, poverty and HIV/AIDS connected, and how does a change in one of these lead to a change in the others? The threat that HIV has brought to the affected countries, primarily in Sub-Saharan Africa, has led to massive social shifts on several levels. Deeply rooted local norms regarding relationships and gender norms can be both challenged and consolidated when local and international organizations work to stop the pandemic. Interestingly enough, Uganda was Sub-Saharan Africa’s first country to successfully slow down the spread of HIV, and one of the continent’s first countries to promote gender equality to the highest priority.  

What happens when international organizations engage health in other cultural contexts, and how can understanding local culture and the individual’s experience of the disease be useful in working with changing norms? HIV’s spread is, in many ways, inseparable from the influence of cultural norms and social interaction, and so understanding its spread requires more than just ordinary medical knowledge.

Like many surrounding countries, Uganda was first struck by HIV in the early 1980s. The high mortality of the disease has influenced national economic priorities as well as social organization. Something that has distinguished Uganda in the fight against HIV is its successful mobilization with information, access to testing and treatment as well as proactive work with women’s rights to autonomy and power on both a domestic and a societal level. This tradition regarding women’s involvement in public and private power spheres can be traced back to president Yoweri Museveni’s large policy changes after the guerilla coup in 1986, through which he gained the political power in Uganda. Whether this was a genuine will to promote women’s rights or an attempt to expand his political support can be debated, but it seems to have had a lasting positive effect on Ugandan politics.

There is a long tradition of colonial ideas about sexuality in Sub-Saharan Africa – often seen as something aggressive and uncontrollable, in line with the old Christian idea of sexuality as an opposition to spirituality. In some ways these ideas have survived into the twenty-first century. For example, many of the sexual norms and gender roles can be found in both Sub-Saharan Africa and in the Global North.

For the past few decades the fight against HIV has followed two principally different strategies. The main policy during the 1980s was what was called zero grazing, named after a way of feeding cattle without letting them roam freely. Zero grazing focused on reducing the number of sexual partners without necessarily pushing monogamy as the only solution. This policy was later replaced by the more conservative ABC concept (abstinence, be faithful, use condoms) supported by both Museveni and the Bush administration in the United States in the early 2000s. ABC mirrors the policies that were supported by Christian missionaries working to stop the spread of syphilis in the early 1900s. The main focus of these policies has been to break the tradition of having several sexual partners being seen as a sign of social status among men – a connection between virility and masculinity embodied by the dictator Idi Amin in the 1970s – making it a somewhat moral campaign.

The ABC concept might have contributed to portraying sexuality in itself as problematic, but it has not primarily focused on the male privilege to dictate the terms of sex. Contemporary social studies, such as those done by Robert Wyrod, Professor of Sociology at the University of Colorado, indicate that the strict ABC concept might not have reduced the number of sexual partners more than the pragmatic zero grazing campaigns. Rather, it has contributed to a culture where people are less inclined to openly talk about sexual behaviour. Further reinforcing this phenomenon is the connection between masculinity and economic safety. As there is a strong ideal surrounding men as family providers and breadwinners, it can be difficult to live up to in a setting with economic uncertainty. Hence, men can be reluctant to engage in anything that reduces their chances of employment. As men with HIV often are stigmatized, discriminated towards on the labour market, and find it more difficult to establish and keep sexual relations, their ability to live up to masculinity ideals regarding work and sex diminishes. This can in turn lead to a culture where men are both unwilling to talk openly about their own positive HIV status, and be more reluctant to test for HIV in the first place. Thus both poverty and notions of what ‘masculinity’ means can contribute to the difficulties of stopping the HIV pandemic.

 

How then, can these norms be challenged? Ideas about what comprises masculinity might very well be connected to a deeper norm where men have the main responsibility for production and women have the main responsibility for reproductive work. One way to go against these ideas would be to improve women’s access to work and their own income, thereby making it easier to challenge the male sexual privilege as the economic consequences of leaving an unfaithful man decrease. As women gain economic freedom, men’s exclusive ability to dictate the terms of sex can be challenged, and as men lose their burden of being the sole family providers, the fear of unemployment might be reduced.

“The HIV pandemic has the potential to be a driving force for gender equality as it makes destructive power relations visible.” More work is needed to prevent the stigmatization of HIV, a change of mindset that could increase the willingness for testing. Parallel to this, a reformulated idea of what it means to be a man is also needed – without multiple partners as sign of social status, without an exclusive male privilege of dictating the terms of sex and with both women and men as family providers. HIV, masculinity and economic uncertainty are connected, and it is only possible to create lasting change by working to improve them all.

By Per Kåks

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