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À Propos Des Femmes Et Du Vih/Sida Au Sénégal: Un Nouveau Regard

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À Propos Des Femmes Et Du Vih/Sida Au Sénégal: Un Nouveau Regard UNIVERSITÉ DU QUÉBEC À MONTRÉAL À PROPOS DES FEMMES ET DU VIH/SIDA AU SÉNÉGAL: UN NOUVEAU REGARD. UNE ANALYSE FEMME/GENRE ET DÉVÉLOPPEMENT / RETHINKING WOMEN AND HIV/AIDS IN SENEGAL: A WOMAN/GENDER AND DEVELOPMENT ANALYSIS THÈSE PRESENTÉE COMME EXIGENCE PARTIELLE DU DOCTORAT EN SCIENCE POLITIQE PAR SUSAN JUDITH SHIP MARS 2009 UNIVERSITÉ DU QUÉBEC À MONTRÉAL Service des bibliothèques Avertissement La diffusion de cette thèse se fait dans le respect des droits de son auteur, qui a signé le formulaire Autorisation de reproduire et de diffuser un travail de recherche de cycles supérieurs (SDU-522 - Rév.ü1-2üü6). Cette autorisation stipule que «conformément à l'article 11 du Règlement no 8 des études de cycles supérieurs, [l'auteur] concède à l'Université du Québec à Montréal une licence non exclusive d'utilisation et de publication de la totalité ou d'une partie importante de [son] travail de recherche pour des fins pédagogiques et non commerciales. Plus précisément, [l'auteur] autorise l'Université du Québec à Montréal à reproduire, diffuser, prêter, distribuer ou vendre des copies de [son] travail de recherche à des fins non commerciales sur quelque support que ce soit, y compris l'Internet. Cette licence et cette autorisation n'entraînent pas une renonciation de [la] part [de l'auteur] à [ses] droits moraux ni à [ses] droits de propriété intellectuelle. Sauf entente contraire, [l'auteur] conserve la liberté de diffuser et de commercialiser ou non ce travail dont [il] possède un exemplaire.» PREFACE The impetus for this thesis project cornes out of my experience as a consultant in Aboriginal community health conducting HIV/AIDS community­ based research, developing education materials, training health professionals and evaluating HIV/AIDS projects. The dramatic growth of HIV among First Nations and Inuit women in the 1990's prompted the national research study 1 conducted on Aboriginal women and HIV/AIDS in 1998 that was part of a larger HIV/AIOS skills-building project that 1 coordinated for the National Indian and Inuit Community Health Representatives Organization. The research revealed how gender in its articulation with 'race' and class inequalities shaped their vulnerability to HIV, their experiences living with HIV and their access to treatment, care and supports as weil as their preponderant role in caring for people living with HIV/AIDS (Ship and Norton 1998,2000,2001). But it also drew attention to the marginalization of Aboriginal women, if not their invisibility, in HIV/AIDS policy, programs and research as weil as the noticeable lack of advocacy on their behalf by Aboriginal AlOS organizations and Aboriginal women's groups, illustrating how women and gender issues have been sidelined in the fight against AlOS close to home. This action research project coincided with a trip to Senegal that 1 took in 1998 when the Society for Women Against AlOS in Africa (SWAA) was hosting an international conference on 'Women and AlOS in Africa' in Dakar. Many of the themes in this conference resonated with research 1 was conducting on Aboriginal women at the time and it brought home to me the need for a broader feminist analysis of HIV/AIDS and for political action to put gender and HIV/AIDS issues on policy agendas. This is no less important now, writing in the aftermath of the AlOS 2006 Toronto Conference in light of my involvement in the Blueprint Coalition for Action on Women, Girls and HIV/AIOS and Women's Networking III Zone, as it was then. AIDS is profoundly political. It is about power relations in the real world that shape how we conceptualize the pandemic and its impact, the policy responses and political choices that guide programs we develop to contain the spread of HIV and to treat the disease as weil as the types of research we conduct. HIVIAIDS is as much about politics, power, social justice and social change as it is about health, medicine, science and technology. The African proverb reminds us that 'It takes a village to raise a child.' This dissertation would not have been possible without the unique and special contribution of numerous people. In particular, 1 want to thank ail of the individuals who took the time to participate in this research and share their knowledge and experience with me. My profound thanks to my thesis director, Professor Chantal Rondeau, Department of Political Science at the Université du Québec à Montréal, for her support and encouragement for this thesis project, her research expertise, timely and valuable insights. Many thanks to Professor Micheline de Sève, Department of Political Science at the Université du Québec à Montréal, for her incisive comments and wise counsel. ln Senegal, 1 am deeply indebted to Gary Engelberg, director at ACI­ Baobab in Dakar for affording me the opportunity to be a research associate and to staff members, Dr. Fatim Dia, Moustapha Dieng, Abdoulaye Konaté, Daour Wade, Diarra Diakhaté and Fatou Diop for their indispensable support and assistance with several aspects of my research. l am also deeply indebted to Professor Souleymane Mboup, Bactériologie - Virologie, Faculté de Médecine et Pharmacie ofCHU A La Dantec, Université Cheikh Anta Diop who acted as my Senegalese supervisor and whose assistance with my research was invaluable. Thank you for your support and for the knowledge you were kind enough to share with me. Thanks to Aziz Hane, program director of the Réseau Africain de Recherche sur le Sida (RARS), for his solid advice and tireless assistance with various aspects ofthis research. 1 also want IV to thank Charles Becker, historian and researcher with multiple affiliations too long to list here, for his sound advice around research and ethics in Senegal. A special thanks to Doctor Papa Salif Sow, Professor in the Faculty of Medicine and Chef du Service des Maladies Infectieuses Ibrahima Diop Mar - CHU de Fann from whom l leamed so much. Thanks to M. Gorgui Demba Ba, documentalist at the ministère de la Santé et Prévention médicale for his invaluable assistance with the archives and sharing his extensive knowledge of the evolution of the national AIDS program in Senegal. Thanks to Samba Gaye who helped me with technical aspects of the research. l want to thank Colonel Sane and Professor Aynina Cisse for warmly receiving me upon my arrivaI in Senegal. My deep gratitude goes out to my good friend Madame Ndeye Sonko, who symbolizes the strength and resilience of Senegalese women, for welcoming me so warmly into her family and assisting me with multiple aspects of this research. To the entire Sonko family, Adja, Astu, Marieme, Yacine, Moussa, Fama, Papice and Paco; 1 thank each and every one of you, who in one way or another made my stay in Senegal a pleasant one and who showed me the true meaning of 'terranga. ' To my little sister Abissatou, may this thesis inspire you to become the woman you are meant to be. To Nafissatou Sar Sow, Codou Bop and Rokhaya Nguer, thank you for your warmth, your friendship and stimulating discussions, 1 leamed so much from each of you. In Canada, a special thanks to Marie-Emilie Sambou, an amazing woman, whose home and heart has always been open to me and whose logistical assistance with this research was incalculable. 1 also want to thank Amadou Tidjane Soumare, Omar Sene, Amary Cissé, Peter Keating, Kenton Kroker, Carl James, Myron Echenberg, Linda Freeman, Eric Hoffman, Donatille Mujawamariya, Patrick Gibson, Frances Anderson, Kando Golhor, Mustapha Cham, Laura Norton and Gifty Serbeh-Dunn, who at varying points during this process have given me support, judicious advice and / or insightful feedback. Thanks to Colette Vidal for her assistance with translation and support for this project. A special thanks to Louise Lafleur-Grignon and Laurence Viens for their assistance with ail things v bureaucratie and to Tony DiSomma for his computer savvy and expertise, along with my brother-in-law Thom Spencer. Last but not least, my deep gratitude to my family, particularly my mother, my sister and my aunts, who supported me every step of the way. To my father and my grandmother who would have been so proud. This thesis is dedicated to al! of the women and men living with HIV/AIDS in Senegal, a celebration of their strength and their courage and to al! of the people who work tirelessly to stem the tide of AIDS. TABLE OF CONTENTS PREFACE ii RÉSUMÉ ix INTRODUCTION 1 CHAPTERI RETHINKING WOMEN AND HIV/AIDS IN SENEGAL 22 1.1 Conceptualizing the Feminization ofHIV/AIDS in Senegal: Review of the Literature and Problematic , 22 1.2 Research Methods 49 1.3 Statement of Limitations 58 CHAPTER II THEORETICAL FRAMEWORK: A WOMANIGENDER AND DEVELOPMENT APPROACH 60 2.1 A WomaniGender and Development Approach 60 2.2 Gender and Gender Relations in the Context ofHIV/AIDS 64 2.3 'Women' as a Social Category: An Intersectional Feminist Framework.. 75 2.4 Gender, AIDS and Development. 78 2.5 Gender, State and Policy 82 2.6 Women's Empowerment in the Context ofHIV/AIDS 90 2.7 Men and Masculinities in the Transformation of Gender Relations 94 CHAPTER III THE GENDERED CONTEXT OF HIV/AIDS IN SENEGAL 96 3.1 Gender Relations in Pre-Islamic Senegal. 97 3.2 Gender Relations and Islam 100 3.3 Gender Relations Under French Colonialism 105 3.4 Women, Gender Relations and the Post-Colonial State 111 3.4.1 Regulating Gender Relations in the Private Sphere: Legitimating Women's Subordination 116 Vil 3.42 Women's Subordination in the Economy 118 3.4.2 Women's Access to Education: Persistent Inequalities 128 3.4.3 Women's Health is Not a Priority 131 3.4.4
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