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Women and Power in the Vulnerability to HIV Infection: the Case of Malawi

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Women and Power in the Vulnerability to HIV Infection: the Case of Malawi University of Southampton Research Repository ePrints Soton Copyright © and Moral Rights for this thesis are retained by the author and/or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder/s. The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given e.g. AUTHOR (year of submission) "Full thesis title", University of Southampton, name of the University School or Department, PhD Thesis, pagination http://eprints.soton.ac.uk UNIVERSITY OF SOUTHAMPTON FACULTY OF LAW ARTS AND SOCIAL SCIENCES School of Social Sciences Women and Power in the Vulnerability to HIV Infection: The Case of Malawi by Emma-Louise Anderson Thesis for the degree of Doctor of Philosophy June 2009 UNIVERSITY OF SOUTHAMPTON ABSTRACT FACULTY OF POLITICS AND INTERNATIONAL RELATIONS SCHOOL OF LAW, ARTS AND SOCIAL SCIENCES Doctor of Philosophy WOMEN AND POWER IN THE VULNERABILITY TO HIV INFECTION: THE CASE OF MALAWI by Emma-Louise Anderson As the HIV/AIDS pandemic matures increasingly more women are infected than men. The heightened prevalence amongst women suggests that they are at particular risk of infection. Although the gendered dimensions of HIV/AIDS have been recognised, this is not fully understood and the tendency is to respond at a surface level only. This research provides a critique of the current response to HIV/AIDS in Malawi and a theoretically informed analysis of why women are vulnerable. It is argued that the response is limited because it fails to engage with the gendered dimensions; and that gendered structures of power underscore the vulnerability of women to infection. This research makes an important contribution to the feminist task of radically challenging the conventional boundaries of international relations, which typically draws upon a masculine form of knowledge. It also challenges the dominance of the scientific discourse that governs the way HIV/AIDS is conceived and makes an important contribution to the literature on understanding the gender context. A ‘feminist interprevist’ approach is employed and the methodology is a combination of a case study analysis, semi-structured key informant interviews, documentary analysis and data analysis. Feminist critical theory and post-structuralist understandings of how power operates through gendered structures provide the theoretical basis for the empirical analysis. The critique of the response to HIV/AIDS in Malawi reveals how it fails to engage with the gender power relations because of pervasive gendered structures. Three aspects of women’s vulnerability to HIV infection are explored: the majority of women are not in the position to negotiate for safer sex; many women do not have the power to leave a marriage if it puts them at risk of infection; and the biological susceptibility of women to infection. It is argued that gendered structures underscore this vulnerability. The gendered structures are deeply embedded and hard to discern. However, where HIV/AIDS travels along the fault lines of society it reveals these deeper structures of power and provides the opportunity to challenge them. It reveals the importance of empowering women across their lives in order for a sustainable and effective response to HIV/AIDS. For Jon Contents Page Author’s declaration i Acknowledgements ii Abbreviations iii Introduction 1 Methodology 7 - Case study 9 - Interviews 12 - Documentary analysis 14 - Data analysis 15 The conclusions and the wider debate 17 Ethics 19 Value and relevance of this research 20 The structure 22 Chapter one: Gendered structures of power 25 1.1 Feminist conceptualisations of how power operates through 26 gendered structures 1.2 Issues that gendered structures raise to inform this research 31 1.2.1 The possibility of empowerment 31 1.2.2 An account of real interests 35 1.2.3 How the response to HIV/AIDS is limited by gendered 37 structures of power 1.2.4 How gendered structures underscore the vulnerability of 40 women to HIV infection 1.3 The application of feminist theory 50 Conclusion 60 Chapter two: A critique of the response to the gendered dimensions 63 of HIV/AIDS 2.1 The context of HIV/AIDS and its gendered dimensions in Malawi 64 2.2 A cause for action 65 2.3 The action that has been taken – mitigating the impact of the 76 perceived crisis 2.4 Current planning for the future – a centralised response 85 2.5 The value of this research 91 Conclusion 97 Chapter three: Negotiating for safer sex 100 3.1 The value of reproduction 101 3.2 Sex is a husband’s marital right 105 3.3 Women have a subordinate position 112 3.4 Women have a gendered role to engage in cultural sexual rituals 124 3.5 The gendered dimensions of the stigma surrounding sex, HIV/AIDS 128 and condoms 3.6 Women lack the knowledge and understanding to be able to 142 negotiate Conclusion 148 Chapter four: Leaving an unsafe marital union 150 4.1 The social significance of marriage 152 4.1.1 Women are socially conditioned to want to marry, be successful 153 in their marriage and persevere 4.1.2 The ideology of persevering in marriage is institutionalised 158 throughout society 4.2 Women are financially dependent upon their husbands 164 4.2.1 Access to and control over land, crops and credit 168 4.2.2 Women are vulnerable if they leave the marriage 173 4.3. The legal status of women 177 4.3.1 The laws on divorce 177 4.3.2 Gendered structures limit the effective use of the legislation 183 Conclusion 188 Chapter five: The risk of contracting HIV 191 5.1 Increased likelihood of HIV transmission during sexual intercourse 192 5.1.1 The tendency for girls to have an early sexual debut 192 5.1.2 The age asymmetry of sexual relationships 198 5.1.3 The prevalence of violent sexual intercourse 203 5.1.4 The emphasis on the man’s pleasure from sex 213 5.1.4.1 ‘Dry sex’ 214 5.1.4.2 Female Genital Mutilation/Circumcision (FGM/C) 217 5.1.5 Sexually Transmitted Infections (STIs) 221 5.2 The predisposition of women to poor health increases their risk of 232 contracting HIV 5.2.1 Poverty and poor health 232 5.2.2 Low levels of nutrition 235 5.2.3 Schistosomiasis 245 5.2.4 Access to health services 246 5.2.5 Pregnancy 249 Conclusion 250 Conclusion 254 - The Theoretical Foundations 256 - Does the response to HIV/AIDS in Malawi engage with the 258 gendered power relations? - How do gendered structures of power underscore the 259 vulnerability of women to HIV infection? - How do gendered structures affect the position of women to 259 negotiate for safer sex? - How do gendered structures of power affect the capacity women 261 have to leave a sexual relationship if it puts them at risk of HIV infection? - How do gendered structures of power underscore the biological 263 vulnerability of women to HIV infection? - Talking meaningfully about empowerment 266 - The relevance and value of this research 268 - The wider debate and further research 270 Appendix 1: List of interviewees 272 Appendix 2: Ethics Application 277 - Ethics Committee application form 277 - Ethics review checklist form 282 - Interview schedule 284 - Participant information sheet 286 - Participant consent form 289 Appendix 3: Conference abstracts 290 – ‘Women and Power in the Vulnerability to HIV: the Case of 290 Malawi’ – ‘Women and Education in the Vulnerability to HIV: the Case of 291 Malawi’ Glossary 292 Bibliography 294 List of Figures Page Figure 1: A map of Malawi 10 Figure 2: Budget allocation for Government Ministries 70 Figure 3: Manyuchi condom advertisement and a supermarket display 138 Academic Thesis: Declaration of Authorship I, Emma-Louise Anderson, declare that this thesis and the work presented in it are my own and has been generated by me as the result of my own original research. Women and Power in the Vulnerability to HIV Infection: The Case of Malawi I confirm that: 1. This work was done wholly or mainly while in candidature for a research degree at this University; 2. Where any part of this thesis has previously been submitted for a degree or any other qualification at this University or any other institution, this has been clearly stated; 3. Where I have consulted the published work of others, this is always clearly attributed; 4. Where I have quoted from the work of others, the source is always given. With the exception of such quotations, this thesis is entirely my own work; 5. I have acknowledged all main sources of help; 6. None of this work is based on work done jointly with others; 7. None of this work has been published before submission Signed: …………………………………………………………………………………………. Date: ………………………………………………………………………………………….. i Acknowledgements This work would not have been possible without the support and guidance of many people. Although I cannot thank everyone here, I hope you all realise how grateful I am. This research was funded by the Economic and Social Research Council (ESRC) including all the fieldwork and language training. I would like to thank Dr Anthony Evans for his guidance and supervision in this research. I am also grateful to Professor David Owen and Dr Chris Armstrong for their advice on the theory chapter, Professor Frank Gregory for his enthusiastic feedback on the upgrade chapters, and Dr Katherine Brown for her support and advice.
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