Impacts of Abstract AIDS on This paper discusses the broad impacts of AIDS on women in Uganda. An extensive literature review and analysis demonstrate that not only is Women. the risk ofHIV-infection and AIDS higher for women than for men in lD Uganda, individual and social impacts of the disease on Ugandan society disproportionately affect women. Both afflicted and non­ Uganda afflicted women are greatly affected by the AIDS scourge through their multiple roles as individuals, caregivers, and mothers. Research by demonstrates that AIDS in Uganda presents severe socioeconomic implications for women as well as a higher risk for infection due to cultural expectations, subordinate status, and patriarchy in the society. Valerie Durrant About the Author Utah State Valerie L. Durrant recently completed her M.S. in Sociology at Utah University State University. Her thesis was entitled "AIDS Prevention: Applying the Theory of Reasoned Action to Sexual Abstinence and Condom Use." She spent a year in Kampala, Uganda, working with AIDS orphans in 1991-1992. She is currently a doctoral student of Sociology at the University of Maryland at College Park. Working Paper #249 October 1994 Women and International Development Michigan State University 202 lntemational Center, East Lansing, Ml 48824-1035 Phone: 517/353-5040, Fax: 517/432-4845 Email: [email protected], Web: http.//www.isp.msu.edulwid See back page for ordering information and call for papers Copyright 1994 MSU Board of Trustees Impacts of AIDS on Women in Uganda Introduction Illness and death caused by AIDS are taking a big toll on Ugandan society. The World Health Organization estimates that 20 to 30 percent of the adults in Kampala, the capital city of Uganda, are mv infected (Van De Walle 1990). The national newspaper of Uganda, New Vision, reported in 1989 that of the country's 17 million inhabitants, 790,522 were infected with the HIV virus, while it is estimated that the actual number is closer to 1.3 million (Barnett and Blailde 1992:23). Until recently, the disease affected men and women equally with 50 percent of the cases reported for each gender. Current reports, however, show that the ratio of women to men with HIV infections and AIDS is 1.42 to 1 (Barnett and Blaikie 1992:33). Considering the changes in the demographics of AIDS in Uganda, it is necessary to focus on the forces increasing the risk and impact of the disease on women. Toward this end, I contend that women are at greater risk for infection because they face inequities within patriarchal relationships and society; Ugandan women are also disproportionately impacted by AIDS, I suggest, because they endure a "triple burden" as individuals, mothers, and caregivers (Storck 1992). Moreover, AIDS has damaging effects on the socioeconomic situation of women. In addition, the consequences of AIDS on the society as a whole disproportionately burden women by worsening their positions and survival capacity through their extended role expectations brought on by the biased character of the disease. Literature Review Because Uganda was among the countries where AIDS was first reported, as well as being one of the first countries in Africa to recognize and address HIV infection, the literature on HIV and AIDS in Uganda is extensive and broad. Research covers the AIDS spectrum of epidemiology, transmission factors, predictions, changes, and its effects on various components of society. Although the literature on AIDS in Uganda is considerable, a neglect of the impact of HIV on women is evident. Because in Africa, AIDS is primarily transmitted through heterosexual intercourse, discussion of AIDS in Uganda cannot avoid mention, or at least assume inclusion, of women. Some authors do address women specifically, but a comprehensive view covering the full impact of the disease on women is lacking. Of primary interest in the study of AIDS in Uganda are the factors in society that facilitate and increase the spread of HIV. The economically disadvantaged situation of developing societies is demonstrated to be a fertile host for the transmission of the virus (Barnett and Blaikie 1992; Storck 1992). The social and political nature of developing countries, involving little availability and access to health care, low literacy and education rates, high stratification, limited resources for coping with the social fallout of HIV and dependency on developed nations (Ankrah 1991), serves to perpetuate a high-risk environment for HIV infection (Barnett and Blaikie 1992; Gould 1993). Few studies, however, address the stratification within developing countries that leaves women in the most impoverished and disadvantaged positions, thereby placing them in high risk conditions. Other factors may better explain the spread of AIDS in Ugandan society. In discussing the transmission of the virus, .Anderson (1992) argues that the heterogeneity, variance, and rate of partner change must be analyzed. Sexual practices elevating HIV infection have cultural reinforcements (Storck 1992). Both men and women face cultural expectations influencing their sexual behavior; sexual activity with many partners is prevalent for men in Uganda (Ulin 1992). Male identity is often based on "sexual conquest and fecundity" (Barnett and Blaikie 1992) and therefore, men are often expected to have multiple partners both in and out of conjugal relationships (McGrath et al. 1993). Behavioral changes lowering HIV rbk include abstinence, monogamy (referred to as zero-grazing by many Ugandans), and condom use. Much of the research on HIV infection in Uganda addresses the implications of condoms for preventing AIDS. Inquiry into condom use demonstrates several obstacles to condom use including their unavailability (Griffiths 1988), the association of condoms with promiscuity and prostitution (Van De Walle 1990), the reluctance to use condoms due to lack of understanding and distrust of Western technologies (Nyonyintono 1991), and religious pressures (Lorch 1993a). Though behavior change by both men and women is essential in order to reduce transmission, Ankrah (1991) identifies the importance for changes in men's attitudes and behaviors before HIV prevention can be effective. A study by McGrath et al. (1993) reinforces this idea. The authors show that Baganda women are changing their sexual behaviors to reduce their exposure to AIDS. Despite behavioral modifications, women still feel highly at risk because they see little to AIDS prevention in their partners' behaviors and have little influence in persuading partners to change. Although research encompasses some gender analysis of behavioral practices, few connections are made between the patriarchal structures that subordinate women and women's lack of control over their own or their partners' behavior. Much of the research identifies the family as a key instrument in transmission. As well as being a medium through which HIV is spread, the family is also the core support system for dealing with AIDS (Ankrah 1991; Eberstein, Serow, and Ahrmad 1988; Onyango and Walji 1988). The social and economi,; pressures that families face because of AIDS, as well as demographic changes, impact the structure and functioning capacity of the family. While the research addresses the family as a whole, it fails to distinguish the disproportionate responsibility women bear in the caregiving and support roles of the family. In addition, women's lack of access to resources is another neglected area that severely impacts women's abilities to fulfill these unrecognized roles in AIDS care. The repercussions of widespread AIDS affects not only those afflicted with the virus, but extends to all aspects of society. Research addresses the socioeconomic impacts of 3 AIDS illness and death on demographics (Barnett and Blaikie 1992), orphans (Beer, Rose and Tont 1988; Black 1990; Lorch 1993b), agriculture and farming systems (Barnett and Blaikie 1992), food production (Abel et al. 1988), industry and occupational health (Sekimpi 1988), social organization (including ag~', rural and urban distributions), and family arrangement (Carballo and Carael 1988). The disruptive effects of AIDS on organizations and institutions within society deteriorate the economic conditions and exacerbate the impoverishment of the people (Ankrah 1991; Sekimpi 1988; Storck 1992). The neglect of women continues when assessing the social and economic impact of AIDS on Ugandan society. Women bear much of the responsibility in subsistence and production, which is severely impacted by AIDS. A small section of the literature does focus exclusively on the impact of the disease on women. According to de Bruyn (1992), women are neglected in AIDS research, prevention, and impact, yet are affected more than are men due to factors tied directly to their gender. Ulin (1992) focuses on th,~ cultural, social, and economic factors which perpetuate and increase women's susceptibility to HIV infection and AIDS repercussions. Despite research which suggests that women may be unfairly burdened due to their reproductive and caregiving roles, this acknowledgement is not carried over into adequate solutions and feasible prevention strategks. In addition, the consequences of AIDS on women's roles as economic producers and their domestic and social responsibilities have not been addressed. When women are addressed in the literature, it is often in discussions of prostitution, transfer of the virus from infected mothers to babies, or another fashion which places the blame of the spread of AIDS on them. This