Women are facing a myriad challenges that negatively affect South Africa’s progress towards an HIV-free generation, says Right to Care, a leading health NGO that supports and delivers prevention, care, and treatment services for HIV and TB.
Many women are being humiliated and abused in their communities and homes simply because they are HIV-positive and taking antiretroviral treatment. Even adolescent girls and young women who are HIV-negative and taking pre-exposure prophylaxis (PrEP) to protect themselves from HIV have to deal with similar challenges and being ostracised.
Nearly 20 years into South Africa’s antiretroviral treatment (ART) programme, HIV-positive people still face stigma and women are bearing the brunt of this discrimination, which is thwarting the country’s efforts to end Aids as a public health threat by 2030.
Dr Seithati Molefi, deputy chief at Right to Care, says, “ART adherence is key to keeping patients well and preventing HIV transmission, but the stigma women face is dissuading them from taking their treatment. They are unable to make better choices about their own health for fear of discrimination and violence at the hands of their male partners and society at large.
“HIV prevention is key to achieving a decrease in HIV infections, mortality and deaths. Young women aged between 15 and 24 are most vulnerable to new HIV infections, unplanned pregnancies and sexual violence. In sub-Saharan Africa, one thousand young women are infected with HIV every day. Right to Care has a dedicated programme to introduce vulnerable young women to PrEP, but they fear backlash from their family and friends if they take it. Women also struggle with abstinence because they are often coerced and forced into sexual relations.
“Our Right to Care teams are active in the fight against stigma and violence,” she says. “We have reports of women being sworn at because they are HIV-positive. Upon receiving their medication, they decant it into a different container to conceal it. Many do not return to facilities to get their treatment, particularly when they worry that their confidentiality is threatened.
“HIV-positive women are often labelled as socially unacceptable and adulterous. They are referred to as ‘geu’, ‘mongwanti' or ‘letekatsi’. Mongwanti is a term that means whore. Letekatsi refers to a woman who ‘sleeps around’. ‘Geu’ is a new derogatory term on social media. It is derived from a photo of a man who is so frail he can only eat mageu, a traditional drink made from maize meal. The assumption is that he is dying from Aids, and those who are HIV-positive are being referred to as geu.
“Many women don’t want to disclose their HIV status to their partners for fear of rejection. A patient reported that she was mocked by her partner for being on ART, and that he swears at her every time she takes her treatment.
“A young girl was laughed at by her friends who labelled her as promiscuous for being HIV-positive, when in fact she was born with HIV. Young girls also fear becoming victims of cyberbullying if their status is exposed on social media.
“Gender-based violence (GBV) has been shown to increase women’s risk of HIV acquisition and is also a barrier to accessing HIV services, treatment and care. A 35-year-old woman who tested positive would not bring her partner to get tested and would not take ART. She returned to the facility after two days, having been beaten by her partner. She would not open a case against him.”
Molefi adds that the introduction of an intimate partner violence (IPV) screening tool in facilities is allowing healthcare workers to identify and better support vulnerable women. This tool involves questions that healthcare workers ask women who test for HIV or start ART. They note the woman’s answers but also her physical responses to the questions, which often tell the real story.
There is also an HIV risk-screening tool that healthcare facilities use, which includes GBV questions. Clients who are at risk of IPV and GBV are then referred to social workers and other NGOs dedicated to women’s needs or Thuthuzela Care Centres.
Molefi says, “Through a USAID-funded DREAMS (Determined, Resilient, Empowered, Aids-free, Mentored and Safe) programme, Right to Care is addressing the structural drivers that increase girls’ HIV risk. These include poverty, gender inequality, sexual violence, lack of education and psychosocial support.
“There is a community of NGOs, each providing a different service – sexuality education, sexual and reproductive health, economic strengthening, family strengthening and post-violence care. Through this coordinated, integrated effort, South Africa is empowering young women, and helping them protect themselves from HIV.
“The DREAMS programme has shown us that collaboration is central to meaningfully addressing women abuse and GBV. No one agency, department or NGO can tackle this alone. A system-wide effort is required so that women and men are supported.
“Gender rules and roles are unclear for many men and they also need support. Right to Care’s circumcision campaign has proven just how successfully men can be engaged and brought together to talk openly about their sexuality and their lives. So, it is possible. We welcome President Ramaphosa’s efforts to put GBV at the top of the agenda. But a lot more needs to be done.”
Issued by Right to Care