tion. On the basis of statistical information, they assert that despite the problems of reliability of statistics, it seems clear that women, especially young women, are the group that should be given the highest priority in HIV prevention work. Further, they conclude that this work should focus on political and social issues rather than individual issues; addressing social inequalities, education, poverty and employment (Gilbert and Walker 2002).
Local grass-root activism and especially women’s activism are growing to powerful political movements in Sub-Saharan Africa (Mama 1997), addressing HIV/AIDS alongside other social and political issues. Of importance in most movements is to situate HIV/AIDS into a wider social context. In South Africa, for example, grass-root organizations involved with women’s empowerment and HIV prevention represent a wide scale of social activism and differing awareness of gendered power relations in the society. The starting point of this activism is often the very statement we began with, that women, especially young women, are becoming infected in greater numbers than men. This statement, as we indicated earlier, can be explained in terms of Western constructions of ‘African AIDS’: AIDS in Africa as something radically different, with different transmission patterns having to do with dramatic differences in Western sexual practices and mystified ‘African sexuality’. Emphasizing that more women than men are dying of AIDS in Africa can, however, also be seen as a way of legitimating women’s political mobilization, especially when it is used by activist women themselves.
Women who are working in organizations dealing with empowerment of women, men’s sexualized violence and issues around women’s health, emphasize the connections between HIV, gender power relations and (hetero)sexuality. For example the Musasa Project in Zimbabwe highlights the difficulties most women face in negotiating safe sex in heterosexual relationships. This project is concerned with the connections between violence against women and HIV: “There is a strong link between women’s low position in society, male violence against women, and the spread of HIV/AIDS” (PACSA factsheet 1999). Women’s lack of voice and power as sexual subjects has also been highlighted as the major obstacle hampering safe sex practices among young European women (Holland et al. 1994).
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The global fight for the right to medication for people living with HIV can be seen as an important part in the empowerment of women. The South African Treatment Action Campaign (TAC), along with other HIV-activism, is raising the issue of HIV from the personal to the political level of global resistance.[72] Access to health care and medical treatment is one important part of this battle, but the social empowerment that such ‘medicalization campaigns’ mean for women also poses a challenge towards other forms of social inequalities (see also Sewpaul and Mahlela 1998). For example in Khayelitsha in South Africa a mother-to-child transmission prevention project that was run in close connection with TAC’s
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Preventing HIV? Medical Discourses and Invisible Women
HIV-activism, focusing on women’s own initiatives and informed choices, has created a political consciousness among women about their health rights, and ultimately a political consciousness about global politics. These women are raising questions on women’s health rights and situate these questions into a larger context of economical exploitation and global capitalism. Interestingly, the obvious point that TAC emphasizes—that the availability of drugs is a human rights issue and an effective tool in HIV prevention—is little mentioned in otherwise socially aware research (e. g. Gilbert and Walker 2002).
Feminist research and the feminist movements in the West have been peculiarly silent about HIV/AIDS as a key feminist issue. According to Treichler (1999) feminism has failed to influence the direction of the epidemic or challenge the stereotypes in AIDS discourse. African feminist scholars are, however, changing this picture (Sewpaul & Mahlela 1998; Tallis 2000; Moletsane et al. 2002; see also Machera, this volume). HIV research and feminist theory in general share conceptual interests—e. g. on power, control and change—and we argue that stronger links could challenge Western views in productive ways. Discussions on power and control involve a whole variety of issues ranging from macro level political questions of social inequalities, poverty and employment, to a symbolic level of gendered constructions of sexuality (Mama 1997; also Gilbert and Walker 2002; Kumar et al. 2001). Ratele’s (2001) important note, that sexualities are always political, and involve political questions of power and racism, is highly relevant in the context of gender and HIV prevention. Grass root women’s activism, however, shows that the questions of sexuality and power are concrete reality that must be addressed, and they are not giving up on the (utopian?) wish that such power relations can be changed.