Ideas and practices of Zimbabwean women in preventing Sexually Transmitted Infections

Prevention of sexually transmitted infections including HIV is not just about abstaining from sex, using condoms or being faithful (ABC strategies). Many other factors determine whether a person will resort to using these strategies or not and we have to take these into account for effective prevention.

In a study carried out among 300 women and men in 1999-2000 in Zimbabwe, it became clear that an individual Zimbabwean woman neither owns nor controls her own sexuality, yet current HIV prevention strategies are centered around the individual. In Zimbabwe, there are more people besides the woman herself interested in how she runs her sexual life, rather hindering than promoting the woman from using the ABC strategies. The other people interested in a woman’s sexuality are, e.g. her nuclear family, her extended family and even people that belong to her community. These relations present the women with complex kinship structures that can have a positive or negative influence on a woman’s sexual relationships. Their kin, according to the stereotypical expectations regarding their marital status, impact upon the sexuality of women of different marital status differently. The research focused on how women of different marital status; unmarried, married, widowed, divorced and sugar mummies experienced their sexuality and their views and ideas on prevention. Different qualitative research methods were used, namely in depth interviews, participant observations, focus group discussions and passive listening. The male partners and those of similar marital status were also engaged in the study to complement the women’s stories.

The study showed that how gender relations are constructed and lived out impacts greatly on how men and women live out their sexual lives exposing or protecting them from risky sexual relationships. There are stereotypes on how women of every marital status are supposed to behave, what many women act out publicly but have difficulties in living out in private. This is a problem made worse by societal expectations. Unmarried women are e.g. not supposed to have boyfriends let alone have sex yet they are expected to get married one day. Consequently sexual health services for this group are scarce and the service givers are often not trained for their roles or live out their cultural rather than their professional expectations on this group.

Some of the cultural practices that are risky have become redundant such as the norm that widows enter a levirate relation with a brother of the late husband. Traditionally it was older women who were widowed and nowadays most women widowed to AIDS are within the sexually active group of 15-49 years.

Findings

1. KIN CAN COMPOUND THE RISKY BEHAVIOUR OF AN INDIVIDUAL WOMAN
   by trying to enforce some societal expectations deemed good like getting married. Many families often override the importance of the health of a woman in order to collect the bride price at her marriage irrespective of the health status of the marriage partner. Married women who want to leave abusive relationships, also e.g. when they feel their lives are at risk to infections due to risky sexual behaviour of partner, may not themselves decide to leave the husbands. They have to negotiate with relatives who more often than not force them to stay in bad relationships for fear of having to pay back the bride price.

In a quest to fulfil societal expectations, some women use strategies that are sexually risky. Unmarried women try to trap marriage partners by getting pregnant and this is often with more partners, heightening their risk of being infected with HIV. Young widows on the other hand, who culturally should not have sex since they are perceived as having no partners, indulge in sexual relationships. Due to stigma surrounding AIDS deaths, they do so without disclosing their health status to partners or without using protection for fear of rejection. These young widows and unmarried women often suffer from bad or lack of sexual health services since they are culturally not supposed to be indulging in sex. These cultural perceptions have permeated the sexual health structures and services.

The discourse around AIDS deaths is still negative. When people die of AIDS the families do not disclose that the death was AIDS related. So future partners are unaware of the risks of getting infected. However, the funeral platform for explaining the cause of death, in spite of its giving conflicting messages often shows some sanity and honesty by the traditional jester who exposes the cause of death in a jocular manner by playing out the deceased’s life and other behaviour such as the sexual one at the funeral. Gossip at funerals may expose the cause of death but might not always be taken as seriously like if a jester would enact the behaviour of the dead person.

2. POLICY AT NATIONAL LEVEL AND THE WELFARE STRUCTURES THAT
   should be in place to support women in difficult situations are mostly absent, inadequate, or are not implemented timeously and correctly. There is little support for divorcees and unmarried women with children, forcing women into risky sexual relations in order to cater for their basic needs such as accommodation, school fees, medical bills and food for themselves and their children, once they leave husbands that are abusive or putting them at risk of HIV infection.
3. HIV MEDICINES, ANTI-RETROVIRAL THERAPIES, ARE STILL NOT AVAILABLE to 15% of those who need them. There are still children being born with HIV since the Prevention of Mother to Child Transmission Programme reaches just about 80% of pregnant women in Zimbabwe.
4. GENDER BASED VIOLENCE IS STILL VERY HIGH WITH MORE THAN 70%
   of the murder cases going through the courts of Zimbabwe stemming from domestic violence, a compounding factor to HIV transmission.
5. THE ECONOMIC AND HEALTH SYSTEMS, THOUGH IMPROVING FROM
   the near collapse in 2008, contribute to poor overall health of the population. Simple ailments are often left untreated due to lack of drugs, unaffordability of treatment by patients or lack of medical personnel. The government has to significantly up its current budget towards the health sector in order to improve its nurse and doctor ratio to patients and the overall administration of the health service sector. Women in Zimbabwe are still largely disadvantaged in terms of opportunities to developing themselves and owning property hence decreasing their agency to negotiate effectively in sexual relationships.

Recommendations

The main recommendations from this study are:

Current mainstream prevention guidelines and strategies tend to focus on the individual as the sole actor of one’s sexuality yet the reality of Zimbabwean women shows otherwise. The many different actors who influence a woman’s sexual life should be addressed in prevention and treated as potential facilitators of prevention rather than just hindrances. Cultural and religious practices that are retrogressive in HIV prevention should be challenged. Stereotypes that do not match with reality should be addressed and policies and other services matched to the reality of people’s sexual lives.

Public fora that draw large crowds and which at the moment help shape discourse around sexuality such as funerals and kitchen tea parties should be utilized to challenge some risk pushing ideas and views but also to channel prevention messages that tally with people’s realities.

The government of Zimbabwe has to work towards a woman and children friendly legal and social welfare system so women do not have to resort to engaging in risky sexual relationships in order to cater for their basic needs. Better implementation of the gender laws and policies to which Zimbabwe is a signatory has to be enforced by government and other civic and judicial groups. The gender relations imbalances have to be continuously challenged and addressed in order to give girls and women their rightful place in society.

Early testing and optimal treatment of Sexually Transmitted Infections including HIV should be policy and access to all HIV positive persons and all HIV positive mothers to prevent infection of their children should be 100%. Zimbabwe should prioritize HIV treatment as part of the HIV prevention strategy.

Gender imbalances are still a big problem. Although there are currently serious efforts to empower women economically within the land sector, there should be consistent support for the women educationally and economically to make their ventures viable. Enforcing equality of representation of men and women in all sectors in the country should be adopted by the government and women focused economic programmes should be implemented. This is necessary in order to improve their independent standing in life in areas such as education, ownership of property and protection from abuse and ill-treatment in society. Gender based violence is unacceptably high and the government needs to step up education on violence prevention within the population, the police and other relevant groups, eliminate causes of violence within homes such as high unemployment and work on improving perceptions of the role of violence within gendered relationships.

The economic situation and the health system of Zimbabwe need serious strengthening. Improvements in the economic sector can result in an improvement in the health of the population especially if this takes place in a non-gender discriminative manner. The health sector has to serve the population from a professional and health ethical perspective rather than a culturally bound and biased manner because this creates gaps in terms of service provision. It is time to move from service provision based on stereotype behaviour towards evidence based behaviour. Much as Zimbabwe is a hetero-normative society, the health sector has to cater for all people irrespective of sexual orientation because all untreated cases like those resulting from men who have sex with men, contribute to onward transmission of sexually transmitted infections including HIV. Some of these men are forced to hide their sexual orientation, enter relationships with women, thereby heightening their risk to infection with STI. Because of gender imbalances, men still refuse to test for HIV and their female partners cannot force them hence the government has to compel the men to test just as pregnant women are obliged to test before the 16th week. This should be taken up with other male centered strategies such as circumcision to reduce the transmission from males to females.

References

Shiripinda, Iris. (2012). Sex, HIV and AIDS. Practices and ideas of Zimbabwean women on sexuality and prevention of infection. Ph.D. thesis. Radboud University, Nijmegen.