Financial Dependence on Partners, Threat of Violence Prevent South African Women From Protecting Themselves Against HIV
The perceived lack of a right to safer sex, financial dependence on male partners and the threat of violence for refusing sex prevent women in South Africa's KwaZulu-Natal province from protecting themselves against HIV, according to a study in the fall issue of the Journal of the American Medical Women's Association. Dr. Quarraisha Abdool-Karim of the Department of Community Health at the Nelson Mandela School of Medicine at the University of Natal administered structured questionnaires to 219 women between the ages of 15 and 44 in the urban town of Nhlungwane and the rural community of KwaXimba, both in the KwaZulu-Natal province, from November 1991 to March 1993. The women were asked questions about demographic characteristics, sexual history, knowledge of HIV/AIDS, perception of risk for HIV, knowledge of sex safe and skills related to safe sex practices and perceptions of their rights to safe sex practices. The majority of the women surveyed (88.1%) were sexually active and had "extensive" knowledge of modes of HIV transmission and methods of preventing HIV infection. However, the survey found several misconceptions regarding HIV transmission. Nearly 40% of the women thought HIV could be transmitted by sharing eating utensils and 59.8% though HIV could be contracted by giving blood. About 80% of the women thought AIDS was curable.
Reasons for Not Protecting Themselves
Although 94.5% of the women said they knew that condoms could prevent HIV transmission, nearly half of the women (48.8%) did not think they had the right to refuse sex with their partners and 46.1% did not think they had the right to insist that their partners use a condom. The study found that only 12.8% had ever used a condom, and 82.4% of the women lacked the skills necessary to use a condom. About a third of the women had never seen a condom. Nearly 60% of the women who were sexually active indicated that they would like their partners to use condoms, but 93.9% of these women said that asking for condom usage would indicate a "lack of trust." About half of the women surveyed said that asking their partners to use condoms would anger the men, with nearly 30% saying that their partners would leave them and 28.5% saying that their partners would threaten to use violence if asked to use condoms. Abdool-Karim states that the majority of women surveyed received money from their partners and that this money was part of their "survival strategy." Most of the women were seeking employment and had an average of eight years of formal education. High unemployment rates, limited education and exclusion from the formal economy kept women from achieving economic independence. "Increasing women's access to power and resources is the ultimate strategy to reduce women's vulnerability to HIV," Abdool-Karim concludes (Abdool-Karim, JAMWA, Fall 2001).