Risks of HIV/AIDS and Gender Inequality in Sub-Saharan Africa



Since the onset of the AIDS virus, Sub-Saharan Africa has been amongst the highest percentage of HIV-positive inhabitants in the entire world. Seventy percent of people living with HIV are believed to be in Sub-Saharan Africa.1 One can assume that the sexual practices of those living within Southern Africa have had to adapt to avoid this devastating disease. Unfortunately, this has not been the case for many countries. Despite numerous efforts to educate countries on sexual diseases and preventions, HIV is still extremely prevalent throughout southern Africa and remains a severe concern for global organizations dedicated to HIV/AIDS prevention.

There is no doubt that sex education within Southern Africa needs to be addressed by governing organizations; however, cultural gender inequalities play an extremely large role in the spread of HIV. Patriarchal gender norms contribute to the high rates of sexual oppression and unequal decision-making in sexual relations. In a research paper by Kate Shannon and other authors, Shannon attempts to understand how “male-controlled decision-making” can influence the HIV risk factor for individuals, especially women.1 In order to understand how these inequalities put women of Southern Africa at a higher risk, Shannon poses questions to locals in Botswana and Swaziland such as “in your sexual encounters, who usually decides whether you use a condom?”.1 Gender equality must become a tool in fighting the spread of HIV/AIDS, as well as contributing to a more progressive and sexually liberated society

Cultural Myths

Sub-Saharan Africa’s culture has been heavily involved with superstition. Witch doctors, or “shamans” are still readily sought out for medical advice, especially with regards to HIV. Many indigenous people still believe that western medicine does not cure them of diseases; they believe that it in fact makes them more susceptible to infections. One popular belief is that needles, such as those used in surgical procedures, will cause the HIV/AIDS infection. These culturally embedded superstitious beliefs begin to impact the sexual behavior of numerous people.

In South Africa there is a strong belief in a mythical creature known as the Tokoloshe. In her article, Why are South Africans Afraid of Tokoloshes?, Molly Brown describes the creatures as, “small, hairy, beings known for their sexual appetites and ability to abduct human children”.2 It is very common for South Africans to pass the blame for sexual irresponsibility from themselves onto this mythical creature. In a newspaper article published in Paterson, a small town in the Eastern Cape of South Africa, journalists penned article blaming the Tokoloshe for the molestation of children, as well as the spread of HIV/AIDS. This cultural belief has presented African men an opportunity to deflect responsibility for their sexually oppressive acts. Not too much research has been done into the effects of this myth, but the South African Government has begun to enforce laws on traditional healers. The South African Government hopes to break away from traditional medicine that continues to hamper medical advancement in Sub-Saharan Africa.

Government Intervention

Because the advancements being made towards HIV prevention in Southern Africa are so slow, HIV continues to spread. In addition to Swaziland, Botswana is amongst the highest infected population. It is believed that of the 1.7 million inhabitants, 17.1 percent of Botswana citizens are infected.3  Despite this shockingly high statistic, Botswana has instigated a multi-sectoral response to HIV and has one of the leading prevention systems.3

The first HIV/AIDS policy did not contain gender concerns, and it was not until 1994 that the first focus on gender became apparent. Despite efforts to empower both males and females in HIV/AIDS prevention techniques, the overall cultural attitude remains heavily patriarchal. Males still remain profoundly in control over sexual decision-making, which can have an extremely negative effect on women (who already have a higher chance of HIV infection than their male counterparts). Patriarchal norms promote the subordination of females and can encourage sexual violence. In a study done in Rwanda, HIV-positive women were 50 percent more likely to have suffered partner violence than those who have not experienced sexual violence.1

Women at Risk

Nthabiseng Phaladze and Sheila Tlou describe in their article, Gender and HIV/AIDS in Botswana: a focus on inequalities and discrimination, how cultural factors prevent women from negotiating safer sex.3 They look at how the prevention strategies, such as the use of male-contraceptive, put in place are not under the female’s control, which puts them in the hands of the males. Tswana culture is heavily based on gender binaries. Males offer financial stability for the family, and the females’ responsibilities are based on childrearing and housekeeping duties. The gender dichotomy of ‘good woman’ and ‘bad woman’ also plays a large role in Tswana culture. Females who utilize their right to sexual freedom can often be labeled promiscuous and are blamed for the spread of sexually transmitted diseases. Phaladze writes, “STDs are popularly associated in Botswana with the ‘bad women’”.3 This is another form of blame shifting that is common amongst Sub-Saharan African men. Males are considered superior and are therefore void of any responsibility towards subjects like sexual disease. In a study of 2049 individuals in Botswana and Swaziland, Kate Shannon found that “higher adherence to gender inequity norms are associated with elevated women’s risk of HIV acquisition”.1 The need for gender equality is becoming increasingly important for many who wish to see a decline in sexual violence and HIV infection. However, with these gender roles so heavily embodied by the Sub-Saharan culture, is teaching gender equality even possible?

Teaching Gender Equality

Botswana school curriculum underwent a transformation in 1995 when the Botswana Government implemented the Beijing Declaration Platform.4 This was an attempt to revoke patriarchal norms by promoting female empowerment within the school system. Despite the declaration, there has been very little change in the societal views on gender. Mavis Mhlauli, a Professor at the University of Botswana, reveals that the “Government of Botswana has called for the elimination of all sex role stereotypes and gender biases”.4 This statement is quite contradictory, considering this is the same government that still has not criminalized marital rape or decriminalized sodomy. The main problem with the declaration is that teachers are not correctly enforcing the changes that it suggests. Mavis Mhlauli observed that both male and female teachers still provided increased attention to male students.4 There is an increased struggle between attempts of reformation and holding onto cultural norms. While Botswana is becoming increasingly more progressive in promoting gender equality, many people are still hoping to retain their cultural heritage. Mhlauli says, “There is a strong conviction among both male and female teachers that even though they advocate for gender equality they should not abandon their culture regarding gender differentiation”.4  Mavis Mhlauli’s study did not focus on higher education, and it is important to observe the sexual practices of University students to form a broad understanding of whether gender equality interventions are positively influencing Botswana’s culture.

In a study of 346 students at the University of Botswana, M.E. Hoque observed that despite a higher use of contraceptives, many students still engaged in risky sexual behaviors.5 Both Hogue and Shannon discuss the risks of intergenerational sex. Intergenerational sex is typically defined by males engaging in sexual activity with women ten years younger (or more), or females engaging in sexual activity with males at least ten years their senior.1 These behaviors increase the chances of the male having control over the sexual encounter, when males have higher control over sexual decision making there is a notable decrease in the use of contraceptive. In a study of 346 undergraduates (a large study given the size of the school), Hoque found that students had a high rate of contraceptive use, as high as 92 percent. However, 26 percent of females and 20 percent of males reported condom use only on occasion.5 Despite the fact that there is no form of official sexual education in the Botswana school system, there is an increased rate of safer sex practice amongst younger citizens. Despite this, deeply rooted cultural beliefs still regulate sexual interactions of Tswana men and women. Drifting from those cultural behaviors can incite extreme prejudice from others.

Homosexual Men at Risk

Gender roles are strictly carved in stone in Sub-Saharan Africa. Males are required to be the dominant sex, and females the subordinate sex. Any sexual activities that stray from these binaries are considered wrong, and are punishable by law. This makes it increasingly difficult to understand the sexual practices of gay men and women of Southern Africa. However, Stefan Baral studied into the sexual activities of men who have sex with men (MSM) amongst 537 men in Namibia, Malawi and Botswana (the size is correlated with the few amount of men who would be willing to risk taking part in such a study). Homosexual men face severe societal pressure. Not only is homosexuality illegal in Botswana, the men would be met with great physical danger if their sexual orientation became known. Only 10 percent of males in Malawi, and fewer than 25 percent of males in Botswana and Namibia had admitted their sexual orientation to their respective families.6 This causes the males to be less likely to seek health services, 20 percent of males admitted to being too afraid to seek medical advice.6 Homosexual men face similar risks to women. Men who do not conform to hetero-normative behavior are considered somehow less masculine and therefore subordinate to heterosexual men.

Finding a Solution

Sub-Saharan Africa is undergoing change. The Government is placing higher pressure on schools to educate young children on gender equality, and there are many independent agencies aimed at reforming gender roles for the protection of females. Emang Basadi is an independent agency that was created to reform patriarchal norms, aiming at creating equality for Botswana citizens. This type of action is becoming increasingly more important. Women of Sub-Saharan Africa have an extremely high risk of HIV/AIDS infection or sexual violence due to the sexual decision-making being heavily oriented towards males. It is clear that despite influences from world organizations, HIV/AIDS is still a tremendously prevalent disease, and there is still a clear aversion to western medical practices.

Reconstruction of gender norms and sexual practices must come from within the culture. Many people of Southern Africa do acknowledge the necessary changes that need to be made, and many are attempting to enforce them. However, cultural practices cannot undergo such dramatic changes overnight. These patriarchal customs have been rooted in the culture for an incredibly long time. Foreign countries enforcing their own belief systems on African culture will not initiate change. For gender equality and the decline in HIV/AIDS to become a reality in Southern Africa, they must be initiated from members within the culture.


1. Shannon, K., Leiter, K., Phaladze, N., Hlanze, Z., Tsai, A. C., Heisler, M., & … Weiser, S. D. (2012). Gender Inequity Norms Are Associated with Increased Male-Perpetrated Rape and Sexual Risks for HIV Infection in Botswana and Swaziland.

2. Brown, M. (2008). Why Are South Africans Afraid of Tokoloshes?. Lion & the Unicorn, 32(3), 260-270

3. Phaladze, N., & Tlou, S. (2006). Gender and HIV/AIDS in Botswana: a focus on inequalities and discrimination. Gender & Development, 14(1), 23-35.

4. Mhlauli, M. B. (2011). Teaching for Gender Equality in Primary Schools in Botswana: Reality or Illusion?. European Journal Of Social Science, 24(1), 134-143.

5.  Hoque, M. E., Ntsipe, T. T., & Mokgatle-Nthabu, M. M. (2012). Sexual Practices among University Students in Botswana. Gender & Behaviour, 10(2), 4645-4656.

6. Baral, S., Trapence, G., Motimedi, F., Umar, E., Iipinge, S., Dausab, F., & Beyrer, C. (2009). HIV Prevalence, Risks for HIV Infection, and Human Rights among Men Who Have Sex with Men (MSM) in Malawi, Namibia, and Botswana.

Last updated May 22 2013.