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International Resource Network in Africa
A collection of essays and creative writing on Sexuality in Africa
Vol. 3, spring 2010
Managing Intervention in Africa in the Age of HIV/AIDS, LGBTQ
Rights, and Research Agendas: A Critical Appraisal
© International Resource Network
Outliers, a collection of Essays and Creative Writing on Sexuality in Africa Vol. 3, spring 2010
Edited and published by IRN-Africa spring 2010
The cover art is a group photo taken at the IRN-Africa’s 2009 conference organized in Syracuse
at Empire State College in New York. The photograph should not be used without permission.
© IRN-Africa, 2009.
Opinions expressed by the authors of articles published in this volume do not necessarily
represent IRN-Africa’s views. Comments, suggestions, and reactions should be forwarded to the
editor at <[email protected]>. IRN-Africa celebrates the linguistic diversity of Africa
and publishes articles in their original official language (French, English -with its variances-,
Spanish, Portuguese).
Mailing address: IRN-Africa
C/O CLAGS
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Fax: (1) 212-817-1564
http://www.irnweb.org/index.cfm
skype: irn-africa
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Table of Contents
“From Liberia with Love”: Officers’ Wives Confronting HIV/AIDS………………………..……3
Adeyemi, Bukola Adeyemi, (Nigeria)
When the “High Risk” Subaltern Speaks: The Zvishavane Women AIDS Prevention Association
(ZWAPA)’s Response to the HIV/AIDS Epidemic, 2003- 2008. ……………………………… 19
Estella Musiiwa, (Zimbabwe)
“Ce qui est fait pour nous, sans nous, est fait contre nous!’’ De l’Internationalisation des
Recherches auprès des MSM en Afrique: Un Etat des Lieux…………………….……………....36
Charles Gueboguo, Researcher (Cameroon)
Contradiction and Transgressions: Exploring Implementation of HIV/AIDS Policy at a United
Nations Office…………………………………………………………….………………………51
Shivaji Bhattacharya, Ph.D. (U.N.D.P., South Africa)
“Condom Use and Perceived HIV Infection”………………………………………...………..…68
Odor King, Olaseha, Igwe Nnenna Clara (Nigeria)
La Problématique des MSM au Burkina Faso…..……………………………………………76
Cyrille Compaoré, MSM researcher (Burkina Faso)
Exclusion and Prejudice from within the “LBGTI Community” .…………….………………....78
Yvette Abrahams (South Africa)
The Realities of Choice in Africa: Implications for Sexuality, Vulnerability, and
HIV/AIDS…………. …………………….……………………….…………….………………..82
Chi-Chi Undie (U.N.D.P., Kenya)
Call for contributions for Outliers Volume 4………………...……………...……………………85
Call for reviews…………………………………………………………………………………...86
Announcement: IRN-Africa 2009 awards recipients……………..……………………....………86
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“From Liberia with Love”: Officers’ Wives Confronting HIV/AIDS
Oyeniyi, Bukola Adeyemi•
“He left here a man, but returned a walking corpse”
…An officer’s wife comments
Introduction
This paper examines three different but mutually related issues. The first is the initial
reactions of wives of ECOMOG[1] soldiers (officers and men) who returned from peacekeeping
operations in Liberia, Sierra Leone and Ivory Coast with HIV/AIDS. This section also covers the
reactions of the immediate family members, neighbors and the larger society within which these
soldiers lived. The second issue is people’s negative perception and misunderstanding of the
pandemic within the Nigerian landscape and how these negative perception and misunderstanding
have helped the spread of HIV/AIDS in Nigeria. The third issue deals with the various coping
measures and strategies adopted by the wives of Nigerian ECOMOG soldiers in the face of their
husbands debilitating health and official neglect.
Nigeria has the largest population in Africa with one in every six Africans being
Nigerian. Although the HIV prevalence rate is much lower in Nigeria than in other African
countries such as South Africa, Malawi and Zambia, by the end of 2005, there were an estimated
2,900,000 people living with HIV/AIDS. This is the largest number in the world after South
Africa. The statistics for HIV prevalence in Nigeria are worrisome. Since the first case of AIDS
was identified in Nigeria in 1986, the HIV prevalence rate has risen from 1.8 percent in 1988 to
5.8 percent in 2001. The 2003 National HIV/Syphilis sentinel seroprevalence survey estimated
that there were 3,300,000 adults living with HIV/AIDS in Nigeria, and that 1,900,000 (57
percent) of these were women. Equally worrisome is the fact that an estimated 240,000 children
(ages 0-14) were living with HIV/AIDS by the end of 2005; an estimated 220,000 deaths due to
AIDS during 2005; and an estimated 930,000 children under the age of 17 have lost their mother
or father or both parents to AIDS in 2005.[2] Undoubtedly, HIV/AIDS has already badly affected
the Nigerian society and economy. If the epidemic continues at its current rate, or worsens, there
could be knock-on effects across the whole region. As must be noted, of the estimated 3,300,000
people living with HIV/AIDS in Nigeria, 67 percent were said to be female.[3] With a 20 percent
prevalence rate in the military, 40 percent were said to be female. These statistics reveal one
important thing: HIV/AIDS in Nigeria has a feminine face. As studies in Nigeria have shown, the
primary mode of HIV/AIDS transmission is heterosexual transmission. Given the socio-cultural
importance attached to female sexuality in Nigeria, as well as in other parts of Africa, it is of
utmost importance to examine the place of women in the HIV/AIDS discourse.
In order to consider the three issues the paper seeks to examine the place of women in the
HIV/AIDS discourse, the paper uses data collected from oral interviews among members of the
Nigeria Army Officer’s Wife Association (NAOWA), especially those whose husbands returned
with HIV, as well as written and archival documents. By focusing on the wives and families of
these officers, the study brings up the need for a more inclusive and holistic approach to
HIV/AIDS interventions. As demonstrated in the various sections, this paper brings up the
dynamic coping mechanisms adopted by wives of these officers in their bids to cater for their
families, especially in the face of societal rejection, official neglect, and absence of institutional
support. As the paper argues, it was official neglect coupled with a lack of institutional support
that allowed for the burgeoning of the pandemic among soldiers and their families in Nigeria. The
Department of History, Faculty of Arts, University of Ibadan, Nigeria
•
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paper closes by suggesting that all policies aimed at confronting the spread of the pandemic,
especially among soldiers, must be holistic and should not focus exclusively on the soldiers who
participated in the peacekeeping operations, but also on their families and other relations who
may have chanced on the virus through filial or conjugal relations of one sort or the other with
these officers.
Following the introductory section is a brief history of the Liberian civil war and the
intervention of ECOMOG (The Economic Community of West African States). The general
background to the story of the emergence of the Nigeria Officers’ Wives Association to respond
HIV/AIDS infections also sheds light on female sexuality in Liberia.
The Liberian Civil War
The Liberian Civil War generally refers to the civil war that erupted in Liberia between
1989 and 1996. As Gus Liebenow, Christopher Clapham[4] and others have argued, when the
ECOMOG peacekeeping force entered Liberia in August 1990, it arrived in a country with a
challenging geography, exploitable natural resources, and strong ethnic and historical divisions.
Although relatively small, the country’s pre-war population stood at a little below two million
people. Its physical geography comprises a low coastal plain, forested hills, and mountains. Thick
jungle, coupled with wet marshy land, made Liberia inaccessible during the rainy season, which
lasts from April until December. Internal communication within Liberia is only possible during
the dry season. Equally, Liberia is ethnically factionalized into about eighteen distinct ethnic
groups. These include the ‘Americo-Liberians’[5], the Mano and Gio in the north, the Mandingo
in the west, and the Krahn in the northeast. None of these comprises more than 20 percent of the
population. In spite of these diversities, Liberia is blessed with considerable amounts of iron ore,
timber, some gold and diamonds, and rubber.
Although they made up barely five percent of the total population, the Americo-Liberians
had ruled Liberia and controlled its socio-economic life from independence in 1847 until 1980.
Important components of its rule included socio-political domination and economic exploitation.
Faced with dwindling economic performance occasioned by a major drop in the terms of trade
(higher oil prices and lower commodity export prices), and the government’s under-budgeting of
the Armed Forces of Liberia (AFL), on 12 April 1980, indigenous non-commissioned officers
staged a military coup and successfully toppled Americo-Liberian rule.
The coup initially enjoyed widespread support from all Liberians. Samuel Kayon Doe, a
Master Sergeant who promoted himself to General and Head of State, began his rule by publicly
executing leading officials of the old regime. He also politicized the AFL, by making it
essentially a Krahn Presidential Guard. These policies alienated many Liberians (politicians and
military alike) and, by 1985, a coup was organized to remove Doe. This failed and incensed Doe
all the more, and in 1985, as a result of the failed coup, the AFL killed as many as 3,000 Mano
and Gio civilians. Widespread corruption and the flight of Americo-Liberians, which brought
more economic problems, followed. This inadvertently drove Liberia into deeper economic ruin
and ethnic hostility. It paved the way for what has since been tagged the Liberian Civil War.
At the thick of all this, Doe’s Minister of Commerce, Charles Taylor, was accused of
diverting about 900,000 US dollars of government money into his personal account and was
declared wanted. Taylor was, at this time, in the United States where he had indicted Doe’s
government in an interview with foreign media. In reaction, Doe demanded the extradition of
Taylor to answer charges of financial impropriety and he was consequently arrested and placed in
custody in Massachusetts. Taylor was said to have bribed his way out of jail and escaped to Cote
d’Ivoire, where he organized and trained a 100-man-strong rebel group called the National
Patriotic Front of Liberia (NPFL). Having survived numerous coup attempts, Doe initially paid
little attention to the NPFL, which entered Nimba County from neighboring Cote d’Ivoire on
Christmas Eve of 1989. Charles Taylor led the largely Libyan-trained and Burkina Faso-equipped
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Mano-Gio NPFL into Nimba County.[6] His main position was the need for democracy in Liberia
and opposition to Doe. He drew significant support from other Liberians, especially from the
north and those who had suffered immensely from Doe’s highhandedness since the failed coup in
1985.
Realizing belatedly that Taylor and his NPFL meant business, Doe rushed a battalion of
the AFL to Nimba County, but the troops created more hostility against the already unpopular
Doe by further brutalizing the Gio and Mano ethnic groups. Taylor took advantage of this antiDoe backlash to increase his men through much of Liberia. By July 1990, Taylor’s men had
reached about 10,000. Although a ragtag group, 30 percent of whom were children under the age
of 17 and lacking substantial military training, the NPFL reached the outskirts of Monrovia by
July 1990. On 2nd July, Taylor’s men attacked Monrovia. The NPFL forces singled out Krahn and
Mandingo civilians for terminal retribution. The AFL also committed atrocities, such as a
massacre in St. Peter’s Lutheran Church on 29 July.[7] The savagery from both sides was
unqualifiable. By August, Doe’s government had clearly lost control of Liberia and Doe and his
men were confined to government buildings. Mediation efforts by religious and other
organizations (Liberian and non-Liberian) failed, as Doe refused widespread demands that he
should resign. A new faction, the Independent National Patriotic Front of Liberia (INPFL), led by
Prince Yourmie Johnson, broke off from Taylor’s NPFL and began fighting Doe’s AFL and
Taylor’s NPFL. Combatants from the three groups were destroying Liberia’s socio-economic
infrastructure. They killed more civilians than soldiers, and refugees were fleeing in different
directions. The fighting became so intense that after 2nd July, no relief ships could enter
Monrovia. Although the United States had more ties to Liberia than did any African country,
neither the US nor any other major powers expressed any desire to intervene in the Liberian
conflict. Of all Liberia’s allies, only Nigeria came to its rescue when it mattered most. Nigeria has
a great deal of influence in the West African sub-region and it is an important member of
ECOWAS. Nigeria established and has played a central role in ECOMOG’s peacekeeping
operation.
ECOMOG’s birth and organizational imperatives
In the face of the international community’s official inattention to the Liberian war, in
April 1990 Nigeria, under General Ibrahim Babangida, led a group of five ECOWAS member
states to establish a Standing Mediation Committee (SMC) to resolve Liberia’s conflict
peacefully[8]. By August, peace was still non-existent, and seeing no alternative and believing
that any further delay could result in a final bloodbath in Monrovia, the SMC, on August 7,
created the ECOWAS Ceasefire Monitoring Group, ECOMOG.
ECOMOG’s mission in Liberia encompassed both peacekeeping and peace
enforcement.[9] Traditionally, peacekeeping operations are conducted with the consent of the
previously warring parties in order to promote security. A peacekeeping force is therefore
essentially impartial and neutral. Its mandate does not extend beyond immediate self-defence. On
the other hand, peace enforcement operations are acts aimed at restoring peace between currently
hostile parties, at least some of whom do not consent to the presence of the peacekeepers. A
peace-enforcing unit goes beyond self-defence: it would pursue, and perhaps destroy, the
violators of a commonly agreed settlement.
ECOMOG’s mandate was “to conduct military operations for the purpose of monitoring
the ceasefire, restoring law and order [so as] to create the necessary conditions for free and fair
elections to be held in Liberia,” and to aid the “release of all political prisoners and prisoners of
war.”[10] Looking at its operations now, one wonders if ECOMOG was indeed a peacekeeping
force. ECOMOG’s immediate problems include absolute ignorance of Liberia’s geography,
political disunity, military incapability, and paucity of funds. These problems were exacerbated
by the fact that ECOWAS itself was badly divided into English and French-speaking states. On
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the one hand, France had close political, economic and military links with its former colonies,
most of whom feared Nigerian dominance of the region. On the other hand, most Frenchspeaking member states of ECOWAS were not only wary of Nigeria’s domination, especially as
Nigeria’s gross national product and population matched that of the combined fifteen other
ECOWAS members. Hence, while Nigeria was the strongest Anglophone power in the region,
Cote d’Ivoire was the leading proponent of Francophone Africa. The two nations have worked at
each other’s disservice since independence, occasioned by their different colonial legacies.
Expectedly, Nigeria and Cote d’Ivoire toed different lines on Liberian war. Most of the
ECOMOG contributors came from Anglophone states: Nigeria, Ghana, Sierra Leone, and Gambia
(Guinea initially was the only Francophone state) while other French-speaking states openly
rejected and opposed any military intervention in Liberia. Besides regional troubles bedeviling
ECOMOG, contributing members to the force also disagreed about ECOMOG’s goals and
methods of operation: Should ECOMOG act only as a peacekeeper or, if necessary, also as a
peace enforcer against Taylor’s NPFL? Along with ECOMOG’s unclear mandate, lack of
acceptance within the region, and mediocre military capabilities; its absolute lack of funding
created a complex misfortune for the regional force. Looting and smuggling, which have
provided the factions with some independent financing, soon became an irresistible lure to
ECOMOG men and they fiercely contested control of Liberian resources with other factions,
sometimes setting the various factions against one another.
Undoubtedly, a weak sub-regional organization cannot create a strong military force.
Faced by pressing domestic concerns and generally moribund economies, West African states
could not support ECOMOG sufficiently, at least financially. Divisions within ECOWAS only
served to ruin what could have been a benchmark for future operations. Even when the deplorable
situation in Liberia compelled all ECOWAS states to endorse SMC’s peace plan, ECOWAS took
no disciplinary action against Burkina Faso and Cote d’Ivoire, who still continued to aid Taylor
against ECOMOG.
Sex and sexuality in Liberia
In most African societies, women and girls, irrespective of age and status, are regarded as
subordinate to men. In Liberia, women are a major support for the family, as they provide all
basic amenities. Nevertheless, the Liberian Family Code requires that women obey their
husbands, who are recognized as the head of the family. Women are regarded as second-class
citizens and a woman’s status depends on her being married.
Pre- and post-war literacy statistics for Liberia show gender-imbalances in socioeconomic, political and educational opportunities. A higher percentage of boys had formal
education. In most cases, customs and practices ensure the subordination of women and girls.
Although treated in this way, women and girls are valued in another sense. They are regarded as
common property not only of their parents, but of the community at large. Hence, any attack or
insult on them is regarded as an attack or insult on their community.
In Africa, women, not minding their age and social status, have no say in sexual matters.
They were subordinated to their male counterparts in different ways. Culturally, a woman is
forbidden from refusing her husband sexual advances. They risk been rejected if they refused
their husband or require him to use a condom or any other form of prevention before sexual
intercourse. Men may have extra-marital affairs, but it is forbidden for women. In fact, the society
considers the man ‘powerful’ when he owns a harem.
Deviant behaviours on the part of women existed, but few and far between. On the part of
men however, sexual related offences are settled within the family and, in most cases, in the
favour of the men. On a more grievous note, a rapist may be compelled to marry the victim, as
rape, although frowned upon, constitutes no grievous fault. In some cases, perpetrators of rape
may be fined. Besides all these, there exists the social-stigma problem, which, among other
things, discourages disclosure of rape. As reported by a Liberian Female Peacekeeper on
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CNN[11], “after all, what has been done can never be undone.” This kind of scenario obscures
the facts and makes many women prefer to suffer in silence rather than risk any ‘unnecessary’
and undue social rejection.
The armed rebel groups that participated in the Liberian War included the Armed Forces
of Liberia (AFL), the Liberia Peace Council (LPC), the Lofa Defense Force (LDF), the National
Patriotic Front of Liberia (NPFL), the Independent National Patriotic Front of Liberia (INPFL),
the National Patriotic Front of Liberia-Central Revolutionary Council (NPFL-CRC), the United
Liberation Movement of Liberia for Democracy (ULIMO), the United Liberation Movement of
Liberia for Democracy-Johnson faction (ULIMO-J) and the United Liberation Movement of
Liberia for Democracy-Kromah faction (ULIMO-K). As the war in Liberia intensified among the
rebels, between the rebel groups and ECOMOG and other observer missions, another war was
carried out by rebel groups – that of sexual violence. The war, as evidenced by the sheer
magnitude of post-war HIV/AIDS and other sexually transmitted diseases, created an
environment in which thousands of women and girls suffered untold hardships during the war.
These hardships include crimes of sexual-abuse and gender-based violence. As the study finds,
women as old as eighty years old, and girls and children as young as three years old in Liberia
continued to be targeted for crimes of sexual violence by combatants and non-combatants with
impunity. Many were gang-raped or abducted by combatants for long periods for sexual slavery.
Others were mutilated or severely injured by having objects inserted into their vaginas. Those that
defended themselves by fighting back when attacked were maimed, blinded or killed.
In CNN’s “World’s Untold Stories: Liberia’s Women Peacekeepers”, Amanpour reported
on Monday 22nd October 2007 that 70 percent of Liberian women and girls were raped during the
war. Sexual abuse in Liberia, as the study finds, is not an irrational action of emotion-charged
combatants (or non-combatants), but a carefully thought-out strategy, an intellectually considered
tactic, and carefully planned acts perpetrated by each group against the other in a mutually
intelligible cultural milieu. As demonstrated above, members of all the armed forces, militia
groups and government forces from neighboring nations perpetrated sexual violence against
women and children as part of the war in Liberia. With the degeneration of the Liberia’s sociopolitical and economic situation, Liberians, especially women and girls, resorted to prostitution.
Many traded sex for food, shelter, or money in order to provide for their families.[12] As
Aderinto[13] argued, survival sex consequent upon wars and conflicts cannot be called
prostitution, as most victims of survival sex are often forced by circumstance. Fatah, [14] a
mother of four whose husband had died during the war, explained that she“dare not refuse men
because I do not want to leave the children hungry.”[15] In some cases, girls as young as six
whose parents could not afford school fees engaged in sex with their teachers in order to stay in
school. Others who were in regular or ad hoc employment slept with their employers to keep their
jobs.[16] Sometimes, they were raped, but they must choose between being sent out of school or
employment and accepting the sexual relationship as a means of survival. “The war has pushed
the girls to prostitution.”[17] An official of the UN puts it in this way: “We have come to the
point where families even push their daughters into prostitution for simple survival.”[18] Women
and girls in these situations have had to ‘trade’ sex with men who might leave them a bit of
money, “for example $0.30”, to survive.[19] The risk of contacting sexually transmitted diseases
such as HIV/AIDS increases dramatically, as women and girls in this situation cannot insist that
men use a condom.
Because of the extenuating circumstances of the war and the frequency of contact with
men outside the households, women and girls who engage in survival sex are at high risk of rape.
As one woman explained it; “we have to keep doing bad things like sleeping with men to stay
alive. We submitted to everything they do. Sometimes, you get paid. Sometimes, you get slapped
around. Sometimes, you are raped and not paid. We submitted to everything to keep our lives and
those of our children.”[20] Similar situations are observed in refugee camps, rebel factions’
camps and military camps. In these camps, many women, including widows of soldiers and
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women whose husbands were missing or were away on duty, were sexually harassment and,
sometimes, raped by soldiers and officers. Many more were forced to trade sex to secure their
continual stay in the camps. Some also brewed and sold alcoholic beverages to earn a small
income. Soldiers, who came to drink, sometimes refused to pay and, sometimes, raped the
women. Mrs. Kwabena, a widow who served local beer to five ULIMO soldiers in March 2001,
was raped in the presence of her two children.[21] Another reported case was that of a sixteenyear-old orphan who lived with her two younger brothers in a wrecked automobile on the grounds
of a military camp. She regularly traded sex with an INPFL lieutenant so as not to be expelled
from her shelter and the camp.[22]
Sexual crimes were not just perpetrated by members of armed factions or combatants
mentioned above; members of ECOMOG, UN observers and other humanitarian and relief
groups have also been accused of sexual violence by Liberian women and girls. Some have also
mentioned opportunistic sex by the police and other people in positions of power, as well as
common criminals and bandits. Almost all who participated in the war, in one capacity or the
other, have been identified as culpable for wartime rape and sexual violence against women and
children.[23] They, especially the rebel groups, systematically raped and abused women and girls
as part of their effort to win and maintain control over civilians and the territory they inhabited.
Reports also abound that soldiers, combatants, and armed robbers raped women in the course of
robbing and looting, sometimes after stealing everything the women owned and sometimes to
punish them if they had no goods worth stealing.
Wartime sexual abuse has occurred not only in Liberia but also in the DR Congo,
Rwanda, Somalia, Darfur, and so on. In all these places, sexual violence against women and
children has drawn considerable international attention and condemnation. Combatants and noncombatants alike deployed it as a kind of asymmetric warfare to either gain control of areas where
natural resources abound for looting, or to ethnically cleanse the blood of their ‘enemies’ and win
the war from another angle.[24] While numerous efforts have been made to examine sexual
violence perpetrated by rebel and government forces in conflict situations, this paper shall limit
itself to the case of sexual violence among ECOMOG soldiers who participated in the
peacekeeping mission in Liberia.
As already noted, ECOMOG was established to monitor the ceasefire in Liberia and to
prevent the war from affecting Liberia’s neighbors. Liberian women and girls have, since the end
of the war, accused the ECOMOG soldiers, among many others, of perpetrating sexual violence
during their intervention in Liberia. The military high command of ECOMOG, especially the
Nigerian Army, has denied this on many occasions. But the outbreak of HIV/AIDS amongst
officers and men who participated in the mission has been an eloquent testimony to their
culpability. It is undoubtedly clear that the West African monitoring and peacekeeping mission
over-performed its mandate by engaging in sexual relations with or sexual abuse of Liberian
women and girls.
While evidence abounds to support the fact that economic backwardness (exacerbated by
the civil war) may have led many Liberians into survival sex, little or no evidence as yet exists to
explain why peacekeepers became entangled in sexual relations with Liberian women and girls.
As noted by Captain Desiree of the Nigerian army headquarters;
Survival sex, rape, and even statutory rape are common during war; they are part of the
war efforts. But it is unfortunate that nearly all soldiers and men that participated in the
ECOMOG mission in Liberia returned home as HIV positive or with full blown
AIDS.[25]
Commenting further on the likely incident in Liberia, the senior officer disclosed further that
most women and children were compelled by the need to provide basic amenities for their
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families to offer sex to soldiers. In some instances, soldiers made sexual relations a prerequisite to
discharging their duties, especially towards the non-combatants.
In some situations; the women themselves offered sex as compensation for their safety. It
is common in Africa, irrespective of situations, to give something back, especially in
appreciation for any good. In some cases, these women and girls were not raped; they
offered themselves in compensation for their safety. To my mind; that is not a criminal
sex.[26]
Colonel Dele Olaegbe, who participated in the mission to Liberia, revealed that sex
during war is normal.
After all, soldiers are also humans. They left their wives and families for many months
risking their lives for the safety of others. Little kindnesses like these are common in war
situations. In fact, most soldiers indulged in it. Nevertheless, it is condemnable.[27]
When asked if he ‘indulged’ in sexual relations during the mission to Liberia, Olaegbe also asked:
‘Do you expect me to answer “Yes or No” to that?’
An HIV positive soldier recounted that;
It all started in October 1994, ECOMOG was experiencing serious funding crisis.
Coincidentally, UNOMIL observers who used to help us with basic necessities were
reduced to about 90 thereby making it the more difficult for them to meet our demands.
We were forced to devise other means of supporting ourselves. We asked some of the
women to perform chores and produce some of our necessities. The more contacts we
have with the civilian population; the more complex and entangling the relations became.
We must do that if we must survive.[28]
Agnes, a Liberian refugee in Nigeria, revealed that;
We did all sorts of things for the soldiers. We fend for their daily needs. Sometimes, you
go there to hawk foods and other items, which, most times, were bought on credit, and
you ended up been raped or you got a ‘boyfriend’. You cannot say no, because you would
not be allowed to hawk in the camp the next day. We have to survive, so we have to
agree.
In fact, you secretly wished a soldier would ask you out, as this guarantee regular source
of income, and a place within the camp. If he is an officer, then you are lucky, as no
soldier can molest you again.[29]
Okiro, a sergeant, revealed that
We talked about HIV/AIDS in camp. Once we noticed you are getting too close
to any of the girls, we jokingly asked the soldier to ‘wear raincoat’. But, you know the
way with our people, they won’t listen. Some contacted gonorrhoea, some syphilis. Some
of the girls are dirty. But they would always tell you: ‘soja work na dirty work’.[30]
Rape, especially statutory rape[31], by soldiers, combatants and non-combatants was also
common. Some children’s vaginas had been ruptured or mutilated in the course of rape. Some
have had objects inserted into theirs. Identifying perpetrators of these heinous crimes has proved
most difficult, as most of the victims were either too young to remember any worthwhile
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descriptions of the culprits or were still traumatized or terrified by the experience. Some were still
fearful for their lives. While some ECOMOG soldiers admitted knowledge of such practices
during the war, none has admitted to guilt of any kind.
Captain Boniface of the Nigerian army testified that cases of girls in such condition
abound. He maintained that some were even raped to death. He however maintained that
intelligence reports available to them while in Liberia revealed that “none of our officers and men
would do such bestial things.”[32] Colonel Nathaniel differed somewhat: “We cannot say that
none of our men did anything of such. Let us just say ‘it is part of the war effort, although
condemnable.”[33]
Mark, who served as a garrison officer, had this to say:
War allows for all sorts of things. No one of us who went to Liberia can claim ignorance
of all these. We encountered it everyday. Parents, sometimes, sent these minors to sell
odds and bits in Camp or to farms to fetch firewood. Some were raped in the Camp. Some
were raped on the streets or on their ways to the farms or while returning. Denying it is
not different from perpetrating the crime. It is also bad.[34]
Many of the men also claimed that they were given condoms even at the airports before leaving
for Liberia. One of the men asked: “To do what?”[35] As Human Rights Watch have maintained,
women and girls in this condition have little or no choice in the matter. They could not insist that
rapists – whether soldiers, rebels or peacekeepers – use condoms, as they needed the soldiers for
survival from the war or for the provision of their daily needs.[36] As most ECOMOG soldiers
claimed, paucity of funding and the dire circumstances of war necessitated this unwholesome
phenomenon.
NAOWA: Organizational origin and responses to HIV/AIDS
Cooperative bodies burgeoned in Nigeria following the introduction of Structural
Adjustment Programmes (SAP) in 1986. SAP describes the policy changes implemented by the
Breton Woods Institutions (International Monetary Fund (IMF) and the World Bank) in
developing countries. These policy changes were conditions or pre-conditions for getting new
loans or lower interest rates on existing loans. Hence, SAP were implemented with the goal of
reducing a country’s borrowing and fiscal imbalances. In other words, the policies are designed to
promote economic growth, generate income, and pay off accumulated debt. To achieve these, free
market programmes and policies, which include internal changes (especially privatization and
deregulation) and external ones, (especially the reduction of trade barriers) were implemented.
Among other things, the implementation of SAP led to job-losses, redundancy, and
extreme poverty. To cope with the situation, cooperatives were formed to channel soft-term loans
for small-scale informal groups. One such cooperative body that developed as a coping strategy
to ward off the adverse effects of SAP is the Nigeria Army Officers’ Wife Association
(NAOWA). NAOWA originated as a cooperative, self-help society granting soft-term loans,
mostly without collateral, to officers’ wives. In the main, NAOWA took advantage of existing
loose organizations of army wives resident in all barracks and police commands, which aimed at
creating an environment within which issues of welfare, sanitation and sundry other communitybased issues were focused on. Today, NAOWA has developed from the modest background of
serving as cooperative, self-help society into becoming a focus of agitation for a better life, not
only for their husbands but also for the families who have had to cope with the shifting nature of
a soldier’s career.
In order to examine the reactions of NAOWA members to the HIV status of their
husband thoroughly, the issue is examined at three different levels: the individual, society and
official levels.
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Individual level
Most officers and men returned home ignorant of their HIV status and ignorantly passed
the virus on to their wives. As in most cases, sex is regarded as a show of love and affection. A
soldier who has left home, sometimes for as long as two or six years, and who managed to return
home, even with half of his limbs gone, has reasons to thank his God. They returned home to the
waiting arms of their loved ones and within weeks of return, most had passed on the virus
unsuspectingly to their spouses and girlfriends. “We all anxiously awaited their arrival. We
longed to see our husbands. Not only because of the fact they have gone for months, but because
many had died in the war. We wanted to know, if we had become widows or not,”[37] Pauline
revealed in an interview. She echoed the general expectations of not only the wives but also the
children, mothers, and friends of these soldiers. Newspapers’ reports of the mysterious deaths of
some of the officers who had just returned from Liberia became the first means for NAOWA
members to learn of the true situation in Liberia. “Even after that, the headquarters continue to
deny the facts,” NAOWA members claimed.
“When I saw it in the papers, I bought one and took it to my husband. He laughed and
asked if he has fallen ill since his arrival. I suspected nothing, as he was healthy, at least
physically. I was confounded when, ten months after, I was diagnosed as HIV positive.
“He was angry at me and claimed that I had been unfaithful to him while he was away.
But that is past now, as no sooner than I was diagnosed that he took ill and was
confirmed to have had full blown AIDS. His sins found him. He committed suicide leaving
us to cope with his unfaithfulness.”[38]
Uloma, a member of People Living with AIDS (PLWA), an organization of HIV/AIDS victims in
Nigeria, revealed how she knew about her husband’s status thus:
When my husband first fell sick, we thought it was fatigue associated with been away in
active service for months. But instead of improving, his situation began to deteriorate. I
was worried, but what can we do.
We went to the military hospital and he was given treatment. Yet the problem persisted.
Nobody suspected anything until he died four months later. When I learnt he died of
AIDS, I knew immediately that I am HIV positive too and may die soon.
I am sure he did not know of his status when he returned. If he had known, he would not
have touched me.
When asked how she felt initially; she remonstrated with herself:
At first, I felt let down. I asked him on his sick bed: How could you have done this to me.
He did not say a word. He was too weak, but I could read his feelings. He did not know. I
knew he was going to die, so I could not but brace myself up.
I hated him at first, and wished he had died in the war. But, he was a soldier. I knew this
before marrying him. Why then should I complain? I cannot as yet forgive myself that
initial moment. It was like a ball of fire passing through my veins.
Agnes, earlier mentioned, reacted differently. She abandoned her husband in the house and was
raving at him.
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I hated him immediately. I told him my God had caught him and revealed him. How
can……did this to me. He met me a virgin and I have since remained faithful to him. How
can he touch another woman? I was mad. I left him in the house and would not go in for
days.
Somebody must have told his mother. She came and was taking care of him. I simply
looked on.
Two days after her arrival; my son said to me: how can you teach us to forgive others
when you are as unforgiving as this? I was perturbed at his words. I went into the house.
But for days, I would not say a word to him.
I cannot believe it yet, but the doctor said I am HIV negative.
Not many women were this lucky. She revealed that they engaged in sex many times, especially
within the first week of his arrival, but that he always used a condom. “Why he did that, I did not
know. I have missed him long to raise petty issues as that.” Could he have known? “I do not
know”. She answered. Obviously, the man may have known that he had contracted the virus and
wanted to, at least, ensure he did not spread it to his wife.
As a female activist in Ibadan argued, soldiers’ wives are familiar with transfers at short
notice and the long absence of their husbands; hence, they are aware of the fact that most soldiers
are a little loose when it comes to sex and that many soldiers often keep concubines and visit
brothels. As research revealed in Ibadan, brothels are situated near barracks, police and army
headquarters as well as rail stations and major motor parks. In two of such brothels in Ojoo
area[39], call girls revealed that many of the returnee soldiers went to visit the brothels when they
first arrived. But when news of death resulting from HIV/AIDS filled the air, “we warned our
girls not to attend to them”[40].
Commenting on how to recognise the soldiers, one of the ‘girls’ said:
“We know them. They usually wear their vests and other items to reflect that they went on
peacekeeping operations. Some talked about it and even offer us dollars. We, I must
confess, longed for them, as they have more money to give than other customers.
When madam warned us not to attend to them; we were unhappy, especially as they gave
us dollars and were more regular than others. I know quite a lot of girls that did not heed
madam’s order. I also know that some girls allow them do skin-to-skin.[41] Some of the
girls are no longer here.
Faced with a dying husband, a soldier’s wife has little institutional support, as none exists to cater
for the officers’ wives. Prior to the official admission of the fact, most wives had to cater solely
for their husbands. Those of them who received pay after the Liberia mission spent it on taking
care of a husband whose fate was unknown.
We spent the money he brought from Liberia and the loan I got from cooperative prior to
his arrival on his care. All these monies went with his hospital and drug money. The
hospital here in the barrack hardly has all the drugs. We had to buy most of them. Even
when it has become known that he was having AIDS, many would not even loan us
money.
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Some of my friends warned me not to borrow money again, as when he finally dies, I
would be faced with the problems of not only taking care and providing for the entire
family but also paying the debts. Much as what they said was true, I cannot just leave him
alone. I am still paying the debts.[42]
The most excruciating problem facing officers’ wives was their absolute dependency. Most of
them have been forced to quit regular employment and consider hawking odds and ands.
“Whatever job you have, you have to resign from it when your husband is transferred”, a local
branch secretary said in Ibadan. In most cases, the majority hawk items such as sachet water or
cigarettes, a few learnt and practiced tailoring or hairdressing and a few took to farming. The
majority is barely literate. This considerably reduces the options available to soldiers’ wives.
Society level
While most spouses initially rejected their husbands after being confronted with the fact of their
HIV/AIDS status, relatives and friends were no better, as most viewed the plights of their HIVpositive kin as just retribution for their low morals and dishonesty.
When I read it in the chapters, I asked my brother but he did not say a thing. I sensed
trouble when he fell sick and, for days, he was not getting any better. I asked him again,
but he would not say a thing.
I told his wife my fear and asked that she talked with him. He refused to talk to any of us.
When the doctors told us, I was not surprised. He has brought shame to us all.[43]
Mrs. Agboluaje, a 65-year-old widow with four grown-up children, lamented thus when asked
about her son:
He is my only son. When he wanted to join the army, I warned against it, but the father
was obstinate. See how it has all ended.
I was told he was sick and I asked them to bring him home but they would not listen. I
also asked them to take me to him, no one would listen. Eventually, they told me his
disease would not heal and that he would die. That he had sex with another woman in
Liberia. I do not know what kind of sickness that would not heal. But I asked them to take
me to him. Whatever curses the man or the woman or the family may have placed on him,
at least, if they see me, they would have been merciful. I would have begged. They would
not let me see him. Later they told me he was dead.
I refused to see him body because he had committed an abomination.[44]
In most cases, friends and neighbours avoided even the children of these unfortunate soldiers.
Many did so to avoid any contact and possible infection, as many believed that contact, no matter
how small, is dangerous. This has nothing to do with ignorance, as many revealed that “NACA
and other health agencies said that body contacts like touching, kissing, etc are incapable of
infecting people”[45], but many are wary of the fact that unhygienic living, especially in
barracks, has exposed most children to wounds and this may, in the course of playing together,
serve as a contact point for possible infection. Even if the chances of father-to-child infection is
remote, as in the cases of children born before the Liberia mission, the possibility of husbandwife infection has reduced the number of friends available to officers’ wives.
Friends have deserted us. They said our mother is infected and she might have infected
us. No doctor has said we have HIV or AIDS, but people avoided us all the same
In fact, our friends in school and other public places made the pain of our father’s death
more severe,[46] a seventeen-year-old girl said.
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In most cases, NAOWA advised many such families to “relocate to a new environment and to
keep their identities as discreet as possible”.[47] A local leader had this to say:
It is sad. To watch a fellow woman suffer the way these people are suffering is
unacceptable. But we can do just little. We, in most cases, asked some of these people to
change environment. To that have relatives that they can go to; have relocated to live
with their relatives. Others lived in other parts of the city where they were barely known.
The army has not established anything, in spite of promises and statements on radios,
televisions and newspapers. All we have to show for the Liberian war is a group of
women forced to bear the brunt of a war that affected Nigeria in no way.[48]
Many Lagos-based newspapers reported cases of soldiers’ wards and children being rejected by
schools and other public places on account of their fathers or mothers’ HIV/AIDS status. At the
height of this, numerous civil society organizations took it upon themselves to challenge these
schools. NAOWA was one of those groups.[49] Oyinlola, who was turned back from school by
the proprietoriess after her father’s confession of his HIV/AIDS status in 2000, recounted her
experiences that morning and ever since.
As the driver dropped me and left, I was summoned by the Principal. When I got to her
office, she told me I have been expelled. That my father has HIV and since they would not
want other children to leave the school, I have to go.
I went home in tears. I told my parents what had happened and they informed some of
their friends. In the evening, reporters came to our house to ask me questions. I could not
go to school the next day, as my mother feared I may be turned back again. I stayed at
home for one week.
Ever since my readmission into the school, others have been avoiding me. Many who did
not get to hear the news of my father’s HIV status got to know it in school that week.
In class, most students would not want to share anything with me. Some would not talk to
me. Even when doctors confirmed that apart from my father, no other person in our
family is HIV positive, they still avoided me. Every morning that I had to go to school, I
feel a sense of shame following me. They would not allow me change school, but I am
managing to cope.[50]
Civil society organizations had insisted that Oyinlola remain in the school, although she and her
family would have preferred she leaves. Many unreported cases of discrimination abound in
different cities in Nigeria today.
Official level
After the initial denial to stave-off embarrassment, the military in Nigeria came out to
admit that some of its men “went beyond the rules of engagement” in Liberia and returned home
with HIV/AIDS. The military shied from explaining why it had not initially conducted tests on
these men before releasing them into society. It also did not explain why it took the military
months to admit to the fact despite the weight of evidence. Despite the official policy, not much
was done to take care of the officers and their families. In fact, the military simply demanded that
infected officers be treated at clinics and hospitals in their barracks and cantonments. It was
considered a national embarrassment, and as such the ‘erring’ officers were left to their own
devices. Hence, HIV/AIDS spread with reckless abandon in Nigeria immediately after the
ECOMOG debacle in Liberia.
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Although governments paid lip service to treating soldiers, little in terms of actual
intervention was experienced. In most cases, hospitals and clinics where these soldiers were
asked to seek treatment hardly had the needed drugs. More often than not, most soldiers depended
on the goodwill of their friends, extended families, and community-based organizations for vital
drugs. It was not until the restoration of democracy in 1999 that a serious national effort was
made in Nigeria to tackle HIV/AIDS. The Olusegun Obasanjo administration placed a high
priority on prevention, treatment, care, and support activities, and therefore established two key
institutions – the Presidential Committee on AIDS and the National AIDS Action Committee on
AIDS (NACA) to coordinate the various HIV/AIDS prevention, treatment, and care activities in
Nigeria. NACA’s main responsibility was the execution and implementation of activities under
the HIV/AIDS Emergency Action Plan (HEAP), introduced in 1996 as a bridge to a long-term
strategic plan. HEAP had two main components: first, to break down barriers to HIV prevention,
and support community-based responses; and second, to provide prevention, care and support
interventions directly. HEAP has now been replaced by the National HIV/AIDS Strategic
Framework, which will run until 2009.
Even with this, little came the way of the military in real terms. For instance, in 2002, the
Nigerian government started an ambitious antiretroviral (ARV) treatment programme to get
10,000 adults and 5,000 children onto ARVs within one year. An initial $3.5 million-worth of
ARVs were imported from India and delivered at a subsidized monthly cost of $7 per person. But
in 2004, the programme suffered a major setback when it was hit by a shortage of drugs. This
meant that most people did not receive treatment for up to three months. Eventually, another $3.8
million-worth of drugs were then ordered and the programme resumed. However, it took a long
time to achieve the 2002 goal because of poor infrastructure and management. At the end of
2006, around 550,000 people were estimated to require antiretroviral therapy, of whom 81,000
(15 percent) were receiving the drugs. Although this is twice as many as were on treatment at the
end of 2005, Nigeria’s coverage rate is still only half of the average for sub-Saharan Africa.[51]
Generally, there has been some progress towards the goals of HEAP but there are still huge gaps
in HIV prevention, treatment, and care services, particularly at community level in Nigeria.
NAOWA’s Coping Mechanisms
In spite of NACA and other civil society groups’ attempts at public education regarding
the pandemic, low literacy and malignant cultural practices affected many Nigerians’
understanding of the dynamics of HIV/AIDS. While stigmatization has reduced considerably,
many still regarded HIV-positive people as “living on borrowed time.” They reasoned; “whatever
you do for them, they would die and your investments would amount to a waste. Why wasting
scarce resources then”[52]. Faced with public rejection, official neglect, and loss of loved ones
who have spent their lives serving the nation, officers’ wives – under the aegis of the NAOWA –
have evolved coping measures geared towards catering for their less fortunate members. In
branches and cell-groups in Lagos, as in some other parts of Nigeria, members have developed
cooperative arms aimed specifically at helping members in distress and those needing soft-term
loans to meet incidental costs like the procurement of AVRs, paying school fees, and other basic
necessities. Levies, donations and fundraising constitute the core of the source of this money.
“We have to resort to this measure to assist our members, especially those whose husbands or
themselves have tested positive to the virus. There are promises here and there, but it is sad that
government, over the years, have not been able to make good their promises,”[53] a female leader
in Abati Barrack, Lagos lamented.
In some hospitals in Lagos, Abuja and Ibadan, NAOWA succeeded in obtaining free
medical care for their ailing members. It must be noted that only consultation is free in any of
these hospitals. The cost of drugs and other incidentals is borne either by NAOWA or by the
affected person. In most cases, NAOWA stands surety for the families of the victims so as to
prevent situations in which a lack of money to procure drugs or pay a hospital bill would prevent
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victims from seeking medical care. In Ibadan, NAOWA has a counseling unit that offers free
counseling services to victims and their families on the best practices capable of sustaining the
lives the victim, ensuring zero infection and dealing with stigmatization.
How have these measures helped the plight of these women and their families? With
increasing economic tension in Nigeria, this measure has proved ineffective, as available
resources cannot meet the demand. Nevertheless, it is a step in the right direction. The cost of
procuring antiretroviral drugs is beyond the common man in Nigeria. The plight of victims is
beyond the reach of the common man. The present stance of the Nigerian government leaves no
one in doubt of the fact that Nigeria has not come to grips with the full impact of HIV/AIDS. As
NAOWA members testified, NACA has tried immensely to create awareness, but much still
needs to be done. Frustration over unpaid pensions and salaries is capable of creating an
unanticipated backlash. Most victims claimed that their lives would have been more meaningful if
their salaries, or gratuities and/ or pensions were paid on time.
Obviously, people living with HIV/AIDS are a vulnerable group. Are efforts really
squaring up to the needs of this group? Evidence abounds everywhere in Nigeria that measures
like these, as commendable as they may be, cannot meet the needs of the group. Victims and their
families have had to either beg on the streets or resort to clandestine means to make a living.
Many victims roam the streets of Lagos and other principal towns begging alms. Some even carry
their medical records around to demonstrate to any doubting alms-givers that their cases are
genuine and deserve assistance. In the course of this study, more than twenty such victims were
interviewed in different part of Lagos alone.
What official reaction have these efforts elicited over the years? Government reaction to
the plight of HIV/AIDS victims, especially ECOMOG soldiers, is felt only on the pages of the
newspapers. Intermittently, government officials have made promises without keeping them.
We were asked to report at the Hospital in Lagos. We did so. We waited for hours; no
one attended to us or says anything. Five hours later, we were told to report back the
next day, as the officials from the Ministry were yet to arrive.
The next day was not different from the previous. We were told to go away and await
further instructions. A victim’s wife reported.
Officials of NACA in Lagos put it this way:
The problems with the army are many and multidimensional. It is the responsibility of the
army to take charge of them. We deal directly with civilians, but we have had reasons to
attend to some of these soldiers.
The major challenge facing the army is on data analysis. No one can say, for certain,
how many people are involved. Experiences in Nigeria have shown that ghost workers, or
soldiers sprang up, in occasions like these and many of the genuine and deserving men
would go home without any assistance.
The second problem deals with procurement. There have been problems of funding and
this affects procurement. We educate the public, but it is the duty of the military hospitals
to take care of their victims.[54]
Conclusions
Civil society groups like NAOWA have demonstrated the way forward by taking charge
when the government is tardy. From evidence presented, it is incontrovertible that denial by the
Nigerian Army helped in fostering HIV/AIDS not only among the soldiers but also those of their
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families who have been infected. The argument in military circles that disclosing the HIV status
of its men was against the personal rights of these officers and men calls for closer scrutiny. The
fact of the matter is that neither the Nigerian Army nor its officers and men knew their HIV status
before and after the mission in Liberia. As research has revealed, the Nigerian Army had no
capability to test for HIV/AIDS at the time. Even if the capabilities existed in Nigeria to test for
HIV/AIDS then, the military was not prepared for such testing before and after the operations in
Liberia or elsewhere. Someone needs to take responsibility for unleashing these officers and men
on the society after the war without any health-related testing. This has shown how ill-prepared
Nigeria was for the peacekeeping operation in Liberia. It also reflects the deficiencies inherent in
the health considerations by the Nigerian Army prior to and after any military engagement. The
price of this was inflicted on innocent wives, girlfriends, children and family members: the virus
itself, as well as the burden associated with living with HIV/AIDS.
While the Nigerian Army cannot undo what has been done, it must however put into its
policy decisions not only the care or needs of the soldiers but also of their immediate families.
Only a holistic, rather than ad hoc, approach to intervention can help Nigeria stave off
HIV/AIDS. Equally, official denial of HIV/AIDS among Nigerian soldiers and an absence of
institutional support for the infected soldiers and their family members who may have chanced on
the pandemic are security problems that must be addressed urgently should Nigeria aim at
surviving the likely problems that may result. The impact on families of official denial and
absence of institutional support has been devastating. As recent trends in Nigeria have shown, it
is not divorce alone that creates single-parenthood and stepfamilies; parental death and
orphanhood due to HIV/AIDS have led many ECOMOG soldiers’ families to the brink of
disintegration. New family forms are emerging, such as ‘skip-generation’ families, where the
parental generation has succumbed to AIDS and AIDS-related illnesses and the families are made
up of grandparents and orphaned grandchildren; and child-headed families, in which grandparents
are not available to care for orphaned grandchildren. The so-called ‘generation of orphans’
encountered everywhere in Lagos and other urban centres suffers particular vulnerabilities and
desperately needs special attention. This generation of orphans and the new family forms that
accompany it are, and will continue to be, a formidable challenge to policy-making on child and
family issues at the national level and in international development cooperation.
NOTES
[1] ECOMOG refers to the Economic Community of West African States Cease-fire Monitoring Group. As the name implies, it was
an intervention force established by Nigeria to monitor the cease-fire in Liberia.
[2] UNAIDS 2006 “Report on the Global AIDS Epidemic”, May 2006. See also CIA “World Factbook”, 2005.
[3] Note that 57% figure given for women does not incorporate girls and female infants. The estimated figure for all females affected
with HIV/AIDS in Nigeria is put at 65 and 67%.
[4] J. Gus Liebenow, Liberia: The Evolution Of Privilege (Ithaca, N.Y.: Cornell University Press, 1969); and Liebenow, Liberia: The
Quest For Democracy (Bloomington: Indiana University Press, 1987); Christopher Clapham, Liberia and Sierra Leone: An Essay in
Comparative Politics (Cambridge: Cambridge University Press, 1976).
[5] This refers to the group of freed slaves (and their descendants) that the American Colonization Society, assisted by the U.S. Navy,
resettled on the shores of Liberia in the 1820s.
[6] Charles Taylor had been Director-General of Liberia’s General Services Agency shortly following the 1980 coup. After some two
years, Taylor left Liberia for America and began criticizing the Doe government. The Liberian government subsequently accused him
of embezzling $900,000 and requested extradition. Taylor was imprisoned, awaiting extradition hearings, but managed to escape and
travel back to West Africa, where he created the NPFL.
[7] AFL personnel killed about 250 civilians seeking sanctuary in St. Peter’s, wounding several hundred others (the bodies rotted on
church pews for three months). The AFL pursued survivors to a vacant USAID compound, where it killed several hundred more.
[8] Three Anglophone states (Nigeria, Gambia, and Ghana) and two Francophone states (Mali and Togo) comprised the SMC. The
three Anglophone states would become heavily involved in ECOMOG, whereas the two Francophone states did not.
[9] A. LeRoy Bennett, International Organizations: Principles & Issues (Englewood Cliffs, N.J.: Prentice Hall, 1991), esp. pp. 140160; Margaret A. Vogt, “The Problems and Challenges of Peace-Making: From Peacekeeping to Peace Enforcement,” in Margaret A.
Vogt, ed., The Liberian Crisis and ECOMOG: A Bold Attempt at Regional Peacekeeping (Lagos, Nigeria: Gabumo Publishing Co.,
1992); and A. Munro, “A New World Disorder? Crisis Management Post-Cold War, RUSI Journal, Vol. 140, No. 1 (1995).
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[10] “ECOWAS Standing Mediation Committee,” Decision A/DEC, August 1, 1990, on the Ceasefire and Establishment of an
ECOWAS Cease-fire Monitoring Group for Liberia, Banjul, Republic of the Gambia, August 7, 1990; cited in Mark Weller, ed.,
Regional Peace-Keeping and International Enforcement: The Liberian Crisis, Cambridge International Document Series, Vol. 6
(Cambridge: Cambridge University Press, 1994), p. 68.
[11] Christiana Amanpour in “World’s Untold Stories: Liberia’s Women Peacekeepers”, Cable News Network, Monday 22nd October
2007.
[12] Human Rights Watch group interview, Monrovia, October 23, 2001.
[13] Saheed Aderinto, “The Girls in Moral Danger”: Child Prostitution and Sexuality in Colonial Lagos, Nigeria,
1930s to 19501, in Journal of Humanities and Social Sciences, Vol. 1, Issue 2, 2007.
[14] All names of victims and witnesses have been changed in order to protect their identity.
[15] Human Rights Watch interview, Monrovia, October 25, 2001.
[16] Human Rights Watch interviews, Nimba County October 17, 2001 and Monrovia, October 23, 2001.
[17] Human Rights Watch interview, Nimba County, October 19, 2001.
[18] Human Rights Watch interview with Gertrude Mudekereza, Program Assistant, World Food Programme, Nimba County, October
17, 2001.
[19] Human Rights Watch interview, Monrovia, October 25, 2001.
[20] Human Rights Watch interview, Nimba County, October 19, 2001.
[21] Human Rights Watch interview, Monrovia, October 25, 2001.
[22] Human Rights Watch interview, Monrovia, October 25, 2001.
[23] In October 2001, a local human rights group in Monrovia found that four women had been raped in Monrovia prison. Human
Rights Watch and local human rights groups have also registered cases of rape by police.
[24] Oyeniyi, Bukola Adeyemi ‘Our Bodies…their Battleground: Interrogating Sexual Violence Against Women and Girls in DR
Congo’ Work-in-Progress.
[25] All names have been changed for security reasons. Oral Interview in Abuja, July 2007.
[26] Oral Interview in Abuja, July 2007
[27] Oral Interview in Enugu, July 2007
[28] Oral Interview in Enugu, July 2007
[29] Oral interview in Ogun State, July 2007. Fortunately for Agnes, the officer she met during the war impregnated and married her
after the war. She resides today in Sagamu, Ogun State.
[30] Oral interview in Lagos, September 2007.
[31] Statutory rape describes raping of minor or children below the age of consent.
[32] Oral interview in Abuja, October 2007.
[33] Oral interview in Abuja, October 2007.
[34] Oral interview at Alamala Barrack, Ogun State, September 2007.
[35] Oral interview at Alamala Barrack, Ogun State, September 2007.
[36] Human Right Watch interview, September 2007.
[37] Pauline, oral interview in Abuja, July 2001.
[38] 35year old Margaret said this in an interview in Abeokuta in 2002. She died two weeks after the interview.
[39] Ojoo area is situated at the main entrance to the Odogbo Military Cantonment.
[40] The ‘madams’, as the owners of the brothels are called, revealed in oral interview, Ibadan, September 2007.
[41] Skin-to-skin is another name for unprotected sex. Oral interview, Ibadan, September 2007.
[42] Interview in Ibadan, September 2007.
[43] Interview with Obinna, Lagos, September 2007.
[44] Oral interview in Abeokuta, September 2007.
[45] National Action Council on AIDS (NACA) is the official agency of government saddled with the responsibilities of public
enlightenment and creating awareness about HIV/AIDS in Nigeria.
[46] Oral interview in Abeokuta, September 2007.
[47] Oral interview in Yaba, Lagos, September 2007.
[48] Oral interview in Yaba, Lagos, September 2007.
[49] The Comet was the first newspaper in Nigeria to publish detailed reports of cases of children been rejected in schools because of
their fathers and mothers status as HIV positive. In most parts of Nigeria, discrimination against people living with HIV/AIDS is
frowned out, in spite of the fact that most people avoided them like plague.
[50] Oyinlola is not the real name. Interview in Lagos, September, 2007.
[51] In 2001, Ranbaxy Nigeria, a subsidiary of Ranbaxy India, India's largest pharmaceutical company, signed an agreement with the
Nigerian Government to supply ARVs manufactured at its plant in Lagos. In 2004 Archy Pharmaceuticals, a Nigerian owned
pharmaceutical company, also set up a new plant manufacturing ARVs in Lagos. The impact of these two efforts are yet to be felt.
[52] Oral interview, Abati, Lagos, September 2007
[53] Oral interview, Abati, Lagos, September 2007.
[54] Oral interview in Lagos, September 2007.
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When the “High Risk” Subaltern Speaks: The Zvishavane Women AIDS Prevention
Association (ZWAPA)’s Response to the HIV/AIDS Epidemic, 2003- 2008
Estella Musiiwa, Ph.D.•
Abstract
The HIV/AIDS epidemic is an area that has drawn the interest of many scholars but there is a generalization that, due to the
moneymaking motives of the Commercial Sex Workers, they have surrendered to be willing vectors of the virus while others try and
fight against the scourge. While scholarship has paid attention to the question of the HIV/AIDS ‘high risk’ groups and the socioeconomic propensities that facilitate the spread of the virus, the dominant perspective is epidemiological in outlook and focuses on
CSWers’ moral individual behaviour. Scholarship on Commercial Sex Workers’ (CSWers) response to mitigate the HIV/ADIS
epidemic highlight their participation in State and Non Governmental Organization (NGO) initiated campaigns. Donor and State
development policies which have looked at CSWers as an irrelevant factor in the HIV/AIDS development policies through the ‘moral
optic’ discourse, have accordingly, shrugged them off as fait accompli of nature. Absent from the discursive space of such campaigns
is the agency of CSWers and their ability to resist hegemonic social and economic structures that oppress them. Taking a subaltern
theory perspective, this paper seeks to demonstrate how CSWers have made efforts, not only to prevent themselves from the scourge,
but have taken the initiative to eradicate their dependence on CSW as a source of livelihood. They have initiated viable social and
economic development activities. The paper concludes that ZWAPA challenged the ‘moral optic’ approach and highlighted the need
to take a multi-sectoral approach in the fight against HIV/AIDS.
Introduction
The mutation of sexual and marital relations (heterosexual, homosexual, transgendered)
over time and space has rendered the definition of ‘sex worker’ or ‘prostitute’ rather problematic.
A person who engages in sexual activities outside formal marriage either for money or just for
pleasure has been described in derogatory terms such as ‘prostitute’, ‘prostituted woman’,
‘whore’, ‘sex worker’, ‘commercial sex worker’, ‘sex trade worker’. A Commercial Sex Worker
(CSWer) has been defined in economic terms as “ a person who in public or elsewhere, regularly
or habitually holds himself or herself out as available for sexual intercourse or other sexual
gratification for monetary and other material gain.”2 More elaborate is The Joint United Nations
Program on HIV/AIDS (UNAIDS Technical Update, 2002) definition of sex workers as “female,
male and transgender adults and young people who receive money or goods in exchange for
sexual services, either regularly or occasionally, and who may or may not consciously define
those activities as income generating.”3 Notwithstanding, such a definition excludes people who
indulge in sex outside formal marriage for reasons other than material or monetary gains. In this
paper, the term ‘CSWers’ will be used to denote the buying and selling of sex in exchange for
money or payment in kind in which the primary motivation for the prostitute is nether sexual nor
affectional4 since the study focuses on economically disadvantaged women who participated in
commercial sexual for monetary and material gains.5
•
Department of Economic History, University of Zimbabwe, Harare Zimbabwe
Cited in B Kyokunzire, “Is Criminalization of Commercial Sex Workers in Uganda an Answer? A Case study of Commercial Sex
Workers in Kampala District”, MA Thesis, Women’s Law, University of Zimbabwe, 2006, 6.
3
Cited in Ambar Basu and Mohan J. Dutta, “Participatory Change in a Campaign Led by Sex Workers: Connecting Resistance to
Action Oriented Agency,” Qualitative health Research, (2008), 106.
4
I. T. Magaisa, “Prostitution in Zimbabwe: A case study of black female heterosexual prostitutes in Harare,” PhD Thesis, University
of Zimbabwe, 1999, 23.
5
Some of the CSWers indulged in CSW for reasons other than material gains. One CSWer stated that she was in the trade because she
was heart- broken and found some sort of solace in “sleeping around”. For another CSWer, she went to the bars for a beer, she could
not resist the temptation of having sex with men, even for free. The author is also aware of the existence of male prostitutes who sell
their sex to women
(euphemistically referred to as “Sugar Mummies”), for their own material and monetary gains or other purposes.
2
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The subject of CSW has received attention in academic circles in terms of unbalanced
power relations between men and women. Radical feminists have pointed out the injustices meted
out on women in CSW. Prominent feminists such as Kate Millet, Kathleen Barry, Carole
Pateman, Catherine MacKinnon, and Kate Kesler, among others, perceive CSW as violence
perpetrated against women not only in the practice of prostitution, but more fundamentally in the
very idea of ‘buying sex’ which is considered so inextricably linked to a system of
heterosexuality and male power that it represents ‘the absolute embodiment of patriarchal male
privilege.6 Some scholars go beyond this perception of women as passive recipients of male
dominated violence to highlight CSWers’ reaction and agency. Gail Pheterson points to the first
Congress of Whores where CSWers who identified themselves as “feminists in exile”
campaigned against their legal discrimination and resisted the discourse that relegated them to a
position of passive victims.7 Khotiswaran also takes note of the category of women’s groups that
were formed by prostitute women themselves as campaigns against a discriminatory legal
system.8 Pheterson and Khotiswaran highlight CSWer initiated campaigns, thereby giving them
voice and agency absent in earlier feminist accounts of CSW.
While scholarship has acknowledged CSWers’ activist campaigns, they tend to be silent
on CSWers and health communication. The HIV/AIDS epidemic has given rise to various health
campaigns against the scourge as well as the capacity of such campaigns to effect change, but
communication in health has been characterized by the dominant top- down epidemiological
approach that excludes CSWers. Viswanath and Finnegan note that low socioeconomic “at-risk
populations” are mostly shrugged off as fait accompli.9 Addressing the increasing societal gap
between the rich and the poor, scholarship on health communication calls for “a reconfiguration
in the realm of campaigns, a reconfiguration that focuses on serving marginalized people.”10
Dutta-Bergman takes the argument further and interrogates the capacity of the top- down
dominant campaigns to effect behavior change.11
There is an emerging corpus of literature on CSW in Africa. Several scholars writing on
colonial Africa have paid attention to reasons for women’s participation in the commercial sex
industry. White argues that the commercial sex industry represented a means of viable
employment for women in colonial Nairobi.12 Writing on Zimbabwe, Jeater traces the link
between prostitution and economic crisis back to the pre-colonial period and then also covers part
of the colonial period.13 Mutimurefu, Magaisa, and Mandangu draw a link between “prostitution”
6
Kate Millet, The Prostitution Papers. (St. Albans: Paladin), 1975; Kathleen Barry, The Prostitution of Sexuality. (New York: New
York University Press), 1995; Carole Pateman, “Defending Prostitution: Charges Against Ericsson”, Ethics. 93: (1983): 561–65;
Catherine MacKinnon, “Confronting the Liberal Lies about Prostitution.” In D. Leidholdt and J. Raymond (eds). The Sexual Liberals
and the Attack on Feminism. (New York: Elsevier Science), 1990; Catherine MacKinnon, “Prostitution and Civil Rights”, Michigan
Journal of Gender and Law, (1993), 13–31; Kate Kesler, ‘Is a Feminist Stance in Support of Prostitution Possible? An Exploration of
Current Trends’, Sexualities 2: (2002), 219–35.
7
Gail Pheterson, A Vindication of the Rights of Whores. Seattle, WA: Seal
Press, 1989, 17.
8
Prabha
Kotiswaran,
“Preparing
for
Civil
Disobedience:
Indian
Sex
Workers
and
the
Law,”
http://www.bc.edu/bc_org/avp/law/lwsch/journals/bctwj/21_2/01_TXT.htm accessed August 13 2009.
9
K. Viswanath, and J.R. Finnegan, “Reflections on community health campaigns: Secular trends and the capacity to effect change”.
In, Public health communication, Ed. R. Hornik, Mahwah, NJ: Lawrence Erlbaum Associates, Inc., 2002, 289-313.
10
A. A. Marshall, and J.K. McKeon, “Reaching the unreachable: Educating and motivating women living in poverty”. In,
Communication and disenfranchisement. (ed.) E. B. Ray, Mahwah, NJ: Lawrence Erlbaum Associates, Inc., 1996, 137- 155.
11
Mohan Dutta- Bergman, “Theory and Practice in Health Communication Campaigns: A Critical Interrogation”. Health
Communication. 18 (2), (2005): 103.
12
Louise White discusses a host of other issues affecting both women and men in colonial Kenya that ultimately lead women to sell
sex and men to purchase it. Central to this, she concludes is the issue of labor migration and according to her “prostitutes” emerging to
provide reproductive labor. She says “…prostitutes’ work is reproductive, in fact, they sell that part of themselves- of male labor
power and formations…prostitutes sell sexual intercourse in a relationship,…they sell as transactions all that is legitimately available
in marriage, and that they are paid out of male wages…” Louise White, Comforts of Home: Prostitution in Nairobi, Kesho Publishers,
1990.
13
Diana Jeater, Marriage, Perversion and Power: The Construction of Moral Discourse in Southern Rhodesia 1894-1930, (Claredon
Press, New York), 1993.
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and the performance of the post- colonial economy, and argue that Commercial Sex Work (CSW)
is a means of economic survival.14 While attention has been paid to efforts at mitigating the
HIV/AIDS epidemic in Africa, Craddock notes that, “the dominant paradigm continues to be an
epidemiological focus on “risk groups” and those individual behaviours that characterize them.”15
Emphasis has been placed on identifying clients and reasons for the predominance of commercial
sex work. Scholarship on Commercial Sex Workers’ response to mitigate the HIV/AIDS
epidemic highlighted their participation in state and Non Governmental Organization initiated
campaigns.16 Ray and Wilson et al make an effort to reconcile CSW and the HIV/AIDS epidemic
but they focus on epidemiological issues.17 The top- down approach to an appreciation of the link
between the HIV/AIDS epidemic and CSW tends to overshadow CSWers’ agency and the
complexities characteristic of CSW over time and space.
This paper responds to this lacuna in health communication by foregrounding voices of
CSWers participating in HIV/AIDS interventions in Zvishavane. Based on the culture-centered
approach to health communication and subaltern studies theory, the major objective of this study
is to bring out the initiatives of a particular organized group of CSWers in their efforts to protect
themselves and their clients from the deadly disease. It will also explain the position taken by the
same CSWers in trying to empower themselves economically in an effort to try and reduce, if not
to completely eradicate their dependence on CSW as a source of livelihoodThe importance of
such an initiative comes in the work of the recent acceptance by medical experts and scholars that
there is need for a multi-sectoral and integrated approach to the HIV and AIDS pandemic.18
Background
Mining towns in Zimbabwe have always had a high level of Sexual Transmitted
Infections (STIs), and after 1985, the highest-level HIV and AIDS cases.19 The scenario is a result
of the migrant nature of the workforce on most of the mines. Apart from the fact that Shabani
Asbestos Mine in Zvishavane is one of the largest and oldest mines in Zimbabwe, there are
several mining companies that are clustered around it such as, Mimosa Platinum Mine, Murowa
Diamond, Mashava Asbestos mines and Sabi Gold Mine. In addition, several of these mines that
operate within the orbit of Zvishavane use the town as their residential town for their workers
who commute daily to and from work. Zvishavane district is divided into Zvishavane Rural and
Zvishavane Urban. An almost common activity in Zvishavane Rural is the illegal panning
activities that are carried out by a significant proportion of the population. In fact, a number of
these gold panners are migrants separated from their families and dependent on Zvishavane
Urban for their supplies and sexual needs. The majority of the population in Zvishavane Urban
resides in the high-density areas of Mandava, Maglas, and Highlands.20 Therefore, the general
14
N. Mutimurefu, “An Analysis of Female African Prostitution in Zimbabwe: A Case of Harare 1980-2002”, BA Honors Dissertation,
Economic History Department, University of Zimbabwe, 2004.
15
Susan Craddock, “Disease, Social Identity and Risk: rethinking the Geography of AIDS,” Transactions of the Institute of
Geographers, New Series, vol. 25, No.2, 2000, 153.
16
Paris S. Jones, “When Development Devastates: Donor Discourse, Access to HIV/AIDS Treatment in Africa and Rethinking the
Landscape of Development,” Third World Quarterly, vol. 25, No. 2, (2004): 392; Susan Craddock, “Disease, Social Identity and Risk:
rethinking the Geography of AIDS,” Transactions of the Institute of Geographers, New Series, vol. 25, No.2, (2000): 153; Ambar
Basu and Mohan J. Dutta, “Participatory Change in a Campaign Led by Sex Workers: Connecting Resistance to Action-Oriented
Agency”, Qualitative Health Research, Vol. 18, No. 1, (2008): 106-119
17
Ray S, “ Constraints Faced by Sex Workers in the Use of Male and Female Condoms in Urban Zimbabwe.” Journal of Health. Vol
78, No 4, (2001); David Wilson et al, “A Pilot Study for an HIV Prevention Programme Among Commercial Sex Workers in
Bulawayo, Zimbabwe.” Social Science Medicine. N0. 5. (1990), 609- 618.
18
National AIDS Council 2000-2004 Strategic Framework, 2000.
19
See ZHDR, 2003, 34 and Charles van Onselen, Chibharo: African Mine Labor in Southern Rhodesia1930-1933, Pluto Press
London, 1976.
20
It is noted that 45% of the population resides in Mandava, 40% reside in other high-density suburbs and only 15% reside in the low
and medium density suburbs. Plan Africa, “Re-designation of Land and Title at Shabani Mine: Zvishavane Master Plan 2000”,
Unpublished Zvishavane Town Council Master Plan Document, 11.
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picture of these high-density areas is that of over-crowding and unemployment that create a
viable climate for commercial sex.21
The economic crisis in Zimbabwe has impacted upon the lives of many people in various
ways. One of the results is the increasing unemployment of the majority of the population and the
earning of unsustainable salaries, which has resulted in the proliferation informal economic
activities such as illegal gold panning.22 This is a very common activity in most areas surrounding
Zvishavane town, especially in the Mberengwa and Shurugwi areas. Like most workers in the
formal mining sector, illegal gold panners popularly known as makorokoza (people who struggle
to do odd jobs to make ends meet), are usually of a migratory nature, separated from their
families for lengthy periods of time at times up to four to six months23. These workers have
increased the CSW potential in Zvishavane for a number of reasons. When the makorokoza are
paid off after selling their gold findings, they usually have significant amounts of money and
leisure time at their disposal. For many, Zvishavane Urban, affectionately known as “Zvish”,
becomes the place to be. Very often their main choices for entertainment are alcohol and sex. The
combination of these factors has created fertile ground for the growth and expansion of CSW in
Zvishavane.
Several reasons account for the high numbers of CSWers in Zvishavane. In a cyclical
web, the economic crisis has led to the migration of CSWers from other surrounding areas, both
rural and urban. CSWers have since the early 2000s moved into Zvishavane where the business is
higher and more rewarding. By March 2008, the estimated number of CSWers in Zvishavane was
650.24 The low level of education is a contributory factor towards CSW. The 2002 Midlands
census statistics noted that 50.26 percent of the Zvishavane were female, about 15 700 in total,
and of these, 1 200 had never attended school.25 This scenario paints a gloomy picture on the
options available for school- leavers and in a town that has limited employment options, CSW has
tended to be a tempting option for scores of young girls and single women. More so, 72.95
percent of the population in the category of paid employees was male while 27.05 percent were
female.26 Women on the other hand have very limited choices as demonstrated by the fact that 62
per cent of the economically inactive population is females and also by the fact that 98 per cent of
all homemakers are female.27 Firstly most of them are uneducated and therefore are not eligible
for the few jobs available to women in the formal sector. Secondly, they are left with the option
of competing with men in the informal sector. Under such a social and economic crisis some
women turned to CSW for survival, hence the spread of HIV and AIDS.28The HIV and AIDS
prevalence in Zvishavane during the period of study was 22 per cent and had been at those high
levels for the previous five or so years, having registered the highest prevalence in the country in
21
Gender imbalances in Zvishavane dates back to the colonial period. The population of Zvishavane, as of many other mining towns
during the colonial period, was largely male. Apart from the fact that male labor was the more preferred, the exclusion of women and
children augured well with the cost minimization and profit maximization policy, which meant that mining interests did not have to
invest a lot of capital in the provision of adequate family housing and other amenities. C. Van Onselen, Chibharo, notes that, beer
drinking and CSWers were provided as antidotes for desires to be with ones family and became colonial methods of labour retention
hence the dualisation of sexual life. It was a situation whereby a man would migrate between the rural and mining towns at regular
intervals, and have sexual intercourse with his wife back home, and a mapoto ‘wife’(relatively stable marital relations where bride
price has not been paid), or CSWer at the mine, at regular intervals. The dualisation of sexual activities culminated in the development
of behavioral patterns conducive to the spread of STIs and ultimately, HIV and AIDS.
22
G. Kusemamuriwo, “Gold Panning in Shamva District, 1980-2002:A Socio-Economic Perspective”, unpublished BA Honors in
Economic History Dissertation, Economic History Department, University of Zimbabwe, 2004, 25.
23
Ibid., 24.
24
Zvishavane Urban, Minutes of DAAC Stakeholders Meeting, Gono One Government Complex, Zvishavane, 23 August 2006.
25
Central Statistical Office, Census 2002: Provincial Profile Midlands, Harare, 2002.
26
Central Statistical Office, Census, 2002. 33.
27
Ibid.
28
The HIV virus, which causes AIDS, was first present in Africa in 1959 in the Western Equatorial African country of the Belgian
Congo. Sub-Saharan Africa has for a long time been the hardest hit region in the world. In 2005, UNAIDS reported that 22.6 percent
of the deaths in Africa were caused by HIV and AIDS and the numbers are predicted to increase by 2010. The hardest hit countries are
South Africa, Botswana, Swaziland, and Zimbabwe.
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2005-2006.29 The combination of the factors above, i.e., gold panners, truck drivers,
unemployment, migrant mining labor force and CSWers, resulted in what became known as the
Sex- Network Concept.30
The dominant top- down epidemiological approach was the first reaction to the
HIV/AIDS epidemic alarm. The National Blood Transfusion service was among the first to
respond to HIV and AIDS by screening all donated blood for the virus.31 Following the response
by the Transfusion Services was the creation of an advisory committee of health experts in 1986,
i.e. The Zimbabwe AIDS Health experts Committee (ZAHEC). Around 1987, the Short Term
Plan was put in place for one year. It was replaced by a Five Year Medium Term Plan 19881993(MTP1). The year 1993 saw the putting in place of the second MTP1994-1998. The two
plans encompassed a multi- sectoral approach to fight the epidemic but nothing was put in place
on the ground to turn the recognition into an action. Increasing levels of HIV infection forced the
Zimbabwean government to introduce the National Policy on HIV and AIDS in December 1999.
The National AIDS Council (NAC) was created in May 2000. NAC formulated the Strategic
Framework for a National Response (2000-2004) document to guide the National response.32
Between 1999 and 2005 very little was done in line with the strategic plans drawn by the NAC in
Zvishavane because of the absence of a District Aids Coordinator (DAC) to head this particular
department.33 The strategic plans put in place by NAC to date, realize and admit the need to reach
out to high-risk groups,34 CSWers included, but do not go on and state how this should effectively
be carried out. Whilst Zimbabwe as a country has been commended for the reduction of HIV and
AIDS levels from 24.2 in 2004 to 15.6 in the last quarter of 2007,35 a similar reduction was not
recorded in Zvishavane. It is against this backdrop that some of the CSWers in Zvishavane took
the initiative to form an Association that would counter the HIV/AIDS epidemic problems.
The Birth and Operation of the Zvishavane Women AIDS Prevention Association
Apart from the fact that intervention on the part of the state and other stakeholders was
neither adequate nor effective, CSWers were neglected despite the acknowledgement of their
vulnerable status. In addition to their realization of their marginal status, CSWers were aware of
the high-risk nature of their ‘profession’ and the short-term nature of the ‘profession’ that
dwindles with age. They appreciated the need to assist one another in reducing dependency on
CSW by investing in other sources of livelihood. The combination of these factors led to the
formation of Zvishavane Women AIDS Prevention Association (ZWAPA), an organization with
a mandate to coordinate knowledge building and economic empowerment. It also aimed at
participating as a stakeholder in the overall national and local AIDS prevention and awareness
policy. It is in this context that the paper gives agency to the CSWers by highlighting their
initiative to mitigate the epidemic.
As already noted, the paper focuses on CSWers who were forced into CSW because of
social and economic problems. Socially, the CSWers belonged to the lowest level of the social
stratum. Of the thirty CSWers interviewed, none possessed the requisite five Ordinary Level
passes. Out of the thirty, twenty- nine had children and none were married, none were employed
in the formal sector and many were struggling in the informal sector based on the sale of
29
Zvishavane Urban DAAC, First Quarter Report 2007, 18.
The Sex Network Concept refers to a map or web of sexual relationships or partners which bring many sexual partners of diverse
background, status, behaviour and other attributes into direct (immediate) and indirect (open or remote) sexual contact.
31
Ibid.
32
Institute of Development Studies and The Poverty Reduction Forum, ZHDR, 2003, 127.
33
Interview with the current District AIDS Coordinator, (hereafter DAC), Mr. Kudakwashe Gumbu, 11 March 2008, Zvishavane.
34
They referred to women (including CSWers) and children.
35
MOHCWA and NAC, The HIV and AIDS Epidemic in Zimbabwe: Where Are We Now? Where Are We Going?, 2004, 22.
30
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vegetables and fruits at the local bus terminus.36 Only four had inherited houses from a late father
or husband while the rest were tenants struggling to pay rentals.37 When asked why they were in
the profession, the beginning or closing statement for most of them would be, “Inhamo chaiyo,”
“Kutambura chete” (It is a serious problem! It is suffering only!),38 suggesting that they were in
CSW not out of choice but out of necessity. One CSWer narrated her ordeal:
My name is X. I am 37. I live in Zvishavane and was born here also. I was
married in Nhema (Shurugwi) and have two children, both girls. My husband
neglected me due to the fact that he had another lady (small house). After the
divorce I then went back home. I stayed with my brother’s wife. I stayed for only
a month and thereafter my brother’s wife started to look down upon me. I had no
money to buy soap and other needs, then my mother told me to go and look for
work as a domestic worker. I went to Mabasa growth point and got a job as a
shopkeeper. I worked as a shopkeeper for only a month then the owner of the
shop started making sexual advances and demanded that I have sexual
intercourse with him. The situation became very hard and I decided to leave. I
then went to Zvishavane town to look for employment as domestic worker where
I stayed in one room with my young sister who was married. After a month she
told me to go to the beer halls and become a Commercial Sex Worker.39
The foregoing shows how poverty, coupled with social segregation in families constituted a
driving force behind the decision to engage in CSW. It suffices to give a very brief account of the
“working relations” of CSWers in Zvishavane prior to the formation of the Zvishavane Women
Aids Prevention Association (ZWAPA). In a ‘profession’ characterised by cutthroat competition
and fights for space and clients, many did not see eye to eye. This made it difficult for CSWers to
discuss common issues pertaining to HIV and AIDS, and in particular its impact on their trade.
CSWers admitted that they often fought for “spots” and clients and as a result they were rarely
friends among themselves,40 making the prospects of discussing the issue that affected their trade
difficult and almost impossible. For a long time, selling sex was something that they did, not
something they talked about, even among themselves. In many cases, the CSWers were in denial
and did not want to openly admit to themselves and to each other that their sole means of survival
was through selling sex. Although many knew the risky nature of their ‘profession’ in terms of
infection and re- infection, they lacked the motivation and capacity to meaningfully address the
risks threats and challenges associated with their profession.
Given the lack of knowledge on HIV/AIDS, the largest percentage of HIV and AIDS
infections in Zvishavane were a result of unprotected sex. One CSWer explained, “My nickname
was Ada Atora (whoever wanted to have sex with me was free to do so). … Most of the times I
was forced to have sex without a condom hence gaining STIs instead of money.”41 Another
CSWer complained, “At first I enjoyed the work but as time went by it became hard for me. I had
unprotected sex with various men. Some of them would agree to use condoms but would tear the
tip of the condom without me knowing as the sex was done in the dark. Some of these clients
used to beat me up and take back their money. I was at risk of being beaten up several times each
week. The clients gave me money plus STIs and I was at the risk of contracting HIV infection.”42
36
Focus Group Discussion with CSWers, Mandava, Zvishavane, 5 September 2007.
Ibid.
38
A few sex workers, however, said they were in the profession because they enjoyed the easy way of making money and would not
go into any other form of livelihood.
39
Musasa Project Documents, Gender Tales from Zvishavane District: Voices of Women and Men Against Gender Violence, 2006.
40
Focused Group Discussion with CSWers, Mandava, Zvishavane, 5 September 2007.
41
Musasa Project Documents, Gender Tales from Zvishavane District: Voices of Women and Men Against Gender Violence, 2006.
42
Ibid.
37
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In fact there was one man nicknamed “King Muswati” (after the Swaziland King who has many
concubines) for insisting on unprotected sex.43 This resulted in the inevitable spread of HIV and
AIDS in Zvishavane.
Increasing cases of illness and death among CSWers awakened some of them to the need
to address the problems they encountered as an unidentifiable group. Credit for mooting the idea
to form an organized association should be given to three CSWers who realized the need to come
together in order to address common medical, social and economic problems that they faced as
CSWers.44 When asked why they decided to form an organisation of CSWers one of the
pioneering trio responded:
As CSWers working individually we were achieving nothing in terms of
addressing life and death issues that concerned our profession. We watched as
our numbers perished as a result of AIDS. All we would say is; Jane or Susan is
now very sick or has died… we did not realize that unless something was done
we also risked being part of that statistics. We also needed to help each other to
sustain our lives together just like other workers. We also realized the increased
chances of working with other organisations that would come in forming such an
organisation … it would assist us CSWers in acquiring knowledge about AIDS,
teach us safer sexual habits as well as afford us a chance to access capital to start
self help projects which would help us to eventually turn away from CSW as a
way of survival.45
Thus, the CSWers realized that as individuals they were not as effective in addressing day to day
problems that they faced, but as an organized group there were higher chances of sharing
constructive ideas and forging working relations with other HIV and AIDS based organisations.
The task thereafter was how to recruit other CSWers to this cause. Mr. M. Pfunda, the Zvishavane
Town Council Public Health Officer, who had helped coordinate of the ‘retired’ CSWers
organisation in Gweru, the Gweru Women Aids Prevention Association (GWAPA),46 assisted in
getting the Zvishavane CSWers together. He invited representatives from GWAPA to give an
inspirational talk to the CSWers in Zvishavane with regards to the advantages of forming such an
organisation47. He noted, “When I came to Zvishavane and worked for the Town Council I saw
the appalling statistics on STIs and AIDS. I also witnessed the reckless manner the CSWers
handled themselves. When they approached me with the idea l was glad to assist them in the
realization of behavioral change among their ranks.”48 Pfunda however pointed out the difficulties
that he and the trio met in bringing the CSWers to understand the motives behind the formation of
the proposed organisation. “Occasionally, we had to use the catch of the prospects of financial
and material returns in order to convince prospective members to join the Association.”49 Most of
the CSWers who joined the organisation expected to get money to start self- help projects.
Notwithstanding the problems encountered ZWAPA was launched 7 November 2003 with a
total of 20 registered CSWers. The name evidently took a cue from its sister organisation,
43
Focused Group Discussion with a CSWer, Chiedza Hall, Mandava, 8 March 2008.
The three chose to remain anonymous.
45
Interview with a CSWer, Mandava, Zvishavane, 5 September 2007.
46
The Gweru Women Aids Prevention Association started off as an organization established by women who had retired from CSW.
They wanted to take care of each other at old age or when they were no longer markatable. The Association hasdeveloped into a
heterogeneous Association that caters for disadvantaged women including widows, divorcees, CSWers and young married women
who are in financial need but are not CSWers. GWAPA trains women in small business skills and grants loans to its members. They
participate in the HIV?AIDS campaings as Peer educators and they perform dramas.
47
Mr Pfunda helped the CSWers as an individual and not on behalf of the Zvishavane Town Council or as part of his job.
48
Interview with M. Pfunda, Zvishavane town council offices, Mandava, Zvishavane, 13 September 2007.
49
Ibid.
44
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GWAPA. However, unlike GWAPA, which was constituted by ex-commercial sex workers, all
ZWAPA members at the time of its formation were indulging in commercial sex.
The objectives of the organisation as stipulated by the organisation’s constitution were;
a) To bring all CSWers, especially the young, under a co-coordinated organisation for the
purposes of information dissemination on issues relating to HIV and AIDS
b) To forge closer working relations between such CSWers and other established bodies
working to fight against HIV and AIDS.
c) To be an important link in the efforts to fight against the HIV and AIDS pandemic
d) To eventually equip CSWers with other sources of livelihood so as to eradicate
“prostitution.” 50
The first executive committee, which was made up of the Chairperson, Vice Chairperson and the
Treasurer, was subsequently formed. 51 Initially, ZWAPA was preoccupied with the
epidemiological issues of the epidemic. It focused on mitigation through behavioural change and
aimed at spearheading and coordinating AIDS prevention and awareness campaigns to its
membership, which was strictly restricted to CSWers. This policy emanated from the acceptance
by CSWers of their limited knowledge of medical and reproductive health. They admitted that
despite the will to protect themselves against the virus, they did not have relevant medical
knowledge.52 Emphasis was put on the need to teach and promote the consistent and proper use of
condoms among CSWers.53
As opposed to some CSWers’ organizations initiated from the top, the ZWAPA subaltern
CSWers engaged a negotiation approach. They initiated a dialogue with HIV/AIDS organizations
whom they approached for assistance in an effort to mitigate the epidemic at an epidemiological
level. They received support from other HIV/AIDS based organisations working in Zvishavane.
Meanwhile, due to the increasing numbers of CSWers and the failure of the many operations put
in place by the police, especially “Operation Chipo Chiroorwa” (Commercial Sex Worker get
married) to take commercial sex off the streets, other organisations realized that exerting energies
in fighting CSWers using legal means was an exercise in futility. Instead, they realized the
importance of educating them and working with them on the risks of their trade and the
consequent need for self-protection, while empowering them into embarking on other sources of
livelihood instead of fighting with them in running battles. In sync with this line of reasoning,
CSWers in ZWAPA was invited to workshops by organisations such as District AIDS Action
Council (DAAC), Midlands AIDS Caring Organization (MACO), and Musasa Project. The
Zvishavane District Aids Co-ordinator (DAC) explained why they decided to cooperate with
CSWers, “Apart from the fact that the CSWers were already an organized group, the reason why
DAAC saw it important to cooperate with them is that they discovered ‘knowledge gaps’ among
CSWers which included HIV and AIDS prevention, condom management and negotiation for
safe sex.”54 However, in most of these workshops, the key issue was behavior change, which not
only encompasses the issue of consistent condom use but also equipped them with the skills to
negotiate for safe sex with different clients.55 One CSWer interviewed stated that the Peer
Education facility went far beyond teaching them on prevention and condom management to
encompass teachings on women’s rights and gender equality.56 In this area the Association
worked hand in hand with the Musasa Project. One of the CSWers gave an account:
50
ZWAPA Documents, ZWAPA Constitution, 2003.
Two of the three pioneers of the Association filled the positions of Chairperson and Treasurer.
Focused Group Discussions with CSWers, Chiedza Hall, Mandava, 8 March 2008.
53
A research conducted by one Dr Susan Weller revealed that 15-31 percent of the time the condom is ineffective if it has not been
stored and worn properly, thus the need to educate CSWs on management and proper use of condoms. Dr Susan Weller “A MetaAnalysis of Condom Effectiveness in Reducing Sexually Transmitted HIV”, Social Science and Medicine vol 36, no12, 1993, 502.
54
Interview with the DAC offices, Mandava, Zvishavane, 11 March 1008.
55
Interview with Mr M Pfunda, Zvishavane Town Council Offices, Mandava, Zvishavane, 6 March 2008.
56
Interview with CSWer, Chiedza Hall, Mandava, Zvishavane, 13 March 2008.
51
52
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I met some Commercial Sex Workers who wanted to form an association for
single mothers and I joined them. Three days later Zvishavane Women AIDS
prevention Association was formed and I became one of the members. After two
weeks Musasa Project began to invite our group for the Commercial Sex Wokers
Peer Educators training workshops. They taught us a lot of things such as gender,
gender violence, sexual and reproductive rights, Sexually Transmitted
Infections(STIs) and HIV, self assertiveness and confidence, good
communication, human rights, condom promotion and negotiation for safer sex.57
Being a human’s rights organisation that deals with gender violence, it was active in bringing
awareness to the CSWers in the Association.58 At that point in time focus was on highlighting the
risks, rather than alleviating dependency on CSW. Additional epidemiological assistance was
obtained from another subaltern CSWer group, GWAPA, which provided Voluntary Counseling
and Testing (VCT) facilities for its members. GWAPA sent its ambulance to Zvishavane for free
counseling and testing exclusively for ZWAPA members twice a year.59 The importance of this
facility was appreciated in light of the fact that Zvishavane did not have such facilities. This was
in line with ZWAPA’s intention, of trying to encourage them to live responsibly in protecting
themselves and their clients, against getting infected or re-infected with HIV and AIDS. Helpful
though this facility seemed, the CSWers’ adherence to it was determined by their monetary
situation and by the response of their diverse clientele who, most likely, were not educated or
simply chose not to adhere to behavioral change.
At the economic level they paid attention to the socio- economic propensities of the
epidemic. They instituted the cultural fictive relationship of sisterhood at the subaltern level.60
The Sister to Sister facility where a revolving credit fund was made accessible to all the members
at a very low interest rate, was implemented in an attempt to reduce the reliance on commercial
sex.61 Through the same facility, Association members also received groceries, purchased and
shared equally among the CSWers every four months. The second, and probably most important
facility for them was the Income Generating Programme.62 All the members were involved in
57
Musasa Project Documents, Gender Tales from Zvishavane District: Voices of Women and Men Against Gender Violence, 2006.
Musasa Project Documents, Gender Tales From Zvishavane District: Voices of Women and Men Against Gender Violence.
59
Interview with ZWAPA Chair-Person, Mandava, Zvishavane, 5 September 2007. The LABAM
(Laboratory Ambulance) donated to GWAPA by the Czech Republic through Rozkos Berz Rizika, has over the years contributed
immensely towards the uptake of HIV prevention services through the Mobile Counselling and Testing Services. The vehicle has also
benefited GWAPA members through the provision of treatment for Gynaecological problems including Sexually Transmitted
Infections in the four projects sites of Gweru, Shurugwi, Chachacha and Zvishavane.
60
Mohan J. Dutta- Bergman notes, “The important role of culture might be particularly evident in the realm of habitual behaviors
where the enactment of the behavior is based on an existing script without thoughtful and systematic assessments each time the
behavior is enacted. Also, the role of the culture might be particularly highlighted in collectivistic cultures in which individual
decision making is simply a reflection of cultural mores and rituals.” Mohan J. Dutta-Bergman, “Theory and Practice in Health
Communication Campaigns: A Critical Interrogation”. Health Communication. 18 (2), (2005): 106. One can draw parallels with
CSWers in India, “Sundari stated, “When a sex worker goes to another and talks about her health, her life, her problems, it is then that
we realized that we had people who wanted to know our problems. This is how trust in the Project [SHIP] and trust in the community
developed.” Situating this contextually in the realm of sex work, we can theorize that developing trust was at the base of the CSWers’
fight against injustice. Though many of them had the willingness to resist violence, they could not do so because there were not many
of them in the community who would come under one roof, trust each other, and resist the forces that marginalize them. The SHIP and
the DMSC were able to instill trust in the community, providing a common platform for sex workers to launch and sustain their
unified struggle against exploitation.” Ambar Basu and Mohann J. Dutta, “Participatory Change in a campaign Led by Sex Workers:
Connecting Resistance to Action Oriented Agency,” Qualitative health Research, 2008, 113.
61
ZWAPA Documents, Sister to Sister Facility. This tarries with the culture- centered approach, which “underscores the importance
of participation of community members in the articulation of health problems as a step toward achieving meaningful change.” Ambar
Basu and Mohan J. Dutta, “Participatory Change in a campaign Led by Sex Workers: Connecting Resistance to Action Oriented
Agency,” Qualitative health Research, 2008, 113. See also Mohan J. Dutta- Bergman, “Recognizing the strong interlinkage between
economics and safe sex practices among sex workers, the Shakti project in Bangladesh offered skills training in alternative modes of
supplementing income, such as embroidery and sewing (UNAIDS, 2000),” 109.
62
ZWAPA Documents, Income Generating Programme.
58
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various income generating schemes in the informal sector, ranging from selling vegetables at the
local bus terminus to cross border trading. Capital for this scheme was made available through
several NGOs before it was disbursed to the various members, as groups or individuals, in order
to kick-start or expand their business ventures.63 The Income Generating Schemes received some
form of assistance from the DAAC, which provided funding and organized seminars on book
keeping and business management but the CSW continued to have control over how the funds
were to be distributed and used. The Peer Education facility complimented the Sister-to-Sister
and Income Generating facilities by educating the members on business management and
advocacy. In order to achieve this, ZWAPA implemented a policy of Peer Education, which
emphasized on conscientising Association members on the subject safer sex practices.64 The
facilities were obviously inspired by the assumption that they would reduce dependency on CSW
if they found viable means of self-sustenance.
ZWAPA moved beyond the economic facet to include the social aspects of CSW by
putting in place the Illness and Bereavement facility to help those CSWers who were already
infected by the AIDS epidemic.65 Under this facility, ZWAPA referred HIV positive members to
NGOs for psychosocial, nutritional as well as Home Based Care (HBC) support.66 The
organisation that helped them in psychosocial support was MACO, which provided herbs such as
Moringa (an herb that has increasingly been used to boost the immune system of particularly
those who are infected by HIV and AIDS) for healthier living67. DAAC played a significant role
in registering positive members with a food aid organization, Africare, which provided mealie
meal, cooking oil, beans and other foodstuffs. Under this facility that provision was made for the
care of a late member’s dependents, especially children of a school going age.68
Although the initial intention for the formation of ZWAPA was to solely reform or
transform the lives of CSWers, this motive was revised with time. ZWAPA initiatives to mitigate
the HIV/AIDS epidemic later addressed women outside the Association. Starting in mid 2006,
ZWAPA began to reach out to the community in two main ways; firstly, in opening its
membership to single mothers who they realized were often in financial crises and were therefore
prone to risky behavior, and secondly in expanding their peer education facility to turn some of
its members into peer educators who educate the public on several issues, but chief among them
the issue of HIV and AIDS. What made the Association open up its membership was that upon
the realization that many of those women in the commercial sex industry had either never been,
widowed or divorced, in fact of all interviewed for this study none were married. It also came
after the admission that the reason why many had joined the industry in the first place was
because of the need to get money to support their dependents. The ZWAPA CSWers were not
ignorant of the stigma attached to the “immoral” nature of CSW. One CSWer clarified, “In my
community I was an example of a rubbish bin because of my behaviour. My neighbours,
relatives, started hating me because they thought I could spoil their children. Some thought I
could take their husbands. At community meetings nobody listened to my ideas because I was
nobody but a prostitute.”69 They incessantly valued ‘womanhood’ as denoted by their cultural
values.70 The Association, therefore, sought to prevent the single mothers who had not yet joined
CSW from doing so by offering them a chance to change their economic base through the Sister
63
Ibid.
ZWAPA Documents, Peer Education of CSWers and the Community.
65
ZWAPA Documents, Illness and Bereavement (not dated).
66
Interview with CSWers, Chiedza hall, Mandava, Zvishavane, 13 March 2008.
67
Ibid.
68
Interview with CSWers, Chiedza hall, Mandava, Zvishavane, 13 March 2008.
69
Musasa Project Documents, Gender Tales From Zvishavane District: Voices of Women and Men Against Gender Violence.
70
Cited in Jane, Scouler. “Interpreting the discursive, symbolic and material position of sex/work in feminist theory.” Feminist
Theory. vol. 5 (3), (2004): 343 “The prostitute symbolizes the value of women in society. She is paradigmatic of women’s social,
sexual and economic subordination, in that her status is the basic unit by which all women’s value is measured and to which all
women can be reduced.”
64
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to Sister facility and the Income Generating facility, hence the heterogeneous composition of
ZWAPA. By 2008, an estimated 120 members of ZWAPA were single mothers not in the
commercial sex industry.71
Instead of the dominant top- down educational system, a significant number of the
members of ZWAPA trained as Peer Educators under GWAPA as soon the organisation got
directly involved in changing the lives of the community. The strategy entailed the training of a
few members of the association who would in turn impart this knowledge to fellow CSWers
outside the Association and the community at large. Dissemination of this information was
targeted for public drinking places like beer halls and bars. In June 2006, the first beer hall
outreach was conducted. One of the CSWers involved in the first outreaches explained, “Our
clients…. This is why we worked in bars and nightspots. We felt this is where the majority of
people who are either not knowledgeable or simply negligent are found. We also felt that the
message would be heard better coming from people who were known to be sex workers
themselves.”72
After changing their own lives the ZWAPA members made a resolution to touch the lives
of others by educating them on HIV/AIDS and the importance of safe sex for the realistic reason
that the AIDS virus can affect anyone in the society not CSWers only. “We wanted to be an
example,” explained one Peer Educator, “from the information we received, we realized that it
must be passed on in order to reduce the high levels of HIV cases in Zvishavane and beyond.”73
The epidemiological campaigns of the Association in this regard were explained by the chairlady,
We are mostly involved in bar-based meetings74, where we talk about safe sex
because we know for a fact that that’s where it begins…. we also set up
workshops on condom demonstrations and management. To further widen our
knowledge so as to help the community, we share information with different
organizations especially DAAC and MACO and also the Zvishavane Town
Council Health Department.75
Behavioural change was promoted through dramas and road shows.76 The DAC stated that
DAAC tried to link potential donors sponsor this programme because “there is nothing that is as
strong as their testimonies, they could change other people’s lives.”77 What is revealed from the
above is that the CSWers started getting the support from the DAAC or NAC and other NGOs,
after they had formed their Association.
71
ZWAPA Documents, Peer Education of CSWers and the Community.
Interview with CSWers, Mandava, Zvishavane, 8 March 2008.
73
Interview with Peer Educator, Mandava, Zvishavane, 7 March 2008.
74
These are meetings held in the bars by the CSWers in a bid to educate the people inside about the dangers of unprotected sex.
75
Interview with Peer Educator, Mandava, Zvishavane, 7 March 2008.
76
See Mohan J. Dutta Bergman, “The highly contextualized nature of media consumption is particularly critical in collectivistic
cultures in which individuals consume media in family and community
settings, necessitating the development of measurement tools that capture the media consumption context. For instance, research
documenting the listenership of TTS indicated that community members formed informal groups that later became formalized into
radio clubs that listened to the program as a group and subsequently discussed the program content; these radio clubs actively
participated in their local and surrounding communities, spreading the message of the social change project. .” Mohan J. DuttaBergman, Theory and practice in Health Communication Campaigns: A Critical Interrogation,” Health Communication, 18 (2),
(2005), 110.
77
Interview with Mr. Mandava, DAC, Zvishavane, 08 March, 2008 (emphasis added). It is important to note that, “Although
campaigns are increasingly using entertainment strategies to place messages in entertainment programs that are more likely to be
consumed by those at risk, … the criticism of the dominant approaches to health communication demonstrates that these approaches
typically are individualistic, ignore the context, and are cognitively biased.” Mohan J. Dutta-Bergman, Theory and practice in Health
Communication Campaigns: A Critical Interrogation,” Health Communication, 18 (2), (2005), 112.
72
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ZWAPA Achievements and Challenges
Having looked at how the Association was formed and what it sought to achieve, it is of
importance, to evaluate how far it has gone in meeting those ends. All of the groups that work
with ZWAPA have commended that it has been highly successful in a very big way. This is
understandable given the groundbreaking activities of the organisation. This study posits that the
performance of ZWAPA since its formation in 2003 has been a mixed bag of fortune. The HIV
positive members had a lot to be grateful for. Single mothers in the organisation have also among
the Association members is that “ZWAPA has taught me to be more responsible.”78 Another
CSWer was more elaborate:
One day I met a certain lady inn the beer hall. She talked to me about a meeting
at Chiedza Hall and I agreed and went to the hall on the specified day. There we
were taught by Musasa Project about STIs and HIV/AIDS and use of condoms
for every sexual encounter. We were also taught about sexual and reproductive
rights and how to be confident and assertive. So after these lessons I started
reducing the number of boyfriends and I began to insist on condom use. Now I
know the value of condoms. I was tested and now I know my status. Now I know
that depending on a man has many dangers. I am now relying on selling
vegetables and fruits as a vendor. My children are now going to school. I now
have one partner and we use condoms all the time when we have sex.79
It has no doubt done well where financial and material assistance of the association members are
concerned. It has also recorded commendable successes in its participation in the fight against
HIV and AIDS. However, the interventions of the CSWers have faced a number of problems,
some of them colossal, in their operations. Nonetheless, it is the contention of this study that these
failures notwithstanding, the Association may serve as an important guinea-pig in testing the
prospects of a truly ‘multi-sectoral’ approach to HIV and AIDS interventions in the national HIV
and AIDS policy that takes into consideration the vulnerable groups on board, CSWers included.
While not much has been done to stop CSW per se, some of them have acknowledged the
positive results of ZWAPA, at least at an epidemiological level. One of the clients noted the
positive impact of ZWAPA on her life:
My behavior changed because of the information which I gained from Musasa
project through workshops. … Because of Musasa Project workshops I attended
I’m now assertive. I now have one faithful partner but I won’t stop using
condoms. I have stopped relying on a boyfriend because I have my own business.
I always seek early treatment when I am not feeling well because I have the
knowledge. I can now share information and ideas with others in my community
even at some meetings because I have changed my behavior.80
Unfortunately the same the same lady occasionally engaged in commercial sex, as she
explained, “Although my vending business is going on well, sometimes I find myself
looking for my old boyfriends to get some cash. The money from business is not enough
as prices of goods and food keep on going up everyday but I now insist on
condoms.”81The organisations that have worked with ZWAPA portrayed its first
five years of existence largely as a success story. MACO reported that:
78
Interview with single mothers in ZWAPA, Chiedza Hall, Mandava, Zvishavane, 7 March 2008.
Musasa Project Documents, Gender Tales from Zvishavane District: Voices of Women and Men Against Gender Violence, 2006.
80
Ibid.
81
Ibid.
79
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Sexual behaviour change had resulted in consistent condom use and the ability
through skills obtained in negotiating for safer sex to refuse for sex without a
condom. Some CSW noted that they had stopped the practice of tying condoms
after sex due to new information gained about transmission of HIV and had also
stopped using cloths for wiping after sexual intercourse. Others reported that they
had implemented behaviour change in reducing the number of sexual partners to
a small number of “regular” clients. Some also noted that behaviour change had
occurred in the reduction of their alcohol intake in order to increase their capacity
for condom use with clients.82
DAAC also noticed change among the CSWers. The DAC stated that the establishment of
ZWAPA had resulted in the CSWers’ “active involvement in HIV/AIDS prevention programmes,
increased condom use, and HIV test seeking behaviour, many are keen on knowing their status
and more than 90 per cent certain of it”.83 As one former CSWer noted, “If different NGOs
including Musasa project, ZWAPA and GWAPA are fighting for one goal which is to stop gender
violence, HIV and AIDS why not Commercial Sex Workers. We want to fight for a better life.
Please, please, please, keep on helping us where ever possible such that I won’t let the project
down so that we ex- Commercial Sex Workers can be able to maintain our changed behaviour.”84
Despite its successes the Association faced formidable internal challenges, chief among
them being the financial support. Up to 2008 their finances as an organisation were not stable as
they received very little donations for starting their programmes. All the facilities within the
Association were under-funded by NGOs were inconsistent in their handouts. Part of the reason
for this situation is the lack of accountability in the way funds are utilized in the organisation. At
that time the Association did not have a specific organisation responsible for its financing and
thus relied on the DAAC to source funds on its behalf. The result was that the CSWers were not
able to inject capital that would significantly change their fortunes and reduce dependence on
returns from CSW.
Apart from the ultimate lack of funds, some fallen members of the association reported
that there was misuse of funds and unfair distribution of those available within the organisation.
One ex-member of ZWAPA claimed that there were several reasons she had left the association
but the most important reason for her departure was the unfair distribution of funds, which she
was tired of ignoring, she stated that, “For one to get money from the revolving fund it took three
or four months especially because those with positions of influence within the association often
rotates funds among themselves living out the rest of the members.85 Another fallen member
stated that, “The work we did for ZWAPA was just too much, we were promised money but this
promise never materialized and yet we had sacrificed our time to do the work…those that
somehow got a hold of the funds had bigger and better businesses.”86 On the other hand the
reason why some of them remained small was because of mismanagement of funds on their part
i.e. as individuals. The members interviewed were asked how the income generating facility had
helped them. A significant number stated, “We got money to start our own businesses. Now we
can eat meat and eggs, and can afford to buy clothing.”87 The majority of the members on the
other hand were still limited to selling vegetables and fruits at the local bus terminus and the
middle class in the association sell second hand clothes at the Mandava flea market.
82
MACO Documents, “Sexual Behaviour Change Among CSW: A Review of HIV Prevention Strategies”, Workshop Report,
September 2006, 3.
83
Interview with the DAC, Mandava, Zvishavane, 11 March 2008.
84
Musasa Project Documents, Gender Tales from Zvishavane District: Voices of Women and Men Against Gender Violence, 2006.
85
Interview with ex- ZWAPA members, Chiedza Hall, Mandava, Zvishavane, 15 March 2008.
86
Ibid.
87
Interview with the CSWers, Chiedza hall, Mandava, Zvishavane, 13 March 2008.
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External problems beyond ZWAPA control exacerbated their financial problems.
Operation Murambatsvina (Operation Restore Oder or Clean Up) instituted to destroy illegal
shanty dwellings in urban areas in 2005) compounded the financial problems. During this
operation the structures that CSWers used for many of their income generating facilities, which
included catering and laundry, were destroyed. Also worsening their financial situation was the
change in NAC policy. In the last quarter of 2005 NAC ceased to be an implementer of
HIV/AIDS strategies hence withdrawing the assistance it had previously offered to the
Association. Finally the financial problems that began to be faced by GWAPA in early 2006 also
had negative repercussions on the association. As mentioned elsewhere, the Association relied to
some extent, on funds from GWAPA, its withdrawal as a donor of ZWAPA dealt a blow to the
association.
Yet another challenge faced by the Association was that many of its members were
mobile, making the consistent and continuous implementation of HIV prevention strategies
difficult. Some of the members of the organisation were cross- border traders and others left the
town to sell their products elsewhere, and therefore miss out on a lot of workshops which served
to keep their behaviors in check. One cross-boarder trader stated that she was at her weakest
when she left Zvishavane to go and sell her products. If business did not go well, she was often
tempted to sell sex and make enough money to get back home.88 This increased her risks of
engaging in unprotected sex, as she would have, again, drifted back, albeit for a short time to
depending solely on sex to get some money. It is evident that for one to change their behavior the
environment and situation they are in is an important contributory factor. The chair-lady also
stated “the fact that a significant number of our members are mobile often puts some of our
projects on hold because very few people will be there to carry them out.”89 Mobility of the
members made the issue of accountability difficult to achieve as the members of the association
would be away from their accountability partners and the Association lagged behind in
accounting for it activities to the DAAC. The DAC pointed out that they often faced the problem
of inconsistent reporting from ZWAPA and he attributed this to the mobility of some of the
members of the Association.90
Another problem faced by ZWAPA is that not all CSWers in Zvishavane were part of the
Association. Pfunda notes that “the important issue was to reach or touch all CSWers in
Zvishavane and bring them under one umbrella.”91 As noted elsewhere in the paper, due to the
sex network concept, in which CSWers are an integral part, an area especially a small town like
Zvishavane, cannot afford to have uninformed CSWers. What further worried the Association
was that the young generation of CSWers who seem to have a much longer time in the industry
than the older generation, were the ones that are not part of the Association. The age group of
reference here is the 15-21 age groups. One stated that “l don’t have time during the day I will be
88
Interview with the CSWers, Chiedza hall, Mandava, Zvishavane, 13 March 2008. This tarries with observation that “The complex
subject positions of migrant sex workers display a ‘dynamic interplay between repression and resistance’ (Kapur, 2001: 857),
mirroring the earlier work of Phoenix which highlights the ambivalence created by women’s resistance in ‘the context of both the
structural constraints and dominant relations of power in the global sex industry’ (Doezema and Kempadoo, 1998: 8). In contrast to
the homogeneous, perpetually victimized, and linear subject embedded in legal discourse or constructions of the third world subject as
a ‘repressed subject’ (Kapur, 2001: 857) in radical feminist work, Kapur offers an image of the migrant woman crossing borders as a
‘resistant subject’: ‘she situates herself as a resistant subject, challenging “patriarchal” control within the family and marriage as well
as a subject who exercises economic choices and social mobility’ (Kapur, 2001: 880). In this schema the migrant subject’s agency is
not ‘free and unfettered’ but is fractured by experiences of violence, poverty, racism, and marginalization (Kapur, 2001: 885). Yet the
benefit of this and earlier postmodern work is that by maintaining a critical distance from oppressive structural factors, theorists are
able to resist attempts to see power as overwhelming and consuming the subject. This creates the discursive space for a transformative
feminist theory which seeks to utilize the disruptive potential of the counter-hegemonic and ‘resisting’ subject to challenge
hierarchical relations.” Scouler, Jane. “Interpreting the discursive, symbolic and material position of sex/work in feminist theory.”
Feminist Theory. vol. 5 (3), (2004): 343–355.
89
Interview with the ZWAPA Chairlady, Chiedza hall, Mandava, Zvishavane, 13 March 2008.
90
Interview with Mr. Pfunda, Zvishavane, March 2008.
91
Interview with Mr. Pfunda, Zvishavane, March 2008.
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tired and need to sleep.”92 This kind of scenario where the younger generation of CSWers were
not part of the Association posed challenges for an Association looking at changing the lives of
CSWers first and foremost, and then the lives of the society in general, because these are the
women that are at the highest risk of engaging in unprotected sex. One CSWer noted, “many of
these young CSWers ran away from their rural homes to come and solicit in the urban area, when
they get there they have no money and accommodation and look at getting money through any
means possible.”93 Also given the fact that the younger generation were more marketable, they
were attracting more clients and getting more money for their services, and therefore at a higher
risk of contracting and spreading the virus. In that context, the need to have them educated and
controlled was apparent.
Finally, the CSWers in the Association were faced with discrimination. Many peer
educators stated that their hardest task was convincing some sections of the society to accept the
CSWers’ efforts to teach society about safer sexual habits. Their first hurdle came ironically from
fellow commercial sex workers outside the organisation. When the researcher asked for views on
the importance of work being carried out by ZWAPA, one CSWer replied quite boisterously, “A
prostitute is a prostitute. She will never change.”94 This made their task cumbersome and
challenging. Their demonstrations in beer-halls did not always fair any better. One ZWAPA
member complained, “Some men would actually want to come and fondle you in the middle of a
demonstration…Most people will simply dismiss us as posturing…They will be simply thinking,
“what can they tell us?”95 The most difficult section of the community was the married woman.
They stated that married women looked down upon them because they had either been divorced
or had never been married. CSWers stated, however that they faced little resistance from the
enlightened part of the society even the police who had previously arrested them and the nurses
that had often embarrassed them in public. Regardless of such obstacles, the CSWers were able to
stage a counter discourse against the general feeling that CSWers wantonly spread HIV and
AIDS.
Conclusion
It is evident that CSWers in Zvishavane were aware of the increasing dangers of the HIV
and AIDS epidemic. Not only did they realize its dangers, they saw the need to play an important
role in helping fight the deadly disease, hence the formation ZWAPA. As the Association sought
to change the lives of CSWers, it also sought to change those of the community of Zvishavane.
Such a move by the Association was met by several challenges; especially financial challenges
and the difficulty of dealing with a community whose perceptions of CSW and CSWers were
nothing short of negative. The Association managed, however, to institute significant changes
that cannot be ignored, especially pertaining to the lives of the CSWers therein. It was in the
process of communicating with each other and coming together that the sex workers were able to
define a set of collective interests that they were able to protect. The ZWAPA CSWers pose as an
example of how a multi-sectoral approach can be successfully implemented in a bid to
specifically address the concerns of CSWers and those that are at the risk of joining the
commercial sex industry. As demonstrated in the paper, the new direction evident in much of the
emerging research on community- based subaltern campaigns prioritizes “high risk” subaltern
CSWers’ ability to take the initiative to address their own problems based on the cultural values
of sisterhood and community dependency. ZWAPA invokes a new discursive space of health
communication that digs into the multiple ways inherent in subaltern agency and their forms of
92
Interview with CSWers outside ZWAPA, Chiedza hall, Mandava, Zvishavane, 10 March 2008.
Interview with CSWer, CHIEDZA HALL, Mandava, Zvishavane, 13 March 2008.
94
Interview with Peer Educator, Mandava, Zvishavane, 7 March 2008.
95
Interview with Peer Educator, Mandava, Zvishavane, 7 March 2008.
93
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resistance and negotiation. The challenge is not limited to subaltern agency as homogeneous but
also entails an investigation of the heterogeneous complexities that shape the outcome of CSWer
health campaigns.
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“Ce qui est fait pour nous, sans nous, est fait contre nous !’’ De l’Internationalisation des
Recherches auprès des MSM en Afrique
Charles Gueboguo•
Résumé :
Les années 2000 en Afrique marquent le début de l’internationalisation des problématiques de recherches auprès des MSM en temps
de sida, dans le champ des sciences humaines. Les résultats révèlent des taux de prévalence parmi les MSM plus élevés que dans la
population générale. Ce qui a conduit les experts à pousser la sonnette d’alarme pour que cette catégorie en Afrique soit incluse
parmi les groupes vulnérables et partant, qu’elle soit prise en compte dans les politiques de santé publique par les Etats. Au-delà de
la pertinence desdits résultats, nous posons l’hypothèse que l’internationalisation des recherches auprès des MSM en Afrique est
révélateur de nos pratiques scientifiques. Le cadre de ces études s’inscrit dans des champs saturés de toutes les ambivalences, entre
prohibitions sociales, interdits juridiques, et « soupçons ». La préoccupation principale va donc se poser en termes de types de
méthodologie à appliquer auprès des catégories difficiles d’accès, de leur pertinence ainsi que de la sécurité des protagonistes. En
convoquant le cadre théorique pragmatiste, nous utilisons le concept de composition comme outil de recherche afin de proposer des
pistes de réflexion à partir d’une revue critique d’une trentaine d’articles et de rapports de recherche autour de la problématique.
Les premières enquêtes auprès des homosexuel/les considérés comme « catégorie
spécifique » en Occident datent des années 1950 (Kinsey 1948 ; 1954). La logique de ces
enquêtes visait la connaissance des modes de vie sexuels de ces individus (Lhomond 2000). Avec
l’épidémie du sida les enquêtes sur les comportements sexuels se verront renouvelées. L’acte
sexuel entre les hommes, dans les recherches sur population générale, va acquérir un statut
légitime (Lhomond 1993). C’est seulement dans les années 2000 qu’en Afrique les pratiques
homosexuelles masculines feront l’objet d’investigations spécifiques. Ce sera le début de
l’internationalisation des problématiques de recherches auprès des Men who have Sex with Men
(MSM) [les hommes qui ont des relations sexuelles avec les hommes], en temps de sida, dans le
champ des sciences humaines. Les approches méthodologiques des différents travaux se veulent
le plus souvent pluridisciplinaires. On parle de sidénologie pour décrire ces nouvelles approches
qui ne donnent plus l’exclusivité au seul champ biomédical. Les équipes de recherche sont
constituées à la fois d’organismes occidentaux riches employant à la fois des chercheursuniversitaires et des partenaires locaux africains, eux-mêmes souvent universitaires et/ou
militants d’organisations locales de droits lesbiens, gays, bisexuels, et transgenres (LGBT). Il
ressort de ces rapports de recherches faits auprès des MSM que dans les pays comme le Kenya, le
Sénégal, le Botswana, le Malawi, le Nigeria, le Cameroun, la Somalie, le Mozambique,
l’Ouganda ou la Côte-d’Ivoire, le taux de prévalence dans ce groupe est généralement plus élevé
que dans toute la population (Smith et al. 2009 ; S. Baral et al. 2009; amfAR AIDS Research,
2008 ; Special Report Africagay, 2007 ; D. Ottoson, 2007 ; C. Johnson, 2007 ; D. Allman et al.
2007; S. Baral, F. Sifakis, F. Cleghorn, C. Beyrer 2007 ; E. Sanders et al. 2007 ; A. Wade et al.
2005). Il s’agit d’une catégorie de la population qui, dans les Etats africains, n’est pas souvent
prioritaire dans les programmes nationaux de lutte contre le sida, comme c’est le cas en Occident.
Les experts ont donné plusieurs alertes pour l’inclusion de cette catégorie en Afrique parmi les
groupes vulnérables et ce faisant, ont demandé qu’elle soit prise en compte dans les politiques de
santé publique par les Etats.
Quoi qu’il en soit de la pertinence de ces données, nous posons l’hypothèse que
l’internationalisation des recherches auprès des MSM en Afrique est révélatrice de nos pratiques
scientifiques, alors que l’épidémie du sida en elle-même est un révélateur social. Les postures
méthodologiques, les approches et conclusions analytiques reflètent les préoccupations à la fois
de leurs auteurs et de l’ensemble social qui rend possible leur production. Les investigations
interviennent dans des moments significatifs où les sociétés africaines sont traversées et affaiblies
par des crises brutales, rongées par la décomposition des réseaux de solidarité. Le cadre de ces
•
Researcher.
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études s’inscrit ainsi dans des champs saturés de toutes les ambivalences, entre prohibitions
sociales, interdits juridiques, « soupçons » pesant sur les équipes de recherches pluridisciplinaires
et à composantes internationales à qui on reproche au mieux d’essayer d’instrumentaliser les
communautés LGBT, au pire d’essayer de faire légitimer en Afrique l’homosexualité. Du constat
que la pratique du rapport homosexuel, condamnée par la morale et par la religion, objet d’un
interdit sévère, est par là même peu avouable (Simon et al. 1972 : 269) dans les aires
géographiques où ces observations se sont déroulées, la préoccupation principale dans un tel
contexte se pose en termes de types de méthodologie à appliquer auprès des catégories difficiles
d’accès, de leur pertinence ainsi que de la sécurité des protagonistes. À partir de la prédominance
des techniques d’approches qui sont privilégiées par les équipes mixtes de chercheurs, il s’agit
d’appréhender comment les spécialistes construisent sociologiquement leurs objets de recherche,
puis les analysent, et de re- questionner ces constructions en fonction du contexte de leur
production. Comment se construisent les différentes techniques de recherches auprès de ces
groupes “marginaux” ? L’internationalisation de ces recherches sur tout le continent implique-telle une standardisation des outils méthodologiques ? Quelle serait donc leur pertinence ? Nous
inscrivons notre contribution à la suite des revues de Baral et al. (2007) et Smith et al. (2009) qui
ont respectivement fait un état des lieux des recherches faites auprès des MSM dans les pays à
faible et moyen revenus de 2000 à 2006, et de celles faites dans les pays d’Afrique subsaharienne
jusqu’en mai 2009. Pour nous en détacher progressivement en convoquant le cadre théorique
pragmatiste. Nous utilisons le concept de composition comme outil de recherche afin de proposer
des pistes de réflexion à partir d’une revue critique d’articles et de rapports de recherche autour
de la problématique : « Sida et homosexualité(s) en Afrique »96. La composition est un outil
théorique mis sur pied par les africanistes qui souligne que dans les sociétés africaines les
individus avaient de la valeur à partir du caractère unique de leurs capacités et de leur
personnalité. La diversité est valorisée par ces sociétés parce qu’une large variété de capacités
fournit un large nombre de répertoires. Dans ceux-ci, elles peuvent puiser à la fois pour leur
reconstruction (idée du changement social) et pour l’atteinte des buts qu’elles se sont donnés à
travers les tâches respectives de chacun (Teunis 2001). Sur le plan individuel, la notion de
composition suggère que les identités (sexuelles ou de groupe) ne sont pas construites à partir des
scénarios prenant en compte l’identité de genre masculine ou féminine ou l’auto-désignation. Les
éléments de la construction identitaire chez les sujets procurent plutôt plusieurs répertoires dans
lesquels un individu peut se projeter. C’est dire qu’il n’existe pas une construction identitaire
homosexuelle, mais des postures multiples chez les sujets s’inscrivant dans une logique de
construction identitaire. La perspective pragmatiste se soucie, en étroite entente avec la
philosophie américaine dite « pragmatiste », de réarticuler connaissance et action, idées et faits
(Herreros 2002). C’est-à-dire que :
« Le détour par la « praxis » permet de mieux connaître ce que l’on observe car
on peut dépasser la chose observée en y agrégeant les effets pratiques induits par
ladite connaissance de l’objet…La vérité d’une proposition est inscrite non dans
l’objet décrit, mais dans ce que la connaissance de l’objet produit comme effets
pratiques qui viennent ou non la corroborer…Il n’y a pas de superposition
possible entre la connaissance d’un fait et le fait lui-même » (Herreros 2002 :
181-182).
Autrement dit, il s’agit de voir comment les pourcentages significatifs sur les taux de
prévalence au VIH parmi les MSM en Afrique peuvent être concrétisés dans les faits. Au-delà de
l’auto-désignation, que peut signifier aujourd’hui pour un MSM, un homosexuel, un bisexuel
96
Il s’agit par ailleurs du titre de notre ouvrage à paraître chez l’Harmattan.
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africain, à partir de son expérience concrète, de son vécu quotidien, le fait qu’il y ait des taux de
prévalence de 15 %, 20 % ou 30 %, quand on sait que son univers est traversé par les
contingences socio-économiques : marquées par les crises, les chaos, la précarité, la course à la
survie, le souci de posséder un habitat viable etc ? Ici le pragmatisme va servir à donner du sens à
l’action (Durkheim 1955 : 136).
Les enquêtes auprès des catégories “difficiles d’accès” comme les homosexuels en
Afrique en temps de sida sont amorcées dans des contextes sociaux difficiles, en plein désarroi.
Les sociétés africaines sont affaiblies par une crise économique brutale, rongées par la
décomposition des réseaux de solidarité. Elles offrent l’image des environnements pour lesquels
la dénonciation de pratiques socialement et pénalement prohibées ouvre un champ cathartique
inespéré. Les appels à la « mise à mort », aux arrestations arbitraires (Camara, manuscrit non
publié) ou au « outing » par médias interposés (Terroirs 2007 ; Gueboguo 2009) se succèdent
comme un exutoire euphorique. Les pratiques des rapports homosexuels restent peu avouables en
public. Trouver des acteurs sociaux qui acceptent avec facilité de s’autodésigner comme ayant
une orientation homosexuelle reste un défi. Le stratagème pour ces individus, à quelques
exceptions près, est nécessairement de s’identifier comme ayant une préférence pour les
personnes de l’autre sexe pour composer avec l’hétéronormativité : prendre pour acquis, dans ce
contexte, le fait que le couple hétérosexuel et par extension la relation hétérosexuelle constitue la
véritable essence de l’humanité (Haller 2002), fondatrice du socle sociale et des solidarités. Le
caractère inapproprié relatif au fait d’assumer une identité homosexuelle a été reconnue à travers
l’usage du terme men who have sex with men (MSM). Il se réfère au comportement sexuel qui est
souvent pratiqué de façon non exclusive, ce qui permet une variété de construction culturelle du
comportement sexuel (Phillips 2003). C’est le compromis trouvé par les chercheurs pour
construire leur objet de recherche à partir de trois principales dimensions, considérées comme
« indicateurs » d’homosexualité : déclarer une attirance pour les personnes de même sexe ; avoir
eu au moins un partenaire de même sexe au cours de la vie, avoir eu un partenaire de même sexe
au cours des six ou douze derniers mois (Lhomond 2000). C’est à partir de la manière dont
chaque sujet de l’enquête se définit : l’auto-désignation, et qui est aussi nommée identité, que ces
recherches circonscrivent leur critère premier de recrutement des “cibles”.
Les outils méthodologiques d’échantillonnage varient selon la prédominance des
spécialités des équipes mixtes de chercheurs. Lorsqu’elles sont fortement représentées par les
sciences sociales ou la santé publique, ou lorsque les objectifs des enquêtes sont tournés
prioritairement vers une connaissance des comportements sexuels et des besoins des MSM en
termes de prévention et d’accès aux soins, c’est la méthode d’échantillonnage non probabiliste
dite « boule-de-neige » ou l’échantillonnage par commodité qui est appelée en renfort [‘snowball
referal’] (Baral et al. 2009 ; Henry et al. 2008 ; Geibel, et al. 2007 ; Wade et al. 2004 ; Niang et
al. 2003). Les unités sont recrutées au fur et à mesure qu’évolue l’enquête et en fonction de leur
disponibilité. Sa limite est que l’échantillon pourrait ne pas être représentatif de toute la
population. Dans les groupes de recherche où les objectifs ont davantage une visée
épidémiologique, les techniques d’échantillonnage font surtout appèlent à la technique re-adaptée
de boule de neige : Respondent Driven Sampling [RDS] (Allman et al. 2007) ou une approche
mixte qui combine à la fois les services de « testing » et de « counselling » volontaires [Voluntary
Counselling and Testing : VCT] et des recrutement par Internet (Wells et Polders 2004 ; Wells
2006) ou des études exploratoires (Motimedi 2008). Ces approches méthodologiques variées ont
permis de faire la synthèse suivante, d’après le rapport spécial de amfAr (2008) : en Afrique 19 %
des MSM sont infectés par le VIH ; 6 % ont une connaissance correcte de la transmission et de la
prévention du virus ; 12 % sont atteints par les programmes de prévention et 21 % ont utilisé des
préservatifs au cours de leurs derniers rapports homosexuels un an avant les enquêtes.
La catégorie MSM, de par ses pratiques si elles ne sont pas protégées, reste un groupe
vulnérable pour les infections sexuelles et a un taux très élevé de prévalence au VIH dans toute
l’Afrique (Beyrer et al. 2009). C’est une population que les chercheurs, dans leur représentation,
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ont tendance à supposer d’emblée “cachée”, parce que discrète et d’un accès qui nécessite une
combinaison de patience et d’astuces. Ces croyances “scientifiques” font établir rapidement que
les MSM sont un groupe “difficile d’accès” pour l’observation et les interventions en l’absence de
base de données. Ce qui est démenti par la possibilité que l’ensemble de ces études révèle : elles
ont été toutes en mesure d’identifier des sujets répondant aux critères d’auto-désignation qu’elles
s’étaient fixées comme “indicateurs d’homosexualité”. À partir de l’auto-désignation, les
catégories homosexuelles sont posées comme groupe sociale éligible pour ces enquêtes. Elles se
font avec les sujets ou les groupes qui s’identifient comme homosexuels, bisexuels et/ou MSM
qui répondent aux questionnaires ou interviews et qui les diffusent auprès des pairs. Les
enquêteurs sont généralement des MSM eux-mêmes formés en quelques jours pour les besoins de
l’enquête et encadrés par une équipe de spécialistes. La constitution des échantillons se fait à
partir des lieux de sociabilité des communautés LGBT et implique que chaque répondant se sente
directement concerné (Lhomond 1993), suivant la logique qui veut que, « ce qui est fait pour
nous, sans nous, est fait contre nous ! ». Si on peut identifier un premier « nous » et l’impliquer
tout au long des études, c’est la preuve que l’homosexualité en Afrique reste peut être seulement
dans la périphérie et cette position supposée dans les abords du construit de tout le groupe ne
devrait pas laisser d’emblée supposer aux analystes qu’elle est cachée : tant que les conditions de
production et d’élucidation de ce vécu caché, en dehors des poncifs culturels ou moraux, ne sont
pas ressorties ; tant que ne sont pas examinées les trajectoires des acteurs sociaux dans
l’appréhension de cette situation et comment elle peut participer ou non dans la construction des
identités sociosexuelles à travers le bricolage, le croisement, la recomposition ou l’éloignement
définitif ou séquentiel d’avec les normes en cours ; tant que la société elle-même n’est pas
interrogée sur la connaissance, la prise de conscience, et ses réactions face à cette réalité. Le
statut périphérique n’est ni permanent, ni univoque. Il peut être choisi, subi, voulu, contraint ou
tout à la fois. Mais quel qu’en soient les fondements, il y a nécessairement des mouvements de
va-et-vient, des échanges plus ou moins continus, entre l’intérieur “ghéttoïsé” et les extérieurs.
Tous forment le socle social. De la réalité homosexuelle africaine, il ressort davantage qu’elle se
réclame d’une visibilité qui se fait désirer en donnant l’illusion de s’invisibiliser, conséquence du
premier rejet (lui aussi parfois illusoire) d’un groupe. Elle se donne à chercher et peut et reste
souvent à trouver. Toutefois, essayer de dessiner un échantillon non biaisé de cette catégorie reste
un perpétuel défi pour les équipes de chercheurs (Yeka et al. 2006). Mais ce qui demeure
préoccupant pour l’observateur, c’est que ces enquêtes parviennent quand même à décrire et à
présenter des lieux de sociabilité des MSM. Il existe de nombreux regroupements associatifs
MSM dans les pays africains qui précèdent lesdites enquêtes. La création de ces associations
identitaires sont filles d’un certain déni politique de leur milieu de production. Ce contexte leur
assigne cette forte signification comme marqueur social (Phillips 2003). Quelques exemples : en
1997 l’association Gays and Lesbians of Swaziland (GaLeSwa) a connu un refus d’une
reconnaissance légale bien qu’il n’existe dans ce pays aucune prohibition légale contre les actes
homosexuels. Le Rainbow Project fut fondé durant la même année en Namibie au moment même
où le président Sam Nujoma proclamait que l’homosexualité devrait être totalement déracinée de
la Namibie. C’est en 1995 que le regroupement Gay and Lesbian of Zimbabwe (GALZ), suite à
son interdiction de participer à une foire internationale du livre au Zimbabwe, a été propulsée et a
obtenu une légitimité forte dans ce même pays et à l’extérieur, ce malgré les allégation du
président Mugabe contre l’homosexualité appréhendée comme une importation des vices des
colons blancs. Le groupe Lesbians, Gays, and Bisexuals of Botswana (Legabibo) fut créé alors
que le gouvernement botswanais faisait passer en 1998 une législation contre les actes sexuels
entre les femmes. Durant la même année, le collectif Lesbians, Gays, Bi-sexuals and Transgender
Persons Association (LEGATRA), , fut formé en Zambie, au milieu du tumulte fait par la presse
et le gouvernement contre les actes homosexuels. Un constat similaire se fera en 2006 au
Cameroun lorsqu’est créée Alternatives-Cameroun. Ce sont donc les exceptions sociales
informées par certaines normes, les assauts politiciens des gouvernements (ce qui semble être leur
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essence) qui ont ouvert une brèche pour ces affirmations individuelles et collectives de postures
sociales identitaires non normatives. En un mot, c’est l’existence dans la sociosphère de ces
mobilisations identitaires qui rend possible l’idée de mise en œuvre de ces enquêtes. Car,
rappelons-le, ce n’est que durant les années 1990 et surtout à partir des années 2000, que les
recherches auprès des MSM en Afrique commencent à être mises en œuvre. En effet, il y a eu des
travaux dès la fin des années 90 au Sénégal (thèse de Youssoupha Niang soutenue en 2000), ainsi
que les travaux autour de Population Council en Afrique de l’Ouest qui vont donner plus tard lieu
à une publication (Niang et al. 2003). Le livre de Foreman (1999) et de son groupe à Panos et
ICASO avait déjà abordé cette problématique. Il avait été présenté à Dakar lors de la Conférence
de la SWAA en 1998, dans une présentation sur les MSM en Afrique. Enfin, pour ne citer que ces
cas-là, le réseau « Droit, éthique et VIH97 » a été créé à Dakar en 1994, l'Afrique du Sud était
représenté, ainsi que les pays anglophones d'Afrique de l'Est (Ouganda, Kenya), et que les
questions de l'homosexualité y ont bien été abordées.
Quelques constats peuvent déjà être posés : les enquêtes sur les comportements sexuels
participent à la construction sociale des sexualités, à partir d’indicateurs qu’elles mettent en avant
pour définir de façon opératoire l’homosexualité. Elles reflètent les préoccupations de leurs
auteurs, qui, à ce niveau, essaient de réifier une réalité considérée un peu trop vite comme
inexistante, alors que les résultats des enquêtes, et les méthodes pour parvenir à ces résultats,
plaident pour le contraire. L’objectif d’identification des sujets en lui-même, même à travers
l’auto-désignation, peut être un processus de stigmatisation. Il semble à ce titre plus judicieux de
parler de minorité plutôt que de tabler sur la notion d’identité sexuelle. Autre réalité qui ressort de
ces travaux : le climat délétère dans lequel vivent les enquêtés. On y parle rapidement d’
“homophobie” sans aucune perspective critique. Or les méthodes ou les théories sur la saisie de la
réalité homosexuelle, à travers ses pratiques ou ses expressions identitaires en Afrique, ne
peuvent pas être séparées des contextes sociaux et des conditions matérielles de la vie des sujets
observés. Sans vouloir nier l’existence de quelques traces d’homophobie en Afrique, nous
pensons plutôt que les réserves autour de l’acceptation du rapport homosexuel ou le déni de
l’homosexualité a davantage un rapport avec un sentiment anti-homosexuel qu’avec
l’homophobie per se. Epprecht (1998) ne dit pas autre chose quand il évoque à juste titre cette
préoccupation concernant le cas du Zimbabwe, ce que nous reformulons : est-ce que les
populations en général où se sont déroulées ces observations peuvent être labellisées comme
« homophobes » quand plusieurs d’entre elles ont juste une très vague notion ce que c’est que
l’homosexualité ? Ce n’est pas dire que l’homophobie naît nécessairement de la connaissance de
son contraire, c’est seulement souligner que parfois les gens ne mettent pas forcément un concept
aux actions qu’ils posent. Cela ne rend évidemment pas lesdites actions inexistantes. En tant
qu’analyste nous pouvons en parler sans la considérer comme une apposition identitaire. Elle peut
apparaître comme multiple, fluide ou fragmenté. C’est pourquoi au concept figé « homophobie »
nous proposons la position non identitaire de « sentiment antihomosexuel ».
Le sentiment antihomosexuel marque la combinatoire entre des sociétés très homophiles,
au sens sociologique du terme (des personnes qui apprécient et valorisent le fait d’être entre
personnes de même sexe) et le rejet des pratiques homosexuelles. Or, si nous adoptons sans
réserve l’acception « homophobie », elle ne permet pas de marquer cette différence et ces
gradients de l’appréhension d’une homophilie désexualisée. C’est la résultante de
l’incompréhension de ce qui apparaît aux yeux du grand nombre comme étrange-étranger.
“Etrange” parce que les manifestations de l’homosexualité commencent à être publicisées dans un
espace où le secret, en l’absence d’un espace privé, doit obéir à des règles (Teunis 2001).
Autrement dit, ce n’est pas l’homosexualité en soi qui est tabou, mais c’est la sexualité exprimée
en public, sans ornement qui l’est. Par ornements, nous entendons, les métaphores, la poésie
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langagière et gestuelle qui entourent le sexe ou la sexualité lorsqu’elle est évoquée ou dite en
public. Exemple: deux garçons ou deux filles qui se tiennent par la main ou par la taille en public
passeraient inaperçus, alors que les mêmes marques d’affection entre un homme et une femme
auraient de fortes possibilités d’être jugées impudiques du fait de leur projection sexuelle dans
l’imaginaire collectif. “Etranger”, parce que ce qui n’est pas socialement modelé ne peut que
venir d’ailleurs, un ailleurs pas si lointain: ce sont les voisins immédiats qui sont la plupart du
temps indexés et tournés en dérision (Henri et al. 2008 ; Epprecht 2008). Ce sentiment antihomosexuel sera aussi exprimé parfois chez une certaine élite africaine en réaction contre le rasle-bol de la mainmise occidentale en Afrique, vécue aujourd’hui sous le prisme de ce qui est
désigné par néo-colonialisme. Le rejet de l’homosexualité dans ce sens est amplifié comme le
rejet de l’impérium occidental, surtout si l’on reste convaincu qu’il s’agit d’une importation
venant d’outre atlantique. Bien que des thèses plaident plutôt pour une importation de
l’homophobie en Afrique (Teunis 2001; Epprecht 2008 ; Murray et Roscoe 1998), il n’en
demeure pas moins que le sentiment antihomosexuel prend la figure du rejet néocolonial.
Autrement dit c’est la variante moderne de l’ « étranger » qui ressort à ce niveau. Ce n’est donc
pas l’homosexualité ou sa pratique en elle-même qui pose problème dans un tel contexte, c’est la
représentation que les individus s’en font, en fonction de leur statut social et de leur capital
culturel et symbolique. Ce sont ces acquis qui motivent les positions, même les plus tranchées,
contre l’homosexualité. Une fois de plus, ce n’est pas la traduction de l’inexistence de positions
homophobes en Afrique. L’expérience de terrain en fonction des conditions de production des
contextes ou les rejets qui sont vécus sur la base de l’orientation sexuelle doit amener à considérer
ces manifestations, en essayant d’identifier la racine des réactions, sans toutefois la généraliser.
Les postures de rejet qui peuvent se rencontrer ne devraient pas nous laisser supposer, en tant
qu’analystes, l’existence de ces rejets comme acte homophobique. À ce niveau, il devient urgent
de faire la différence entre “catégorie pratique” dans l’usage des concepts couramment utilisés
par tous (MSM, gays, homosexuels, bisexuels, homophobie) et “catégorie analytique”. Par
catégorie pratique, Brubaker (1998), à la suite de Bourdieu, entend :
« Quelque chose d’apparenté à ce que d’autres ont appelé des catégories
“indigènes,” “populaires” ou “profanes.” Il s’agit des catégories de
l’expérience sociale quotidienne, développées et déployées par les acteurs
sociaux ordinaires, en tant qu’elles se distinguent des catégories utilisées par les
socio-analystes, qui se construisent à distance de l’expérience ».
L’analyse des postures ou des autodésignations identitaires homosexuelles et celle des
positions antihomosexuelles en temps de sida en Afrique ne devrait pas amener à supposer
comme allant de soi l’existence d’une « identité » homosexuelle ou de l’homophobie. Il s’agira
plutôt d’expliquer les processus et les mécanismes par le biais desquels les postures des sujets
peuvent se cristalliser ou se fixer, dans le temps et dans l’espace. L’analyste cherchera à rendre
compte des processus de concrétisation de la réalité identitaire homosexuelle et du sentiment de
rejet de l’autre pouvant intervenir dans cette concrétisation et la place qu’occupent les
comportements des MSM face au VIH et en fonction de l’environnement social.
Sur l’impact que peut avoir le milieu social défavorable, l’exemple sénégalais avec ses
vagues homophiles est révélateur, comme le souligne cette analyse de Irinnews98. Mais avant d’y
proposer une lecture rapide, regardons d’abord ce tableau sur la prévalence et législations sur les
homosexualités en Afrique.
98
« SÉNÉGAL:
La
récente
vague
homophobe
fait
ses
premières
http://www.irinnews.org/fr/ReportFrench.aspx?ReportId=85790, consulté le 29 août 2009.
41
victimes
du
sida »
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Outliers, a collection of Essays and Creative Writing on Sexuality in Africa Vol. 3, spring 2010
Tableau1: Taux de prévalence au VIH parmi les MSM, dans la population générale et
législations sur les homosexualités en Afrique
Pays
Afrique du Sud
Bénin
Botswana
Côte-d’Ivoire
Ghana
Kenya
Malawi
Namibie
Nigeria
Sénégal
Soudan
Tunisie
Zanzibar
Zambie
Prévalence
parmi
les MSM
Prévalence
population
générale
Homosexualité
criminalisée ?
13,9 %
25,5 %
19,66%
18,0 %
25,0 %
43,0 %
21,4 %
12,4%
13,5 %
21,5 %
9,3 %
5,0 %
12,3 %
33%
18,8 %
1,8 %
18,1%
4,7 %
2,3 %
6,1 %
14,1 %
10,8%
4,4 %
0,9 %
1,67 %
0,1 %
0,9 %
13,6%
Non
Oui
Oui
Non
Oui
Oui
Oui
Oui
Oui
Oui
Oui
Oui
Oui
Oui
Une mise en relation des lois et des taux de prévalence suggère que le milieu social
hostile reste un marqueur d’un fort taux d’infection et de prise des risques. Pour revenir sur le cas
du Sénégal, on constate que les effets immédiats du regain de violence99 à l’encontre des MSM se
matérialisent par les décès, les abandons dans l’observance de la prise des traitements quand il
n’y a pas abandon et la possible recrudescence des comportements à risque. D’où cette peur que
« l’épidémie ne flambe » observée chez le secrétaire exécutif du Conseil National de lutte contre
le VIH/Sida dans ce pays, « si l’on reste muet. » En effet la fuite des représailles vers les
périphéries ou des endroits cachés, quand on peut être identifié comme MSM, ouvre le champ à
l’interruption de la prise des médicaments pour les personnes séropositives qui étaient sous
antirétroviraux (ARV). L’antropolgue Cheikh Niang a rapporté à Irinnews, dans l’article cité, ce
témoignage d’un jeune MSM mort il y a deux mois et qui était séropositif au VIH : « A l’époque, il refusait d’aller à l'hôpital par crainte d’être stigmatisé. Il a
récupéré. Il s’est construit. Et c’est cette même personne qui, apeurée, a pris la
99
« Depuis février 2008, date de la publication dans la presse locale de photos d’une cérémonie gay qui avait déclenché une véritable
chasse à l’homme dans tout le pays, rapporte Irinnews, les actes de violences et de répression à l’encontre des membres de la
communauté homosexuelle au Sénégal se sont succédés. En janvier 2009, neuf membres de la communauté gay, parmi lesquels le
responsable de l’association Aids Sénégal, ont été condamnés à huit ans de prison pour « acte impudique et contre nature et
association de malfaiteurs », un mois après avoir été arrêtés dans une maison de la banlieue de Dakar, sur dénonciation anonyme du
voisinage. »
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fuite [lors des récentes violences], sans possibilité de se procurer des ARV. Il en
est mort.»
A ce témoignage, s’ajoute aussi celui de plusieurs professionnels du corps médical qui
reconnaissent que leurs patients MSM hésitent de plus à venir en consultation, à cause de ce
climat délétère mais aussi de la législation en vigueur qui pénalise l’homosexualité à la moindre
dénonciation/délation : « comment voulez vous qu’on lutte [contre le sida] si c’est pour… risquer
d’aller en prison à la moindre dénonciation ? On ne peut plus avoir confiance », affirme un
militant d’une association MSM. Il ajoute : « on croyait pourvoir faire confiance à nos
partenaires, mais on se rend compte que dès qu’il y a un problème, on est laissé à nous-mêmes.»
D’où ce risque d’un retour dans les marges des comportements sexuels sans aucun risque que l’on
peut supposer. Le fait que le taux de prévalence à VIH soit près de 21% au sein de la catégorie
MSM dans ce pays ne pourra pas modifier la tendance. Ici le contexte social reste porteur de la
responsabilité d’un taux de risque qui pourra être difficilement jugulé. La priorité dans un tel
contexte pour les acteurs sociaux c’est d’une part la survie, en choisissant de vivre reclus, loin de
l’ire sociale. Ce qui va entraîner d’autre part que la gestion des comportements sexuels va se faire
suivant une rationalité qui va prioriser l’urgence des besoins, des désirs immédiats aux risques
que l’on peut en courir si on ne se protège pas. La contrainte de vivre en retrait va dès lors exclure
la contrainte de l’observance dans la prise des médicaments pour ceux qui sont séropositifs, mais
aussi la contrainte première, qu’on pourrait supposer, issue des premières mobilisations dans les
campagnes de prévention, pour une attitude qui amoindrirait l’exposition au VIH. Les
comportements des acteurs sociaux, bien que à risque pour l’observateur, seront qualifiés de
« raisonnables ». Cette ‘raisonnabilité’ est mise en relation avec le contexte social de production
de leurs actions. Le raisonnable est une adéquation des conduites de l’individu à un univers
normatif (Calvez 1996) qui se rapporte à une évaluation éthique des conduites : nécessité de
vivre à l’écart pour les besoins de survie et satisfaction des besoins immédiats, qui peuvent se
présenter, en l’absence de toute protection. Même s’il y a l’idée de se protéger, se posera toujours
le problème de l’accessibilité des outils de protection dans un environnement difficile. C’est
pourquoi, si les individus peuvent être rationnels : adéquation des moyens choisis, par rapport aux
fins poursuivies ; ils ne sont pas toujours systématiquement raisonnables, surtout quand ils sont
dans l’impossibilité de l’être. Il ressort dans cette mise en relation des taux de prévalence et du
contexte social ou législatif prohibant l’homosexualité qu’il y a une inséparabilité entre
l’exclusion et les risques d’infection (Phillips 2003). Le premier constitue et forme le socle du
second. On peut dès lors poser que les stigmates sociaux rendent la situation des sexualités en
Afrique complexe pour les acteurs. Et les observateurs noteront que cette situation sera le champ
ouvert à un cumul des cursus sexuels100 : entre les MSM d’une part, la sexualité étant vécu dans
les marges du risque. Et les MSM et leurs partenaires de l’autre sexe d’autre part (Larmarange,
Desgrées du Loû A, Wade A 2009). C’est ce que nous désignons par la « bisexualisation de
l’homosexualité » africaine : pour traduire la prégnance du contexte social délétère qui poussent
les MSM, dans une négociation avec les normes, à avoir aussi des relations sexuelles avec les
personnes de l’autre sexe. Le comportement homosexuel sera celui qui sera souvent caché, tandis
que le comportement hétérosexuel sera publicisé, voire claironné, comme marqueur de
conformité à l’hétéronormativité.
100
Le cursus sexuel renvoie à l’héritage des expériences sexuelles passées d’un individu, transmis à un autre. Celui-ci, à son tour,
lègue le sien (son héritage du passé sexuel), en termes de risques d’infections à des maladies possibles et à venir. Il renvoie d’après
Samy Tchak (2000) à : « [l’]ensemble des expériences sexuelles qu’une personne, homme ou femme, a déjà eues et celles qu’elle
pourrait avoir aussi dans sa vie, et qui ont pu, ou pourront, lui faire contracter des maladies et/ou des virus sans qu’elle le sache
forcément, et qu’elle peut transmettre à ses partenaires qui peuvent lui transmettre bien d’autres (…). Le cursus sexuel nous fait
hériter du passé sexuel de l’autre, qui hérite aussi de notre passé sexuel en termes de risques pris. »
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Pour revenir sur notre propos, comme corollaire à la vision des spécialistes sur le
caractère difficile ou caché de l’homosexualité, alors qu’il est seulement exceptionnel comme
tous les faits sociaux, il y a également comme une volonté de standardisation méthodologique.
Elle est traduite par cette recommandation des experts internationaux en santé publique à devoir
utiliser la technique d’échantillonnage RDS (Yeka et al. 2006 ; Johnston et al. 2007; Heckathorn
1997), comme alternative pour l’approche des populations « cachées », qui ne convergent pas
dans les milieux identifiables ou accessibles. Même s’il y a une réserve : avant d’utiliser l’outil
RDS comme technique d’échantillonnage, il est recommandé qu’une première étape dite
« formative » soit conduite (Johnston et al., manuscrit non publié). Nous la traduisons par
« recherche informative ». La recherche “informative” est définie comme une méthode
d’investigation qui utilise des techniques d’évaluation rapides pour explorer des indicateurs clés
dans le but d’informer la mise en œuvre des programmes d’activités ou des recherches
subséquentes (Johnston 2007). Cette approche préliminaire est utilisée pour planifier, mettre en
œuvre et prédire l’aboutissement des techniques de recrutement par RDS. Elle prépare également
en avance un corpus spécifique et informé de questions pour conduire la recherche effective. Les
chercheurs ont découvert que cette première approche constitue une étape essentielle pour assurer
le succès des résultats des enquêtes qui seront menées par la suite (Simic et al. 2006 ; Geibels et
al. 2007). Il a aussi été déterminé que le travail “informatif” permet aux chercheurs d’évaluer si la
méthodologie RDS est une technique d’échantillonnage optimale permettant de décider, pour une
population particulière et pour un contexte socioculturel, de la mise en œuvre des détails qui
conduiront au succès de l’enquête et à la plausibilité de ses résultats (Johnston et al., manuscrit
non publié). Cette méthodologie s’est avérée utile dans l’information d’interventions en santé
publique qui impliquaient les infections sexuellement transmises (Needle et al. 2003 ; Power
2002). Malgré cette restriction qui doit nécessairement passer par l’étape que nous qualifions d’
“informative”, nous restons peu enclin à adhérer totalement pour une uniformicisation des
modèles d’approches pour faire état des pluralités dans les pratiques sexuelles des catégories dites
difficiles d’accès ou « cachées », comme on le suppose des MSM en Afrique. Il serait plus
opportun de recommander des approches plus discursives qui vont tenir compte de la spécificité
de chaque contexte étudié et des conditions de production de ces contextes qui interagissent avec
le vécu des sujets qu’ont veut observer. Chaque champ de recherche doit impliquer des méthodes
de recherche qui lui soient propres (Teunis 2001) et tiennent compte des conditions qui incluent
le rapport à l’histoire des peuples (très faiblement abordé dans ces études ou pas du tout),
l’exploitation économique, le sexisme et tout autre forme de mode de domination (Standford
2000). On pourrait nous objecter que ce n’est pas précisément l’objectif de ces enquêtes, mais du
point de vue d’une analyse en profondeur, il est nécessaire de prendre également tous ces
éléments en compte.
Une autre préoccupation est de savoir ce qui a été fait, depuis que les résultats sur les taux
de prévalence exceptionnels au sein de la catégorie MSM ont été annoncés par les équipes de
recherche d’une part, et la signification concrète de ces données dans le quotidien des individus
observés. Malgré la pertinence de ces travaux, on constate que les gouvernements africains ne
suivent pas toujours dans la mise en œuvre des programmes de prévention qui s’adressent à ces
catégories, et cela, en dépit des fortes recommandations de l’ONUSIDA. Or au début de
l’épidémie sur le continent, les recommandations de l’OMS ont connu une mobilisation massive
de la part des Etats, alors qu’il est établi que les programmes de lutte contre le VIH n’étaient pas
les fruits d’une réponse sociale africaine face à la pandémie du sida, mais le résultat d’une
politique internationale, pérennisant par la même occasion l’hégémonie d’un discours de santé
publique centré sur l’occident. On pourrait arguer que les enquêtes auprès des MSM en Afrique
en temps de sida ne permettent pas une évaluation du nombre d’homosexuels dans la population,
comme ce fut le cas des enquêtes européennes (Lhomond 1993 ; 2000). La prise en compte et
l’évaluation des résultats de ces investigations restent un enjeu des débats politiques internes.
Mais face à l’échec massif des premières campagnes hétérocentriques de mobilisation contre le
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sida en Afrique, il est devenu inapproprié, voire problématique d’y assumer de parler de VIH/sida
comme se transmettant exclusivement par voie hétérosexuelle. Même s’il reste vrai qu’en Afrique
subsaharienne, les rapports hétérosexuels non protégés sont responsables du large pourcentage
d’infection au VIH, il existe désormais des évidences croissantes à propos des taux élevés de la
transmission au VIH parmi les MSM dans le continent. C’est ce qui a poussé des pays comme le
Nigeria, le Kenya, le Sénégal, le Maroc ou la Tunisie à intégrer dans les plans stratégiques de
lutte contre le sida, la composante MSM, en dépit du fait que les pratiques entre personnes de
même sexe y restent légalement prohibées (voir tableau ci-dessus). En effet, le Nigeria a promis
de promouvoir des ressources pour un changement effectif de comportement de l’ordre de 95 %
au sein de la population MSM, dans le « Nigerian National Strategic Framework for AIDS »
comptant pour 2005-2009. Pour le Kenya, le « National Strategic Plan for HIV/AIDS » pour la
période 2006-2010 souligne que les MSM, en tant que groupe, ont un risque élevé d’être infecté
et de passer ainsi l’infection à la population générale. Il continue en proposant de développer des
stratégies spécifiques afin d’adresser les besoins des hommes qui ont des rapports sexuels avec
d’autres hommes dans ce pays. Le Sénégal, dans son « Plan contre le Sida de 2007-2011 »,
identifie les MSM comme cible principale dans la lutte contre le sida. Le Maroc, à travers
l’Association de Lutte Contre le Sida (ALCS), développe des programmes spécifiques adressés
aux MSM, notamment par le projet : Prévention Proximité Masculine (PPM). Existant depuis
1993, il est centré sur la prévention auprès des travailleurs de sexe masculin et des MSM. La
Tunisie, par le biais de l’Association Tunisienne de Lutte contre les MST/sida, développe un
immense programme de prévention et de prise en charge des MSM. L’engagement de ces Etats
peut être considéré comme le premier apport positif pour les catégories MSM. Toutefois, ces
études ne soulignent pas comment les données avancées pourraient participer de manière concrète
à la construction des identités sexuelles. Que signifient au quotidien pour un MSM tous ces taux
de prévalence ? Y a-t-il une incidence mesurable dans les comportements sexuels des MSM
quand on sait que le contexte de production de ces données est marqué à la fois par un déni de
l’homosexualité et par des crises généralisées ? Or il est connu que le contexte social exerce un
poids considérable sur les conduites des individus, sur les jugements et les attitudes. Il peut aussi
influencer les méthodes d’approches des chercheurs (Simonet 2009).
Il est vrai que les techniques de recrutement des équipes de recherche ne visent pas
seulement l’efficacité dans leur volonté de faire participer les sujets concernés par la
problématique de recherche. C’est le « nous » dont nous parlions. Mais leur intégration dans le
processus de l’enquête obéit aussi à un besoin de respect des principes fondamentaux d’éthique
de la recherche. Il s’agit du respect des personnes impliquées, du principe de bienfaisance et du
principe de justice. Le premier principe renvoie à la capacité et aux droits qu’ont tous les
participants aux enquêtes d’être à tout moment les arbitres de leurs propres choix et décisions.
C’est à ce niveau qu’intervient le processus du consentement éclairé d’une part, et celui de la
possibilité pour l’enquêté d’interrompre le déroulement de l’enquête à tout moment sans nécessité
de donner une explication à sa décision ou s’il ne se sent plus à l’aise ou en sécurité d’autre part.
De leur côté, les équipes de recherche, à travers le principe de bienfaisance, assument la
responsabilité du bien-être physique, mental et social de tous les participants. On parle encore du
principe de non-malfaisance. Et enfin, le principe de justice implique que les chercheurs doivent
peser équitablement les risques et les avantages de la participation à l’étude. Le recrutement et la
sélection des participants à la recherche doivent dès lors s’opérer dans un souci d’équité. Ces
principes fondamentaux sont respectés par les équipes de recherche, car ce sont les étapes
cruciales qui permettent ou non la publication des résultats dans les revues scientifiques avec
comité de lecture, et partant l’acceptation de ceux-ci comme scientifiquement discutables. Ce qui
est donc fait pour le « nous », l’est fait avec ce « nous » et par conséquent ne l’est pas fait contre
ce « nous-là ».
Cependant elles nous renseignent peu sur la manière dont ce « nous » peut s’en servir ou s’en
sert pour une dynamique effective dans les comportements sexuels, dans les constructions
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identitaires ou dans le renforcement des capacités des participants (Henri et al. 2008). Il y a certes
un apport incontestable qui décrit un corpus de connaissances sur les pratiques sexuelles
contemporaines des MSM en Afrique : les configurations de ces pratiques sexuelles (avec les
économies des risques, les tactiques pour gérer ces risques quand elles existent, les savoirs et les
non-savoirs autour des possibilités d’infections sexuelles, l’espace d’expression voire les
modalités transactionnelles ou non de ces pratiques…) sont mises en exergue. Les parallèles sont
faiblement établis entre les modalités desdites pratiques telles qu’elles se vivaient dans l’histoire
(Niang et al. 2003) et telles qu’elles se vivent aujourd’hui, pour voir s’il y a rupture ou
continuum ; pour voir si les sujets ont un rapport avec ce passé-là qui influencerait ou non la
construction de leur identité ; pour établir si les participants y font appel ou non et quel serait la
signification. Il y a également croisement infime entre l’hégémonie des structures postcoloniales
et la manière dont les MSM décident de prendre en charge leur vie, de la structurer envers ou par
devers les réserves sociales. Les logiques d’action dans les modalités qui présentent quand et
comment se négocient les rapports sexuels et les techniques convoquées pour se protéger sont
moyennement dévoilées. Si, comme nous l’avons souligné, ces enquêtes permettent de construire
des identités sexuelles, elles ne renseignent pas sur la manière dont la construction de ces
identités sexuelles converge avec la construction de l’identité de victime, de marginal quand elle
existe. On ne sait pas si les sujets tirent leur force du déni social pour parvenir à construire une
identité sexuelle forte et si dans ce travail, la prise de conscience du risque en termes d’infection
au VIH est renforcée ou reste considérée comme peu urgente.
On pose, dans ces recherches, la question fondamentale du droit à la santé pour tous, ou
celle de la dépénalisation de l’homosexualité pour une meilleure prise en charge de cette
catégorie dans le combat contre le sida (Baral et al. 2009), sans suffisamment souligner que la
lutte pour les droits LGBT en Afrique est surtout une action au sujet du droit avant d’être une
contestation entre les contenus juridiques, les signatures ou les ratifications des traités
internationaux par les Etats africains. Elle gagnerait à être davantage présentée comme une
position au sujet de l’accès universaliste au droit avant d’être une lutte entre les droits. Comme
base pour l’accès à l’information totale pour tous en rapport avec le VIH/sida en Afrique, les
notions d’indivisibilité des droits et de l’inséparabilité de l’exclusion et de l’infection doivent être
soulignées (Phillips 2003). Ces deux notions ne sont pas antithétiques. Elles se complètent. Il y a
d’une part l’indivisibilité des droits humains qui doit s’appliquer à toutes les catégories sociales,
et d’autre part l’inséparabilité des notions d’exclusion et d’infection dans la lutte contre cette
pandémie, car l’une forme le lit de l’autre. Les infections peuvent effectivement être nourries et
entretenues par les exclusions (dénonciations, incitations à la fuite, discriminations et
stigmatisations). Ce combat, en temps d’épidémie du sida, n’aura de force que quand les MSM en
Afrique refuseront de se laisser toujours placer par les observateurs dans la périphérie, dans la
marginalité. À force d’assumer cette représentation aux marges des espaces sociaux, sous le
prétexte de la clandestinité ou du caractère caché (qui ne l’est en réalité que pour les observateurs,
mais pas pour les parties prenantes), les catégories MSM en Afrique semblent coopérer à leur
mise à l’écart, se refusant ainsi à se voir insérer dans la question du débat social d’un continent en
quête de lui-même, qui ploie sous les affres des crises. Les MSM devraient être considérés et se
penser eux-mêmes d’abord comme des citoyens à part entière et s’intéresser à la res publica (la
chose publique) comme telle. C’est la question de leur engagement social qui est soulevé ici. À
leur tour, les observateurs et peut être les politiques ne se méprendront peut-être plus sur
l’appréhension de leurs conditions.
Les sujets MSM en Afrique en temps de sida, comme partout ailleurs, sont dotés de
plusieurs personnalités sociales : pour les Etats, ils sont citoyens ; pour les proches, ils sont
parents, ami(es), camarades, collègues, voisins… ; pour les membres des réseaux
d’homosociabilité, ils sont pairs et pour les observateurs, ils doivent pouvoir être l’intersection
entre toutes ces subjectivités particulières. C’est ce que traduit la notion de composition à laquelle
nous avons fait appel. Cela souligne le fait que les catégories enquêtées, au-delà de
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l’autodésignation ou de la construction identitaire faite par les analystes, ne commencent pas
nécessairement leur journée avec des préoccupations en termes d’orientation sexuelle. Il y aurait
plus de plausibilité à dire qu’ils la commencent avec des soucis liés aux contingences
économiques, culturelles et politiques de leur milieu social. De ce fait, leur donner accessibilité
aux résultats d’enquêtes menées auprès d’eux en échangeant sur la façon dont ils envisageraient
de se l’approprier, leur serait bénéfique. Former les meneurs MSM en Afrique au leadership et les
inviter à s’initier à la culture de l’ « accountability » : rendre compte d’une activité dont on a la
responsabilité à la fois auprès des pairs et des pourvoyeurs de fonds. Le but est de travailler à
éviter de voir émerger certains leaders MSM qui se servent de la cause homosexuelle pour des
raisons individuelles ou pour l’intérêt d’un groupuscule de privilégiés sommairement éclairé (il y
a un lien entre le statut social, la position en tant que leader, et la possibilité d’échanges directs
avec les partenaires internationaux) et potentiellement impliqué dans des pratiques de distractions
financières. C’est le cas au Cameroun avec l’association Alternatives-Cameroun au Cameroun.
Dès le départ, elle a pourtant engagé un mouvement d’occupation de l’espace public de
revendication qui semblait exceptionnel pour le milieu (Gueboguo 2008). Adopter cette démarche
serait un moyen d’éviter de perdre des ressources, car l’internationalisation de ces recherches
implique souvent que les partenaires du Nord, qui sont également les grands pourvoyeurs de
fonds et les initiateurs de ces enquêtes, offrent une aide financière aux associations LGBT locales,
soit pour le suivi des campagnes de prévention, soit pour des prises en charge des traitements des
personnes séropositives au cours de l’enquête, soit pour le renforcement des capacités de ces
regroupements (location d’espace de sociabilité ; achat de matériel ; rémunération du personnel
pour amoindrir la dépendance économique des membres militants...). Les moyens financiers mis
à disposition pour ce faire ne sont pas toujours judicieusement utilisés. La cause tient, entre
autres, de la faiblesse des capacités de bon nombre de mouvements associatifs LGBT en Afrique ;
de la présence dans les corps associatifs de sujets qui assument ouvertement le fait de devoir et de
pouvoir vivre de leur militantisme ; de l’absence en leur sein de leaders pouvant servir de modèle,
eux-mêmes n’ayant pas toujours de modèle dont ils se réclament officiellement de l’idéologie. À
ce niveau, en temps de sida, la logique de l’action de plusieurs MSM militants en Afrique
converge avec la représentation sociale qui veut que l’homosexualité soit source
d’enrichissement. Il suffit dès lors d’avancer son orientation sexuelle comme programme d’action
d’une activité pour « impressionner » les partenaires étrangers et pour que les financements
suivent. Dans un tel panorama, on comprend pourquoi, dans les représentations de certains
leaders politiques (Mugabe, Nujoma…), ces partenariats dans les recherches avec l’Occident
semblent masquer d’autres enjeux non avouables.
La construction de ce « nous » collectif par les chercheurs devrait non seulement intégrer
les individualités physiques ou groupales comme cela se fait déjà à travers les techniques
d’approche dans un souci d’éthique de la recherche et humaniste respectable, mais elle devrait
également s’opérer en prenant en compte tout le contexte social, toutes les structurations
historiques et mentales qui produisent ces individualités. À partir de ce travail à distance de
l’expérience, il serait plus propice aux observateurs d’établir une différence entre catégorie
pratique et catégorie analytique dans la construction des concepts comme celui de l’homophobie
ou encore sur celui de l’identité homosexuelle en Afrique en temps de sida. La prégnance de
l’usage qui est faite de nos jours autour de ces concepts comme catégorie pratique n’implique pas
qu’on doive en faire usage comme catégorie d’analyse. Nous avons fait appel à la notion de
« composition » pour suggérer que les identités ne sont pas construites à partir des scénarios
prenant en compte l’identité de genre masculine ou féminine. Les éléments de la construction
identitaire chez les sujets procurent plutôt plusieurs répertoires dans lesquels un individu peut se
projeter. Ce dont les enquêtes actuelles auprès des MSM en temps de sida ne tiennent pas
suffisamment compte. À partir de cette notion, on peut déduire dans ces travaux, qu’au-delà des
données forts significatives sur les taux de prévalence au sein de cette catégorie, au-delà du
corpus de connaissances fournies sur les trajectoires sexuelles et de l’économie des mécanismes
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de protection contre le VIH, que les analystes essaient d’enfermer un grand nombre de personnes
enquêtées, ayant vécu des trajectoires différentes et accidentées, qui connaissent une variété
d’innovations et des adaptations. Toutefois, ces enquêtes établissent que les sujets MSM en
Afrique sont peu exposés à des campagnes de prévention contre le sida qui leur soient adaptées.
Beaucoup reste encore à faire, car certains risques sont encore largement ignorés ; c’est le cas des
pratiques pénio-buccales, de l’utilisation des substances qui peuvent rendre le préservatif poreux.
La majorité des répondants affirment utiliser systématiquement les préservatifs au cours des
rapports pénio-anaux. Il serait intéressant d’observer cette fréquence dans la durée et sur un
échantillon plus grand. Et de manière générale, il serait plus indiqué de montrer comment les
données de ces enquêtes peuvent intervenir dans le changement des comportements sexuels pour
une meilleure prévention et dans la construction des identités sexuelles.
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Contradictions and Transgressions: Exploring implementation of HIV/AIDS Policy at a
United Nations office
Shivaji Bhattacharya, Ph.D.•
Abstract
This paper explores the duality between stated Rights-based HIV and AIDS policy and its implementation in a Human Rights-based,
United Nations office in South Africa. The paper demonstrates that although HIV and AIDS policy is an integral part of the
commitment of the organisation, the implementation of the policy, in the form of a Workplace Wellness Program (WWP) supported by
budgetary resources, is weak and incomplete. Classical and contemporary accounts of ‘bureaucracy’ and the organisational ‘rule
book’ are drawn upon to locate the argument. It is claimed that whilst the value systems and politics of managers in the United
Nations system lead them to be defined as highly progressive, some of their practices within their institutions are contradictory,
indifferent and manipulative leading to the perpetuation of discrimination and anxiety amongst HIV-positive staff. Thus, human
agency and ingenuity supersedes organisational structure and the rigour of organisational policies and rules.
Introduction
This paper presents a qualitative analysis of the dichotomy between official HIV and
AIDS policy and its implementation in a human rights-based, United Nations affiliated office,
located in South Africa. The paper integrates detailed vignettes in drawing attention to how
personnel in the South African office perceive and experience the implementation of HIV and
AIDS policy. Additionally, the voices of bureaucrats are also integrated in an effort to interrogate
management attitudes and mindsets on matters of policy and treatment of staff. The study
explores staff member’s sense of being stigmatised and prejudiced, when living with the virus
and their responses to it. In this, I bring a personal perspective to the study, by relating my own
views of living with a potentially life threatening disease to the views of the participants in the
work place in which the study is conducted. Classical Weberian and contemporary accounts of
‘bureaucracy’ and the organisational ‘rule book’ are drawn upon to illustrate how human agency
and ingenuity supersedes organisational structure and the rigour of organisational policies and
rules. The contradictions highlighted necessitate a careful scrutiny of organisational dynamics and
invite introspection within individual UN offices vis-à-vis HIV and AIDS policy implementation.
It is envisaged that the findings will induce the commissioning of a larger study carried out by an
independent body and funded by the United Nations, enabling the validation and enhancement of
the argument presented in the case study and provide more recommendations for the way forward
for the United Nations.
Methodology
The research upon which this paper is based is exploratory in nature and designed to
probe the dichotomy between policy and implementation of HIV and AIDS policies. The primary
sources of data were 22 personal in-depth interviews. It captures 22 individual stories,
perspectives and emotional considerations in the form of testimonials obtained through a variety
of commonly used enquiry-techniques outlined by Thomas (2003: 63-66) as “loose-question[s],
tight-question[s], converging-question[s], and response guided” questions. The primary method
of research was Participant Interviews (PI). However, the research also had an element of
Participant Observation (PO) since the researcher sought to make sense of the personal testimony
of participants and the manner in which these testimonies interacted with one another through
active participation and continued observation.
The selection of participants was based on pre-selected criteria:
(1) Geographical proximity: All participants were available in the geographically
contiguous cities of Johannesburg and Pretoria in the Gauteng province of South Africa. They
•
Senior Policy Adviser HIV & AIDS and Human Rights, United Nations Development Programme in South Africa. This paper is
based on a doctoral research conducted through the Department of Sociology, University of Pretoria, South Africa.
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were all, directly or indirectly, working with the United Nations system selected for the study. (2)
Accessibility: The availability for interviews on HIV and AIDS related research required more
than mere geographical accessibility. Suitable participants had to be located and their consent
obtained. All participants volunteered for the interview. They were assured that confidentiality
would be maintained and that their names would not be disclosed in the study. (3) Representative
sample: At the time, the office in which the study is located had approximately 80 personnel
(with various contracts ranging from regular to temporary) employed in workplace. The 22 who
agreed to participate, constituted 27.5% of the work force making it a robust sample.
The sampling of 22 participants was representative101 but non-purposive. It represented
men (ten participants) and women (twelve participants) in roughly equal proportions,
management (including senior management), professional (advisory positions without
administrative responsibilities) and non-management. The representation included both
permanently contracted staff and temporary staff members and constituted the consensual
representation of staff openly living with the virus. The remaining staff members among the
interviewees were either unaware of their status or sero-negative. Permission to undertake the
study from the required level of authority in the organisation was obtained. The questions that
guided this research were: (1) How do personnel in a local office of a large Human Rights based
bureaucracy perceive and experience the implementation of HIV and AIDS policy in the
workplace? And (2) How does the Human Rights based bureaucracy, as exemplified by this
South Africa case study, implement the HIV and AIDS policy in its workplace?
Overview of Issues: The scale of the epidemic and its manifestation in the workplace
HIV and AIDS is arguably the “greatest public health threat facing South Africa”
(Mangcu 2008: 49-50). The severity of this threat to the nation makes the South Africa location
of this study pertinent. Compounding the problem of the HIV epidemic in the country has been
the relative apathy and “intransigence” of governments in South Africa. Early indication of the
HIV and AIDS threat in the country can be traced back to the apartheid years of the 1980s when
the government “dismissed HIV/AIDS as a disease affecting homosexuals” viewing the epidemic
as due retribution for “people regarded as wayward”. Despite an egalitarian constitution that
prescribes Rights to people without discrimination of gender, race or sexual orientation, the
apathetic approach persisted even beyond the apartheid years. According to Mangcu (2008: 50)
even under Nelson Mandela’s government HIV and AIDS responses were driven by a heteronormative and homophobic paradigm, resulting in AIDS not receiving “as much attention as it
warranted”. By the time Mandela handed over the reigns of government to his successor Thabo
Mbeki in 1999 the epidemic had already spread to “7 percent of the population” in South Africa.
Between “denialism” and a recommended promotion of “beetroot, lemon and garlic” the Mbeki
government drove Stephen Lewis, the United Nations Special Envoy in Africa to describe the
incumbent South Africa government’s HIV and AIDS responses as “obtuse, dilatory and
negligent about rolling out treatment.102” By 2005 HIV prevalence (in percentage terms) reported
in the 2006 report released by UNAIDS (The Joint United Nations Programme on HIV/AIDS)
rose to 18.8% in the age group 15-59 years.
Given the significance of AIDS as a key issue in South Africa, it is vital for international
development organisations, such as the United Nations, who advise and support the national
response to be consistent and proactive not just in their policy advice to the government in South
Africa but in their own HIV and AIDS policy implementation. A review of existing data hints at
the reality that although HIV and AIDS policies are an intrinsic part of the commitment of
101
I use the term representative, not in a statistical sense, but to mean that I sought to ensure diversity (gender, functional, contractual)
with the overall objective of obtaining a width and depth of thought and opinion on the subject matter.
102
See http://www.kaisernetwork.org/health_cast/uploaded_files/Lewis%20Closing%20Speech.pdf
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international development organisations such as the United Nations, the implementation of these
HIV and AIDS policies in the form of Workplace Wellness Programmes (WWP) supported by
budgetary resources is not comprehensive. According to a UNAIDS study with assumptions
accepted by the UN Human Resources department, the total number of staff employed by the
United Nations worldwide in 2004 was “56,619 fixed term staff members.” The average HIV
prevalence rate among the global UN workforce was estimated at “1.73%” (UNAIDS/IAAG
(22)/06.4: 29). The numbers of UN staff and their dependants living with the virus are
summarized in the table (Table 1.1) below. Results show that worldwide, as many as 3,500 UN
staff members and their dependants (of a total of 257,616) could be living with HIV.
Table 1.1: Number of UN staff and dependents globally living with HIV.
Staff only
Dependents only
Staff
and
dependents
HIV
N
Living
N
Living
N
Living
prevalence
with HIV
with
with HIV
HIV
Fixed term
1.7%
56619
978
141548 1711
198167
2689
Contingency 1.7%
16986
293
42464
513
59450
807
Total
UN 1.7%
73605
1271
184012 2224
257616
3495
staff
The above figures are global statistics from 2004 (UNAIDS 2004: 46). They suggest that the total
estimate of people living with the virus at the United Nations globally was estimated to be about
1.7%.
It should be noted that the above UNAIDS report offers the following rider:
It should be cautioned that the above estimates are associated with a lot of uncertainty.
The effect of HIV is different for people of different social class, age and sex and
estimates should ideally be adjusted for these factors. However, in the absence of
information on these factors, the estimates were based on assumptions that were agreed
upon in consultation with Human Resources (UNAIDS/IAAG (22)/06.4: 29).
This cautionary rider explains the difference in the two different prevalence figures estimated in
the above two studies of the United Nations system. While one suggests the figure may be 5% the
other estimates it to be 1.73%. The dichotomy between the two figures is not germane to this
study. What is important is the understanding that both figures could be considered high and
unacceptable from the moral and efficiency point of view. It is therefore vital for the United
Nations to act urgently to fully implement its own HIV and AIDS policy.
The bar chart below (Figure 1.1) is taken from the same ILO/AIDS Progress Report of
June 2004. It demonstrates that, while almost 80% of the offices assessed by ILO had interagency
work plans for dealing with HIV and AIDS, a little over half had budgets available for the
implementation of the workplan.
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Figure 1.1: Rapid assessment of the implementation of HIV and AIDS workplace policies and programs in the UN Workplace in
Eastern and Southern Africa.
The study (ILO/AIDS 2004: 3- 4) goes on to state that, 92% of United Nations Country
Offices reported that they had adopted the 1991 UN Personnel Policy on HIV/AIDS.103 A few of
the agencies namely ILO, UNDP and UNICEF had even proceeded to internalise the policy,
integrating it in their human resources policy framework, which they had adapted to the
particularities of their organisations. 85% of United Nations Country Offices were set up to
provide healthcare services at the workplace for HIV and AIDS treatment, care and support, not
just for staff members but also for their dependants living with the virus. 57% of the Country
Offices reported that staff members, especially those on transitory contracts, were likely to fear
disclosing their sero-status even at the risk of missing out on the possibilities of claiming health
benefits. This 57% figure indicates that, though the policies are in the process of being
implemented, some members of the workplace are confident enough about the HIV workplace
programme, to disclose their sero-status and request the benefits to which this entitles them.
These statistics indicate the situation as it is manifested, but do not explain the dichotomy
between policy and practice.
The recently designed Wellness Programmes in International Organisations are
sometimes proactive (as indicated by the presence of prevention programmes), but are primarily
reactive in nature to enable the organisation to manage the complex socio-medical consequences
(stigma, discrimination and criteria based access to treatment) of contracting the virus.
Reflecting on the study findings
The significance of any finding pertaining to the dichotomy between HIV policy and its
implementation, in international development organisations such as the United Nations, is rooted
in Gewirth’s concept of universality and practicability. He argued that it is not a matter of all
103
The key objective of the 1991 policy may be inferred to be the mitigation of the impact of HIV/AIDS on UN staff and their
families. The four key policy areas are: a) preventive health measures b) voluntary counselling, testing, and confidentiality c) terms of
appointment and service d) health insurance benefits programmes. The guidance notes address implementation in each of these areas.
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rights holders having the same right at the same time and to the same degree of immediacy. Nor
is it a matter of duty bearers fulfilling all rights at all times to the fullest extent of the need. It is,
as Gewirth (1982: 65) states, a matter of principle that everybody has the right to be universally
“treated in the appropriate way” when the need arises and those in authority have the duty to act
in accordance with the right, within the constraints of feasibility and cost, when they have the
ability to do so.
The analysis and qualitative interviews establish a tension between policy and practice.
The directive of the UN Personnel Policy on HIV and AIDS and the manner of its
implementation in the workplace is not consistent. There are clear written regulations and policies
related to HIV and AIDS. These policies and guidelines, endorsed by the Secretary General of the
United Nations, are designed to guide managers in their engagement with HIV in the workplace.
However, despite the rule-based operations of bureaucracies, the written rules are far from
sacrosanct. As one of the interviewees, Lydia, observed, “The implementation of the policy …
does not reflect fully the spirit in which the policy was intended when it was introduced”. The
source study from which this article is extracted deliberates on two aspects of power; the
perceptions that smudge the efficacy of policy, and the expressions of power that determine
policy implementation or the lack of it.
In order to assess the merits of the argument it is important to outline the Weberian power
hierarchies of a bureaucracy. First, the “decision-making authority” directly relates to the “task
responsibility” assigned to individuals in the organisation. Secondly, “each lower office in the
hierarchy is under the control and supervision of a higher office” (Jones 1995: 113-119). This
organisation of reporting structures and authority clearly exists at the United Nations, the
international development organisation under observation. However, Weber’s description of the
rule book as an absolute truth (what Weber [1978: 975] calls, “calculable rules”) and that
generates one clear interpretation that guides decisions and actions in a particular direction, does
not apply in this case study. On the surface of things the rule book does appear to rule. The rule in
the context of this study is the stated HIV/AIDS policy, which comes with the endorsement of the
organisation’s senior-most executive authority, the Secretary General. However, the
implementation of the policy often fails to conform to principles enshrined in the HIV Policy.
From testimonies gathered, the dichotomy in implementation seems to be related to the
judgments, decisions and interpretations of managers and senior staff and not to inefficiency. In
fact, it is my observation that the subversion of the policy, as evidenced in the interviews,
requires knowledge of a broad range of organisational rules and a degree of efficiency in its
execution. Some rules appear to clash with the manager or decision-maker’s beliefs, views or
self-interest, resulting in them rationalising their actions and decisions of non-compliance through
an interpretation of the rules. Some of the decisions and actions taken by the managers and on
their behalf may be determined by what Weber (1978: 975) extrapolates to be “purely personal …
elements.”
As Max Weber states in Economy and Society (Weber 1978: 926), “The structure of
every legal order directly influences the distribution of power, economic or otherwise, within its
respective community”. In the “legal order” of a bureaucracy, power and authority are divided
across different entities such as operations managers, heads of office, human resources and
headquarters as also into specialist functions like medical officers and medical boards. It is
sometimes difficult to locate the source and reason for the manipulation of a situation,
particularly if the person or persons do not wish to be visible in their actions. This works well in
the manager’s favour, if the manager is circumventing a prescribed policy and does not wish to
draw attention to his or her actions.
I invoke Maud’s (a participant in the study) case here to illustrate the observations made
in the two earlier paragraphs. First, that decision maker’s circumvent stated policy using multiple
interpretations. Second, the specific point and level of management at which the decision is being
made is not always evident to the staff member. In Maud’s case, the medical body that carried out
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the tests indicated unfitness without taking a clear position on the action that needed to be taken.
Doctor A, who was in touch with the selected employee reassured her but did not take a clear
position and moved the decision to the organisation’s HQ and medical board. The HQ board
stated that Maud was unfit to work, but did not inform Maud of the “standards that they used” (to
use Maud’s words) to make the decision. The holders of power within the international
development organisation further manipulated the situation when they kept Maud working for six
months without giving her any indication that she would not be allowed to complete her
contracted one year tenure. During these six months (a safe window for the management, when
they employed incumbent without making any long term commitments to her), Maud filled in for
3 unoccupied portfolios. She was also asked to train the person who eventually replaced her,
without being informed that she was doing so. After all this, it seemed reasonable for the
organisation to tell Maud that her medical examinations deemed her unfit to work and that she
would not be allowed to complete the term of the contract she was selected for. A section of the
conversation with Maud is quoted below:
SHIVAJI: But did they explain what the medical problem was and how that medical problem, if
it was not related to HIV… would affect your work?
MAUD: No, they did not really explain.
SHIVAJI: Like there are other staff members who have had TB, they do not necessarily lose
their job for TB.
MAUD: No, no.
SHIVAJI: With medication you are treated, you are okay.
MAUD: Yes, you are okay.
SHIVAJI: The people with cholesterol problems, they have their medication, their cholesterol
comes down and they continue their work.
MAUD: Yes.
SHIVAJI: So did they explain the medical reasons to you?
MAUD: No, they did not, no.
SHIVAJI: Did they give you any compensation?
MAUD: No …. and they even told me that I should not worry about coming back to work
because they felt that I was not too strong to come to work. Maybe that is when they were
preparing to get someone for the post I was on, because they were able to fill up those three posts
and they already got someone, because there was a lady who I was training at the HR, but I
thought they were training her for [an]other [job], [in] an[other] agency. Because, when I was
training her they did not exactly tell me that she was going to work in my office …
SHIVAJI: She is now holding your post?
MAUD: Yes, she is.
The lack of transparency in the decision-making of senior managers and the manipulative
exercise of power evidenced in Maud’s case is anecdotally corroborated by another interviewee,
Phillip. A senior manager in the same organisation, Phillip said with reference to another incident
known to him, “I have seen one case … where … somebody fell sick and then there was this
desperate attempt to come up with a reason … to come up with a performance issue that never
was documented before.”
This instance is a clear indication of management’s efforts at manipulation. Wrong
(2002: 28) notes that, “If … the power holder fails to make explicit certain actions he [or she]
induces … he [or she] has manipulated the power subject in addition to exercising other forms of
power over him [or her]”. In both Phillip’s testimony and Maud’s this manipulation is in clear
evidence.
The above testimonies lead to the conclusion that decision-makers within large
international development organisations manage situations not only by the letter of the policy, but
also by their own individual perceptions. They interpret HIV policies to resolve emerging
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situations in consonance with their own judgment. In the case of Maud this interpretation would
be that persons living with the virus are ill-equipped to effectively take on a post in the
organisation. When there is a mismatch between the statement of policy and their own views,
managers find other policies and approaches to resolve the situation as they see fit. Both Phillip
and Maud’s testimonies corroborate this finding. Phillip talks of managers potentially trying, post
facto, to construct performance criteria to remove staff from their posts. Maud talks of separation
on grounds of an unexplained lack of fitness. This, at a time when she had covered up for three
vacant posts and unknown to herself trained the person who was being groomed to replace her.
Consequently, the study from which this article is sourced finds Arendt’s views on
bureaucracy (as a “rule of Nobody”) extremely useful. She rationalises her point with the
observation that, “in a fully developed bureaucracy there is nobody left with whom to argue, to
whom one can present grievances, on whom the pressures of power can be exerted” (Arendt as
cited in Wrong 1997: 251). While it is true that some of the voices in my research did not have a
person to “argue” with, or one to “present grievances” to, it was not for the same reason that
Arendt implies. According to her the rule book takes precedence and control rather than
individuals. The findings of this study, however, demonstrated that human agency uses its
resources and ingenuity (to varying degrees of success), to interpret and manage the rules and
policies of bureaucratic structure.
The above argument is consistent with the finding that the rule book that guides and
determines policy implementation is only as exact as the managers and staff members who
interpret and implement them make them out to be. Thus, based on the assumption that
individuals differ in background and perspectives, it is my syllogistic conclusion that similar rules
would be implemented differently in different organisations based on the person who is in charge
or the persons who are at the receiving end of policy decisions. As Karl Marx (Gubrium &
Holstein cited in Denzin & Lincoln 2003: 215) would have it, people (in this case both the
managers and staff) are inclined to construct their own world as they see it, though not entirely on
or in their own terms and, I add, with differing results. While this study is designed to explore the
dichotomy between stated HIV policies and its implementation in the workplace of a specific
United Nations organisation, the findings cannot be validly extrapolated across all UN and
Bretton Woods Institutions globally. While one study (ILO/AIDS 2004) suggests that (in Africa
at least) the situation may be similar, the findings cannot be universalized on the strength of this
one study alone. That would need to be the task of a larger global initiative undertaken in the
future.
The testimony of staff members, at all levels of the organisation, ingeminate the view that
the realisation of the HIV and AIDS policy within UN agencies is incomplete. Lydia, one of the
participants in the research, sums it up in her statement,
“The implementation of the [HIV and AIDS] policy … does not reflect fully the spirit in
which the policy was intended when it was introduced.”
Lydia’s observation is a significant one, in the light of a few factors: First, according to
the UNAIDS publication, ‘Living in a world with HIV and AIDS’ (UNAIDS/04.27E 2004: 46) a
significant 5% of UN employees are estimated to be living with the virus, yet the organisational
commitment to allocating budgets for implementation for the implementation of the HIV and
AIDS policy is still low. In this study, participants Maud, Patricia, Caitlin, Lydia and Leon all
testify to either being discriminated or experiencing discrimination firsthand, validating the
statistic presented in the ILO Progress Report 2004. Also, the United Nations agencies are Rightsbased organisations, purportedly subscribing to Gewirth’s (1982: 65) fundamental assertion that
equity is a “matter of everyone’s having, as a matter of principle, the right to be treated in the
appropriate way when he [or she] has the need, and the duty to act in accord with the right when
the circumstances arise… and he [or she] has the ability to do so…”.
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Further, the rule book which, according to Weber and various sociologists and political
scientists since, is thought to play a key role in determining the path of a bureaucracy does not
appear to be significant when it comes to the implementation of HIV and AIDS Policy in the
workplace at the United Nations Agency where the study was located. The rule, in this case the
HIV/AIDS policy, carries the endorsement of the organisation’s senior most executive authority,
the Secretary General. However, the implementation of the policy often fails to conform to
principles enshrined in the HIV Policy. From testimonies gathered, the dichotomy in
implementation seems to be related to the judgments, decisions and interpretations of managers
and senior staff and not to inefficiency. It is my observation that the subversion of the policy, as
evidenced in the interviews, required knowledge of a broad range of organisational rules and a
degree of efficiency in its execution. Some rules appear to clash with the manager or decision
maker’s beliefs, views or self-interest, resulting in them rationalizing their actions and decisions
through an interpretation of the rules. Some of these actions are driven by “purely personal…
elements” (Weber 1978: 975).
Maud, Leon and Mona’s personal experiences of feeling stigmatized and discriminated
along with Caitlin, Phillip and Lydia’s second hand narrations of observed discrimination is a
chilling testimony of what Norman Geras refers to as “the contract of mutual indifference” (Geras
1998: 28). As suggested earlier, we, (and in this statement I also wear the hat of a United Nations
staff member) should view Geras’s insight from an action-oriented position, where we as human
beings in a society, as colleagues in a workplace commit to a contract of mutual empathy, in
which we have the responsibility to empathise and support those around us in need, to the best of
our ability. I have suggested that this empathy would create a momentum for positive social
change, as articulated in the United Nations Charter and (in the context of this study) address
some of the drawbacks of the gap between policy and practice emerging in the presentation of the
research findings.
It would be pertinent at this juncture to introduce my personal experience to the analysis
of the study, as an insider to both the content and context of the study. In March 2008, I
developed a carcinogenic tumour in my appendix. I went through a series of surgeries all of
which were successful in removing the cancer from the body followed by a six-month
intervention of chemotherapy, prescribed as a treatment for cancer and a prophylactic against
recurrence. Yet, despite the prognosis being good this medical episode in my life has influenced
my perspective vis-à-vis living with a potentially life threatening illness in the workplace. For
instance, I now fear that I may be viewed as a person with a potentially life threatening illness
who would, in the medium or long term, be ineffective as a staff member. I further fear that this
may prejudice the organisation and decision makers into subtly denying me a fast track career in
the organisation leading to my concern that this mindset may affect my career ambitions at the
UN. It would be fair to state that I have had no evidence that these fears and concerns of mine are
real or founded in fact. My colleagues and supervisors have been nothing short of considerate and
supportive. I had colleagues from South Africa and senior colleagues from my head quarters in
New York visiting me through my convalescence and recovery from surgery. I have been told
that despite work considerations my health was a priority and that I should take whatever time I
needed to nurture myself to good health. Yet, despite the positive prognosis of my recovery and
the overt generosity of colleagues, I fear that a covert and subtle prejudice from colleagues, may
affect my career in the organisation. This fear of mine is in no uncertain terms linked to the
experiences of some of my participants in this research. Maud lost her job and was never told
why, Leon’s medical coverage is limited, and Mona has felt the effects of stigma. My head was
reeling with questions, “Were Leon, Mona and Maud’s experience evidence of prejudice against
people living with a life-threatening illness? Was I to be another victim of this? Should I be
concerned? Did I need to mount an extraordinary effort within the workplace to protect my career
and inoculate myself against what I feared may be a prejudiced view of people living with a
potentially life-threatening ailment?” I came to the conclusion (invalid as it may seem in
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hindsight) that I had to act on my fears as real concerns. This is what I did. I returned to work as
soon as I possibly could and took every opportunity both verbally and in writing to reassure
colleagues and superiors that I was well, recovered and back at work 100%. I pushed myself hard
to take on more work and deliver on and ahead of deadlines. I made every effort to establish that
the cancer was in the past and irrelevant to my performance in the present.
The situation described above reminded me of a conversation I once had with a colleague
living with the virus. She had mentioned that, as a person living with HIV, she felt that some
colleagues while overtly supportive tended to write her off as a terminal health case and therefore
not likely to be a long term investment in the organisation. As a reaction to this she tended to
over-correct by pushing herself to the limit and taking on more work than she would normally
have done, with the sole purpose of establishing her presence and proving her competence. In the
same way, I was, as a result of my medical situation, attempting to establish competence in a
manner I would not have done six months back.
My personal experience of living through a potentially life-threatening health condition,
corroborates and underlines my view, in this study, that HIV and AIDS policies and indeed other
health policies for life-threatening aliments (within large international development organisations
mandated by the Charter of Human Rights and equity), are only as effective as the men and
women who implement and live by them determine them to be. In order for the implementation to
be effective, it is necessary for staff members at all levels to be engaged collectively in the
response. Given the understanding that there is an epidemic in our society and citizens are living
and dying with the virus, it is crucial for Human Rights-based bureaucracies to reconstruct
themselves and espouse change, rather than baulk from it, in order to effectively “identify and
solve problems almost before they have names” (Bennis 1993: xii).
Even the compelling rigidity of the bureaucracy’s commitment to being governed by the
rule book cannot render HIV policies fully implemented unless those that live by their codes take
concerted action to make them so. The concerted action to fully implement HIV policies in the
workplace is rendered more complex in the light of the fact that perception leading to
stigmatisation and marginalisation in the workplace is not just a factor of stigmatising another
living with HIV, but also a factor of self-stigmatisation by those living with a life-threatening
medical condition.
Organisations are neither static in their characteristics nor stationary in time and the
United Nations too will evolve as time goes by. This study is a snapshot of a United Nations
agency as I see it struggle to reconcile its stated mandate to implement a Human Rights-based
HIV and AIDS policy with the contradictory actions of some of its managers and the consequent
stresses undergone by some of its staff dealing with real, potential and perceived stigmatisation
and discrimination. It is also important to understand that the limitation of the ‘rule book’ lies in
the fact that, while it can articulate organisational principles and define courses of action, it
cannot legislate the good judgement of managers. This understanding that has not been captured
in Weber’s analysis of bureaucracies and their modus operandi.
Revisiting the findings of the study in the context of the two questions posed earlier by
the author one finds that there is a strong sense among staff members that the implementation of
the workplace HIV and AIDS policy is both ineffective and unfair. It is generally believed that
HIV positive staff members are discriminated against, stigmatised and involuntarily dismissed. In
this feeling of unfairness lies the fundamental contradiction of policy and practice in a Human
Rights-based international organisation located in post-apartheid South Africa. In an era when the
country’s defence of social justice is celebrated throughout the world, the ‘organisational citizens’
talked about themselves as having no Rights - of experiencing discomfort about revealing their
statuses, particularly if their contracts were under consideration for renewal. The ignominy of the
matter lies in the fact that the international development organisation (despite being a
humanitarian organisation) has not demonstrated its ability to comprehensively practice its own
Rights-based policies. For instance, there is inadequate information-dissemination on HIV-related
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Rights of staff members and those employed in the workplace, staff members have experienced
job-losses having contracted the virus and others are struggling to gain access and reimbursement
for medical treatment.
An important finding of the study is that implementation of internal policy is sometimes
thwarted by the interplay of structural dynamics, such as: Personal mandate driven managers in
charge of implementing HIV and AIDS policy; some inefficient systems of mandate setting,
monitoring and implementation; a “heavy” bureaucracy; over-centralisation; a lack of
transparency; a lack of democracy and a high top-management turnover (which could suggest
leadership in flux). A central premise of the findings is that the relevance of Weber’s theory of
bureaucracy in today’s context cannot be adequately determined simply at the theoretical level. It
is necessary to simultaneously monitor the bureaucracy’s responses to current issues, such as (in
the case of this study) the implementation of an HIV and AIDS policy in the workplace, in order
to determine the efficacy of the theoretical framework and to understand emerging variances and
evolutionary patterns.
Further, it would be a fallacy to view Weber’s model of bureaucracy as indisputably
complete. The bureaucratic structure of the present-day international development organisation is
an evolved version of Weber’s bureaucracy. As such, it doesn’t exactly replicate the
characteristics of the model. Also, these organisations exist within their own unique environment,
which are subject to variations over time. These variations, in turn, drive exogenous changes in
the bureaucratic structures of large international development organisations. This study, therefore,
suggests that Weber’s model (still largely relevant) can be made more contemporary by allowing
for the evolution of the bureaucracy to accommodate environmental variations across timelines.
Concluding thoughts: The road ahead
One of the participants, Lydia, provided me with the insight that underpins my
recommendations for the way forward. She was clear that managers were not necessarily setting
out with the objective of being maliciously and wilfully discriminatory towards those living with
the virus. None of my conversations with managers or even staff members in this study
conclusively yielded such an observation. As Lydia pointed out in her interview,
… the [HIV] policy is not being implemented efficiently and in its full spirit because the
larger organisation is ignorant of all of the issues that need to be addressed for the policy
to be implemented properly.
Lydia’s observation begs the question, “What would remove the managers’ and staff’s
ignorance of “the issues that need to be addressed”? What would enlighten them, not just to the
rule of law or the text of the policy, but to the reality and principle that the policy is founded on?
What would alert them to the reality that living with the virus is not necessarily a death sentence
and that those living with the virus are capable of the same level of productivity as those living
free of it…. the reality that stigma and discrimination can induce those living with the virus into
self-stigmatisation and push them into concealing or ignoring their status to their own and the
organisation’s detriment?
What would inculcate in them the values and principles on which, not just the AIDS
policies but the raison d’être of the United Nations is founded…the principle that human rights
are universal, inalienable and indivisible?
Most significantly, what role does the organisation play in bringing parity to the
dichotomy between the HIV and AIDS policy and the actions of managers? Clearly the
organisation has both the mandate and the responsibility to manage the environment within the
organisation and to induce reality based and principles driven views, decisions and actions from
managers, in the larger interest of ensuring an efficient and equitable implementation of policy.
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I present a set of initiatives104 that may help address some of the emerging issues:
The competency test would enable the organisation to determine the gaps in knowledge
and the emotional and psychological needs of managers and staff as they deal with HIV in the
workplace.
The information exchange process would provide a learning process for managers and
staff on the facts of the virus in both its bio-medical context as also its socio-economic and
cultural context in society and the workplace.
A counselling session could be a crucial part of the orientation exercise as mere
information exchange may be inadequate for staff members and managers who have strong preconceived notions and misconception about the virus and those living with it. Counselling could
open their mind to the new information they receive and set them up better for the next session on
policy and implementation.
Policy orientation and implementation sessions could enable the staff and managers to
understand the policy and how they could best implement it. They would get a sense of what the
United Nations HIV and AIDS policy is, what it mandates for the staff and managers and how a
full and comprehensive implementation of the policy is not just a human rights necessity but
could increase productivity in the workplace. This, I believe, could go a long way towards
addressing Caitlin’s concern that, “if we [the United Nations] were functioning more as a
coherent system and not as request and demand and then erratic supply, it might actually be quite
different.”
Experiencing the reality of living with the virus may require more innovation. It could
begin with a motivational speech followed by an open conversation and question and answer
session with a counsellor living with the virus. If feasible it may also help to select certain staff
members and managers to work in close proximity with a staff member known to be living with
the virus. This is a more feasible option in countries like South Africa, Lesotho, Botswana and
Swaziland among many others, where the epidemic is more generalised and larger numbers of
staff members may be openly living with the virus.
It may also be feasible for an organisation, like the United Nations, which works across
geographical borders and linguistic categories to establish a growing roster of roving AIDS
Ambassadors. Such a roster would comprise United Nations staff members with requisite
organisation-relevant-skills (such as management, finance, secretarial or any of a host of others)
and the additional qualification of living openly with the virus. These roving ambassadors could
be empowered further with counselling skills and sent out to United Nations offices across the
globe to work with other staff and management teams. Over and above their contribution as
professional accountants, contract specialists or secretaries, they could take on the additional task
of mainstreaming HIV in the workplace. The initiative would provide a process of experiential
learning, empowering fellow staff members with knowledge about the virus and living with it. It
could serve the purpose of normalising staff perceptions of the virus and make them comfortable
with the idea of working alongside a person living competently and productively with the virus,
through the sheer experience of doing so.
I am aware that the United Nations often has to rush staff members with specific skills to
country offices to temporarily fill in skill shortage situations while they are selecting a suitable
staff member for the job. These situations could naturally and seamlessly provide an opportunity
to mobilise the skilled roving ambassadors to country offices temporarily, if a skill match can be
established.
104
While some of these initiatives (such as the competency test, information exchange and counselling sessions) have been
sporadically practiced elsewhere in the organisation, they have not been brought together as one consistent and institutionalised
intervention mandated for staff and managers.
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I am also aware of such staff members in the system, already equipped to perform such
functions. One of them is a colleague, who of her own volition has been a friend and mentor to
me, not just as an adviser on work related issues pertaining to HIV, but more recently from the
psychological and lifestyle perspectives to deal with the personal reality of being faced with a
life-threatening ailment. This person, from my experience, is already equipped to take on such an
assignment.
I believe the significance of the study is substantiated by the fact that the implementation
of HIV and AIDS policies within the United Nations workplace has been reviewed and studied by
an insider to the system. At one level it dispels the notion that “Outsiders, rarely experience the
UN firsthand” (Weiss et al. 2005:1) and need to be content with second hand material cobbled
together from news pieces and editorial articles, the Internet and textbooks. At another level the
study also dispels the view that the United Nations appears be “more a collection of boring
bureaucrats than a creative centre of gravity for international problem-solving” (ibid.). As a staff
member, I argue, that I have taken a step towards dispelling the view that the United Nations are
staffed by “boring bureaucrats” by taking the trouble, late in life, to re-engage with academia to
freshen up my perspectives as also my research and analytical skills. The study demonstrates that
staff members of the United Nations are able to objectively review their policy implementation
and have the support of senior management and the organisation to do so.
The significance of the study also lies in the fact that the research and analysis is
designed to induce organisational introspection at the United Nations vis-à-vis the HIV and AIDS
workplace policy implementation. It is envisaged that this study will stimulate a broader and
more in-depth study based on larger and more geographically dispersed samples, spread across
countries with varied HIV prevalence and incidences. It is also envisaged that such a study will
be carried out by an independent body and funded by the United Nations. This I believe will
enable validation and enhancement of my argument from a larger evidence base across countries
and continents, providing more recommendations for the way forward for the United Nations.
It would be pertinent to conclude the article by revisiting aspects of the United Nations
Charter that may inspire the organisation that I work for, love and respect, as it takes considered
steps towards universally and comprehensively implementing the HIV and AIDS policy in its
own workplace. The effective implementation of the HIV and AIDS policy is, to a great extent, a
matter of concern and respect for the equality, dignity and worth of the human person.
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Condom Use and Perceived HIV Infection Among Geriatrics Aged 65-102
Years in Nigeria•
a,*
Odor King , Olaseha, Issacb, Ajuwon, Ademolab and Igwe Nnennad
Abstract.
The study was cross-sectional in design. A multi-stage sampling procedure was used to randomly select 400 geriatrics in four
locations in Southwest Nigeria. A pre-tested questionnaire with information from 10 FGDs was used. The FGD data were analyzed
thematically, while the questionnaire data were analyzed using descriptive and chi-square statistics. Slightly more than half (50.5%)
were males, while 49.5% were females. Twenty-five percent of the participants had extra-marital sex since they attained the geriatric
age. However, among this subgroup that had extra-marital sex, only few (6.8%) used a condom. There was no significant difference
between gender and condom use, hence more males (5.3%) than females (1.5%) used a condom during the last episode of extramarital
sex (p<0.05). Low level of condom use was sustained by the view condom is not worthwhile (34.5%) and the opinion (50.0%) it was
not designed for geriatrics. There was probability assumption among the FGD participants that sex at elderly could not lead to
pregnancy and the assertion that condom is relatively new technology. On the other hand, majority (60.3%) preferred patronizing
traditional healers while few (10.3%) believed herbs/concussion could prevent HIV/AIDS. Similarly, majority (89.3%) did nothing to
avoid infection/pregnancy during sex; while few (5.8%) had confidence in herbal medicine.
Introduction
The United Nations defines elderly people as those over 60 years of age. Definitions
vary, however, depending on culture, life expectancy and people’s own perceptions of age, some
may include all adults over 50 (HelpAge/Alliance, 2003). Research indicates that older people
make up a significant proportion of the poorest of the poor, and even without the added threats
created by diseases; many older people struggle to survive and suffer poverty, social exclusion
and age discrimination. In most African countries, older people have few forms of support outside
their families (Heslop, et al 2002). In terms of demography, 54.6% of Nigerians are within the 1564 years age bracket and 3.1% within the 65 years and over bracket. Nigeria’s birth rate is 40.65
births/1,000 people, death rate is 17.18 deaths per 1,000 people and the population growth rate is
2.37%. Infant mortality rate is 98.8 deaths of 1,000 live births (UNDP, 2005). Age is one of the
characteristics of social differentiation; the perception of age is nevertheless socially constructed.
However, without correct information about sexual behaviour, they are often unaware that some
traditional practices (such as wife inheritance and sexual cleanings) are risky – “sexual cleanings
is the practice in which a widow has sex with another man following the death of her husband, to
purge the husband’s spirit” may expose to sexually transmitted infections (STIs) including HIV
infection. So if elderly people were informed, they could help reshape practices and beliefs in the
family and community (HelpAge, 2003).
The fact remains that even though this century has witnessed some revolutionary studies
in human sexuality (Masters & Johnson, 1970), the area is still considered fairly taboo by many
researchers, and we therefore have far too many questions and too few answers about all areas of
human sexuality. One area that has been particularly neglected is sexuality in the elderly.
Considering that today the elderly people are living longer and that their segment of the
population is increasing more than any other, more emphasis ought to be placed on their quality
of life, which for many includes sexuality (Schlesinger, 1996).
In Africa particularly Nigeria, a survey of the literature shows that elderly people suffer
disproportionately from sexual and reproductive health (SRH) negligence (Samba, 2005), yet
Proceedings of the 8th International Conference on Urban Health, ICUH 2009, Nairobi, Kenya October 18 – 23, 2008.
Dept of Health Promotion, University of Ibadan, Nigeria
b
Dept of Health Promotion, University of Ibadan, Nigeria
c
Dept of Health Promotion, University of Ibadan, Nigeria
d
Alvan Ikoku College of Education, Owerri, Nigeria
•
a
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there are almost no programmes to address this problem. Elderly people’s SRH negligence as
compared to young people has been over emphasized in the recent past. Donor agencies and
development partners, governments and even NGOs focus their huge resources on getting young
people to the levels that will ease their sexual behaviour. The elderly are not considered serious
subjects of concern; the assumption is that, their sexual behaviour, life experiences and maturity
automatically give them a “clean bill of health.” Moreover, studies have also shown that people
show lukewarm attitudes around issues of sexual health behaviour among the elderly. According
to Alliance, (2004) instead of exclusion, include older people in Sexual and Reproductive Health
issues, rather than considering them as potential obstacles to discussion around sexual matters but
this should be done in an age-and culturally sensitive perspective.
However, engagement in risky sexual activities is prevalent among the elderly and this
could lead to HIV infections. Similarly, the underlying assumption, supported by emerging
empirical study by Mohammed-Ali (2005) in a study in Ethiopia, is that sex with elderly people
increases the young people’s risk of becoming infected with HIV/STIs. This finding partly
explains the higher vulnerability of young people to HIV and sexually transmitted diseases
(STDs) in Bugna district. This is usually because sexually active young girls are at increase risk
of STD due to the organisms causing STD penetrate more easily the cervical mucus of girls than
that of older women (McCauley et al, 1995 in Iwuagwu et al, 2000). This survey therefore,
contributed to new body of knowledge about elderly sexual behaviour. This would help us to
appreciate the underlying information about the geriatric sexual activities.
The
Problem
Sexual risky behaviour is a public health problem and a formidable barrier to
development in developing countries and researchers have confirmed this statement in diverse
places worldwide. In Nigeria, people pay little or no attention to issues of sexual health behaviour
among the elderly. The geriatric are not considered serious on priorities of sexual matters.
Furthermore, in Nigeria today, data show that elderly people continue to engage in risky sexual
behaviour and practices (Muruko, 2005) are still startling and mostly not available. With the
advent of HIV/AIDS in Nigeria, many elderly people are saddled with the adverse effects of the
scourge, resulting from risky sexual practices including extramarital sexual relationship. This
study hitherto, examined the sexual behaviourial patterns of the elderly people ranging
from 65 to 102 years old. The results and findings would be useful and also assist in
planning an effective geriatric health programmes.
This study is significant for three major reasons: firstly the study would serve as
baseline information for the design of evidence-based SRH development programmes for
the elderly. Secondly, this research would assist bilateral and multilateral agencies,
development partners including Organizational institutions in mainstreaming the elderly
people’s SRH in their programmes.
Table 1: DEMOGRAPHIC ATTRIBUTES OF RESPONDENTS
Gender
Male
Female
Total
Age
65-74
Frequency
202
198
400
N
154
%
38.6
69
Percent (%)
50.5
49.5
100
Total
N
202
198
400
%
50.5
49.5
100
N
148
N
302
%
75.7
%
37.1
© International Resource Network
75-84
85-94
95 years and
above
Total
Educational
Level
No
Formal
Education
Primary
Secondary
NCE
HND/B.Sc
Postgraduate
Total
Outliers, a collection of Essays and Creative Writing on Sexuality in Africa Vol. 3, spring 2010
35
11
2(%)
8.8
2.8
0.5
38
9
3
9.5
2.3
0.6
74
20
5
18.3
5.0
1.0
202
50.5
198
49.5
400
100
85
21.2
115
28.8
200
50.0
86
21
9
1
202
21.5
5.2
2.3
0.3
50.5
62
15
2
4
198
15.5
3.8
0.5
1.0
49.5
148
36
2
13
1
400
37.0
9.0
0.5
3.3
0.3
100
FINDINGS FROM SURVEY
Respondents’ View about Condom use by Educational Level
As shown in table 2, the perceptions of the respondents about reasons for non condom
use show that educationally 27 (8.8%) of the respondents both low and high level education
perceived condom use as reducing sexual drive; which comprised 24 (6.1%) with low level
education and 4 (0.8%) high level. More than one quarter 103 (25.3%) reported it is nonsense;
this represented one quarter 100 (25.1%) of respondents with low education and few 3 (0.6%)
with high education. Half 200 (50.0%) of the respondents said condom was not meant for the
elderly; with 194 (48.0%) of them with low education and 6 (1.1%) high education respectively.
Only a few 3 (0.8) with low education held the view that it is harmful to use condom. On the
other hand, 23 (5.3%) of the respondents believed it is good and useful for them; with 20(5.1%)
with low education and 3 (0.6%) with high education respectively. Finally, a few 9 (0.6%) of the
respondents had not experienced condom use before, with 6 (2.3%) of the respondents with low
education and 3(0.6%) with high education respectively (see Table: 2).
Table 2: Respondents’ View about Condom use by Level of Education
Educational Level
Response
Low Education
High Education
N
%
N
%
No Response
31
8.3
4
0.8
No sexual drive
24
6.1
3
0.6
Total
N
35
27
%
9.7
8.8
Nonsense
100
25.1
3
0.6
103
25.3
Not for Elderly
194
48.0
6
1.1
200
50.0
Harmful
3
0.8
-
-
3
0.3
Good / Useful
20
5.1
3
0.6
23
5.3
No Interest
6
2.3
3
0.6
9
0.6
Total
378
95.7
22
4.3
400
100
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Chi-square: 43.3 df: 30
1. Low Education: No Formal Education, Primary and Secondary Education 2. High Education:
(Tertiary) - NCE, B.Sc and Postgraduate Education
SEXUAL PRACTICE OF THE RESPONDENTS
Respondents’ Frequency of Extramarital Sex
As shown in Table: 4.5, a total of 82(20.5%) of the respondents engaged in extra-marital
sex once, this comprising 70(32.4%) males and 12(6.7%) females; while 22(5.5%) engaged twice
since they attained the age of 65 years. Of this number, 15(9.2%) were males and 7(3.9%) were
females that enagegd in the extramarital sex; while a few 16(4.0%) engaged in it more than twice.
In addition, it was clear that more males 11(6.2%) than females 5(2.8%) engaged in extramarital
sex more than twice.
Respondents’ Condom Use since attaining 65 years old
Among those who were sexually active during the period of the survey, including those
who had engaged in multiple sex since they attained the age of 65 years, only few 27(6.8%) used
condom; while the majority 343 (85.8%) did not. Of the number that used condom during the
period 24(11.9%) were males and very few 3 (1.5%) were females. However, by contrast, those
who did not use condom during the period, comprised close to half 96(47.8%) of males and a few
24(13.4%) females respectively. Moreover, more than a quarter 120(30.0%) engaged in multiple
sex.
Respondents’ Reasons for Non Condom Use
The survey finding shows that the reason for non-use of condom was that majority 122
(36.2%) did not like to use it. Of this number, 104 (65.4%) were males and 18 (10.1%) were
females. Also a sizeable proportion 70 (20.8%) who did not think of condom during sex, were
4(2.4%) males and 66(37.1%) females; while a few 35(10.4%) reported that their partners did not
like to use condom, this number comprised 31(19.5%) males and 4(2.2%) females. A few
16(4.7%) viewed condom as not necessary, this was reported by 10(6.3%) males and 6 (3.4%)
females. However, on accessibility and availability a few 5(1.5%) of the respondents did not have
anyone at hand; while only the male 3(1.9%) respondents reported they could not get one (see
Table: 5).
Table 3: Respondents’ frequency of Extramarital Sex since attaining 65 years
Male
Female
Total
Frequency of extramarital sex
N
%
N
%
N
Once
70
32.4
12
6.7
82
Twice
15
9.2
7
3.9
22
Many
11
6.2
5
2.8
16
None
17
11.2
153
64.9
170
Can’t Remember
3
1.7
3
1.7
6
No Response
81
39.3
23
16.0
104
Total
201
100
198
100
400
Table 5: Respondents’ Reasons for Non-Condom Use
Reasons
Male
N
%
Female
N
71
%
Total
N
%
%
20.5
5.5
4.0
42.5
1.5
26.0
100
© International Resource Network
None at Hand
Couldn’t get
one
Partner didn’t
like it
I don’t like it
Not necessary
Didn’t think
of it
No Response
Total
Outliers, a collection of Essays and Creative Writing on Sexuality in Africa Vol. 3, spring 2010
4
3
2.5
1.9
1
-
0.6
5
3
1.5
0.9
31
10.5
4
2.2
35
10.4
104
10
4
56.4
6.3
2.5
18
6
66
10.1
3.4
37.1
122
16
70
36.2
4.7
20.8
46
202
18.9
100
103
198
46.6
100
86
400
25.5
100
Discussion
In general, the elderly people have fewer opportunities to access education than the
younger people, although, education is not really enough to change people’s behaviour.
Nevertheless, it seems the elderly could still practice positive behaviour if the three groups of
factors of PRECEDE Model are adopted and promoted. For instance, adequate social support and
the influence of significant others would enhance the adoption and maintenance as well as
sustainability of positive sexual behabviour. There were more Christians (63.0%) than other
religion (37.0%).
Unprotected sex and risk behaviour are predominantly common among the elderly. In
this study those who had extra-marital sex, majority (85.8%) did not use condom. This could be
probably due to perception of condom use by the elderly people. This is also substantiated in the
FGD results in which majority expressed their views that condom use is for prevention of
pregnancy. This shows that the elderly are limited in their knowledge about the purpose of
condom use. They lack the understanding of its use to prevent sexual infections. The reason
according to the FGD findings is that, many elderly believed that condom reduces pleasure during
sexual intercourse. This is consistent with the results of PROMACO (2001) in a study in Burkina
Faso that elderly men and women agreed that condom reduces sexual pleasure. In another study
by Sunmola, (2005) who also found that condoms hindered elderly sexual satisfaction, caused
health problems and reduced their sexual interest. While in this study very few (1.9%) of the
elderly talked about unavailability and inaccessibility of condoms for non-use. These attitudes to
condom use are largely influenced by general negative perceptions. This can be addressed within
the contexts of ecological model by providing information that would erase negative perception
and barrier at all levels. The fact that thirty percent of the elderly engaged in extramarital sexual
relationships either once, twice or more have negative effects on healthy ageing. In the FGD
majority of the females posited that elderly women, who engage in multiple sexual intercourses,
usually have hypertension and other diseases because a sperm, which should be flushed out
during menstruation, accumulate in their body system. While some males on the hand were of the
view that elderly men who engage in sexual intercourse would experience back pains and
arthritis.
Condom Use and Non Use
A few (6.8%) sexually active elderly have used condoms since attaining the age of 65
years, especially those who engaged in multiple sexual intercourses. This is particularly the case
among elderly men (11.9%) than women (1.5%) in this study. This differential by gender is very
well known, as studies by Akinrinola et al (2007) have shown that men often tend to report more
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Outliers, a collection of Essays and Creative Writing on Sexuality in Africa Vol. 3, spring 2010
condom use than women, even among the elderly in marital relationships. However, it is still
unclear whether this is due to actual difference in use or reporting error, as it may be argued that
women may fail to report condom use because their partner, not they, put the device on. In this
study, more elderly men (68.2%) report more interest in sex in the two years preceding the study
than women (12.6%) do. By nature, men show more interest in sex than women as discussed
earlier. This could also be probably because of culture, which seems to restrict females from
sexual expression and safe sexual negotiating power when compared to their male counterparts.
This cultural norm is prevalent in many African countries, especially in Nigeria as reported in
some quarters such as in a rural community in Nigeria that men could have extramarital sexual
relationships while their wives abstain (Ajuwon, et al., 1994).
Another important reason for non-use according to the FGD findings is that both sexually
active elderly men and women reported that they felt safe with their partner. Yet, in the view of
Guiella and Madise (2007), feeling safe depends very much on the type of partner and whether or
not there are other concurrent sexual relationships. Despite extensive efforts in promoting
condom use, some elderly people still engage in risky sexual behaviour and condom use remains
relatively low. Akinrinola et al (2007) found that a multitude of factors might impede elderly
people’s ability to protect themselves by using condoms, including attitudes towards condoms
and ineffective use of the method. This implies that the elderly especially the females should be
adequately educated on the safety and effectiveness of condoms. This is essential because of the
unique dual protection of preventing pregnancy and infections it offers. The condom has become
a popular method for sexually active people being promoted for preventing unwanted pregnancy
and STIs including HIV/AIDS. Socioeconomic circumstances or gender inequalities that
characterize the sexual relationships between men and women could hinder adherence and
consistent use.
Conclusion
Risky sexual practice among the elderly is a growing public health problem. Government
has significant roles to play. This study has shown elderly persons are still sexually active at old
age, while some engaged in risky sexual activities. In addition, the sexual perception is relatively
negative; this misperception may be due to knowledge inadequacies and if not properly
addressed, may adversely affect their sexual health.
Recommendations
Based on the findings of this study, the following recommendations are made thus:
1. As a matter of urgency, it will be more appropriate for government at all levels to formulate and
enforce laws and policies that would promote geriatric health.
2. Government and development partners should collaborate to initiate geriatric health intervention
programmes. Part of this programme should provide home-based counselling including sexual and
reproductive health services to meet their sexual needs.
3. Finally, as sizeable proportion were involved in unsafe sexual practices. Therefore, health education
intervention programmes such as training on safe sex practices are needed to address the problem.
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75
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La Problématique des MSM au Burkina Faso
Cyrille Compaoré105
Résumé
Bien que des études anthropologiques aient montré que les pratiques sexuelles entre hommes existent dans tous les pays du monde, en
Afrique, l’existence de telles pratiques sexuelles est le plus souvent déniée ou marginalisée, parfois associée à un comportement
importé de l’occident. Au Burkina Faso, depuis 2001, plusieurs tentatives de recherches sur les MSM sont demeurées vaines le climat
socio-politique étant peu favorable à traiter de façon ouverte de la question des MSM du fait de la sensibilité du sujet. Néanmoins,
dans le cadre du projet targting vulnerable groups in national HIV/AIDS programs. The case of men who have sex with men –
Senegal, Burkina Faso, the Gambia », dirigé par le Professeur Cheikh Ibrahima NIANG de l’Université Cheikh Anta diop / Dakar,
une étude exploratoire sur les MSM a été réalisée à Ouagadougou (COMPAORE Cyrille Juillet 2003). Prenant en compte les résultats
de cette première étude sur les MSM au Burkina Faso, des investigations ont été menées sur la situation des MSM dans le contexte de
l’épidémie du VIH/sida dont la présente étude rend compte des résultats obtenus.
L’étude vise à contribuer à une meilleure connaissance de la situation et de la réponse au
VIH/sida chez les MSM au Burkina Faso. Dans le cadre de cette étude, la méthode
ethnographique a été utilisée pour la collecte des informations sur les MSM. Compte tenu des
difficultés de rentrer en contact avec les MSM qui, dans la majorité des cas cachent leur sexualité
du fait de la stigmatisation sociale, l’utilisation de la méthode de « boule de neige » a permis de
mobiliser 86 MSM.
Outre la réalisation d’une revue de presse sur les MSM, la collecte des données à
nécessité des entretiens informels et des focus groups avec des MSM sur des thématiques ayant
trait à leur vie sexuelle et sociale ainsi que sur leurs facteurs de vulnérabilité aux IST/VIH/sida.
Des concertations ont également été réalisées avec des personnes ressources d’institutions et de
structures de lutte contre le sida se trouvant dans une perspective tolérante dans le but de
capitaliser les services de prévention et de prise en charge mis en place en faveur des MSM. De
même, certains leaders politiques ont été approchés pour évaluer leur adhésion pour la prise en
compte des MSM dans les programmes de lutte contre le sida.
Les résultats de l’étude montrent que les MSM au Burkina Faso sont de jeunes burkinabé
âgés de 19 à 45 ans avec une moyenne d’âge de 25 ans dont un nombre important d’entre eux est
bisexuel. Outre l’identification des différents profils de MSM, de leurs signes identitaires, l’étude
à permis de connaître la trajectoire de leur orientation sexuelle et leurs facteurs de vulnérabilité.
Bien que les MSM aient été touchés par les messages de prévention, l’absence de messages qui
les ciblent fait que ceux-ci ont une faible perception de leur situation de risque. D’ailleurs,
certaines considérations en leur sein font état de l’inexistence de risque d’infection par le
VIH/sida chez les MSM. Il en résulte de la part des MSM des comportements à risque se
caractérisant par le multipartenariat associé à une faible utilisation des préservatifs. Toutefois, ces
facteurs de vulnérabilité sont renforcés par la stigmatisation et la discrimination sociale au niveau
familiale, communautaire et médicale. Egalement des cas de violence policière et médiatique ont
été révélés.
A défaut de la réalisation d’une étude épidémiologique, une collecte de données
statistiques réalisée en 2005 auprès de structures associatives (AAS et Vie Positive), révèle
que sur 200 MSM, 38 cas de VIH ont été décelés soit un taux de prévalence de 19% contre
une moyenne nationale de moins de 2% selon les estimations de l’ONUSIDA 2005. Bien
qu’au Burkina Faso, le climat socio-politique soit peu favorable à traiter de façon ouverte de la
question des MSM du fait de la sensibilité du sujet, certaines initiatives sont en cours dans les
perspectives de la prise en compte des MSM dans les programmes de lutte contre le sida.
105
MSM chercheur au Burkina Faso
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A ce titre, deux ateliers sur les MSM et le VIH (Atelier conjoint IPC, Population Council, AAS et
Vie Positive en décembre 2004 et l’atelier sous-régional sur les groupes vulnérables organisé par
AIDS/France avec comme structures hôtes AAS, REV+ et ALAVI en novembre 2007) ont été
réalisés à Ouagadougou dans le but d’identifier des axes d’intervention en matière de lutte contre
le sida ciblant les MSM. Toutes les structures associatives impliquées dans l’organisation de ces
ateliers, intègrent des MSM dans leur programme de lutte contre le sida.
De même, au niveau national, dans le cadre de la formulation de la requête du 9ème Round
du Fonds Mondial, une option a été faite d’intégrer les minorités sexuelles (MSM, lesbiennes) au
titre des groupes spécifiques. Par ailleurs, une étude portant sur l’Analyse de la distribution des
nouvelles infections par le VIH au Burkina Faso et recommandations pour la prévention, réalisée
en mars 2009, préconise dans les prochaines planifications, de prendre en compte les nouveaux
groupes tels que les MSM, les consommateurs de drogue injectables.
Conclusion et perspectives
Malgré l’existence d’initiatives en faveur de la prise en compte des MSM dans les
programmes de lutte contre le sida, des réticences persistent au niveau institutionnel et politique
en ce qui concerne la réalisation d’une étude approfondie sur les MSM. Aussi, il est essentiel de
réaliser une recherche dont les résultats pourront permettre de susciter un dialogue social sur la
prise en compte des MSM dans les programmes de lutte contre le sida. A ce titre, un projet de
recherche multipays, élaboré en juillet 2007 « analyse des représentations socio-culturelles et
politiques des pratiques sexuelles entre hommes – la réponse africaine à la vulnérabilité des
MSM aux IST/VIH/sida » (Burkina Faso, Burundi, Côte d’Ivoire, Cameroun, Mali, Niger,
Sénégal), (COMPAORÉ Cyrille), est disponible. Cette recherche vise à l’identification des
stratégies socialement, culturellement et politiquement acceptables pour la mise en œuvre de
projets de lutte contre le sida ciblant les MSM. La finalité de cette recherche est de poser les
bases pour une concertation inter-africaine pour la prise en compte des MSM dans les
programmes de lutte contre le sida.
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Exclusion and Prejudice From Within the “LBGTI Community” That Perpetuates Cycles
of Discrimination and Violence
Yvette Abrahams, Ph.D.•
Happy Pride Month, everybody! And thank you so much for inviting me to present this
topic to you. I think it is one of the most important topics we can address. As the LGBTI
community, although we are probably many more than we think, it would appear as if biology
destines us to always be a minority --because amongst the children of LGBTI people, a minority
is, LGBTI--. This means that not only are we a minority community, but we are also a community
that has to reproduce itself by means other than by birth. The way in which we bring new people
into our community, and the way we teach them to be good LGBTI, has to in the main be through
other than blood ties. This means that, although unity is important for any oppressed group of
people, it is crucially important for us. We cannot hope to be strong as long as we are divided.
When we act cruelly towards each other, we are not only weakening our own strength, but the
very institutions and mechanisms that create and bind community. In these times, when LGBTI
people are jailed in Kenya for daring to get married, when a bill in Uganda threatens to
criminalize not only queer behaviour but LGBTI identity itself, and when our own Minister of
Arts and Culture boycotts an exhibition of lesbian art on the basis that it is ‘pornographic’ and
‘threatens the rights of children’; well in these times we shall clearly have to stand together or go
down separately.
At first I thought I should do this paper about intersectionality (the way race, class,
gender and ability divides us from each other and weakens us as a community). But on second
thoughts I decided it was better to talk less about the structures in which we have to live our lives,
and instead lay the emphasis on how we relate to those structures. So I am going to ask you to
take the hierarchies on which this society is built rather for granted, to be aware of them but as a
background against which our own personal dramas are played out. Instead I want to focus on the
psychological aspect of LGBTI cruelties towards each other, and suggest that our cruel behaviour
is based on a hatred of self. Now this is not a very new idea, and I am going to expand on it based
on the classics. I hope you don’t mind me being so old-fashioned, I know there are lots of new
and exciting things being written by young scholars in the field ofl “Queer studies.” I wanted to
present some of their work, but I doubt I will have the time tonight. So I thought why not start
with the classics? And hopefully later on you can fill me in on what the young people are
thinking.
My starting point, then, would be the work of Audre Lorde, and specifically her essay on
hatred and anger published in 1984: “Eye to Eye: Black Women, Hatred and Anger.” Lorde in this
essay argued that it is the hatred we meet from the outside world which causes us to hate
ourselves, and we act out of that hatred to behave in cruel ways towards each other. She writes
“For each of us bears the face that hatred seeks, and we have each learned to be at home
with the cruelty because we have survived so much of it within our own lives.
Before I can write about Black women’s anger, I must write about the poisonous seepage
of hatred that fuels that anger, and of the cruelty that is spawned when they meet. I have
found this out by scrutinizing my own expectations of other Black women, by following
the threads of my own rage at Black women, back into the hatred and despisal that
embroidered my life long before I knew where that hatred came from, or why it was being
•
Commissioner for Gender Equality in South Africa. This is a transcript of a speech gave at Triangle/CGE workshop on GenderBased Violence and Human Rights on March 10, 2010 in South Africa.
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heaped on me. Children know only themselves as reasons for the happenings in their lives.
So of course as a child I decided there must be something wrong with me that inspired
such contempt.”106
In this essay, Lorde is writing mainly about racism, and she takes us on a journey through many
very painful episodes in her childhood where she was taught that her self and her skin colour107
were an object of hatred. Now Lorde’s logic is simple: children learn by example, and if you
expose a child to hatred on a daily basis, then you are teaching a child to hate. The child learns to
hate first itself as obviously deserving of hatred, and then others because hatred becomes a
legitimate mode of feeling and action. Lorde’s biographer explains:
“She appreciated what internalizing all that hatred meant: every human interaction she
had was tainted by the negative passions and intensity of its by products, namely anger
and cruelty. She’d come to value the hatred of her enemies more than the love of her
friends, because that hatred was the source of her anger, and that anger fueled great
strength. Even more, anger alone, it seemed, kept her alive. But if that were true, Lorde
reasoned, then ridding herself of the hatred of her enemies might also diminish the source
of her power – which was anger. She saw anger as more useful than hatred, but
limited.”108
Of course, to a South African, this reasoning resonates with frightening intensity. I have seen
comrades who have come through the struggle survive on hatred and anger, letting it motivate
them and bring them through circumstances no human being should ever have to survive, to wage
the liberation struggle that freed us. I have heard them say: “Do not take this hatred from me. It is
what keeps me going.” So I can understand why Lorde clung to her feelings. All the more reason,
then, to admire her courage in writing “Eye To Eye.” In this essay, Lorde trawled her psyche
right down to its painful depths. In psychological terms one could say that she allowed herself to
see herself fully and wholly, and insisted on being absolutely honest about those parts of her
identity we are normally ashamed to show. She demonstrated an astonishing ability to accept
those parts of herself we normally lie about – even to ourselves. In stepping away from her
denial, Lorde made it possible for us to walk the same path towards self-acceptance and self-love.
Now Lorde was talking about racism, but I do not see why the same argument cannot be
applied to homophobia as well. I have spoken elsewhere about my experiences growing up a
lesbian child, who learnt very early on to keep a secret. When you as a child feel things which are
to you perfectly normal and natural, like love for the same sex, but at the same time you are given
a powerful message by society that these feelings are unnatural, disgusting, against God,
destructive of the family and counter to the laws of Creation, you very quickly learn to keep your
natural feelings to yourself. You learn very young to hide your true self, to live a lie, and to
manufacture an acceptable personality to the outside world. Relaxing, in the sense of being happy
about who you are and how you love, becomes an unknown luxury to the LGBTI child. With
time, all that worrying and hiding weakens you, and next thing you know, you have bought into
society’s values about you. You begin to believe there is something wrong with you, and that you
are worthy of hate. The step from there to hatred and anger of others; to hatred and anger as a
106
. Lorde, Audre Eye to Eye: Black Women, Hatred and Anger in Sister Outsider: Essays and Speeches, The Crossing Press,
Trumanburg, NY, 1984, pp. 146.
. Because, as has often been said about Lorde, “…each part of the self she constructs is based on a sense of corporeal materiality
that she attempts to render in both her prose and poetry... As a writer, Lorde is acutely aware of this indissolubility: She perceives her
body as a text and is conscious of her texts as emerging from her body.” Cf. Margaret Kissam Morris “Audre Lorde: Textual
Authority and the Embodied Self “ in Frontiers - A Journal of Women's Studies , January 1, 2002.
107
108
De Veaux, Alexis Warrior Poet: A Biography of Audre Lorde W.W. Norton, NY, 2004, pp. 320.
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normalized, legitimate way of being, is not long. And if we do not take the journey Lorde took from self-knowledge to self-love – we can easily end up being life-long abusers of each other.
There are differences, of course, between racial hatred and homophobia, which must be
emphasized. Because the Black community does increase by birth, and has access to the family
and church as community-building institutions, it is able to be stronger and more resilient to selfhatred. In the LGBTI community it is often the family and the Church, which undermines us.
Also the Black community must, by and large, of necessity lead a public existence. Most Black
people cannot live in a racial closet. Again this gives it a “self-evident”, or seemingly
unconstructed status that serves to strengthen it. We, on the other hand, are often forced to build
community with people who cannot, or will not, identify themselves with us.
Finally, although we are like the Black community in that rejection from one of your own
is ten times worse, and so we tend to be internally rather homogenous, as well as intolerant of
diverse ways of thinking and being (yes! Just think of our internal prejudice against bisexuals);
still I would say that precisely because the forces holding our community together are so weak,
this factor is ten times stronger for homophobia then it is for race. In other words, while racism
out there may make Black people stick together and stifle dissent, this force is weaker in the
Black community. So it became possible to develop, for instance, a strong Black
feminist/womanist movement. The community was strong enough to tolerate dissent. In the
LGBTI community, by contrast, homophobia out there still often makes acceptance and support
of your own a matter of life and death. When children are thrown out of home and deprived of a
right to education because of their sexual orientation, all they have is us. So we become afraid of
disagreeing with respect, of enjoying open debates, and appreciating our truly kooky diverse
selves. Of course that will breed resentment and misery eventually, which then will come out in
fighting 9hatred as a way of life), and that in turn serves to weaken our struggle.
All of these factors, I would say, make the impact of homophobia much more devastating
than racism in legitimizing hatred and anger as a way of life. Our job in creating a resilient
community is simply that much harder. But I have no doubt we can do it. It is hard work, slow
and exhausting. My contribution is to remind us that a strong and loving community must begin
in strong and loving selves. I want to end by reiterating the values I think are crucial:
•
•
•
That hatred and anger cannot, must not, be accepted as a way of life. We need to
remember the love of our Great Creator who made us, and constantly remind ourselves
that when we begin to internalize the ways of the oppressor we are acting counter to
Creation. We need to choose life, not a living hell.
That we have to act continually to avoid the related values of the structures we live in:
racism, sexism, and classism. In fact, like the KhoeSan of old, I think that any form of
hierarchy is not acceptable. The principle of hierarchy itself is inimical and anti-life. It is
also immoral.
Lastly, that this work of self-discovery and self-redemption which we undertake is not for
ourselves alone, but as I began by saying, is for the purpose of freeing ourselves from all
hierarchies. In other words, I am not recommending navel-gazing for its own sake. I am
saying ‘put hatred, anger and violence behind you because between climate change and
the need to put food on tables we really should not be wasting time or energy.’ Again,
this is just going back to our organizational roots. As Barbara Smith reminds us:
“Nobody sane would want any part of the established order. It was the system –
white supremacist, misogynistic, capitalist, and homophobic – that had made our
lives so hard to begin with. We wanted something entirely new. Our movement
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was called lesbian and gay liberation, and more than a few of us, especially
women and people of color, were working for a revolution.””109
Thank you!
109
. Smith, Barbara The Truth that Never Hurts: Writings on Race, Gender and Freedom Rutgers University Press, New Jersey, 1999,
pp. 180.
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The Realities of ‘Choice’ in Africa: Implications for Sexuality, Vulnerability, and
HIV/AIDS
Chi-Chi Undie, Ph.D.•
For the last couple of weeks, as I’ve thought about what I wanted to talk about today, I’ve been
fixated on the term ‘choice’ and the ways in which this phenomenon plays out in many of our
African contexts. The very word, for me, immediately invokes questions which a conference
such as this one provides the space for us to consider. First question: What are the realities of
‘choice’ in African settings and how do these realities shape sexualities, vulnerability, and the
HIV/AIDS pandemic on the continent?
I was browsing through the conference agenda and I noticed that a key slogan of this
conference is the following empowering phrase: ‘My Sexuality, My Choice, My Right’ – and since
the phrase is italicized, I read it with an emphasis on the word ‘my.’ Despite the liberating effect
that these words undoubtedly have, in considering them, I was confronted by a series of
questions: To what extent is choice an individualistic and linear phenomenon in African contexts?
What do we gain by making the assumption that it is? What do we lose by addressing the
possibility that it might not be?
If we talk about ‘choice’ without considering how this concept is embedded in (and, thus,
informed by) perceptions of ‘culture’, prescriptions by religion, economic realities, the realities of
stigma and discrimination, and the legitimized censoring of sexual and reproductive health
information, for instance, how much ‘choice’ are we really offering to prospective rights-holders?
Are we merely holding forth an ephemeral concept?
I’m convinced that, in many African settings, when we employ this term, we are rarely
talking about a singular choice. More often than not, we’re grappling with a multiplicity of
choices and players/stakeholders – some of whom (or of which) prevail today, others of which
may prevail tomorrow. A key question therefore seems to be: In each instance in which choice
emerges as an issue, whose choice prevails; how; and why? And what are the implications of
these dynamics for sexuality/sexualities, vulnerability, and HIV/AIDS?
To explore this issue, I could introduce any number of topics that intersect with the broad
topic of ‘choice, sexuality, vulnerability, and HIV/AIDS.’ I could talk about young people living
with HIV and the ways in which their choices are constrained and their sexuality is forcibly
shaped by censoring much-needed sexual and reproductive health information, or by prescribing
what sexuality should mean for them. I could focus, for instance, on people living with
disabilities. I could talk about coercive sex and the utter lack of choice. With the allotted time,
however, it is impossible to touch on every imaginable issue. I am therefore limiting myself to
just one concrete, vivid scenario to illustrate these points further. The scenario centers on married
couples. There was a time when married people were seen as being among the least interesting
research ‘subjects.’ Those days are gone. As we now know, marriage is no longer necessarily a
sanctuary of sexual safety (Glynn et al., 2003; PAI, 2008). Given the reticence toward the use of
condoms within (as opposed to outside) marriage (Chimbiri, 2007), marital sex in Africa is now
increasingly acknowledged as amounting to risky sex.
In the last 3 months or so, I have become acquainted (either directly or indirectly) with
five heterosexual women in the city that I work in, all of whom are either currently married or
were once married to men who have sex with men. Most decided to dissolve the union once they
became aware of this reality. One is currently in the process of deciding what to do next –
Associate research scientist, African Population and Health Center. This paper was presented at the 4th Africa Conference on
Sexual Health and Rights UNECA Conference Centre, Addis Ababa, Ethiopia, February 8-12, 2010.
•
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whether to leave or stay. From my perspective as a qualitative researcher, an ‘n’ (i.e., sample
size) of 1 is as ‘significant’ as an ‘n’ of 5 or 500. As a qualitative researcher, I was struck and
intrigued by the common themes that emerged from the stories of these women. They were all
initially pleased and, indeed, relieved, to observe that their partners seemed to have little interest
in other women because that gave them the impression that they had ‘married well,’ choosing
committed men to spend the rest of their lives with. Secondly, they were all similarly concerned,
puzzled, and hurt by their husbands’ lack of sexual desire – which they later came to realize was a
lack of sexual desire for them as women. Thirdly and most strikingly, most of them were
proactive about employing carefully-crafted strategies for enhancing their husbands’ sexual
desire. Their stories were strikingly similar – to the extent that several of these women picked out
the same exotic location, took their husbands on a trip there, armed with sexy negligee, and on a
mission to get their sexual needs met. The efforts of each of these women failed miserably. In one
instance, the woman was shunned and accused by her spouse of being hypersexual. Ironically,
she was a newly-wed and had only had sex twice in that year. In another instance, the woman’s
spouse was so repulsed by the idea of having sexual relations with his wife that he vomited.
The question is: Who is exercising choice in a scenario such as this? Is it the men in this
example, who had their sexual liaisons with other men on the side (and were therefore being
‘true’, in a sense, to their sexual orientation), but at the same time sought out marriage partners of
the opposite sex, perhaps to fulfill societal/familial obligations? Is it the women, who chose these
men as life partners – women who, for the most part, chose to leave their husbands, even though a
dissolved union is not what any of them really wanted? This is an example that demonstrates that
our choices are often informed by many factors other than ourselves or what we truly desire.
As I’m sure we can appreciate, ‘choice’ – though it has been an important buzz word for
a long time, once unpacked, can be seen as a much more complex concept that its simple name
suggests. As a poignant example of how choice and sexuality are intertwined with vulnerability,
one of these women – the one that is yet to make up her mind about what to do about her situation
– is now most likely HIV-positive. Incidentally, all of the men in this true story happen to be
living with HIV, although none of their wives were privy to this critical piece of information.
How much choice do we have if we can only be our authentic selves in a clandestine
fashion? How much choice do any of us really have when we lack relevant information? The lack
of knowledge, which translates into lack of true/informed choice, gives rise to vulnerability, and
plays a major role in fuelling the HIV pandemic.
I, personally, love the liberty that informed choice can afford. I’m all for choice provided
it is allowed to develop in a stigma and discrimination-free environment, and in an environment
replete with comprehensive sexual and reproductive health information. I’m all for choice
provided it refers to careful and considerate choices – because without care, consideration, and
responsibility, my choice can mean your vulnerability.
In the words of Rosalind Petchsesky, ‘We all share a sexuality with its capacity for erotic
pleasure, fantasy, exploration, creation, and procreation, as well as danger and abuse. We all
share a body, with its capacity for health and wellbeing as well as disease, deterioration, violation
and death’ (Petchesky, 2005, cited in Jolly, in press). And, might I add: we all share a choice.
This is why information and knowledge, openness and honesty/truth are so critical. Information
and knowledge make room for true choice to exist. Openness turns shame and secrecy on their
heads and makes room for honesty, thus ensuring that true choice thrives. In our presentations
during this conference, therefore, I look forward to learning, to gaining information and
knowledge from all of you, to being inspired by our openness and truthfulness as a group, in
order to move this continent closer to the achievement of sexual health and rights.
References
Chimbiri, A.M. (2007). The Condom is an ‘Intruder’ in Marriage: Evidence from Rural Malawi.
Social Science & Medicine (64) 5: 1102-1115.
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Glynn, J.R., Carael, M., Buve, A., Musonda, R.M., & Maina, K. (2003). HIV Risk in Relation to
Marriage in
Areas with High Prevalence of HIV Infection. Journal of Acquired Immune Deficiency
Syndromes (33) 4:
526-535.
Jolly, S. (in press). Sexuality and Poverty: What Have They Got to do with Each Other? In Old
Wineskins, New Wine: Readings in Sexuality in sub-Saharan Africa, eds. Chimaraoke O.
Izugbara, Chi-Chi Undie, and Jennifer Wanjiku Khamasi. New York: Nova Science
Publishers.
PAI (Population Action International) (2008). The Silent Partner: HIV in Marriage. Available at:
http://www.populationaction.org/Publications/Fact_Sheets/FS37/SP_Factsheet.pdf.
Petchesky, Ros, 2005, ‘Rights of the Body and Perversions of War: Sexual Rights and Wrongs
Ten Years
Past Beijing’, UNESCO's International Social Science Journal, special issue on Beijing+10 Vol
57.
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Call for contributions for Outliers Volume 4
Issue Title: Uganda's Gay-Hating Bill and Global Battles
Submit brief biographical details and paper (800 words – 2 000 words) by August 30,
2010. Submit to: Desiree Lewis <[email protected]> [email protected] and send a
copy to [email protected]
Note: email subject should include the following: The author’s initials, the mention
OutliersV.4, and title of the submission - as in “DLewis_OutliersV.4_Understanding the
Bill…” or “SNyeck_OutliersV4._Politics of…..”
The anti- homosexuality bill introduced in Uganda in October 2009 sparked off widespread outrage, condemnation and, in certain quarters (and not only Uganda), massive
support among defenders of the authoritarian, gay-hating status quo. Among many on the
left, both in the west and in Africa, the Bill testifies mainly to a backwardness that critics
thankfully believe is alien to their own countries. So, certain South Africans heaved a
sigh of relief in the belief that South Africa, unlike Uganda, is a country where gay,
lesbian, intersexed and transgender rights are firmly protected. Similarly, in the West, the
zeal with which certain donor organizations, NGO workers and activists launched the
battle to defend human rights violations in Uganda speaks volumes about their
complacent belief in their guaranteed freedoms. Ironically, the gay-hating mindset from
which proponents of the Uganda bill take their cue, (especially the Christian
fundamentalism that the homophobic zealots in Uganda presently express) draws directly
on certain philosophies in the West: the obsession with “natural” African sexuality as
patriarchal and heterosexual is a colonial prescription. And it's a prescription that many
Africans have tragically embraced. The current neo-fundamentalist Christian obsession
with patriarchal and heterosexist morality, family structure and values has been directly
fueling the rhetoric and beliefs of many gay-hating Ugandans today.
For radical African gays and other progressives committed to all forms of imperial, racist,
homophobic violence and othering, the Bill raises three sets of issues:
1 – to confront the Ugandan Bill as a global problem with global repercussions
2 - to use vibrant and outspoken ways to speak about the Bill not simply as “expressing
homophobia”, but as promoting sustained hatred and violence.
3 – to raise debate about global systems that currently work to reproduce homophobia
and authoritarianism throughout the world.
This issue of Outliers provides a forum for wide-ranging writing addressing these
themes. Radical gays, lesbians, transgender and intersexed people, (especially from
Africa) as well as other progressives are invited to submit essays, opinion pieces,
interviews and writings in any genres.
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Call for review: we are currently looking for a reviewer for the book Trans: Transgender
Life Stories from South Africa (Eds. Ruth Morgan, Charl Marais and Joy Rosemary Wellbeloved,
2009). All enquiries should be addressed to [email protected]
IRN-AFRICA 2009 AWARDS
“Contradiction and Transgressions: Exploring Implementation of HIV/AIDS Policy at a United
Nations Office” by Shivaji Bhattacharya, Ph.D. (South Africa)
IRN-Africa Desmond Tutu Award
“When the “High Risk” Subaltern Speaks: The Zvishavane Women AIDS Prevention Association
(ZWAPA)’s Response to the HIV/AIDS Epidemic” by Estella Musiiwa, Ph.D. (Zimbabwe)
IRN-Africa Fanny Ann Eddy Award
“From Liberia with Love”: Officers’ Wives Confronting HIV/AIDS” by Adeyemi, Bukola
Adeyemi, (Nigeria)
IRN-Africa Simon Nkoli Award
Congratulations!
http://www.irnweb.org/en
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