An Interdisciplinary Approach towards Alleviating the AIDS crisis in South Africa

Improvisation of Grameen Bank Project for Female initiative and Economic Empowerment

INTRODUCTION

Among various infectious diseases, HIV proves to be one of the most problematic due to both its physiological as well as socio-cultural manifestations. The rampant spread of the HIV epidemic around the world is, hence, leading to a growing public health crisis which needs to be urgently addressed in order to ensure the security and wellbeing of all members of the global health community. Sub-Saharan Africa, among other parts of the world, is especially facing the most devastating and heart rendering consequences. South Africa, a country within Sub-Saharan Africa, has also distinctly faced the violent wrath of HIV first hand. In terms of South Africa, three distinct factors need to be addressed. Firstly, any program which chooses to address the HIV crisis, must work under a socio-culturally relevant context and be both culturally sensitive as well as culturally conscious. Secondly, any program needs to ensure long term sustainability factors such as initiating programs which make individuals self sufficient rather than dependent on that very program. Thirdly, and most importantly, the program must address gender disparities and should try to alleviate the situations for women by providing programs which encourage the empowerment of women both economically as well socially. Hence, a program improvised on the Grameen Bank project, may allow sustainability, and feasibility permitting the women of South Africa to access financial and social empowerment along with an access to education.

POLITICAL AND SOCIOCULTURAL CONTEXT

Many non-white South Africans are still suffering the grave repercussions caused by Apartheid. Apartheid, which led to the strict segregation among the races, was instated from 1948 to 1994. Apartheid led to the empowering of the minority white elite which controlled much of the socioeconomic and political power in the country. The segregation took away voting rights and citizenship of individuals who resided in South Africa but were not of European descent.[1] The schools and medical systems were completely segregated but the nonwhite South Africans were not provided with the same technology and expertise as those of the minority elite.[2] This not only created a deep divide in society but also lead to very poor health, education and living conditions for the nonwhite South Africans. Apartheid also led to a range of factors which still affect gender relations as well as the family unit in general.

The impact of Apartheid can still be felt because Apartheid served as the leading catalyst for the displacement of numerous men from their “ethnic homelands” (also called Bantustans[3] during the Apartheid movement), to crowded and hazardous working conditions in Johannesburg and other neighboring cities. These men continue to travel these far distances even today to find job opportunities. The conditions for these men are especially dire since they receive minimal wages and are forced to stay away from their families for six months or more at a time. Many of the former “ethnic homelands” are left with mainly women who are waiting for their loved ones to come home. They are a few men who stay in the village due to either injury or a lack of employment. But these men too grow resentful of their circumstances as they are unable to support their families and are left behind with the women.

The isolation of women in the former Bantustans along with the massive dislocation of the men from their “ethnic homelands” to Johannesburg and other cities prove to be one of the leading factors which leads a disease like HIV to spread like wild fire from one isolated area to many new areas. The National Health Department in South Africa reported that the number of cases of HIV between 1991 to1993 increased by 60% in the span of those two years.[4] The influx of men in South Africa who were and often times still are away from their families led and leads not only to the growth of the sex industry in the area but also leads to the sporadic spread and outburst of HIV.[5] HIV reins havoc among both men and women in South Africa also for a variety of other socio-cultural reasons.

Since promiscuity was and is often times seen as a sign of masculinity in the black South African culture, the men in these conditions often times seek the solace of a prostitutes in times of loneliness and distress. The stressful and hazardous conditions in factory and mine work in Johannesburg also persuaded men to seek prostitutes. [6] Many men therefore began to become infected through their visits the brothels. Many of these men would return home to their wives after six months to a year and transmit the infection to their wives. HIV, therefore, also has specific socio-cultural implications for women.

GENDER DECONTRUCTION, INEQUALITY & GENDER BASED VIOLENCE

Women hold a subordinate role in society making them more susceptible to coercive or various types of unwanted sexual behavior. A woman in these circumstances has no choice but to submit to her husband or another man for an assortment of reasons. Firstly, a woman’s wish to use a condom may not be respected due to the gender disparities which are still largely prevalent. Secondly, a woman’s desire to use a condom may be construed as a woman not trusting her husband as well as not accepting him fully. Thirdly, a woman who proposes to use a condom can be construed as ‘lose’ by her very suggestion to use protection with her partner despite the fact that it is socially acceptable for her male partner to have multiple sexual partners. Condoms are also perceived as uncomfortable and unnatural in monogamous relationships. Even though, a woman may have reasons for not trusting her husband, her husband may still be humiliated by the suggestion of a condom and this may propagate more of an abusive situation.[7] Additionally, much physical violence and emotional violence still persists. It is estimated that 80% of rural South African women are victims of domestic or sexual violence.[8] That being said, a women may not even be given a choice to consent and may be subjugated to abuse by her spouse. Furthermore, practices like “dry sex” also further propagate the spread of infection of HIV in women. “Dry sex” is a practice in which the women are intentionally wiped dry in order to increase the sensational pleasure for the man. This practice makes the woman’s vaginal canal more prone to bleeding, further leading to the spread of HIV. [9] Additionally, even if women are monogamous there is no guarantee that the males in the relationship are the same way. Men who are promiscuous are often times considered more masculine and therefore having multiple sex partners is, in a way, encouraged from a cultural stand point. Consequently, the spread of HIV is also reinforced due to certain cultural influences.[10]

Women are also very much economically dependent on the male members in their life, and economic stability is sometimes conditional upon the consent to have sex. [11] Other factors such as, the myth that having sex with a virgin will cure one of AIDS, also leads to many cases of sexual abuse and violence on individuals as young as infants who are female.[12] These and other myths which surround AIDS and treatment for AIDS make women very vulnerable not only to their own partners, but also to other men in the community. “One in every three women in SA is in an abusive relationship, a woman is killed by her partner every six days and there is a rape every 35 seconds.”[13]

A female is especially put in a compromising position in these circumstances because she is very much dependent on the male members of her family for survival. Even though physical and emotional abuse may be prevalent, women may see it as a better alternative than to starve themselves.[14] Therefore, allowing a way in which women are able to be educated and empowered may provide some hope for the future. Although it cannot be explicitly stated that this will stop all men from abusing their wives, this may boost the level of self confidence of these women so that they can sustain a living for themselves independent of the men in their lives. If women have a way to economically empower themselves, this may lead to better conditions in the months in which her husband is away.

ECONOMIC EMPOWERMENT AND EDUCATION FOR WOMEN

Economic empowerment and education are, thus, essential for women in South Africa for various reasons. Firstly, rural South African society is heavily a patriarchal system where women are still treated like second class citizens. In a typical family unit, the men are expected to work outside the home either on the farm or away in the city, where as women are left to take care of the children and the home. This system grants much economic power and access to males as they are the ones who are directly financially benefiting from their work. Although some of this money does go to the woman for household expenses, the primary money holder persists to be the man. This creates a strict divide among men and women, as men continue to gain economic strength and wellbeing where as women continue to work just as much or more than the men, but do not get financial compensation for their work. With a separation of the private sphere of the home and the public sphere of the work place, it creates a society in which men have economic power and gain this through their work, however all the hard work which takes place in the home such as cooking, cleaning and rearing children becomes free labor leaving the female vulnerable to exploitation not only from her husband but also other male members of the family.[15]

Furthermore, economic empowerment for women also holds other optimistic promises. Some studies have shown that women led households potentially show a 12% decrease in malnutrition compared to their male counterparts. This is predicted due to the fact that females are more likely to spend their incomes on the collective need of the families such as school fees or winter clothes, whereas many men are more likely to expend money on beer and other pleasure central activities. These studies therefore assume that a woman’s income proves to be more “multiplied” in the sense that it can lead to the raising of standard of living of the whole family, as a woman is more sensitive to the needs of her family and is more likely to spend her income in ways which will better support both her family’s health as well as overall wellbeing. Therefore, because women spend more of their incomes on alleviating dire conditions, women are predicted to be better able to climb the social ladder than men are able to do in similar circumstances. [16]

The access to education for women also leads to considerable economic growth of the whole country for various reasons. Firstly, access to education lowers the fertility rate as it slows population growth. Secondly, raising the education level of women also decreases infant mortality. For instance, even in a country with a GDP as low as $300 per person, the “doubling of female secondary school enrollments” has indicated a decrease in infant mortality from 105 to about 78 for every 1000 individuals.[17] This is another interdisciplinary solution which may allow for empowerment of women from a broader context, leading to the overall wellbeing and health of not only these women but also their families.

Numerous other reasons exist for why economic empowerment and access to education are integral not only in promoting the wellbeing and health of the society but also in promoting economic growth of the country. For instance, if more women are educated leading to the slowing of growth of population, this would allow for “long term sustainable development.”[18]

DEVELOPMENT PROGRAMS AND IMPLEMENTATION

Investing time and effort in order to explore the cultural and social factors of each and every location would indicate that development projects would have to spend much time and energy in these endeavors. Many development projects are, however, executed and implemented in a very superficial level as development workers move from one location to another in a fairly quick manner. In order to spur a real growth and change in any society, it requires a very intimate familiarity with that culture. Development managers therefore do not have the time or the resources in order to heavily invest. Therefore, this leads to abundant development projects yet a low success rate as the institutions implementing these projects do not evaluate cultural and social influences.[19]

Recently programs have been implemented in South Africa in order to alleviate the massive public health crisis caused by the AIDS epidemic. For instance, “critical interventions” from the CDC (Center for Disease Control in the US) have included the implementation of a HIV literacy program through which numerous booklets are being passed out informing individuals of the nature and scope of the disease.[20] Additionally, a range of non governmental organizations such as the South Africa Development Fund grant small amounts of money to various development projects involving human rights concerns. These programs range from projects which teach certain skills, such as sewing and bead work to HIV affected women, to other programs which have set up cooperatives in neighboring villages. These projects, although small scale, have given much hope and accessibility to many parts of rural South Africa. The Health Ministry of South Africa has also, very recently, initiated a five year plan for tackling HIV.[21] Although many attempts, like the, five year initiative, are being made to alleviate the AIDS crisis in South Africa, other interdisciplinary solutions also need to be evaluated in order to be constantly critical and focused on not only what programs should be implemented, but also, how these programs prove to be cost affective, beneficial and sustainable in this society.

SOLUTION: GRAHMEEN BANK PROJECT

Keeping the concerns of feasibility, sustainability and accessibility in mind, a program which has recently shown much success and promise in meeting these goals has been the Grameen Bank (GB) established in Bangladesh. Although the socio-cultural and political climate differs between Bangladesh and South Africa, women are still treated as second class citizens. This project basically set up a “bank for the poor” by establishing a banking system which loans money with no collateral. GB has successfully provided credit for the “poorest of the poor” in Bangladesh and has allowed individuals who were bound by poverty to change the quality of their lives. The “credit delivery system” is based on various factors. Firstly, women are given priority. Secondly, credit is given in small amounts to individuals who qualify to receive a loan. Qualifications may range from age and skill to the amount of time available to dedicate to a particular “business.” The delivery system is based specifically to meet the needs of the poor, so individuals are less likely to be trapped in an inconvenient financial situation in which they feel overwhelmed. The delivery system is also set up so that “borrowers are organized in small homogenous groups.”[22] This allows the building of relationships based on trust and reliance. This also further facilitates the sense of community women feel with each other. The payment methods are set up so that it is most suitable for the poor. For example, individuals are given small loans which they are able to pay off in installments in the span of a year. The individuals who wish to participate either engage in a skill which they are already familiar or take classes to learn a new trade of their choosing. This very choice allows women to feel empowered economically and otherwise. Another very intriguing part of the project is the “undertaking of a social development agenda.” The bank, hence, also serves to raise social and political awareness in the groups which are involved and encourages women to partake in “social and physical infrastructure projects” which address the needs of sanitation and clean water among other factors. Grameen Bank therefore facilitates the lives of women in Bangladesh by providing them access to both economic empowerment as well as self sustainability.[23]

GRAHMEEN BANK: BANGLADESH VS. SOUTH AFRICA

Another reason why a program like the Grameen Bank project may be suitable for South Africa is due the approach which the bank itself has taken for formulating practical solutions. It states that the bank is and should be based on “social background” rather than “pre-established technique.” This is critical as the banking system needs to be customized to the specific society. For example, a system which is based on this type of socio-cultural context rather than pre-established notions of banking techniques already holds promise as it does not assume universality in how individuals will approach the bank.[24]

SUSTAINABILITY

This project differs from the less successful development projects defined above as it addresses that development is a “long term” process, and that sustainability is therefore essential. A program which is founded on long term sustainability certainly holds promise of being successful in its attempts of program implementation. The failures of many development projects are not because the intentions are not good or just, but perhaps that these intentions are not carried out in the proper cultural context in which these intentions ought to be carried out. Therefore, both cultural sensitivity and long term sustainability is critical to any development project.

A project like GB for its entire caliber can be foreseeable and imaginable in the near future in South Africa for various reasons. Firstly, the GDP of South Africa is $8506 in the year 2006, compared to the GDP of $2018 in Bangladesh.[25] This indicates South Africa may provide fertile ground for a project of this type. When looking at GDP, often times the numbers can be misleading as they are based on averages. However, because, both Bangladesh and South Africa has a large gap between the rich and poor individuals in the country, it is partially being assumed that South Africa will be able to sustain a project of this sort. Although the mortality of adult lives in South Africa is much higher, this is largely due to the devastation of HIV in South Africa. However, if an economic empowerment program of this sort is implemented, this may allow females who are HIV infected to gain easier access to medication further extending the duration of their lives.

CONCLUSION

Although HIV has various implications for women in South Africa, programs which seek an interdisciplinary solutions will prove to be most successful. For example, the improvisation of the Grameen Bank project may lead to the much needed economic empowerment of women in South Africa. Although gender disparities may still exist, giving women access to education and economic empowerment can only help to bridge the gender gap which has made women quite vulnerable to unwanted sexual behavior among other exploitative factors. Although this solution is not directly oriented to tackle HIV, economic empowerment of a woman is essential for her ability to either stand up to her husband and/or to be self-sufficient. Although gender perspectives may take a longer time to change, female empowerment will certainly facilitate economic and financial freedom which will hopefully lead to a sense of confidence and achievement among these females. Although men may continue to be abusive, this may make women less dependent on the male members of their family for financial reasons, and allow them to feel a sense of accomplishment, pride as well as a sense of control of their own lives and the lives of their children.

Bibliography

Foot Note Numbers	Title
1	“Historical images of Apartheid in South Africa”	Historical images of Apartheid in South Africa. Retrieved March 22, 2007, from Human Rights Web site: http://www.un.org/av/photo/subjects/apartheid.htm
2	“Post Apartheid South Africa: The First Ten Years”	Nowak, M. (Ed.). (2005). Post Apartheid South Africa: The First Ten Years. Washington DC: International Monetary Fund Publication services.
3	“Bantustan”	Bantustan. (2007 ). In Wikipedia [Web]. Retrieved March 22 2007 , from http://en.wikipedia.org/wiki/Bantustan
4,14,15	“Gender Based Violence”	(2006). Gender Based Violence, Retrieved March 26, 2007, from UNICEF Web site: http://www.unicef.org/southafrica/hiv_aids_729.html
5,10	“Women and AIDS in South Africa: a conflicted history leads to a dispiriting present.”	Suich, A (2006). Women and AIDS in South Africa: a conflicted history leads to a dispiriting present. UN Chronicle, 43.2: 12(3), Retrieved march 20 2007, from http://find.galegroup.com/itx/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T003&prodId=ITOF&docId=A152633365&source=gale&srcprod=ITOF&userGroupName=viva_uva&version=1.0
4,6	“The scale of South Africa’s AIDS crisis”	Pemrey, Graham (2007, March 20). The scale of South Africa’s AIDS Crisis. Retrieved March 26, 2007, from AVERT Web site: http://www.avert.org/aidssouthafrica.htm
7	“South Africa: Gender, Socioeconomic Status, and Youth HIV Risk”	Hall, K. (2006 February 2). South Africa: Gender, Socioeconomic Status, and Youth HIV Risk. Retrieved March 27, 2007, from Population Council Web site: https://www.popcouncil.org/projects/TA_SouthAfGenderHIV.html
8	“Men and Violence Are Barriers to Preventing HIV in Women”	(2004 March 24). Men and Violence Are Barriers to Preventing HIV in Women. Retrieved March 27, 2007, from EngenderHealth Web site: http://www.engenderhealth.org/news/newsreleases/040305.html
9	"Is "DRY SEX" one of the hidden reasons for the country horrifying AIDS epidemic? (Investigation)."	Tshabalala, L. (April 2005). "Is "DRY SEX" one of the hidden reasons for the country horrifying AIDS epidemic? (Investigation)." Marie Claire , 12.4:203(3), Retrieved march 22 2008, from http://find.galegroup.com/itx/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T003&prodId=ITOF&docId=A130390260&source=gale&srcprod=ITOF&userGroupName=viva_uva&version=1.0
11	"In Soweto, South Africa, transactional sex may increase women's risk of HIV."	(2004 November 4 ) "In Soweto, South Africa, transactional sex may increase women's risk of HIV." Women's Health Weekly , 18, Retrieved March 22 2007, from http://find.galegroup.com/itx/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T003&prodId=ITOF&docId=A123784878&source=gale&srcprod=ITOF&userGroupName=viva_uva&version=1.0
12	“HIV/AIDS, the stats, the virgin cure and infant rape”	Earl-Taylor, M. (2002 April). HIV/AIDS, the stats, the virgin cure and infant rape. Science in Africa , Retrieved march 22 2007 , from http://www.scienceinafrica.co.za/2002/april/virgin.htm
21	“ South Africa unveils five-year HIV plan”	(2007 March 14 ). South Africa unveils five-year HIV plan. Retrieved March 27, 2007, from Yahoo News Web site: http://news.yahoo.com/s/po/20070314/co_po/southafricaunveilsfiveyearhivplan
16,17, 18	“Gender Inequality and the Economy: Empowering Women in the new South Africa”	Maharaj, Z. (2000). South Africa: Gender Inequality. Africa Policy E-Journal, Retrieved March 20. 2007, from http://www.africaaction.org/docs99/gen9908.htm
19	"Oversight crisis at development banks: slashed wrists, blood-smeared offices and workers too terrified to complain: what can be done to root out alleged corruption at the world's development banks? (The world: multilateral finance)."	Andersen, M. (2003 March 4). "Oversight crisis at development banks: slashed wrists, blood-smeared offices and workers too terrified to complain: what can be done to root out alleged corruption at the world's development banks? (The world: multilateral finance)." Insight on the News 19.6, 32(2), Retrieved march 22 2007 , from http://find.galegroup.com/itx/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T003&prodId=ITOF&docId=A98415812&source=gale&srcprod=ITOF&userGroupName=viva_uva&version=1.0
20	“The Emergency Plan in South Africa”	(2007 January 8). The Emergency Plan in South Africa. Retrieved March 26, 2007, from Center for Disease Control and Prevention Web site: http://www.cdc.gov/nchstp/od/gap/countries/south_africa.htm
22,24	“Grameen Bank Project: Credit Delivery System”	(2002 September). Credit delivery system. Retrieved March 23, 2007, from Grameen Bank Web site: http://www.grameen-info.org/bank/cds.html
23	“Grameen Bank Project: A Short History”	(2002 September).A short history of Grameen Bank. Retrieved March 23, 2007, from Grameen Bank Web site: http://www.grameen-info.org/bank/hist.html.
25	“World Health Organization Data”	(2007). South Africa. Retrieved March 22, 2007, from World Health Organization Web site: http://www.who.int/countries/zaf/en/
13	“South Africa: Gender Inequality ”	Ali-Dinar, A. (1999, August 22). South Africa: Gender Inequality. Retrieved March 22, 2007, from University of Pennsylvania: African Studies Center Web site: http://www.africa.upenn.edu/Urgent_Action/apic_82299.html

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1 Article: “Historical Images of Apartheid in South Africa”

[2] Book: “Post-Apartheid South Africa: the First Ten Years”

[3] Bantustans: an ethnic reserve for nonwhite individuals predominantly in rural parts of South Africa which were created as part of the racial segregation policies of Apartheid.

[4] Article: “Scale of South Africa’s AIDS crisis”

[5] Article: "Women and AIDS in South Africa: a conflicted history leads to a dispiriting present."

[6] Article: “Scale of South Africa’s AIDS crisis”

[7] Article: “South Africa: Gender, Socioeconomic Status, and Youth HIV Risk”

[8] Article: “Men and violence are barriers to preventing HIV in women”

[9] Article: "Is "DRY SEX" one of the hidden reasons for the country's horrifying AIDS epidemic? (Investigation)."

[10] Article: "Women and AIDS in South Africa: a conflicted history leads to a dispiriting present."

[11] Article: "In Soweto, South Africa, transactional sex may increase women's risk of HIV."

[12] Article: “HIV/AIDS, the stats, the virgin cure and infant rape”

[13] Article: “South Africa: Gender Inequality ”

[14] Article: “ Gender Based Violence”

[15] Article: “Gender Based Violence”

[16] Article: “Gender Inequality and the Economy: Empowering Women in the new South Africa”

[17] Article: “Gender Inequality and the Economy: Empowering Women in the new South Africa”

[18] Article: “Gender Inequality and the Economy: Empowering Women in the new South Africa”

[19]Article: "Oversight crisis at development banks: slashed wrists, blood-smeared offices and workers too terrified to complain: what can be done to root out alleged corruption at the world's development banks? (The world: multilateral finance)."

[20] The Emergency Plan in South Africa

[21] Article: “South Africa Unveils 5 year HIV Plan”

[22] Grameen Bank project: Credit Delivery System

[23] Grameen Bank project: A Short History

[24] Grameen Bank project: Credit Delivery System

[25] World Health Organization Data