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3 Gendered Responses to Living with AIDS Case Studies in Rwanda Ruth Kornfield and Stella Babalola In order to gain an understanding of why HIV prevalence rates remain high and how HIV prevention could be achieved in sub-Saharan Africa, it is necessary to understand how HIV-infected individuals respond to their situation . It is also necessary to understand how those individuals respond so that needed resources can be allocated and made available to people living with HIV and AIDS (PLWHA) as well as to those caring for them. The issue of gender is particularly important to these understandings because in sub-Saharan Africa, HIV is primarily transmitted through heterosexual intercourse , and the epidemic is shared by both men and women. In addition, because of women’s increased vulnerability to the infection, for both biological and social reasons, HIV prevalence rates are higher among women than men. Of all persons infected in sub-Saharan Africa, an estimated 58 percent are women and 42 percent are men (UNAIDS 2002a). The epidemic is exacerbated by inadequate health care and generally low individual health status due to poor economic conditions and limited access to necessary resources, all of which are differentiated by gender (de Bruyn et al. 1998; Farmer et al. 1996; Foreman 1999; Morrell 2001; Schoepf 1988; Setel 1993; Susser 2000; UNAIDS 1999; Vlassoff and Moreno 2002; Whelan 1999). This chapter sheds light on the gendered dynamics of reactions to HIV infection by comparing the responses of men and women living with AIDS in Rwanda and examining the similarities and differences and underlying reasons for these responses. It shows how the process of discovering one’s HIV-positive status, living with a highly stigmatized illness and lack of resources, the emotional and sexual reactions, and the social support and health maintenance/survival strategies are mediated by imbalanced gendered cultural, social, psychological, and economic phenomena. 36 Ruth Kornfield and Stella Babalola Background HIV/AIDS is a major problem in Rwanda. By the end of 2001, an estimated 8.9 percent of Rwandans, representing about 500,000 people, were infected with HIV. Proportionally more young women than young men are infected; it is estimated at between 8.9 and 13.4 percent of the female youth aged fifteen to twenty-four years are infected, compared with only 3.9 to 5.9 percent of their male counterparts. Women comprise 58.1 percent of the approximately 430,000 HIV-infected adults, or about 250,000 individuals, and men comprise 41.9 percent, or about 180,000 individuals (UNAIDS 2002a). One peculiarity of HIV infection in Rwanda is that the prevalence is high in both urban and rural areas. From a low level of about 1 percent in the mid-1980s, HIV prevalence rates in rural areas rose rapidly to nearly 11 percent by the late 1990s, probably because the social and political upheaval of the mid-1990s fostered high population movements, widespread use of rape as a weapon of war, and high-risk sexual behaviors in refugee camps (UNAIDS 2002b). In Rwanda, there is a high level of stigma surrounding HIV/AIDS and a low level of support for those infected and affected by the virus (Kornfield et al. 2002). Antiretroviral treatment is not generally available in the country, and most HIV-infected people have limited or no access to drugs for treating opportunistic infections associated with AIDS. People who are seropositive occupy a very large percentage of beds in the hospitals. Unfortunately , the services are inadequate, and many people cannot afford to pay for them. As a result, an emphasis has been put on home-based care, but there is community resistance to this because of the stigma concerning AIDS and lack of knowledge, as well as limited resources of family members or friends. PLWHA have been organized into groups called PLWHA associations, which have a legal status allowing them to officially receive food aid and financial grants. Their objective is to improve the conditions of PLWHA through the provision of material resources, moral support, education, and income-generating activities. However, many of these associations are new and are experiencing multiple problems that prevent them from being effective. While Rwanda does have an AIDS control program, there is no systematic functioning national program to care for people living with AIDS. A few nongovernmental organizations (NGOs) and churches implement periodic projects, but these projects rely on foreign donors, with only sporadic funding resulting in lack of continuity of interventions. The result [3.137.220.120...

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