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Published 15 June 2011

Gender inequity plays a major role in the HIV battle, says Sasha Kasthuriarachchi.

My most powerful memories from my first ever trip to Zambia are the many stories that opened my eyes as to how poverty and HIV/AIDS are inextricably linked. Sitting with a group of women, I heard about a recent case of child abuse in a community that had already experienced several similar occurrences. A 13-year-old girl had been raped by a 70-year-old man after being enticed by the offer of 20,000 ZMK - the equivalent of £2.67. The family had succeeded in ensuring the man was arrested but their daughter was now pregnant and also needed treatment for a sexually transmitted infection.

The economic situation for the majority of rural Zambians is hand-to-mouth and extreme poverty has also forced some mothers to make awful and difficult choices: the group explained how a mother might purposely send her daughter to collect food from an older man knowing full well that this would come at a price but unaware of any other way in which to get food to feed her family. The impact of these 'transactional relationships' are reflected in the HIV prevalence statistics: females aged 15-19 are around six times more likely to be infected with HIV than their male counterparts.

My work with PEPAIDS has highlighted to me how overall, women are profoundly disempowered in Tonga society. Their subordinate position becomes further entrenched through practices such as Nkolola (a sexual initiation ceremony), polygamy and attitudes towards female sexuality,

Nkolola is a period of preparation for pubescent girls who are coming of age. Girls are taught subservience to their future husbands in every aspect of their behaviour - including sexuality. Polygamous relationships are also acceptable in Tonga culture for men but not women. A wealthy man can afford to pay the bride price to a number of families, giving himself many wives. If a woman is one of many wives, there is increased possibility that she may seek extra-marital sex for her own gratification. Given the prevalence of HIV/AIDS, this means that the man and all his wives are put at extreme risk of contracting the virus.

I saw for myself the effects of this type of gender inequality on a visit to the Ndeke clinic in Mazabuka, where I watched expectant mothers, some in their teens, and most HIV positive, come to collect their anti retroviral medication. Some women spoke of how receiving a positive test result was almost a death sentence - it would be the 'end of your life' as your husband could divorce you for bringing disease into your marriage. In the nurse's room, I was shown a folder containing medical records of women who had tested positive but had never returned to the clinic for their medicine. The battle against the stigma associated with being HIV positive remains an uphill struggle.

Through lengthy in-depth focus group discussions, SAPEP has discovered that a woman's sexual pleasure is not considered by the man in modern Tonga culture. This leads to an increased incidence of 'dry sex', with consequent micro-laceration in the vagina and increased risk of HIV transmission. While this is clearly not wholly responsible for the extreme HIV rate, it reflects a generalised disempowerment of women that is extremely dangerous in light of the HIV/AIDS crisis.

Sasha Kasthuriarachchi is one of the eight 2010 Vodafone Foundation World of Difference International winners. To find out more about this opportunity visit the World of Difference website.

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