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If it can be said, as it can, that by the year 2020, the number of deaths from AIDS in Africa will approximate the number of deaths, military and civilian combined, in both world wars of the 20th century, then it should also be said that a pronounced majority of those deaths will be women and girls. The toll on women and girls is beyond human imagining; it presents Africa and the world with a practical and moral challenge which places gender at the centre of the human condition. The practice of ignoring a gender analysis has turned out to be lethal. . . .For the African continent, it means economic and social survival. For the women and girls of Africa, it's a matter of life or death.

—Stephen Lewis, U.N. Secretary-General’s Special Envoy on HIV/AIDS in Africa, July 2002.

The story of the HIV/AIDS crisis in Africa, which has already claimed more than 20 million lives, is one of massive neglect and denial. Millions of Africans had already died before the continent’s AIDS epidemic even registered on the global radar screen or was publicly recognized as a problem by decision-makers in affected countries. It took even longer for Africa and the world to notice that in this epidemic, unlike AIDS in other regions of the world, women and girls became ill and died in greater numbers than men and boys. Sadly, policymakers still are not taking into account the extent to which AIDS prevalence in Africa is a direct result of relentless human rights abuses that women and girls suffer because of their gender.

The protection of the rights of women and girls in sub-Saharan Africa is a key to turning around the continent’s AIDS crisis. Relative to the scale of the problem, however, such protection is virtually ignored as a policy tool and certainly not viewed as a central element in ever larger national AIDS programs. The challenge of protecting women and girls from these AIDS-related human rights abuses is enormous. The abuses are many and varied, including rape within and outside of marriage, other sexual violence and coercion often abetted by poverty, domestic violence, unequal property and inheritance rights, divorce laws that exacerbate women’s economic dependence on their husbands, and discriminatory barriers to education and health services. All of these human rights abuses have existed for a long time and many have been life-threatening, but with HIV/AIDS they are lethal on a massive scale.

HIV/AIDS impoverishes families. Its spectral presence in the household makes it less likely that girls will be enrolled or kept in school because families prefer to use their scarce resources for boys’ education. Girls are also more readily called upon to care for the sick or to earn income in times of need. The absence of antiretroviral treatment, still the rule and not the exception in Africa, means that people are dying, not living, with AIDS. Women widowed by AIDS suffer the injustice of both statutory and customary law that militates against their being able to retain marital property. The stigma of AIDS often leads to their being abandoned or abused. The millions of children orphaned by AIDS face a stunning array of human rights abuses, many of them more frequent and deadly among girls than boys. Girls and women in households touched by AIDS and by poverty frequently find their choices and possibilities so diminished that they have to turn for survival to the sex trade or to situations of lodging or work that expose them to sexual abuse and violence, increasing the risk that they themselves will die of AIDS.

Human Rights Watch has documented many gender-based human rights abuses in Africa that fuel the epidemic and make unbearable the lives of women and girls already living with HIV/AIDS. Our research is based largely on the moving and often horrifying stories told to us by African women and girls who have suffered abuse; many such stories are featured in this report. It is our hope that some understanding of the human reality of these abuses will lead to greater protection of the rights of the girls and women like those who have courageously told us of their experiences at the center of a deadly epidemic.

AIDS distinguishes itself from other high-mortality infectious diseases by the fact that young adults are disproportionately stricken. This also means that the orphaning of children is a consistent feature of AIDS deaths. In several African countries, Human Rights Watch has documented a range of atrocious violations of the rights of children orphaned by AIDS or whose parents are ill with the disease. These include physical and sexual violence by those who care for them in the absence of parental care, trafficking for their labor, hazardous labor of other kinds, abuses associated with living on the streets, and abusive treatment in schools. Girls are more likely to suffer the worst consequences of these abuses, especially sexual and physical violence. The plight of girls affected by AIDS in Africa, as of all AIDS orphans, constitutes a human rights emergency.

Even for girls whose families are not directly stricken by AIDS, entrenched poverty, the favoring of boys’ over girls’ education, and lack of legal protection against discrimination and exploitation often contribute to situations in which they see no options but to trade sex for survival. As a girl in Kenya told us, “I may have to go into prostitution, and then I know I will get HIV and die; I would rather have a real business, but it is not easy.” Even if they understand the risk of AIDS, girls may through economic desperation resign themselves to sex without condoms if there is a greater return in money, food or other elements of survival. Others find themselves unable to negotiate condom use out of fear of violence or coercion. In spite of these abuses, it is difficult to find programs of significant scale that attempt to protect African girls from sexual abuse and coercion as part of national AIDS programs. It is rare to find a decision-maker on the continent who links these sexual and gender-based abuses to the strikingly higher HIV prevalence among girls and young women than their male counterparts that persists in many countries.

Child trafficking is a shocking and long-standing crime in many parts of Africa, and it, too, takes on lethal dimensions in the face of a raging AIDS epidemic. Orphans and other children without parental care are plainly more vulnerable to being lured into trafficking with the promise of schooling or lucrative work, as Human Rights Watch discovered in its encounters with previously trafficked children in Togo. Boys are also trafficked, but girls may be the first to be pulled out of school and sent abroad in cases where parents cannot afford school fees. Trafficking of girls is also more likely to lead to situations of domestic work or work in streets and markets where sexual violence is a high risk. A number of girls who told us their stories had also been exposed to the risk of sexual and physical violence in the course of their transportation from Togo to another country in the region. Combating child trafficking has been the subject of numerous high-profile declarations by virtually all affected countries in Africa, but states continue to allow anti-trafficking programs to be underfinanced and inadequately supported by effective national and regional laws and law enforcement practices. The link between child trafficking and AIDS appears not to be appreciated at the policy level.

Girls who have the opportunity to stay in school too often face sexual abuse in school or on their way to or from school. In South Africa, for example, Human Rights Watch encountered many girls who had been raped and sexually harassed by teachers or school administrators, a heinous abuse of power by those in authority over children. Others recounted having been raped or harassed by fellow students as school managers stood by and did nothing. South Africa is hardly alone in this regard. To date there have been few well financed programs that address protection for girls at school.

Married women in Africa may not be any more protected from HIV/AIDS risk than other women and girls. In African society, as in many parts of the world, married women often face violence and abuse if they demand condom use or refuse sex from their husbands or long-term partners. Human Rights Watch’s investigation of the link between domestic violence and HIV/AIDS in Uganda showed that men were often ready to beat their wives rather than confront the reality of AIDS or allow their wives to seek HIV testing and counseling. In story after story, women were confronted with the presumption that marriage entails automatic consent to sexual relations of which the terms are dictated by the husband. In Uganda as in many countries, this presumption is shored up by divorce and property laws and customary practices that disadvantage women who try to escape abusive marriages. With few exceptions across Africa, marital rape is not recognized as a crime, and domestic violence is seen as a right of married men. Even in Uganda, the African country cited most frequently for its success against HIV/AIDS, domestic violence and abusive subordination of women do not figure in AIDS program priorities.

HIV/AIDS will cause many millions of African women to be widowed, and widowed at a younger age than would have been the case in its absence. Gender inequality in property and inheritance laws in Africa poses a grave threat to women in these circumstances. African women’s rights to own, inherit, manage, and dispose of property are under constant attack from customs, laws, and individuals, including government officials, who believe that women cannot be trusted with or do not deserve to own or control property. The devastating effects of property rights violations¾including poverty, disease, violence, and homelessness¾are only magnified and made more lethal for women who face the stigma of having been widowed by AIDS or who are themselves HIV-positive.

An in-depth study of property rights violations by Human Rights Watch in Kenya recounted many stories of women excluded from inheriting property, evicted from their lands and homes by in-laws, stripped of their possessions, and forced to engage in risky sexual practices in order to keep their property. Many widows we met were coerced into the customary practice of “wife inheritance,” whereby a widow is taken as a wife by a relative of her late husband, or ritual “cleansing” whereby widows are obliged to have sex (usually unprotected) one time or over a short period with a man who is a social outcast. Not only do these practices demonstrate that many African women have virtually no control over their own bodies but they also place the women at risk of contracting and spreading HIV. Their destitution in being stripped of all they have removes their last hope for caring for themselves and their children. Injustices in women’s property rights have been ignored for decades by governments across Africa, and redressing them seems to figure nowhere in HIV/AIDS policies and programs.

Property ownership and domestic violence are examples of areas where customary law is a major obstacle to the realization of women’s equal rights in Africa. Customary laws are mostly unwritten, constantly evolving and prone to subjective interpretation. In some countries, there are as many customary laws as there are ethnic or tribal communities. Most African countries have ratified the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), which obliges them to eliminate customary laws and practices that are based on the idea of inferiority of women (or of men) or on stereotypes of women. But the application of customary laws that embody injustice for women still goes unchallenged across the continent.

Among the most horrific gender-based violations of human rights in Africa in recent years has been the use of rape as a weapon of war. Although not as geographically widespread as other abuses described in this report, sexual violence in war goes hand in hand with the near universal subordination of women and girls on the continent. Women and girls in the Democratic Republic of Congo, Sierra Leone, northern Uganda, and Burundi told Human Rights Watch of unimaginably horrific abuses they suffered in those country’s civil conflicts. Rape is used strategically in these cases to terrorize the population and destabilize the economy, which is very effectively done when women’s economic activities are impeded by fear and violence. The international bodies that can exercise some leverage in these situations have done virtually nothing to push for basic protections that could reduce these abuses and mitigate their worst effects.

With respect to virtually all of the gender-based abuses described here, Human Rights Watch has consistently found that legal and judicial remedies for women and girls are inadequate or nonexistent. Even where sexual violence laws are adequate, the laws are rarely enforced. The stigma of rape keeps it underreported and its perpetrators safe from prosecution. When women or girls are courageous enough to file complaints, law enforcement officials are rarely trained for sensitive and effective handling of sexual and domestic violence cases.

Though the abuses are many and deep and are often shrouded in shame and secrecy, they are not impervious to policy, legal and program solutions. This report offers recommendations for concrete measures that can have immediate and long-term impact on the worst manifestations of HIV/AIDS-related human rights abuses against women and girls. These include actions to promote equal access to health services and education, equality in property and inheritance laws and related elements of economic dependence, and measures to protect women and girls from sexual abuse and to ensure that perpetrators are brought to justice. In some cases, because these are relatively new areas for policy and programs, it may not be easy to get the policy right on the first try. But the policy paralysis that now surrounds gender-based human rights abuses linked to AIDS in Africa is scandalous and deadly.

There are some signs that since the U.N. General Assembly Special Session on HIV/AIDS and the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria, both in 2001, HIV/AIDS in Africa is beginning to attract international funding, though still on a small scale relative to the scale of the epidemic’s destruction. As national AIDS control programs across the continent draw greater national and international resources, they provide an opportunity to transform the level of support that the fight against gender inequity in Africa has so far enjoyed.

It is a shame that a crisis of the proportion of HIV/AIDS is necessary to focus attention on human rights abuses of women and girls in Africa, but it would be unconscionable for governments to miss this opportunity. African governments and donors alike must begin to see protection and fulfillment of the rights of African women and girls as a central strategy in the fight against HIV/AIDS. This means more than occasional rhetorical flourishes or poorly funded gender components in larger projects. It means real resources, real coordination across sectors, and real participation by women in decision-making. Without this commitment, the conspiring forces of HIV/AIDS and gender inequality in Africa will win the day.1

1 Note on methodology: this report relies heavily on Human Rights Watch’s extensive documentation of human rights abuses against women and girls in Africa and our experience advocating for elimination of these abuses. A list of prior Human Rights Watch reports drawn upon for this report, each of which includes detailed policy and legal recommendations, is found on the back cover. These reports provide first-hand testimony and additional legal and policy analysis related to many of the issues discussed here.

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December 2003