The traditional practices of wife inheritance and ritual cleansing described above are not the only ones that carry an elevated risk of HIV/AIDS for African women and girls. Two such practices are described below.
Female genital mutilation (FGM) is an umbrella term for a number of culturally motivated practices that involve partial or complete cutting of female genitals, usually performed in childhood or adolescence.158 The World Health Organization (WHO) estimates that between 100 and 140 million women and girls have undergone FGM and that about 2 million more are added to that number each year.159 According to WHO, the practice is widespread in twenty-eight African countries, which account for the vast majority of FGM cases worldwide, with Burkina Faso, Central African Republic, Cote d’Ivoire, Eritrea, Ethiopia, Gambia, Guinea, Mali, Somalia, Djibouti, Sudan, Liberia and Sierra Leone among the countries in which more than 40 percent of girls are estimated to be affected.160 Some 15 percent of women and girls who have undergone FGM have suffered the most severe form, infibulation, whereby the clitoris and labia are removed and the vaginal opening is stitched shut, leaving only a small space.161 But over 80 percent of FGM cases in Somalia, Djibouti, and Sudan involve infibulation.162 Although few clinical studies have been conducted, it is clear that at least some forms of FGM increase the HIV transmission risk faced by women and girls, both in that unsterile instruments may be used in the cutting and because some FGM is associated with chronic genital injury and tearing, ulceration, and delayed healing of injuries, all of which may increase HIV risk.163
Twelve countries have criminalized FGM by law, including some of those noted above as having high prevalence of the practice. According to the Center for Reproductive Rights, as of January 2003, perpetrators of FGM had been prosecuted only in Burkina Faso, Ghana, Senegal, and Sierra Leone among sub-Saharan countries.164 In spite of legislation, FGM gets little policy and program attention in Africa, and there is certainly little evidence that it is linked at the policy level to HIV/AIDS. Attention to HIV/AIDS programs and policy and to the importance of basic protections for women and girls provides an opportunity to energize decision-makers to enforce existing legislation and take other measures to limit the practice of FGM.
In some parts of Africa, so-called “dry sex” is frequently practiced whereby girls and women attempt to dry out their vaginas in an effort to provide more pleasurable sex to men.165 Human Rights Watch found that in Zambia, dryness is achieved by using certain herbs and ingredients that reportedly reduce vaginal fluids and increase friction during intercourse. Given the likelihood that dry sex will cause tears and lacerations in the vaginal wall, especially among adolescent girls, the practice increases the risk of HIV transmission.166 A 1999 report by the Zambian Ministry of Health and the Central Board of Health stated: “to enhance male pleasure, a number of women continue to practice dry sex, which can increase vulnerability to infection through exposing genital organs to bruising and laceration.”167
While in Zambia the practice is being discouraged by counselors working with young people and in official government documents, it is hard to know whether it is on the decline. “Like condoms, it is difficult to say if people follow what they know,” noted Brenda Yamba, an NGO official in Lusaka.168 AIDS educators discuss the dangers of dry sex in outreach programs, explaining that it is an easy way to transmit HIV. But, as one counselor told Human Rights Watch, “Men love dry sex. If you’re wet, they think it’s not normal. So we talk about it in outreach; we say ‘stop using those herbs.’”169
Counselors at the YWCA (Young Women’s Christian Association) drop-in center in Lusaka, Zambia, one of the main NGOs providing counseling for abused girls, explained that girls are made to believe that they are supposed to be dry. There is even a name given to girls who are too wet—Chambeshi River, referring to a river in Zambia.170 Some men tell girls that being wet means that they have been with too many men. Service providers working with sex workers noted that they do not generally practice dry sex; rather, it occurs more in “stable” unions where the girl or woman is seeking to maintain the relationship.171
158 Center for Reproductive Rights, “Female circumcision/female genital mutilation (FC/FGM): Legal prohibitions worldwide (fact sheet),” June 2003 [online] at http://www.crlp.org/pub_fac_fgmicpd.html (retrieved July 24, 2003).
159 World Health Organization, Female Genital Mutilation: Fact Sheet no. 241, June 2000 [online] at http://www.who.int/inf-fs/en/fact241.html (retrieved July 20, 2003).
160 WHO, Estimated prevalence rates of FGM, updated May 2001, available at http://www.who.int/docstore/frh-whd/FGM/FGM%20prev%20update.html (retrieved July 24, 2003). WHO notes that the national prevalence estimates vary in quality and reliability.
161 United Nations Population Fund, “Forms of gender-based violence and their consequences: Female genital mutilation,” available at http://www.unfpa.org/intercenter/violence/gender2c.htm (retrieved July 24, 2003).
162 Center for Reproductive Health, FGM Fact Sheet.
163 Margaret Brady, “Female genital mutilation: Complications and risk of HIV transmission,” AIDS Patient Care and STDs, vol. 13. no. 12, pp. 709-716, December 1999.
164 Center for Reproductive Rights, “FGM fact sheet.”
165 National HIV/AIDS/STD/TB Council, "Strategic Framework 2001-2003," (Lusaka: October 2000), p. 9.
167 Ministry of Health/Central Board of Health, p. 49.
168 Human Rights Watch interview, with Brenda Yamba, project manager, SCOPE-OVC (Strengthening Community Partnerships for the Empowerment of Orphans and Vulnerable Children), Lusaka, May 19, 2002.
169 Human Rights Watch interview with women from PALS, Lusaka, May 23, 2002.
170 Human Rights Watch interviews with counselors at YWCA, Lusaka, May 20, 2002.
171 Human Rights Watch interview with Professor Nkandu Luo, Lusaka, May 21, 2002.