Free The Means of Reproduction: Sex, Power, and the Future of the World by Michelle Goldberg

likely than young men to be infected. 2 The reasons for these disparities have as much to do with patriarchy as biology. “The subordinate position of women and girls—politically, socially and in sexual encounters—is ingrained in every aspect of the pandemic,” wrote Alex de Waal in AIDS and Power . 3 Stephen Lewis, the former United Nations special envoy for AIDS in Africa, went further, telling me, “The struggle for gender equality is the single most important struggle on the face of the planet.”
     
     
    A daughter of Uganda’s elite, physician Lydia Mungherera knew, in a vague and academic way, how bad things were for many women in her country. Her mother, after all, was a feminist who attended the Beijing women’s summit. Yet it wasn’t until she discovered that she was HIV-positive that the depth of women’s suffering became visceral to her.
    Mungherera was wracked with HIV-related dementia when she was brought home to Uganda from South Africa, where she’d been living and working, in 1997. Her CD4 count—a measure of immune system functioning that’s between 500 and 1,500 in healthy adults—was 1. Most people in her condition would have been dead the next day, but somehow Mungherera’s family nursed her back to health. She’d been so sick in South Africa that she was barely aware of her diagnosis, but in Uganda she learned to live with it, eventually going on antiretroviral drugs. Soon she joined the Network of People Who Are Living With HIV and AIDS, training others in the use of the drugs. She quickly noticed that the pandemic was hitting women harder than men, and not just for biological reasons.
    “Culturally, in African countries, men dominate women, and so I found myself [asking], how can we tackle this disease if we don’t fight for women’s rights?” she said. “Women don’t have rights in deciding when to have sex, and how to have sex—whether to use a condom or not. Men can have as many partners as they want—there’s a lot of polygamy here, and women don’t have a choice. You find that women are locked up in marriages where they’re not happy, and they don’t have the financial and educational empowerment to leave those marriages. There’s a lot of domestic violence, and I believe that violence drives the pandemic.” When it comes to HIV in Africa, marriage is a primary risk factor for young women. 4 At the same time, some poor single women, desperate for food, clothes, and school fees, find themselves forced into sex with older men in exchange for gifts, a survival strategy so common that billboards in Kampala, Uganda’s capital, warn against “sugar daddy” relationships.
    Looking for a way to make a difference, Mungherera, herself a mother of two, decided to focus on HIV-positive mothers, the cohort she saw as most vulnerable, and in 2004 she formed a support group called the Mamas Club, which now has branches in several Ugandan cities. Today the club, based in Kampala, draws women every day to its two-room headquarters, where they practice money-making skills like tailoring and embroidery, pool their money to make small investments, and share their burdens with each other. They also learn about family planning and their legal rights regarding property and child custody. Despite all their unfathomable miseries, the atmosphere is jovial— some of the women sing as they work on their crafts, or make jokes and erupt in knowing laughter. It’s hard to spend time with them without being a little awed by their resilience. But their stories offer a microcosmic view of the systematic discrimination that is killing so many.
    Annet, an astonishingly cheerful young woman with chin-length braids and a wry sense of humor, was fourteen when she was raped by a thirty-five-year-old, the brother of a friend. She got pregnant and, terrified about how her harsh father would react, she ran away to the only place she could—the home of her rapist, who became a kind of common-law husband.