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The Underground Economy of AIDS


ISSUE:  Winter 2006

In 2001, a group of scholars at University of California, San Francisco came up with a scheme that they hoped would protect African women from HIV. They had been working in Zimbabwe, a poor, politically troubled nation in Southern Africa, where the epidemic had killed more than a million people over two decades. Virtually everyone in Zimbabwe was aware of AIDS. The country had been exposed to anti-AIDS media campaigns since the 1980s and a school-based AIDS education program since 1994. Nevertheless, by 2001, around a quarter of all Zimbabwean adults were infected with HIV, and the virus was spreading rapidly, especially among teenage girls. It was urgent for researchers like them to come up with a solution.

Their idea seemed simple. For years, UCSF graduate student Megan Dunbar had been interviewing teenage girls living in the slums around Zimbabwe’s capital, Harare, and like many AIDS experts, she had come to recognize how the spread of HIV was driven by poverty and by unequal power relations between men and women. Many of the girls told her that they relied on boyfriends for material support. Although few of the girls were truly destitute, Dunbar came to see how their bleak, impoverished lives led them to place great value on the smallest gifts of cash, jewelry, make-up, and clothes. Most of the girls said they had only one sexual partner and were not prostitutes. But the transactional nature of their relationships placed them at very high risk of HIV, because some of their boyfriends were supporting other girlfriends at the same time, and they were thus at high risk of HIV themselves. Some of the girls said they used condoms, but since several of them had been pregnant, they cannot have used them all the time. When Dunbar asked them about the risks they were taking, they said that their economic difficulties were a far greater concern for them than AIDS was.

Dunbar reasoned that helping these young women earn enough money to meet their material needs would protect them from AIDS. Boys could always find odd jobs like running errands or helping out in the bus park, the girls said, but people didn’t hire girls. So Dunbar decided to set up a small loan—or microfinance-program to enable the girls to start their own small businesses. Since the 1970s, similar “microenterprise” programs had helped many poor women around the world gain a degree of financial independence. In some cases researchers had found that women who participate in such programs have fewer children than other women, and those children are healthier. Dunbar wanted to see whether such a program could also help protect young African women from HIV by giving them more personal autonomy and control over their sexual lives so they could assert their rights within relationships and decide for themselves whether to have sex or not, and insist on condom use if they did.

Admittedly, this was not an auspicious time for anyone to start a business in Zimbabwe. The economy was in a dire state, due to a combination of disastrous leadership by the country’s president Robert Mugabe and ruinous advice from foreign creditors such as the IMF and World Bank. The 1990s had seen the closing of numerous factories and the firing of thousands of public sector teachers and health care workers. The poor young women Dunbar wanted to help had few skills; some could barely read. Even in better days, Zimbabwe’s formal economy would have offered them few opportunities. However, the slums around Harare, like those surrounding cities and towns across Africa, were home to a bustling informal economy in which cheap food, clothes, and household products were traded at makeshift markets and among neighbors, relatives, and friends. Millions of poor, unskilled Africans, including women, earn their living in the informal economy, even in relatively wealthy countries like South Africa and Botswana. Dunbar reasoned that with a small amount of capital, girls in the slums of Zimbabwe could do so too.

During the past twenty years, public health and population experts have come to recognize the fundamental links between women’s health and women’s empowerment. Strengthening women’s economic independence has been declared an important HIV prevention strategy by the UN Commission on the Status of Women and by UN Special Envoy for HIV/AIDS in Africa Stephen Lewis. “Finally the world seems to understand that [in Africa] this is a gender-based pandemic,” he said in 2001. “Unless there is recognition that women are most vulnerable . . . and you do something about social and cultural equality for women, you’re never going to defeat this pandemic. This is the fundamental centerpiece of the whole blessed crisis! Men haven’t changed their behavior, so women somehow have to be strengthened to be able to ward off the men.” If Dunbar’s scheme worked, it would provide further confirmation of the strong links between women’s empowerment and AIDS, and provide a remedy as well.

Dunbar’s study was funded by the US National Institutes of Health, a vast organization that spends some $3 billion a year on AIDS research and has a powerful influence on global health policy. It is not surprising that NIH would have looked favorably on Dunbar’s proposal. US foreign policy experts increasingly recognize that gender inequality is not only an injustice in its own right, it also hinders economic development. Women’s labor generates most of the wealth in developing countries, but most of it is unpaid. Microfinance programs bring women into the cash economy, which could help spur economic growth, instill the poor with entrepreneurial habits, and encourage greater understanding of the benefits of free markets.

During the summer of 2004, Dunbar’s program, which was called Shaping the Health of Adolescents in Zimbabwe, or SHAZ, recruited fifty young women aged 16 to 20 from Chitungwiza and Epworth, two slum neighborhoods near Harare. The women were given training in entrepreneurial skills such as making a business plan, identifying markets, and managing finances. The young women also attended a series of workshops in the subject of AIDS prevention that included sessions on sexual relationships, gender inequality, and the use of condoms. In September, each woman chose a business to go into and received a loan of about $150, to be repaid in monthly installments with their profits.

When I arrived in Harare six months later, only 5% of the girls had met their loan repayment targets, one of the worst records of any microfinance project, anywhere in the world. Zambuko Trust, the microfinance agency that administered the loans for SHAZ had actually lost track of nearly half the girls in the program. More worrisome still was that SHAZ seemed to be having the opposite of its intended effect on the young women’s sexual behavior. The researchers had not anticipated that their program to “empower” these poor women was actually placing them right in the path of HIV.

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Shortly after I arrived in Harare, I met Tafadzwa Mandipaza-Jemwa, the Zambuko Trust loan officer who was working with SHAZ. “I knew there were going to be problems from the beginning,” she said. “The greatest error the researchers made was to assume that any poor person can just go out and start a business. Many of them just can’t do it on their own.” Tafadzwa told me she was still in touch with many of the girls, and she offered to take me to their homes in Chitungwiza, about fifteen miles from Harare. For three days, Tafadzwa and I drove through the rain-soaked slums searching for SHAZ participants, and listening to stories of one failed business venture after another.

We met a bright twenty-year-old named Proud, who told us she used her loan to buy a sack of used clothes from a dealer in Harare. The clothes in turn came from dealers in the US who collected donated items and shipped them overseas. Zimbabwe once had a lively manufacturing sector of its own that produced clothing for the local market. The factories were protected by tariffs and subsidies, but in the 1990s, the World Bank and IMF which loaned the Zimbabwean government millions of dollars a year, insisted that these barriers to free trade be eliminated. This move all but wiped out Zimbabwe’s clothing factories and threw thousands of people, many of them women, out of work. Before long, the local market was flooded with cheap secondhand clothing from the US, and cheap imports from China, two countries that use trade barriers to protect their own manufacturers.

The imported secondhand clothes created new opportunities for unskilled people who began to transport and trade them all over Africa. Proud planned to resell the used clothes she bought in Harare in the rural village where her grandmother lived. On her first business trip, she found that although people in the village wanted to buy the clothes, they had no money. Instead, they offered to pay her in sacks of maize meal—the staple food of Zimbabwe, which they grew on their own plots of land.

Proud’s timing seemed favorable. She knew that the maize meal would fetch a good price in Harare. In recent years there had been periodic food shortages all over the country, and people were eager to stock up. Until recently, Zimbabwe had been the breadbasket of the region. Millions of tons of maize were grown on vast commercial farms owned by whites whose pioneer ancestors had settled more than a century ago in what was then known as Southern Rhodesia. These mostly British settlers displaced thousands of African peasants and at independence in 1980, President Robert Mugabe promised his people that this land would be returned to them. By the late 1990s, a period of deepening poverty in Zimbabwe, Mugabe declared that the process of restitution was going too slowly. Cadres of young Mugabe loyalists claiming to be veterans of the liberation war then appropriated virtually all of the commercial farms in the country and expelled their white owners. Mugabe then instructed the “war veterans” to parcel off the land into smallholdings for landless peasants. Unfortunately, many of these peasants lacked the seeds, fertilizers, capital, and skills to run the farms; others had no idea how to farm at all. Food production fell sharply, and in order to avert famine, the government was forced to regulate prices. This created a black market, which provided opportunities for traders like Proud.

Proud packed the maize meal into a large canvas sack and set out for Harare by bus. On the way, the vehicle was stopped by the police, who soon found Proud’s contraband maize and confiscated it. When Proud protested, one of the policemen made a pass at her.

Everywhere the SHAZ girls went, it seemed, men tried to seduce them. Several feared they would be raped. A girl named Immaculata told me she had hoped to use her loan to work with a friend of her mother’s who was a cross-border trader. Every Saturday night the older woman boarded a bus to Zambia, where prices were lower, and on Sunday she brought a load of goods—kitchenware, toys, and other cheap imported items—back to sell in Chitungwiza. Immaculata arranged to join one of these buying trips, and set out one Saturday afternoon for Harare. She made it as far as the bus station. She stood for a while amid the noise and the dust and the leering strangers and then she just went home.

Several young women vanished entirely after receiving their loans. When Tafadzwa went to visit them, their relatives said they had moved away. SHAZ was an experiment, and girls who did not repay their loans were not penalized. But Tafadzwa suspected many were afraid she would punish them anyway. Some would shout at her, and others just burst into tears when they saw her. “I don’t know why they did that,” Tafadzwa said. “Maybe it’s a way of avoiding repayment. Maybe when they think about the loan they also start to think more deeply about their other problems. The other day I went to visit a girl at her house and her grandmother told me she wasn’t around. She said the girl had gone up-country somewhere. But then a few hours later, I saw the same girl in the road.”

At a tiny crumbling house on the edge of a tiny alley in Chitungwiza, we met the aunt of one of the young women who had disappeared. She said her niece had become “unruly” after receiving her loan, and was now out of town with a boyfriend. “The trouble started when the first loan payments were due,” the aunt explained. “She ran away because she can’t repay the loan. The way girls escape from trouble is by getting a man, so that’s what she’s doing. She’s looking for that money now.”

The grandmother of another young woman whom Tafadzwa had not seen in months told us, “When she got her loan she went and bought six pairs of slippers. I don’t know what she did with them. Then she eloped with a man in the road.” She asked us, “What did you teach them at that program? To go after men?”

At another house, the brother of a loan recipient told us that his sister was not around, and then he swore at us and told us never to come back again.

Most of the girls who disappeared were orphans. It is part of the cruel logic of the AIDS epidemic that children whose parents have died of the disease are roughly three times more likely than other children to become infected themselves when they become sexually active.

It is not known why orphans are so vulnerable to HIV, but after talking to the SHAZ girls—or the people who knew them—it is not hard to speculate. Some are raped or seduced by people who should be protecting them; others are propelled by necessity into prostitution. Others, neglected and abused, turn bitter and rebellious.

Tafadzwa’s male colleagues at Zambuko were afraid of some of the SHAZ girls. “When we went to give out the loan money, some of the girls were flirting with us,” a male Zambuko accountant told me. “They kept saying, ‘You are very handsome!’ The orphans were the toughest of all.”

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What the Western researchers and aid workers who advocate for the empowerment of African women may not realize is that sex is integral to the frontier economy in which the poor live. You don’t see this when you drive around the muddy lanes of places like Chitungwiza and gaze out the window of your vehicle. You see the Chitungwiza market with its wooden stalls tented with plastic sheets; you see stout women in headscarves, long dresses, and heavy cardigans bustling over heaps of vegetables; you see women selling fly-strewn coils of raw meat, or dusty pairs of shoes displayed on tarps on the ground, or racks and racks of clothing—frilly Chinese-made party dresses, polyester men’s dress shirts, shiny track suits. You see ancient minibuses heaving along with bales of goods teetering on their roofs. You get a powerful sense of interdependent, organic complexity; you see how creative the poor can be, even in the wreckage of an economy like Zimbabwe’s. Poor people are ingenious at finding a livelihood. They seem to recover from the worst blows the way forests regenerate after a fire, and often do better if no one tries to cultivate them. But the rules governing this seemingly spontaneous process are as intricate and subtle—and as tough—as those of any other system in nature.

Throughout history, poor women have used their sexuality to cope with poverty, a trend that has almost certainly increased with economic globalization. Traditionally, most poor women in developing countries worked on family farms and their sexuality was generally supervised by their relatives. However, this system of small scale family-based agriculture has become increasingly unsustainable. These days, small farmers cannot possibly compete with the large commercial farms that market their products all over the world. These companies, often owned by powerful businessmen or multinational companies, have access to the best fertilizers, and the best techniques in irrigation, pest and weed control, marketing, packaging, shipping, and quality assurance. Economic globalization has brought benefits and opportunities to some people, but it has also all but destroyed, in a few generations, a way of life that had sustained billions of people for millennia. President Robert Mugabe’s quixotic attempt to turn back the clock and return the land to his people is unlikely to restore it.

Impoverished women all over the world—many abandoned by feckless men who are themselves very poor—have had to negotiate new strategies to fend for themselves and their children. Interestingly, impoverished women in Africa and Asia have been adapting to this situation in different ways, and their differing strategies may partly explain why HIV infection rates in southern Africa are ten to one hundred times higher than they are virtually anywhere in Asia.

In Asia, impoverished women whose families are unable to support them often end up in the organized brothels of Bombay, Bangkok, or Shanghai. These women are at high risk of HIV, but because each of their male partners tends to have sex with them infrequently—perhaps five or ten times a year—these men, and their wives, are at relatively low risk of infection. Condom use is increasingly the norm in encounters with prostitutes, and this further protects the general population from HIV. This probably explains why in Asia, HIV rates in the general population are low and stable or declining, and mainly concentrated in the big cities where the brothels are.

Compared to Asia, a relatively small fraction of impoverished women in sub-Saharan Africa work exclusively in the sex trade and the continent has few organized brothels. Instead, many poor African women work in the informal economy as traders, hairdressers, shop-keepers, and so on. Although these women are not considered prostitutes, and have many fewer sexual partners than Asian prostitutes do, they often make casual sexual arrangements with male “facilitators”—for example, the man who delivers the clothing they sell, or the police officer at the roadblock, or the man who rents them space in the market. Such relationships are often based on friendship and mutual trust as well as economic expedience. Nevertheless, the risk of contracting HIV in such relationships can be just as great as it would be if they were dedicated prostitutes with hundreds of partners a year.

When it comes to HIV risk, it is not only the number of sex partners that matters, but whether those partners are part of a larger sexual network involving long term concurrent relationships. In Africa, a tradition of polygamy, along with widespread poverty—especially among women—has give risen to a system of sexual networking in which a significant number of men and women have more than one—perhaps two or three—ongoing relationships at a time. Such “long term concurrency” is far more dangerous than the “serial monogamy” common in Western countries—or even the casual and commercial one-night stands that occur everywhere—because it links people up in a giant web of relationships that creates ideal conditions for the spread of HIV. The women who engage in concurrent relationships—or who tolerate male partners with concurrent partners—are not prostitutes, even though their relationships often have a “transactional” aspect. But because these relationships are long-term and involve a degree of trust and sentimental attachment, condoms are seldom used. This is why in Africa, HIV rates are lowest in traditional farming communities, and high in places where women participate in the informal economy such as periurban slums like Chitungwiza or small market towns along truck routes or beside large development projects such as mines or in rural areas where people have abandoned farming and now rely on remittances from migrant workers in the informal economy. Empowering African women by helping them start small businesses may have many benefits, but it is not always the best prescription for fighting HIV, because when they try to empower themselves by finding niches in the informal economy, they are often forced right into the path of HIV.

In both Asia and Africa, the AIDS epidemic is driven by poor women’s struggles to negotiate a livelihood in a male-dominated society. Why have Asian women tended to resort to formal prostitution, while African women have turned to informal sexual bartering in longer-term relationships with men they know? A 1989 article by the Australian demographer John Caldwell, entitled “The Social Context of AIDS in Sub-Saharan Africa,” suggests there may be historical reasons for this. In Asia, as in Europe, land was a family’s most valuable asset, and families had to guard a daughter’s chastity to ensure she did not lose her dowry to some rogue pretender from a lower social class. A clear cultural distinction emerged between “good” or “moral” women, who had sex only in marriage, and “fallen” or “immoral” women, who were estranged from their families and wound up in the brothels and dark alleys of the slums. In most of Africa, the soil is far less fertile than in Asia and Europe, and African Iron Age farmers tended to practice shifting agriculture. They would settle in one place for a period of time and then move on when the soil was exhausted. Their most valuable commodity, Caldwell notes, was labor, not land, and therefore the economic consequences of out-of-wedlock births were less serious. This does not mean that African sexuality is not governed by strong moral rules. It is, but they just don’t always correspond to traditional Western or Asian morals. In particular the distinction between a “moral” and an “immoral” woman is far more complicated, and based on a range of characteristics, for example, whether she is polite, respectable, and generous, whether her children are clean and well-behaved and whether she drinks or fights with others.

It is also important that she be extremely discreet. While male infidelity is often tolerated—indeed, a man who can support several wives or mistresses may be expected to do so, and may even be seen as failing in his social duty if he does not—women must keep their affairs secret. But because so many African women are so poor, many rely on more than one man to support them and their children. If a woman accepts a gift or support from a man, she is generally expected to sleep with him and may suffer abuse or violence if she refuses. On the other hand, if her husband or long-term partner finds out about an affair—or even grows suspicious—he may well beat her for that reason too.

*  *  *  *  

Some of the young women in the SHAZ program did succeed in business, at least at first. But then things soon fell apart for nearly all of them as well. Sometimes relatives would see them gaining independence, and—perhaps sensing the inevitable sexual risks this independence involved—tried to rein them in. The mother of one young woman offered to keep her daughter’s loan money for “safekeeping” but then spent it herself and never returned it. Another young woman named Primrose told me how she had used her loan to buy and sell firewood. The money came in quickly and at first she was able to make the repayments. She had already taught herself hairdressing and she planned to open a salon when she had enough money.

As her firewood business took off, Primrose noticed a change in her husband’s behavior. He was a factory worker and they had a daughter who was now four. The marriage went well, at first. But a few years ago, he had started drinking and coming home late and spending all his money on beer and, Primrose suspected, other women. When Primrose asked him where he had been, or asked for money for the child, he beat her up. But now that she had her own money, he started to treat her with more respect. He brought more of his own money home, and sometimes in the evening the two of them would sit and plan their future together. Then one day, another man made a casual pass at Primrose when she met him on the road. She blew him off. “I am not the Scramble for Africa,” she said, referring to the nineteenth-century competition among the imperial powers of Europe for sovereignty over different parts of the continent. But she made the mistake of telling her husband about the incident. A few days later, he broke the man’s glasses in a barroom brawl. Primrose had to spend every penny she had earned to get her husband out of jail, and now, she says, he has no intention of paying her back.

“Does he think you would leave him if you got the money back?” I asked.

“Yes, he’s aware,” said Primrose.

“In Africa, you can’t empower women and girls in isolation,” a Zimbabwean woman who worked for SHAZ explained to me. “African society isn’t individualistic. When the Western people promote ‘empowerment’ they just end up promoting the breakdown of families, which is happening anyway.”

Western feminists often fail to realize that African society is like a giant web. It is impossible to alter one strand without making a mess of the entire thing. This connectedness is captured in the ancient African concept of Ubuntu—the meaning of which is expressed in the Zulu saying, “A person is a person through other people.” When the anti-apartheid hero Archbishop Desmond Tutu uses the word Ubuntu in his speeches, his Western listeners usually assume he is referring to a special African version of humanitarianism or solidarity. But Ubuntu has a broader meaning than this. It also captures the system of obligations and responsibilities that constrain behavior, restrict individualism, and limit freedom. The American women of the 1950s, whose ideas shaped contemporary feminism—and are now helping to shape contemporary development policies—saw gender inequality as being entirely due to the arbitrary economic and social discrimination against women by men. Freedom meant negotiating with men, challenging them, and in some cases, suing them. African women, on the other hand, are oppressed by the entire system under which they live. Their families are being torn apart by poverty and there are no institutions to protect them. They are obliged to use whatever resources they have, including sex, to negotiate a degree of freedom in a world wracked by forces they can barely comprehend.

Copyright © by Helen Epstein

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