– Emily Esplen, Women’s Rights Coordinator, One World Action
“Women are supposed to be silent in Malawi”
“Men are somewhere up top and we women are the followers”
“Sometimes I am treated as though I’m not there”
These are just some of the reflections shared by women during a focus group discussion facilitated as part of a gender audit of the Malawian Network of People Living with HIV (MANET+), supported by One World Action.
In a country where women’s experiences clearly remain profoundly shaped by gender inequality, women and girls living with HIV are among the most marginalised. Yet when I had the privilege of meeting members of the Coalition of Women Living with HIV in Malawi (COWLHA), it was their strength, solidarity, resourcefulness, positive vision and humour which characterised our exchange. Far from having no voice, these women articulated their challenges and solutions with absolute clarity and talked about intimate issues with more openness and honesty than I’ve ever experienced in the UK – from violence to condoms to sexual pleasure.
Supported by One World Action, COWLHA was established in 2007 as the first ever platform for women living with HIV in Malawi. Despite being such a young organisation, COWLHA’s achievements are remarkable. In Kasungu district of Malawi, where I met with a group of COWLHA members, what began as a collective of just 21 women has grown to encompass 430 members. Supported by a small number of very dedicated staff, these women are driving forward changes in their lives and communities.
COWLHA members told me they are no longer economically dependent on men. Now they have a garden in the district where they grow maize – a visible rebuttal of the common perception that people living with HIV are unproductive. Most striking for me were their powerful testimonies about the changes in their sexual relationships. As a result of training in human rights and communications skills, women told me they are now able to negotiate condom use with their husbands and talk more openly with their partners about their sexual lives – an enormous step in a country where sex remains a major taboo.
Empowering women to have more control over their sexual and reproductive lives is not only crucial in terms of HIV prevention, it is also enabling COWLHA women to enjoy more satisfying sex lives, an achievement that is all the more significant in light of pervasive assumptions that women living with HIV are not entitled to a love life. Another positive effect of greater dialogue between partners about sexuality is that more men are remaining faithful to their sexual partners, helping to reduce transmission of HIV.
Challenges remain, but COWLHA women were clear about the support they need to build on the positive changes achieved so far. Access to training and equipment to support the provision of home-based care is a major concern for COWLHA members, especially as women provide the vast majority of this care – a result of gender inequality, combined with inadequate health services. Others spoke of the value of supporting exchanges with other COWLHA members to enable them to share challenges and successes, and build solidarity.
Better access to female condoms is a priority for many. Female condoms are women-initiated, putting women in control of decisions around contraception. This is empowering in itself as well as being hugely important in preventing HIV transmission in a context (as in many countries, the UK included) where men are often resistant and inconsistent in their use of condoms. Yet despite the huge benefits, COWLHA members told me they find it really difficult to get hold of female condoms – often hospitals and district health offices lack supplies, a situation reiterated time and again in my conversations with women in Malawi. Better availability of female condoms, combined with training in how to use them – to help demystify female condoms and support women to feel confident about using them – could go a long way in empowering women, and protecting against HIV transmission, STIs and unwanted pregnancy.
I left Malawi not only energised and inspired by the strong, courageous women I met there, but also with clear lessons from these women about what the UK needs to do to support pioneering indigenous women’s movements like COWLHA. The UK’s commitment to increase women’s access to family planning is a positive step, but it seems that investment is still largely oriented towards greater provision of male condoms. Yes, female condoms are more expensive. But from what I heard in Malawi, they could prove much more effective in enabling women to take control of their sexual lives – surely a worthy investment. Plus it seems nonsensical to prioritise shipping out condoms for men – even though we know there is enormous resistance to using them – while women are actively asking for female condoms but can’t get hold of any due to lack of supply.
What I also learnt in Malawi is that it is possible to transform the deep inequalities in women’s sexual relationships with men. Often this crucial goal drops out of donor strategies to improve sexual and reproductive health and promote women’s empowerment because it is deemed culturally sensitive or simply too difficult to achieve. Yet for sexual and reproductive health interventions to have any chance of success, transforming unequal gender power relations is a prerequisite. As COWLHA members made clear, by supporting local grassroots organisations to challenge cultural norms, sensitise communities, and make women aware of their human rights and confident about claiming them, deep changes are possible.
This brings me to my final thought. While in Malawi, I was very struck by the absolutely crucial role that networks of people living with HIV – like COWLHA and MANET+ – are playing in responding to the epidemic. These organisations have detailed knowledge, rooted in local realities, of the social, cultural and political barriers to women’s sexual and reproductive autonomy. They are also best placed to navigate these sensitivities, including by engaging with the ‘gatekeepers’ of culture, such as traditional leaders. Moreover, as organisations of people directly affected by HIV, they have a legitimacy that INGOs and other CSOs lack. And while there is always a risk that INGOs will shift their attention and resources elsewhere along with changing development fads, these grassroots organisations are here for the long haul, making them crucial to building a national response that is sustainable.
Despite all this, in a context where the vast majority of bilateral donor support goes directly to the government, local organisations in Malawi are facing huge challenges in accessing the funds required to sustain their work and strengthen their impact. These challenges are becoming all the more pronounced with the shrinking of civil society space and the silencing of civil society voices, which make the challenges of securing funding from a hostile government all the more acute.
It is vital in light of these challenges that the UK plays a leading role in supporting this vital and difficult work to continue, and championing pioneering organisations like COWLHA, by channelling money to organisations best placed to work in partnership with truly grassroots organisations.
What was most clear from the women I met in Malawi is that HIV is a complex social and economic challenge which will only be met by tackling gender inequality and ensuring that the participation and leadership of those most affected by HIV are central to the response. These are not new lessons, yet they continue to remain peripheral to the global response. It’s about time we paid more attention to the priorities articulated so clearly by women living with or affected by HIV directly, and become much better at supporting them in driving forwards a holistic, gendered response to the epidemic.