The gender context of vulnerability to HIV/AIDS: The case of men and women in low income areas of the city of Lilongwe in Malawi

Ezekiel Kalipeni, Jayati Ghosh

Research output: Chapter in Book/Report/Conference proceedingChapter


The HIV/AIDS epidemic in Malawi and other southern African countries has wreaked havoc with tragic demographic, economic and social consequences. In Malawi, HIV/AIDS prevalence in the urban areas of Lilongwe and Blantyre has been much more pronounced in comparison to rural areas. For example, in 2005 standardized urban prevalence rates for Lilongwe and Blantyre were 19.8 percent and 26.3 percent respectively, compared to 12 percent for rural areas (Weir et al., 2008: p. 20). As Weir et al. note, although the high prevalence levels seen in previous decades have abated, both these cities suffer from an ongoing and unrelenting epidemic. These authors identify a number of community and individual based factors which have fueled the rapid spread of this epidemic, namely, HIV stigma, poverty, marital patterns, labor migration and mobility patterns, sexual norms, religion at the community level and education and knowledge about the disease at the individual level. In a similar vein Lindgren et al. (2005) tease out these very same factors in a study they conducted through focus group interviews with Malawi women. Using a gender/power relationships approach, Lindgren et al. describe these factors which are poignantly characterized by the statement, “We are just vessels for our husbands” (p. 70). Their study offers a wealth of information relating to women’s roles, power relations and the general disempowerment of women in Malawian society, all factors which have led to the rapid proliferation of HIV. They conclude that health education alone is insufficient to stem the tide of HIV in Malawi. If HIV is to be effectively tackled, then there is a need to shift the approach from a concentration on the “Abstinence, Be faithful, and use a Condom” (ABC) approach to a multidisciplinary and systematic approach that includes women’s education and economic empowerment, as well as modifying legal and social structures that contribute to the spread of HIV/AIDS in Malawi. Our study contributes to the unraveling of the community and individual level factors in low socioeconomic income areas of Lilongwe. Employing the gendered nature of vulnerability to HIV, we attempt to answer two basic questions: (1) what makes women in Malawi vulnerable to HIV? (2) How is this vulnerability configured differently than for men? Thus the central goal of this paper is to examine in greater detail the social and economic contexts of vulnerability to HIV among women in comparison to men in the city of Lilongwe. It is of great importance that we understand the socioeconomic and cultural contexts of HIV spread, particularly in cities such as Lilongwe where rates are two times higher than in rural areas. The standard biomedical/epidemiological model with its focus on behavior change alone needs to be reconsidered in the case of HIV/AIDS. Our argument is that HIV/AIDS is rooted in structural factors of history and poverty and in culture and society more than it is in biology and environment; that is, we explicitly link structure and agency. Therefore analysts have to consider HIV/AIDS, first and foremost not as a health issue or by invoking a biomedical epistemology, but rather as a development issue as several authors have argued. Consequently, moving beyond the health dimensions into broad development programs that diminish poverty and women’s vulnerability to disease is required. Unfortunately, biomedical and epidemiological models of inquiry and dealing with HIV continue to dominate and obtain an unfair share of the resources. This situation persists in spite of the fact that the prevention and treatment strategies for AIDS currently being employed, which focus on the individual as the locus of disease and prevention, have had limited success. By assuming that individuals can automatically change their behaviors through awareness and condom possession, interventions comprising educational outreach and access to condoms leave root causes of HIV untouched. We need to recognize that biomedical and epidemiological studies and the solutions these studies offer in terms of behavior change have been insufficient to explain the rapid proliferation of AIDS in Africa because they fail to address the root causes of vulnerability. It is in this context that our study concentrates on the gender dimensions of vulnerability by highlighting women’s and men’s insights on what they consider to be the root causes of the epidemic in the low socioeconomic income areas of Chinsapo, Area 25 and Area 29 in the city of Lilongwe (see Figure 1.1). It is our hope that this study will partially fill the gap left by biomedical and epidemiological studies. The results and discussion highlight the gendered nature of vulnerability, particularly how gender inequality and poverty influence the different ways that men and women become infected. We reiterate Lindgren’s et al. (2005) study and Van Donk (2006) that any interventions that fail to address the broader issues of African social and economic life are bound to fail. This is because HIV in sub-Saharan Africa is a complex and regionally specific phenomenon rooted in local economies, deepening poverty, migration, gender, global economies and cultural politics (Kalipeni et al., 2004a, 2004b).

Original languageEnglish (US)
Title of host publicationGendered Insecurities, Health and Development in Africa
PublisherTaylor and Francis
Number of pages29
ISBN (Electronic)9781136285370
ISBN (Print)9780415597845
StatePublished - Jan 1 2012

ASJC Scopus subject areas

  • General Economics, Econometrics and Finance
  • General Business, Management and Accounting
  • General Social Sciences


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