By Deborah Johnson
SHE’S 48 YEARS OLD WITH TIGHT RED CURLS AND BAGS BEneath her eyes. She slouches slightly in the orange office chair, stretching out her feet. From her eye shadow to her sneakers, everything she wears is blue. Married to one husband for 28 years, she has children and grandchildren. She also has AIDS. She never used drugs or had multiple sexual partners. She did have sex with her husband without a condom.
For some years now, I’ve been listening to women who are HIV-positive tell their stories. In support group after support group, I’ve heard about how they trusted their partners and how that trust was violated. The women live with an angry welter of emotions they try to repress, if only because they know the damage stress can do to their T-cell counts.
One 23-year-old had a boyfriend who had hemophilia; he never used condoms and never mentioned HIV, even though he knew he had already infected another woman. A divorced man with two children didn’t tell his 46-year-old girlfriend he had AIDS, not even when he was hospitalized with an AIDS-related infection. A seven-year live-in partner of another woman denied infecting her, even though he tested positive for HIV; she didn’t know he was having sex outside their relationship.
All of these women discovered their HIV status only after they became seriously ill with infections they “shouldn’t” have had. The numbers don’t lie; heterosexual transmission in the United States is rising dramatically. Today 40 percent of newly diagnosed women become HIV positive through heterosexual sex. In Orange County, CA, where I live, it’s almost 50 percent. The seldom mentioned fact: A large percentage of these women are married or in committed relationships.
Public education efforts around AIDS almost never deliver the message that these women needed to hear in order to protect themselves. I have analyzed more than 300 HIV/AIDS television public service announcements (PSAs) from three dozen countries as part of my doctoral dissertation research. For the most part, these educational “commercials” emphasize the risks that Men – not women – run They either ignore women entirely or offer them factual information without offering any suggestions about how to use this information in the context of casual and committed relationships.
In almost half the PSAs I studied, there were no women at all. This was true even in countries where women’s infection rates equal men’s. When women did appear in the PSAs, it was usually in ways that reinforced our subordinate status. The PSAs featured twice as many male as female authorities, three times as many male celebrities, and a whopping 10 times as many male narrators.
THE NUMBER OF WOMEN DID OUTSTRIP MEN, HOWEVER, in self-effacing, care-giving roles as wives, mothers, and friends of people with AIDS. At first glance, putting women in positive roles may seem laudable. But in health education, putting a woman in any role is problematic. Being a wife or mother has never protected any woman from HIV/AIDS. And sex workers (as women in prostitution are called in international health promotion literature these days) who use latex condoms properly all the time are just as safe as anyone else. Showing women in these roles denies our multifaceted individuality and reduces us to only what we represent to others: a wife to a husband, a mother to a child. It strengthens long-standing notions of “good” and “bad” women. It’s an easy out for PSA creators, because it makes the message seem inclusive, when in fact it is most likely exclusive.
When PSAs emphasize the risks that men, not women, run of HIV, they undercut the rights of women in relationships by positioning men as the sole sexual decision-makers. Even worse for HIV/AIDS prevention, they equate safe behavior with staying away from sex workers and being faithful to your wife. We’re already experiencing their backlash, as literally thousands of women who thought themselves “safe” are finding themselves infected.
SOME PSAS TRIED TO SHAKE MIDDLE-CLASS WOMEN OUT OF this complacency. But instead of striking at the heart of the problem, which is women’s inclination to believe and trust men, the PSAs simply showed women in comfortable surroundings explaining how they became infected:
Josephine had only two boyfriends. Because
“we were perfectly ordinary,” they didn’t use
An African American woman with a baby didn’t
know “my man was shooting up drugs and sharing
needles.” Not until he died.
Tracy never dreamed her partner had used a
needle. When the doctor said she had AIDS,
Tracy replied, “You’ve made a mistake. I can’t
have AIDS. How could I have that?”
PSAs like these keep women in their place. The women accept what their partners have done and, at most, regretfully shake their heads. There’s no attempt to model responsible behavior for HIV-infected men. And female
viewers learn nothing from them about how to ask the right questions at the right time to assess their personal risk.
In a handful of PSAs, women in casual relationships do broach the subject of condoms. But the scenarios are repetitive and traditional:
Two pairs of feet–male and female–rub each
other in bed. A woman’s husky voice asks,
“You’ve got the condoms, haven’t you?”
The man breathlessly replies, “No, I forgot.”
“But we agreed to use one,” she protests.
“I know, but I haven’t got AIDS, have I?” he argues.
Turning away, she says, “Sorry. No condom. No sex.”
A woman in bed tells her male partner, “Don’t take this the wrong way.”
The man says, “What?”
She asks, “Do you have protection?”
Affronted, he demands, “Do you think I’m gay?”
“You don’t have to be gay to get AIDS,” she explains.
He gets up to find a condom.
A naked couple are making love. The woman
asks, “Do you have a condom?”
“Of course,” he replies.
“Can I do it for you?” she offers.
None of these scenarios face up to the real difficulties. It’s one thing to ask a casual partner to slip on a condom; it’s quite another to ask a man who has sworn fidelity to you and been with you for years. And in both long- and short-term relationships, gender-based power imbalances can make suggesting condoms unthinkable.
Consider a woman in Peru, known to health educators, who has struggled for decades with poor eyesight. After she lost one pair of glasses, her husband refused to buy another. She was too “stupid,” he said. Imagine her asking him to use condoms.
A nurse practitioner working with women on the East Coast found it was easier to help them stay off drugs than to get them to ask their partners to use condoms. If a woman did have the guts to bring up the subject, the man often refused. Some even turned abusive. Studies in Los Angeles and San Francisco found that almost half the intravenous drug-using women who are HIV-positive have experienced domestic violence.
In many cases, women fear that asking men to use condoms will lead to rejection or abandonment. If the woman is economically dependent, she and her children could wind up on the street.
Condoms also carry a stigma. Studies on every continent demonstrate that both men and women perceive condoms for use when having sex with “others/’ not stable partners. Or for women “of the street, not the home.” Even sex workers who are scrupulous about using condoms with clients tend to avoid them with boyfriends and husbands. All too often, condom use has become a sign for the level of trust in a relationship rather than simply a sensible means of protection.
I found only one PSA in which a woman refused to use a condom:
A young man explained to a male friend,
“She told me that if I used condoms that
would mean I didn’t love her.”
TODAY MORE THAN A MILLION WOMEN AROUND THE world are HIV-positive. With the percentage of new cases in women skyrocketing, it’s time to acknowledge that past approaches to HIV/AIDS prevention haven’t worked. We need to rethink how we portray women, how we deal with gender-related power imbalances, and how we avoid the simplistic idea that if women only knew how to protect themselves, they would.
We could begin by creating HIV/AIDS PSAs specifically for women. These would build on the premise that women are individuals, not appendages of men and children. Separating HIV/AIDS risk from roles, the PSAs would focus on how women in any role communicate with partners. Viewers don’t need to know if a woman is a wife, mother, girlfriend, or sex worker. They only need to watch women express and stand up for themselves in the best ways they can.
For some women, this will mean choosing the right moment to ask a partner what he knows about HIV/AIDS. For others it will begin with a conversation about bisexuality and drug use. For still others, it may mean telling a partner they’ve put condoms in the nightstand. Effective communication, not sexual behavior, is the point.
PSAs can teach women to empower themselves by small steps…they don’t have to jump to the big one right away. For example, educational messages could show how to use humor to bring up touchy subjects, how to question men in direct rather than indirect ways about their health, and how to be assertive in ways that enhance rather than threaten relationships.
Some PSAs already do this:
A woman who wants to start using condoms
playfully snaps one on her partner’s bare
butt. They laugh and begin talking about it.
A woman who has had sex with someone else
thinks through how to tell her live-in
partner that they need to use condoms.
Taking responsibility for their sex life is not easy for many women who think of sex as something that happens to them rather than something they choose. But that can change. In U.S. high schools today, teenagers are learning how to resist social pressure and stand up for what they want through practicing refusal skills, or how to say “no” without destroying their relationships. Admittedly, this is a long way from asking a husband of 28 years to start using condoms. But the underlying premise that an individual has the right to take care of herself and to communicate this to others is a new and significant shift.
OF FOUR WOMEN I KNOW WITH AIDS, TWO FOUND OUT they were HIV-positive when they became pregnant; another casually took a free test at a class; the fourth was tested after her husband died of AIDS in jail. Not one woman’s sexual partner told her that he was – or could be – HIV-positive. That has to change.
DEBORAH JOHNSON, PH.D., is working on a book on children and AIDS. Her research has been partially funded by the Center for Economic Policy Research and the Institute for Research on Women and Gender at Stanford University and the Henry Kaiser Family Foundation in support of the Stanford Health Promotion Resource Center.