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Diana E. H. Russell, Ph.D.
AIDS As Mass Femicide: Focus On South Africa


       Diana E. H. Russell and Roberta A. Harmes (Eds). 
         Femicide In Global Perspective

“Male sexual privilege is what drives the [AIDS] epidemic.”
— Mark Schoofs, Pulitzer Prize winning journalist, December 7, 1999, p. 68

“In this country [South Africa], rape is not just a devastating act of violence.  It can be a death sentence.”  —
Kelly St. John, 2000, p. A1

The lethal impact of AIDS on many women and girls must be recognized as a form of mass femicide that is devastating women throughout the world.  These femicides are occurring as a result of the overlap of four gender-related problems: AIDS, male sexism and domination, genital mutilation, and rape.  The following paragraph illuminates the role of male sexism and domination in causing the rapid spread of AIDS in the Caribbean.

According to Jeannie Relly, the Ministry of Health in Trinidad and Tobago reported that seven out of eight people infected with HIV/AIDS between the ages of 10 and 19 are female (February 2000, p. A15).  The Jamaican Health Minister attributed the spread of AIDS to “the irresponsible sexual behavior of our men” (p. A15).  Peggy McEvoy, AIDS policy team leader for a Caribbean program, explained that “married women face high risks because their partners are unfaithful and will not use condoms” (Relly, 2000, p. A15).  If the women insisted that their husbands use condoms, “Their husbands would kick them out,” McEvoy explained (Relly, 2000, p. A15).  “Many women are also unaware that their husbands are having extramarital affairs,” McEvoy added. 

Because the causes of women's vulnerability to AIDS in the Caribbean are common in most parts of the world, I consider the global spread of AIDS to be chiefly due to sexist male behavior.  Although some unknown percentage of women who die of AIDS are not necessarily victims of femicide (those who became infected by dirty needles, for example), many more are. 

The Global Distribution of HIV/AIDS

A recent global estimate of the number of people in the world living with HIV/AIDS is 34.3 million, approximately 24.75 million of these infected individuals are living in Africa compared to:

00900,000 in North America
1.3 million in Latin America
520,000 in West Europe
420,000 in Eastern Europe and Central Asia
5.6 million in South and Southeast Asia
15,000 in Australia and New Zealand
(United Nations AIDS Program cited by Perlman, June, 2000, p. A6)

According to another source, two-thirds of the people in the world who are infected with HIV/AIDS live in Africa (Shaw, 1999).  The highest rates of infection in the world are currently found in seven Southern African nations, including South Africa where “At least one-fifth of the population is infected” (the UNAIDS report [June 27, 2000], cited by Perlman, June 2000, p. A6; Russell [July 2000] specifies 20‰ of adults as infected).  Hence, the primary focus of this analysis will be on the particularly devastating impact of AIDS in Africa.

In sub-Saharan Africa, new figures show that 55‰ of all infected adults are women“ (Schoofs, 1999, p. 68).  And according to data compiled at UNAids: “For every 10 African men with the disease there are 12 infected women” (Reuter, 1999, p. 4).   

The causal relationship between male sexism and domination, genital mutilation, rape and the AIDS epidemic in Africa will now be addressed in this order.

Male Sexism and Domination and AIDS

Heterosexual males' sexist and misogynist beliefs and behavior toward females in patriarchal societies is a major cause of the spread of AIDS, and hence of increasing rates of femicide. (1)  The passage on the spread of AIDS in the Caribbean (above) gave examples of common manifestation of male sexism and male domination that can have lethal consequences for females when their male partners have HIV/AIDS:

1. Males who refuse to wear condoms with their female partners despite engaging in sexual relations with others (male and/or female);

2. Males who engage in sex with others (male and/or female) but who fail to divulge their non-monogamous behavior to their female sex partners.  This deprives these women of the opportunity to protect themselves from contracting HIV, to protect any children they may have from the same fate, and to save their own lives by refusing to engage in sexual relations with their partners. 

Other examples include:

3. Husbands who are entitled by patriarchal law or custom to expect, demand, and/or force their wives to engage in sex with them, and who act on this conjugal right.

4. Men who are ignorant of their HIV-positive condition and who do not wear condoms or refuse to wear them.

5. Men who have sex with prostituted women.  These women are at very high risk of having HIV/AIDS, especially if they fail to wear condoms.  Many women — including prostituted women — do not know the importance of wearing condoms for protection and/or they accommodate their customers who may dislike or refuse to wear them.  Some men are also ignorant of their importance whereas others consider it less satisfying and put their own enjoyment above women's preference and/or safety.

The women and girls who contract HIV/AIDS from their male partners because of their sexist attitudes and behavior, and/or their superior power and dominating status, are — when they die — victims of femicide. 

Village Voice journalist Mark Schoofs (1999), who won the Pulitzer Prize in 1999 for his series of articles on AIDS in Africa, devoted one article to “Death and the Second Sex.” This article on femicide provides devastating evidence of male domination in Southern Africa, and how this relates to AIDS.  For example, Schoofs (1999) notes that “African women subordinate their sexual safety to men's pleasure” (p. 67). “Throughout southern Africa, where the AIDS epidemic is worse than anywhere in the world,” many African women practice “dry sex” (Schoofs, 1999, p. 67)  Some women dry out their vaginas with soil mixed with baboon urine, others use “detergents, salt, cotton, or shredded newspaper” (p. 67).  Schoofs (1999) describes the way in which Sipewe Mhakeni dried out her vagina:

Mhakeni used herbs from the Mugugudhu tree.  After grinding the stem and leaf, she would mix just a pinch of the sand-colored powder with water, wrap it in a bit of nylon stocking, and insert it into her vagina for 10 to 15 minutes.  The herbs swell the soft tissues of the vagina, make it hot, and dry it out.  That made sex “very painful,” says Mhakeni.  But, she adds, “Our African husbands enjoy sex with a dry vagina.  (p. 67)”

Other women also reported that having dry sex was painful.  Furthermore, “research shows that dry sex causes vaginal lacerations and suppresses the vagina's natural bacteria, both of which increase the likelihood of HIV infection.  And some AIDS workers believe the extra friction makes condoms tear more easily” (Schoofs, 1999, p. 67).

Schoofs noted that Southern African girls “are socialized to yield sexual decision-making to men” (p. 67).  Prisca Mhlolo, who was in charge of counseling at an organization for HIV-positive Zimbabweans, noted that women are not even allowed to say, “Can we have sex?” so it's even more difficult to bring up the subject of condoms.  For example, Mhlolo's husband, who had infected her with AIDS, objected to her suggesting that he wear a condom when he developed open herpes sores on his penis, accusing her of having found a boyfriend. 

Because women in southern Africa “are unable to negotiate sex,” they have to “risk infection to please the man,” Schoofs observed.  He quotes Mhlolo as commenting that this situation “is part of our culture … and our culture is part of why HIV is spreading” (p. 68).  Schoofs maintains that African men “retain the mindset of polygamy” which was practiced in their traditional cultures.  Now, instead of men practicing polygamy in those African nations where it is illegal, they “have many partners through commercial sex or 'sugar daddy' relationships that lack the social cohesion of traditional marriages” (p. 68). 

Carael's U.N. study (September 1999) found that HIV “spread more quickly in places where girls became sexually active at an earlier age” (Shaw, 1999).  According to a UNAids report, “older men, who often coerce girls into sex or buy their favours with sugar-daddy gifts, are the main source of HIV for the teenage girls” (Reuter, 1999, p. 4).  For their part, some “young girls think the older men can provide for them,” according to Anne Buve of the Institute of Tropical Medicine in Antwerp, Belgium (Shaw, 1999).  Their relationships with older men, whether forced, coerced or bought, increases their vulnerability to contracting HIV.  As Peter Piot, executive director of the Joint U.N. Program on HIV/AIDS, points out, “Gender inequality — including women's economic dependence on men — is a driving force of the AIDS epidemic” (Associated Press, 2000, p. A6).

Genital Mutilation and AIDS

Despite a number of different factors that contribute to the perpetuation of genital mutilation in many regions of the world, I concur with Efua Dorkenoo's (1999) view that “the roots of the practice lie in the patriarchal family and in [the patriarchal] society at large” (p. 95).  As long as gender inequity persists in societies that practice female genital mutilation and the more extreme the gender inequity is, the more difficult it will be to combat this sometimes lethal operation.

Although “there have been no comprehensive global surveys of the prevalence of female genital mutilation” (Dorkenoo, 1999, p. 91), experts Fran Hosken and Nahid Toubia estimate “that there are at present more than 120 million girls and women who have undergone some form of female genital mutilation” (Dorkenoo, 1999, p. 87).  According to several sources cited by Dorkenoo (1999), most of these mutilated girls and women live in 28 African countries.  However, this operation is also performed:

in the Southern parts of the Arabian peninsular and along the Persian Gulf and, increasingly, among some immigrant populations in Europe, Australia, Canada, and the United States…  It has also been reported to be practiced by…  the Daudi Bohra Muslims, who live in India — and among Muslim populations in Malaysia and Indonesia.  (Dorkenoo, 1999, p. 87)  

The World Health Organization's Technical Working Group defines female genital mutilation as “the removal of part or all of the external female genitalia and/or injury to the female genital organs for cultural or other nontherapeutic reasons” (cited by Dorkenoo, 1999, p. 88).  This WHO group differentiates four types of female genital mutilation, ranging from the mildest Type 1 form which involves the removal of the clitoral hood to complete clitoridectomy.  In Type II operations part of the labia minora are removed along with the clitoris.  Type III, known as infibulation,involves the complete removal of the clitoris and labia minora, together with the inner surface of the labia majora.  The raw edges of the labia majora are then stitched together with thorns or silk or catgut sutures, so that when the skin of the remaining labia majora heals, a bridge of scar tissue forms over the vagina.  A small opening is preserved … to allow the passage of urine and menstrual blood.  (Cited in Dorkenoo, 1999, p. 88)

Type IV is a new category to cover other surgical practices, for example, “cauterizing by burning of the clitoris and surrounding tissue” and the introduction of substances into the vagina to tighten or narrow it (Dorkenoo, 1999, p. 88).

Dorkenoo (1999) estimates that 80‰ of all the female genital mutilation performed qualifies as type II whereas about 15‰ constitutes type III.  This most extreme form of female genital mutilation is widely practiced in Somalia, Sudan, Ethiopia, Eritrea, northern Kenya, and small regions in Mali and northern Nigeria (Dorkenoo, 1999, p. 88).

 Despite the intense interest of many AIDS researchers in discovering why this disease is such a mammoth scourge, particularly in Africa, the likely connection between AIDS and genital mutilation has received very little attention.  Yet because HIV is transmitted by HIV-infected sperm or blood entering the bloodstream of someone who was formerly free of the virus, the tendency of mutilated genitals to bleed puts genitally mutilated women at high risk of catching this disease.

The more severe the form and the more widespread the practice of female genital mutilation is, the more this atrocity contributes to the massive numbers of women and girls infected by HIV.  Many subsequently die — the victims of femicide.  Unknown numbers of female genital mutilation victims also die from non-AIDS-related infections, particularly maternal deaths. 

The age at which female children are subjected to genital mutilation varies widely in different societies.  In some groups, this operation is performed on babies only a few days old, in others, at about seven years old, and yet others, at adolescents.  The crude methods still frequently used to perform these unnecessary, dangerous and sometimes fatal operations are often used on a number of young girls on the same occasion, with only a superficial water rinse of the knife or razor blade.  Hence, if one child has AIDS, all the other girls are likely to get it too.

Women who have been infibulated have often been sewn up so tightly that intercourse can easily cause their mutilated genitals to bleed.  This means they are far more at risk of being infected by AIDS.  In addition, genital bleeding is common among infibulated women who have intercourse because of the friction involved, their vulnerability to vaginal tearing, and their lack of lubrication due to a deficiency of sexual desire.  Bleeding also occurs because newly wed men frequently cut open their brides' tightly-sewn vaginas on the wedding night to accommodate their penises and/or use their penises to force their way in.  Women are also sewn up when their husbands leave home for an extended time, and cut open again when they return.  In addition, pregnant women have to be cut open to give birth, after which they are tightly sewn up.  If a husband resumes intercourse before his wife's wounds have healed, bleeding is especially likely to occur. 

Hence, the horrific compulsory patriarchal custom of the most severe types of genital mutilation imposed on millions of girls in Africa causes females of all ages to be at much greater risk of dying because of the lethality of AIDS.  The likelihood that the less severe forms of genital mutilation also result in more bleeding than non-mutilated genitals is an empirical question that is in urgent need of research.

Genital mutilation also causes numerous fatal health complications — aside from AIDS.  Unknown numbers of young girls die from infections as a result of the often unhygienic methods in which this excruciatingly painful operation is performed.  Unknown numbers of infibulated women die during childbirth, or because of fatal infections caused by being repeatedly cut open and sewn shut.  Therefore, genital mutilation is also a form of mass femicide in its own right.

Because genital mutilation is designed to suit men's sexual needs and to maintain inordinate control over women, AIDS deaths resulting from this practice qualify as femicide.  And because genital mutilation is so widely practiced in so many countries in Africa and elsewhere, it qualifies as mass femicide. 

Rape and AIDS

Sub-Saharan Africa, where 10‰ of the world's population reside, “has almost 70‰ of the world's HIV/AIDS sufferers,” according to Reuter (1999, p. 4)

There are no reliable statistics on the prevalence of rape in Africa.  However, South Africa has been identified as having one of the highest rates of the countries for which a rape rate has been estimated.  For example, Radhika Coomaraswamy, the United Nations Special Rapporteur on violence against women, noted that if the South African police estimate that only approximately 2.8‰ of the rapes that occurred there were reported to them — then “South Africa would … probably have the highest level of rape among countries which have taken the initiative to collect statistics on violence against women” (1997, p. 3). 

More recent sources are far less equivocal.  “South Africa has … the world's highest per capita rate of rape,” states Kelly St. John (2000, p. A1).  As high as rape rates are in the United States, St. John maintains that “A woman [in South Africa] is five times more likely to be raped than in the United  States” (p. A5; Daniel Wakin (1999) gives the comparable figure of three times more likely.  In addition, approximately one in eight South African adults were infected with HIV in 1999 (Wakin, 1999), and “HIV/AIDS is spreading faster in South Africa than anywhere else in the world” (St. John, 2000, p. A5).

The prevalence of the AIDS virus “makes sexual assault increasingly lethal” in South Africa (Wakin, 1999).  In the fall of 1999, “five insurance companies began selling 'rape insurance'” in South Africa (St. John, 2000, p. A5).  One firm sells a policy “whose benefits include a triple cocktail of antiretroviral drugs for 28 days and free HIV testing for a year after a rape” (St. John, 2000, p. A5).

For reasons unknown, violence against women, including rape, has escalated since ex-President Nelson Mandela and the African National Congress came to power in April 1994.  For this and other reasons, there has been considerable international publicity about the high rape rate in South Africa.  In a country with a high rape rate as well as a high rate of AIDS, there will be a higher rate of rape-related AIDS.  Hence, the very high rates of rape in South Africa have undoubtedly contributed to the severity of the AIDS epidemic there, as well as to the epidemic of rape-related femicides (Cape Town is now frequently referred to as “rape town.”

Another factor that contributes to both the rape rate and the rate of AIDS in South Africa is the belief of some males in the myth that a HIV-infected man “can cure himself of HIV if he has sex with a virgin” (St. John, 2000, p. A5), which only young children can be presumed to be.  Some AIDS-free men also choose to rape girls rather than women because they assume that young girls will be free of AIDS.  Hence, growing numbers of female children are become victims of this form of femicide when they contract the fatal disease.

African men in some other African countries also believe the myth about the curative effect of sex with virgins, which only young children can be counted on to be.  Michel Carael of the U.N. AIDS office in Geneva was the lead researcher on a random sample study of 1,000 men and 1,000 women in each of four towns situated in Zambia, Kenya, Cameroon, and Benin.  The researchers found that “The prevalence of the virus in very young girls is a major dynamic in this epidemic” (Shaw, 1999).  They also reported that

the younger a girl was having her first sexual experience, the more likely she would be to contract the disease [HIV] — partly because of the belief among many sexually active men that young girls are “safe,” and even that sex with a virgin can cure AIDS.  (Shaw, 1999)

Strategies to Prevent AIDS

The more AIDS there is, the more at risk rape victims and genital mutilation victims are to catching this fatal disease from AIDS-infected rapists and sex partners.  Therefore when rape rates rise, so does the prevalence of AIDS for females — and hence femicide.  Given the epidemic proportions of rape and AIDS in many nations, and rape, AIDS and genital mutilation in many others, this means these problems cause geometrically rising numbers of femicide casualties in the world today.

South African President Thabo Mbeki has been heavily criticized by many leaders and AIDS specialists in Western nations for his rejection of expensive anti-viral medication as a means of dealing with the severe AIDS problem in his country.  His position did not waver when he was offered the medication at a substantially lower price.  Besides objecting that even at this allegedly bargain basement price, a medication strategy was not affordable in South Africa, Mbeki also argued that AIDS in Africa appears to be significantly different from its manifestation in other countries. 

Although I think Mbeki should provide anti-AIDS medication for pregnant and child-bearing women as well as victims (male and female) of rape, incestuous and extrafamilial child sexual abuse, and other forms of sexual assault, I think he was correct to reject the costly medical approach practiced in the United States that focuses on prolonging the lives of everyone who is already infected with the AIDS virus and whose illness is covered by medical insurance or Medicare, rather than focusing on the prevention of the disease. 

However on July 7, 2000, Boehringer Ingelheim, “an international pharmaceutical company that markets a powerful antiviral AIDS drug” that has proven effective in preventing the “transmission of the AIDS virus from pregnant women to their infants” announced “that for the next five years, it will donate free supplies of the drug to every nation in the developing world that asks for it” (Perlman, July 2000, p. A1).  Presumably, Mbeki's economic reason for rejecting the medication approach to AIDS for pregnant mothers in South Africa will no longer apply.

Ignorance about the connection between common sexist and misogynist sexual practices and the etiology of AIDS seriously undermines the efficacy of prevention strategies that emphasize medication above all else.  Common male attitudes regarding manhood, male sexuality, and male entitlement to dominate their female sex partners, are not influenced by medication. 

Hence, the first order of business requires educating people about the role of sexism and male domination in the spread of AIDS, and eradicating these manifestations of patriarchy.  It is not enough to conduct educational campaigns that focus only on the need to avoid risky behavior, such as the failure to use a condom, the need to find out a potential sex partner's sexual history, the danger of having sex with many different partners, and the particularly high risk nature of unprotected anal sex as compared with oral or penile/vaginal sex.

It is also of utmost importance that those responsible for knowingly infecting another person with HIV/AIDS should be prosecuted for murder or femicide.  Prosecutions would add the necessary teeth to ensure that educational campaigns are taken more seriously.  Although a handful of men with HIV/AIDS have been prosecuted in the United States for deliberately infecting their female sex “partners,” most guilty parties appear to be immune to any serious social sanctions.  To my knowledge, no AIDS perpetrators have been prosecuted for attempted femicide before their victim(s) die, and/or femicide afterward her (their) death despite their crime(s).

For example, pornographer Larry Flynt has been accused in print of having his wife Althea injected with the AIDS virus (Rider, 1997).  Althea, who was also convinced of Larry's role in this crime, subsequently died of a combination of this disease and a drug overdose.  But this charge does not appear to have been followed up by the police.  Nor does it appear to have had a negative impact on Flynt's reputation.  It seems unlikely that the equivalent charge would have been equally ignored had Althea been accused in an equally credible account of injecting Flynt with the lethal virus.

Letting these men off the hook is an outrageously sexist reaction to a serious femicidal crime.  It reveals a shockingly casual attitude about the millions of women and girls who have died because of men's sexist and duplicitous behavior. (2) The patriarchy so devalues women's lives that the behavior of HIV/AIDS-positive male femicide perpetrators is not taken seriously. 

It is vital that the femicidal nature of the AIDS epidemic is recognized.  Hopefully, this article will contribute to the achievement of this important goal.




1. There is also a biological factor that contributes to males more readily infecting women with AIDS than vice versa.  Schoofs (1999) points out that “Because a man ejaculates into a woman men are more likely to transmit the virus, whereas women are more likely to contract HIV without passing it on” (p. 68).  However, my analysis focuses on non-biological factors.

2. Although I think that women as well as men who are guilty of this offence should be prosecuted, this should not include women whose actions are controlled by another (e.g., their husband or father insists that they have sex with another man despite their HIV-positive status).




Associated Press (2000, June 7). CU.N. meeting on women's rights deplores sex traffic, rise in AIDS.  San Francisco Chronicle.

Coomaraswamy, Radhika. (1997). Report of the special rapporteur on violence against women. Its causes and consequences: Report on the mission of the special rapporteur to South Africa on the issue of rape in community. Benevera: United Nations, Economic and Social Council.

Dorkenoo, Efua. (1999). Combating female genital mutilation: An agenda for the next decade. Women's Studies Quarterly, 27(1-2), pp. 73-86.

Perlman, David (2000, June 28). AIDS making Africa a land of living dead.San Francisco Chronicle, pp. A1, A6.

Perlman, David (2000, July 8). AIDS drugmaker to give medicine to poor nations. San Francisco Chronicle, pp. A1, A7.

Relly, Jeannie. (2000, February 26). Societal norms, poverty blamed for rapid spread of Aids in the Caribbean. San Francisco Chronicle, p. A15.

Reuter, London, England. (1999, November 24). Gloom as AIDS toll rises.Cape Times (South Africa), p. 4.

Rider, William. The real Larry. Penthouse, 28(6), February 1997, pp. 44-52, 101.

Russell, Sabin. (2000, July 7). AIDS experts to meet in eye of epidemic. San Francisco Chronicle, pp. A1, A16.

Shaw, Angus. (1999, September 15). Teen sex linked to AIDS in Africa. San Francisco Chronicle.

Schoofs, Mark. (1999, December 7). AIDS: The agony of Africa: Part 5: Death and the second sex. Village Voice, pp. 67-

St. John, Kelly. (May 22, 2000). When rape is a death sentence. pp. A1, A5.

Wakin, Daniel J. (1999, October 12). Women fearing rape, HIV turn to new insurance. San Francisco Chronicle.

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