'Making Men Listen'

Sex was an unusual topic for a 90-minute meeting with an African head of state. But when representatives of the World Bank and other international groups met last month with Jerry Rawlings, president of Ghana, they could talk of little else. With one out of 20 people in the tiny West African nation infected by the AIDS virus, the sexual behavior of his citizens has become one of Rawlings's chief concerns. In Africa's patriarchal, conservative and religious societies, the president's frankness would have been unthinkable just a few years ago. "He talked about the need to be faithful to partners and the need to use condoms," said Brian Dando of the World Health Organization. "Getting [sexual] behavior to change is difficult. But the most important thing is that the politicians are talking openly about it."

Nearly 70 percent of the world's HIV-positive people live in Africa--a plague that is helping to turn the continent's cultures upside down. As recently as 20 years ago, African leaders attacked family planning as a Western imperialist plot. Foreign-aid workers widely promoted birth control during the 1980s, but many complained that a lack of sexual openness hampered their work. "Up until now, you couldn't really say 'condom' in Africa," says Judith Senderowitz, a reproductive-health consultant to the United Nations and others. "Now, thanks to AIDS, you can." The shift has implications beyond the realm of public health. "The AIDS crisis is making men listen to women," says Dan Odallo of the Kenya-based Population Communication Services. "That produces empowerment."

Empowerment is a popular buzzword these days, but in Africa it means something quite specific--something that can make the difference between life and death. According to the World Health Organization, the rate of HIV infection is higher for women than for men in most African countries; in several big cities, one out of three pregnant women has HIV. The vast majority of these women are monogamous and have been infected by their husbands, who, according to longstanding African tradition, are not. "Women have to be able to protect themselves, to have enough power to say no or to insist on using a condom," says Senderowitz. "That's a tough one, but it does start with being able to assert yourself."

African women are asserting themselves as never before. Local feminist movements have gained momentum; many now oppose female genital mutilation and other kinds of violence against women-once chiefly the concern of Western human-fights organizations. Change has been slower in Muslim countries such as Mali and Sudan. But in other nations, women have taken high-profile positions in government and in newly influential nongovernmental organizations (NGOs). Since women who die of AIDS often leave orphans in the care of the state, governments have incentive to respond. Uganda, which suffers an AIDS rate among pregnant women of 29.5 percent, has produced two of Africa's leading spokeswomen on public health. The secretary-general of the Fourth World Conference on Women, which wrapped up its work last week in Beijing, is Tanzanian Gertrude Mongella. Women jammed the African delegations to Beijing in unprecedented numbers. "We have entered the battle for power," says Dr. Peju Olukoya, a professor of family health care in Nigeria.

In Beijing, they did just that. Many Western women credited Africans for having won the relatively liberal language in the conference's final platform. "Africa has emerged as the heroine of this conference," said Joan Dunlop, director of the International Women's Health Coalition. In one negotiation, the delegate from Argentina (which generally follows the Vatican's conservative line) proposed excising the words "sexual freedom" from a particular passage. It was almost 5 o'clock in the morning, and the European delegates were all but asleep at the table. It was the Namibians who proposed the compromise that saved the day. "It's shocking to find African countries more progressive than others," says Barbara Klugman, coordinator for the Women's Health Project in Johannesburg. Just as shocking, perhaps, that women are spurring the change.

Most new victims of HIV in Africa are women--fueling a feminist movement that wants to transform sexual politics.