Implications sen et al 2002 ) .In

Implications of Gender can have both positive and
adverse effects on the mental, physical and social stability of men and women
in a society. Gender, here can be defined as Social constructions used to
determine what behaviours equate to masculinity and femininity (G. sen et al
2002 ) .In this sense gender norms deals with roll allocations and prescribed
behaviours that are expected within a social construct. Gender norms constitute
part of the social roles that are related to the values system of the society
that creates it. These expected behaviours within a society are not necessarily
beneficial to their livelihoods as seen with regards to heath outcomes on both
parties (J. Filadelfiová and L. Kobová). Biological determinations based on the
sex of a person rather than the gender, have contributed to the reasoning as to
why men and women behave the way they do towards health due to innate reactions
that are hardwired into their biological mechanisms. Gender is developed on the
basis of masculine and feminine tendencies where as biological notions are more
binary in regards to the difference between a male and female physiologically.

Although it is undisputed that men and women clearly have different advantages
and disadvantages based on their biological makeup, this methodology over
simplifies health outcomes by basing them on the question “which is the weaker
sex?” (Bird ad reiker, 1999,) Thus this essay aims to analyse health outcomes
through a gendered lens, which will primarily focus on socio-economic factors,
deconstructing societal constructs and their inequalities that shape men and
women’s interaction with health, These interactions vary between societies
depending on cultures and traditions. However biological notions used to
justify ‘naturally’ occurring reactions of men and women will be touched upon
to further understand how these psychological impressions which have determined
masculinity and femininity continue to perpetuate gender norms. Within this
context, Gender roles are socially constructed as well as framed as an
extension of biologically determined social functions. Thus examining the
complex interaction between social and biological factors effecting health
issues not only on the individual scale but continued patterns in men and
women’s health in general. The advantages and disadvantages men and women have
in society due to gender norms created through cultural and traditional
practice will be discussed comparatively with particular reference to south
Africa and the impact of HIV on both men and women within the country.

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Empirical evidence from other sources will also be included to show the
differences as well as similarities in attitudes towards health outcomes in the
north and south. Over the years South Africa has seen substantial annual GDP
growth rates averaging at 2.83 % from 1994 until 2017, reaching an all time
high of 7.10 % in 2016 Although,
Considered to be one of the fastest emerging economies in sub Saharan Africa it
is also home to the highest HIV epidemic in the world with as much as 7.1
million infected by the end of 2016

With such prevailing GDP growth success rates the HIV epidemic is still at an
all time high, arguably suggesting that GDP rates solely, cannot necessarily
translate into practice in relation to health outcomes, specifically HIV in
this case. With 19 % of the population living with HIV in 2016, although the
concentration of infected people varies in different regions of the country,
south Africa currently stands to be the best reference for further analysis as
to why and how gender norms directly impact the prevalence of negative health
outcomes, specifically in regards to HIV With reference to the HIV epidemic in
South Africa, the disadvantages women have in regards to reproductive health
and their designated roles within patriarchal households will be discussed
first, followed by their advantages. This will be followed by the disadvantages
and advantages men within the same context in regards to following cultural and
traditional norms, which create their social behaviours. The information with
then be looked at comparatively to discuss whether men or women are impacted
more by health outcomes in regards to HIV within the region. Increased risk of
HIV in the case of women and young girls has continuously been associated with
gender based violence and gender eniquity within the household. Women are at
higher risk of gender based violence if they deviate from prescribed
behaviours, posing a greater risk on women’s long term health outcomes as women
who are raped and beaten are linked to high morbidity and mortality rates.

These include reproductive health issues, as well as psychological issues
including depression and posttraumatic stress disorder, which tend to go
unnoticed. Gender based violence in intimate heterosexual relationships

has been a key drive in the transmission of HIV with
more than 30% of partnered young women between the ages of 15 and 24 years old
experiencing violence within their relationship, are 50% more likely to
contract the disease in Uganda, Tanzania and south Africa These actions are deemed justifiable
by both men and women particularly in the case of women’s infidelity or
assumptions of a mans infidelity by his spouse, disobedience child neglect and
non performance of domestic work as well as sexual intercourse. In both cases
women are liable for the actions of the men, as their provocation has led to
the resulted outcome. Being viewed as a normality within South Africa and a lot
of other African countries law enforcement is viewed as unnecessary or even
more so unsuccessful. Women, who have been psychologically trained into
thinking that these measures are justifiable and necessary, therefore reject
the idea of seeking medical support. According to reports f a health survey in
Tanzania 60% of women and 42% of men deemed it a societal norm to have gender
based violence within intimate relationships under any of the circumstances
listed above. The patriarchal nature of society within South Africa relates to
women equating strength and the ability to provide with masculinity. Men also
view their worthiness as dependant on their strength, toughness and ability to
control women on both a societal and relationship level. From this, stems the
normality of high-risk sexual behaviours and predatory sexual practices. Thus
the restrictions places on the women’s societal role disable them from
influencing the circumstances of sex as priority is given to their partners
needs and wishes (Varga, 1997). As one of the most common and easily attainable
methods of HIV prevention, using a condom is during intercourse is not
prioritised because of concerns about men’s sexual pleasure, therefore women
tend not to ask or will not persist the issues if there partner refuses. (Wood,
2000). The notion of promiscuity is highly frowned upon within south Africa
therefore women who have pre marital sex fear being condemned if attention is
brought to their sexual activity by telling family members or others (e.g.

through purchase of condoms or a visit to a clinic), creating barriers for the
adaptation of preventative practices (Wood, Maepa, & Jewkes, 1997). (Varga,
1997). A study of young women aged 18-24,in Soweto, South Africa, found they
knew where to access SRH services but that common experiences of providers’
unsupportive attitudes, power dynamics in relationships and communication
issues with parents and community members prevented respondents from accessing
and utilising the information and services they needed. Cultural limitations
that promote intergenerational sex and prostitution from a young age become a
necessity for some due to economical deprivation. Putting women at further risk
of HIV (Wojcicki and Malala, 2001). In Africa, Sex is largely viewed as a form
of reciprocity, hence becoming a useful resource for women living in poverty
conditions. (Caldwell, Caldwell, & Quiggin, 1989). Due to economic
vulnerability women are forced to step out of cultural norms and diverge into
sex work as a means of reliable income making them, more dependent on this work,
also disabling them from dictating the terms of the exchange. A case study in
South Africa showed that it was quite common for women outside of sex work to
be compensated after a night together with money by their boyfriends or
husbands. Expenses included n health services would also deter women from
seeking medical advices those within poverty induced regions would need the
money for daily necessitates including food and if the priorities of children
within the house hold would come first. Due to women being in charge of the
domestics within a heterosexual relationship they are also financially
answerable to their spouse therefore restricted from leaving their home duties.

These factors have contributed to women’s unfortunate circumstances o not being
able to easily access medication or pre natal care to prevent mother to child
transmission. Young girls particularly in education who need extra money for
school fees or simple necessities and are scare of giving their parent extra
financial burdens, end up being harassed by teachers and others and from this
stems sexual exploitations amongst young women as they grow into adult hood.

(Omaar & de Waal, 1994; Niehaus, 2000). This is where relationships with
older men are deemed to be more attractive as it seems more economically
beneficial, contributing to increased intergenerational sex. This brings
attention as to why gender differences in age specific HIV is more prevalent in
South Africa (Vundule, Maforah, Jewkes, & Jordaan, 2000). For women
particularly, the epitome of femininity lies in the ability to have and keep a
male partner, which is also linked to the notion of a better livelihood as
their partner will create economic stability. Women’s social worth in society
stems from this as single women are linked to having a low status in society
(Campbell, 2000). Aggravating their partner by asking to use protection comes
with two main fears, that their partner will leave them by doing so and that by
ending up alone they will eventually be ostracized in society, as well as fear
of violent behaviour from the spouse as condom use is linked to promiscuity.

(Campbell, 2000). Suggesting
condom use may be seen as tantamount to implying or admitting infidelity as
condoms are associated with prostitution, promiscuity and disease or an
implicit challenge to a male ‘right’ to have many women.  Due to these same fears women are more
acceptant in regards to their male partners having other multiple sexual
partners which ironically is viewed as the epitome of masculinity by men within
the society, hence why being single is viewed as unusual in a society where men
are allowed to have various sexual partners. Due to the increased fear of abuse
South African women tend to have new partners whilst maintaining their old
relationships This further diminishes the control women have over their body as
intercourse with multiple partners increases the susceptibility to contracting
HIV amongst other STDs. Along side this as mentioned earlier is an increased
tolerance for verbal and physical abuse.

Women within certain societies are viewed as susceptible
to uncleanliness at certain times, for instance during menstruation. Jewkes and
Wood suggested “these ideas are highly prevalent in south Africa where dirtiness
or pollution is a dominant pathological process in indigen-ous health systems.”
Notions of pollution link in with cultural interpretations of dirt being either
physical or moral uncleanliness. Research in South Africa suggested that part
of the structural formation of gender bias in STD contractions is attributed to
the views from both parties that women are repositories of moral and physical dirt (Simbayi et al., 2000). 
Thus men who have sex with morally clean women, view using a condom as
unnecessary, as she would not be harbouring risk of disease. Commonly shared
belief amongst different ethnic groups in south Africa is that sex with a
virgin will cleanse a man of infection, where young girls are increasingly
targeted by sexual predators. Evidently these women and young girls are placed
at a higher risk of contracting HIV amongst other STDs. (Leclerc-Madlala, 1997).




Risk of catching HIV has
been based around dominating assumptions including, women’s biological factors,
their reduced sexual autonomy and men’s privilege over them. This has lead
public health services including treatment and campaign services for HIV and
AIDS, to target women and children more so than men.  Therefore social policies aimed to increase the
accessibility as well as availability of different HIV prevention initiatives
have been directed towards reaching as many women and children within the
global south as realistically possible. South Africa has the largest
antiretroviral (ARV) programme in the world, as of December 2015, 3.4 million
people were on ARVs. Women had benefited the most and continue to benefit from
this as they managed to reduce mother to child transmission from 3.5% in 2010
to 2.7% in 2011. Sexual
and reproductive health services have often been at the forefront of attempts
to promote women-centred care

Post apartheid in south
Africa saw women become more politically involved after 1994 with women
covering 43% occupancy in cabinet posts and 46% in deputy minister positions
after the 2014 elections. This helped to shed light on gender based violence in
relations to women health in all aspects, where in 1999 the sexual offences and
community affairs was established (SOCA) alongside the creation of sexual
offences courts to address sex offence cases.

The world development
report 1997 managed to outline health policy reform agendas without
consideration of appropriate institutional changes necessary to eradicate
implications of gender bias. However the silence was broken when the WHO  (world health report 2003) mentioned the need
to encourage women participation I health care governance and management.  Gender equity here had become a key theme
conflated with improved health provisions. 
This has extended to the Women and Gender Equity Knowledge Network of
the WHO, proposing concrete approaches to gender mainstreaming for health in
non-governmental as well as governmental organisations. This has been centered on
the primary needs of women’s health rights with successful initiatives in south
Africa such as the development of policies on abortion and violence in South
Africa. The primary focus for reducing gender inequality is by encouragement of
relationship empowerment through women. Recent structural policies in South
Africa have been aimed at increasing women educational prospects   



power imbalances are the primary basis for feminist perspectives that rely on
this to justify women’s unwillingness as well as inability to persuade their
partner to use a male condom. However this research method continuously ignore
other contributing factors including women’s reluctance for condom use simply
to increase physical pleasure for them. This also dismisses the fact that men’s
lack of use is also motivated by effect or emotion. In this sense gendered
power dynamics solely cannot be blamed for unsuccessful HIV prevention.


These gendered bias
assumptions to some extent can be challenged as in many interpersonal
relationships with men, women display sufficient amounts of sexual agency and
strength. Literatures on sub Saharan Africa have evidently proven this, yet
have continuously been over shadowed and remained unexplored. Role of pleasure
for both partners results in the unanimous decision for the dismissal of make
condom usage, behavioral models have acknowledged this whether directly or
indirectly yet empirical evidence has always focused primarily on men, not
considering the significant role women also play within this decision making
process. Preliminary
qualitative investigations in the United States and the United Kingdom have
found that a significant proportion of women dislike the feeling of male
condoms. Although not dismissing the vulnerability frameworks reasoning of
partner relationships in most male dominating relationships, there are several circumstances
in which women do have input towards their sexual relations where the condoms’
effects on pleasure may alter women’s preferences or use patterns.


Talk about education

The women’s vulnerability framework
places emphasis on the social and economic justices women predominantly endure
due to patriarchal indoctrinations imbedded in cultural and traditional factor
moulding societal interactions. Although undoubtedly women are at higher risk
of contracting HIV through contributing factors above as well as biologically,
this framework lack perspective in regards to the heterosexual males
interaction with HIV and their dismissal of Health services due to societal
pressure which have created the patriarchal persona they are subconsciously
forced to adapt to which negatively impacts women as well as themselves. Less light is shed on the fact
that heterosexual men, too, are also infected with HIV this is evident, as men
have to be infected initially in order to infect a woman. However participatory
methods of prevention have predominantly targeted to women. Here, women are
viewed as the vulnerable ones, considered deserving of HIV protection, and men
are not seen with the same sentiment. This paradigm suggests that
heterosexual women, but not heterosexual men, are susceptible to and
disadvantaged by HIV.

rather than creating services to amend men’s behavioural attitudes towards
women, men’s gender socialization is perceived is ignored. Essentialist assumptions of
the male sex drive as immutable on the premise that “boys will be boys.” Biologically Uncircumcised men
in sub Saharan Africa are at higher risk of catching a HIV infection in
comparison to circumcised men.

constructions of what it is to be a man deems risk taking behaviour as a
normalised cultural definition of masculinity. These behaviours include lack of
care for their own health, which is linked to alcohol and drug abuse and thrill
seeking practices. These definitions create a society in which having multiple
sexual partners and sexual adventures are normalised. By creating sexual double
standards men’s increased objectivity of women creates negative and dominating
attitudes towards them. Viewed as emotionally detached in comparison to women
their senses of invulnerability prevents them from seeking health information
or services to prevent or correctly administer HIV (lack of HIV testing). By
being viewed as conquerors of women there is less willingness to see the
victimization of men as they are to some extent forced to align with expected
societal gender norms including. Majority of heterosexual men view sickness as
a sign of weakness leading to reluctance in seeking health services when
necessary.  A national representative
cohort study carried out in Uganda presented evidence suggesting that men were
1.43 times more likely to die than women when they attended ART treatments
later on down the line rather than at the first opportunity to seek help. A
similar test carried out in South Africa showed similar numbers where men were
1.47 times more likely to die than women because of reluctance to seek health
advice. Assumptions from a
model framework suggested that , if these figures were to remain
constant  HIV deaths would be  much higher amongst males aged 15 to 49 in
comparison to females within both countries.  

randomised trials in south Africa have been adapted to understand male behaviour
change and have recognised that men are disproportionately under represented in
HIV campaigns and services having a direct impact on outcomes of care.  Failure of men to engage in health services
also impact house  hold income as they
are usually the bread winners. Migration for employment is common among men in
sub Saharan Africa, moving away from their partners and families for long
periods of time put men at greater risk of getting HIV due to increased drug
abuse and sexual exposure within their setting. If the main income generator of
the household dies or fall severely ill due to refused HIV care, the house hold
income can be drastically effected. Women and children who carry out the
economical activity at home would also be negatively impacted.

practiced in many African nations, 
increases the difficulty in targeting homosexual men for HIV prevention
and treatment. Due to social stigma and homophobic violence linked to prescribed gender norms, men are
unwilling to seek help with fears it will unveil their sexual deviances. Men
who fall under this category are viewed as needing specific support, in place
such as Uganda for instance, where illegal sexual activities are punishable by
death if the person in question is HIV positive. Anyone within government
sectors and HIV service providers who is aware of this and fails to report this
information is punishable with up to 3 years imprisonment. Male prostitution in South Africa
has seen HIV prevalence among  this
demographic to range from 40% to 88% in the last decade, considerably high in
comparison to women in the general population.