Social Science & Medicine 56 (2003) 425–438
Book reviews
AIDS, sexuality and gender in Africa: collective strategies
and struggles in Tanzania and Zambia,
Carolyn Baylies and Janet Bujra with the gender and
AIDS group; Routledge, London, New York, 2000, 222pp
This book about AIDS, sexuality and gender in Africa
is based on research and practical field experience from
six communities across Tanzania and Zambia. Carolyn
Baylies and Janet Bujra are the main contributors to the
book. The other contributors (seven females and one
male) are members of the gender research group from
Tanzania and Zambia.
Women constitute the focus for the research, and the
proposition on which the book rests is that women in
Africa have always organized themselves in networks
and groups of mutuality. This organizational capacity
has contributed to making womenFnot only vulnerable
victimsFbut also the authors of their own protection
against AIDS. As such, women are seen as a source of
strength as well as the backbone of public sector and
community-based initiatives aimed at care and protection.
Recognizing the existing power relations between men
and women, the authors examine the following hypoth-
eses: first that the success of strategies to confront the
spread of AIDS rests precisely on the recognition of
gendered power relations. Second, that a way forward in
the fight against AIDS could be to build on women’s
existing organizational skills. This means that AIDS
campaigns can be enhanced if built on existing organiza-
tional skills and practices, especially amongst women.
The book offers rich perspectives on the challenges
that women have faced individually, collectively and as
members of community and non-governmental organi-
zations. Based on interviews and first hand accounts the
book provides deep, descriptive and powerful insights
into people’s livesFin particular those of womenFthe
structural gender inequalities, and culturally condoned
male sexual behaviors and sexual practices harmful to
women. The authors demonstrate the negative impact of
patriarchal ideologies, ideologies of masculinity, how
these ideologies disorient women’s contributions, and
how they have contributed to women not only finding
themselves particularly vulnerable to infection but also
required them to shoulder the burden of responsibility
for community education and care. The need for
historical and contextual analyses is emphasized if the
nature of women’s response to the HIV/AIDS epidemic
is to be understood.
However, as pointed out in the preface of the book, as
the research progressed it was recognized that it was
very difficult for women to challenge men’s power and
negotiate for safer sex. Following this, the authors raise
the important question of how far women’s organizations
can actually contribute to the struggle against AIDS:
‘It is one thing for women to organize collectively to
raise awareness of the dangers of AIDS and its modes
of transmission, to raise self-esteem and muster the
courage to say no to unwanted sexual contact. It is
quite another to challenge men’s power in the lonely
moment of private relations and to negotiate for safer
sex. Unequals cannot negotiate’ (Preface xii).
This recognition puts into question the initial thesis
on which this book is based: that the fight against AIDS
could be to build on women’s existing organizational
skills. It also puts into question the authors emphasis in
their final conclusions on ‘women setting the agenda’
and ‘for women’s groups to continue to define objec-
tives’ in the fight against AIDS (196). While the authors
recognize recent international emphasis on men’s
responsibility as well as the need to focus on men as
key to halting the epidemic, they do not subscribe to
men participating in setting the agenda. Even if some
men interviewed did agree to modify the arena of
personal sexual activity the authors conclude that broad
norms of masculine behavior were left intact (195).
There is no doubt that it is a most difficult task to
bring men in and involve them in addressing their own
role in the progress of the HIV/AIDS epidemic and to
make them fight for equality along with women. As
argued by the authors
‘Attempts to alter power relations are likely to be
resisted by those in positions of dominance if such
attempts threaten their position of relative privilege
and access to resources’ (194).
As my own research clearly demonstrates, men do not
willingly give up their male privileges, and certainly not
in situations of poverty and disempowerment (Silbersch-
midt, 2001). However, as the authors also observe even
though the women are the most vulnerable, men are not
spared. And men know that. Of course men should be
made aware of their role as vectors of the HIV infection.
But if men are vilified, made responsible for the
epidemic, told to be responsible partners, yet not
426 Book reviews / Social Science & Medicine 56 (2003) 425–438

allowed to set the agenda together with women, my The paradox offering promise is that, although the
argument here is that women will not succeed in their nature and severity of its impact is a consequence of
efforts to ensure a genuine mutuality of interests, as inequalities of power, AIDS can serve as a leveler of
suggested by Baylies and Bujra. Moreover, it is most conflicting interests. Both rich and poor are among
important to recognize firstly, that it is not likely that those afflicted. If women are most vulnerable, men are
men will be motivated to give up their privileges unless not spared. AIDS threatens the future by claiming the
they see some benefits and unless they are made aware of lives of the young. In this sense the epidemic exerts a
the fact that they will also benefit from gender equality. strong persuasive influence, illustrating the illusory
Secondly, it is crucial to understand that all men are not nature of any vested interest in maintaining a status
the same. There are many masculinities, as an increasing quo, which can bring harm to, so many (196).
body of literature on men and masculinity both in
With its deep insights into people’s lives, their beliefs
developed and developing countries clearly demon-
and disbeliefs in Zambian and Tanzanian communities,
strates (Cornell, 1995; Foreman, 1999; Morell, 2001).
the extensive drawing on other authors’ work and that
The fact that Baylies and Bujra, on the one hand,
of international organizations combined with its unique
doubt if women and women’s organizations can actually
and optimistic perspective, this book is certainly
contribute to the struggle against AIDS, and, on the
essential reading for all those working in the fields of
other hand, see women as the agents of change, as those
development, African studies and health. To this should
setting agendas for collective actions (among women!)
be added that the book also identifies a set of useful
and for challenging existing power relations between
principles, which inform the devising of strategies so as
gendersFis confusing. It makes this book suffer
to ensure their greater effectiveness in meeting objectives
from a loopsidedness. On the one hand, it advocates
and their congruence with broader structural changes,
the challenging of gender inequality (that is seen as
including gender relations. Last but not least, the
driving the epidemic), and the stressing of the
authors end up stressing that consideration needs to be
mutuality of interest (of women and men). On the
given on how to bring in men and how, organizationally
other, the initiative should remain with the disadvanta-
to tackle forms of masculinity in the context of AIDS.
gedFthe women. As deeper structural changes are
This issueFnow also predominant not only among an
needed, especially a transformation of gender relations,
increasing number of researchers but also on interna-
it is up to women to be vigilant to ensure that prevailing
tional agendas (UNAIDS, 2000) is one of the most
gender relations are not simply reproduced by new
important among many outstanding issues in relations
strategies. This reminds me of the signboards ‘women
to the HIV/AIDS pandemic.
should stand together to fight AIDS’ that I have come
across in East AfricaFas if the fight against HIV/AIDS
is a women’s fight and responsibility; a beliefFwhich
References
Baylies and Bujra seem to supportFbut that I strongly
disagree with. This is because it tends to reinforce the
Cornell, R. (1995). Masculinities. Cambridge UK: Polity Press.
tendency to make the already disadvantaged and Foreman, M. (1999). Aids and men: taking risks or taking
vulnerable women shoulder the burden of responsibility responsibility? London: The Panos Institute and Zed.
for communication and care, while men can be free- Morell, R. (Ed.) (2001). Changing men in Southern Africa.
wheeling: they cannot be relied upon as long as their University of Natal Pres, Pietermaritzburg, ZED Books
privileges are at stake. This book would have gained in Ltd, London & New York.
importance if it had gone beyond blaming men and Silberschmidt, M. (2001). Disempowerment of men in rural and
instead had contributed with new insights into mascu- urban East Africa: Implications for male identity and sexual
linities and men’s need to hold on to their prescribed behavior. World Development, 29(2), 657–671.
roles that are not only lethal to women but also to UNAIDS (2000). Men and AIDSFa gendered approach. Men
make a difference: 2000 World AIDS Campaign (www.
themselves.
unaids.org).
In spite of my above disagreement with the authors I
find the book extremely inspiring and intriguing. It is in
Margrethe Silberschmidt
particular because it promotes the challenging and
Department of International Health, Institute of Public
positive contention that for all its destructive power the
Health, Panam Institute, University of Copenhagen,
HIV/AIDS epidemic harbors strong libratory potential,
Blegdamsvej 3, 2200 Copenhagen N, Denmark
both in respect of transforming gender relations and in
E-mail address: m.silberschmidt@pubhealth.ku.dk
encouraging greater democratic participation:

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