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‘The epidemic in this country has the face of a woman’ 1 : Gender and HIV/AIDS in South Africa 2

Epidemiological data clearly show that the highest levels of HIV prevalence occur in sub-Saharan Africa. Less visible, however, is the complex combination of forces that fuel HIV epidemics in this region — these have been dubbed 'the lethal cocktail.' It is this 'cocktail' that creates an enabling environment for the spread of HIV. The HIV epidemic in the region is increasingly 'feminised' as a growing proportion of new infections occurs among and affects women. The gendered pattern of distribution of HIV in South Africa reflects a similar pattern. The aim of this article is to interrogate the contextual factors underlying the differential vulnerabilities of men and women, and the implications for HIV prevention, treatment and care. The analysis, based on a review of documents and applicable literature, reveals that a perilous mix of biomedical, political, economic, and cultural forces shapes the gendered dynamic of the HIV epidemic in South Africa. The article identifies a theoretical framework to decode the most common components of this mix, namely: lack of access to material resources, cultural norms wherein women are subservient to men and masculinity is partly defined in terms of multiple sexual partners and intergenerational sex, combined with high levels of violence against women. We conclude by offering a framework for gendered interventions for HIV prevention, treatment and care.