More than three decades into the AIDS epidemic, the story of women in KwaZulu-Natal—an impoverished region with one of the highest AIDS rates in the world—is not an easy one. Living under patriarchal cultural and religious traditions makes women especially vulnerable to the disease, and they continue to suffer much higher rates of HIV infection than men. Encouragement of male promiscuity, the high incidence of rape, and the myth that sex with a virgin will cure AIDS are just some of the factors why it can be difficult for women to protect themselves.

Meanwhile, in the Christian churches that dominate life in the region, women are taught to subjugate themselves to male power; frank talk of sexuality, especially that of women, is frowned upon.

Some recent HIV/AIDS statistics out of South Africa paint a harsh picture: Nationally, about 11 percent of the population are infected, 7.9 percent of men and 13.6 percent of women. (In KwaZulu-Natal the rate surges to almost 16 percent, the highest in the country.) Younger women are especially vulnerable. Among 20- to 24-year-olds nationwide, 21 percent of women are positive compared to 5 percent of men. Women 25 to 29 are more than twice as likely to be positive as men in the same age group.

Dr. Beverley Haddad has been on the frontlines of the AIDS epidemic in her native South Africa since the late ’90s and knows the realities behind these grim statistics firsthand. A development expert with a long history of social justice activism within the Anglican Church, Haddad was ordained by Bishop Desmond Tutu in 1993, one of the first wave of South African women to be admitted into the priesthood. She is currently director of the Theology and Development Program at the University of KwaZulu-Natal in Pietermaritzburg, where her work focuses on gender, AIDS, and social transformation in the church.

In a recent talk at the Pacific School of Religion in Berkeley, California, where she is teaching a course on AIDS and the church, Haddad imparted her own harsh statistics: over 39 percent of pregnant women in the KwaZulu-Natal town of Vulindlela are HIV positive, for example.

In the face of this overwhelming health crisis, coupled with endemic poverty, how do these women survive? And what are the prospects for overcoming this epidemic as we observe the 21st annual World AIDS Day?

A Theology of Retribution: Suffering for Your Sins

Haddad’s answers to those questions contain some hope and a lot of despair. And they are nuanced, not the kind of easy inspirational slogan you might find in a brochure for an international aid agency.

While Anglican, Catholic, Protestant, and other “mainline churches” operate important HIV/AIDS programs nationally, such as one run by Hope Africa, which grew out of the social justice work of Haddad and other Anglicans in the 1980s, the role of churches, especially the smaller “indigenous churches,” in the day to day ground battle against AIDS is mixed at best.

Here women face the brunt of what Haddad calls “a deeply patriarchal culture,” and churches (the dominant institutions in daily life in rural areas) do little to combat this.

Men are assumed to control women’s sexuality and sexual practice, so “it’s really difficult for women to negotiate safe sex with a condom, especially with their husbands.” Rape and sexual violence are also extremely high, which also “renders women more vulnerable to HIV transmission.”

The congregations in the pews on Sundays are 80 percent women, while it’s almost exclusively men behind the pulpits. In a recent study of 16 male clergy in Vulindlela (most of whom have had very little formal theological training), Haddad found that in the face of the AIDS crisis, these men tend to resort back to “a theology of retribution.” In terms of AIDS sufferers, they assume “if something bad happens to you, you must have done something wrong.” In other words: you’re suffering for your sins.

While the message delivered from the pulpits is often one of retribution and contributes to the “stigmatization and discrimination” against HIV-positive women, inside the powerful manyanos, or women’s prayer unions, it is often more enlightened. In her decade of AIDS work in the region, Haddad hasn’t seen much improvement in the systemic problems at the root of the AIDS crisis—the poverty and gender violence—but “the change in awareness is phenomenal.” This is especially true for women, more of whom understand that “people really are dying of AIDS-related illnesses” and aren’t “bewitched or something.”

In some instances, the manyanos are emerging as safe sites for discussion of taboo subjects such as HIV/AIDS and sexuality using the Bible as the point of departure. For example, Haddad reports that in one group, reflection on the passage on the rape of Tamar (2 Sam. 13:1-22) spurred a conversation among the women about the issue of rape in their communities.

The manyanos, as well as the growing network of health clinics, which women attend in much greater numbers than men, has contributed to a gender gap in HIV/AIDS knowledge that Haddad says must be addressed by the church and in public education campaigns.

“Allowing a Holocaust to Happen”

As a member of the Circle of Concerned African Women Theologians, Haddad has also been a key player in the development in academia of “survival theologies of poor and marginalized women.” Closely linked to African-American “womanist theology,” including the writings of Patricia Hill Collins and Delores Williams, survivalist theology focuses on ordinary women’s “survival strategies as a form of agency.” It also embraces the tendency of poor women to approach Christianity and the Bible as vehicles of hope and tools for survival. In contrast, traditional male-dominated Christian theology is more retribution-based.

For Haddad, it’s essential to understand that for poor rural women of faith in South Africa, the spiritual and the material, the sacred and the secular, aren’t separate entities. Information they get from the clinic and from the manyano, for example, is interwoven into their experience of God. As feminist theologians, “there’s a danger of doing our theorizing in isolation from the lived reality of ordinary women who don’t make these kinds of distinctions.”

Dr. Haddad, who was an activist in South Africa’s freedom struggle, is a veteran of uphill battles, but she admits to being “overwhelmed” by the realities of the AIDS epidemic. “It’s one thing to be involved in the liberation fight… You kind of thought, this is going to end in my lifetime.” But after attending the International AIDS Conference in Mexico City last year, she realized “there is no obvious sign of the epidemic diminishing until at least 2030.”

Since teaching in the United States for the last five months, Haddad has been further sobered by “just how ignorant Americans are about Africa in general and the AIDS epidemic specifically.” She wants her students to understand that “the epidemic is a justice issue, not a moral issue.” While African leadership holds its share of the blame, global economic equality is an even bigger issue, as is the exorbitant cost of anti-retroviral medicines. “I think the biggest indictment of the so-called developed world is that they are allowing a holocaust to happen in Africa… when there are drugs available to save people’s lives.”

Although condoms are widely available in health clinics in South Africa, their effectiveness against the epidemic is hugely stifled by cultural and religious attitudes both inside and outside the country. Adding to local custom among males, which eschews condom use, especially between married couples, President Bush made his massive AIDS relief program “entirely conditional on messages of abstinence and not condoms.” (The Obama administration has only recently updated the guidelines for the program, known as PEPFAR, to lighten the restrictions on family planning.) And on his first visit to Africa, to Cameroon in 2008, Pope Benedict reiterated the Church’s extremely conservative stance against condoms. “Ordinary people just get on and do what they have to do, deal with it in a hidden way, but the Pope is a powerful person and it would be really nice if he would say things differently,” Haddad said with a sigh.

“People are trapped in theologies of retribution,” Haddad said. “What we need are theologies that are life-giving.”