Coping with patriarchy and HIV/AIDS: Female sexism in infant feeding counseling in Southern Africa

Abstract

In an ethnographic study focusing on infant feeding counseling in southern Africa conducted in the period 2003-2006, mothers complained of feeling judged, shamed, and stigmatized by their female counselors. Female counselors confirmed that they revert at times to confronting and shaming mothers. We postulate the hypothesis that this behavior of shaming and judging can be understood as female sexism; it finds its rationality within the internalized gender dynamics of a highly sexist society, further polarized by the moral stigma of AIDS. We found the underlying dynamic to be judgmental distancing, which can be understood as a psychological defense mechanism; it enables the counselors to avoid looking in the mirror of the self that they see reflected in their female clients. Judging the mothers as individuals for the predicament they find themselves in provides the counselors with a subconscious buffer that protects them from the reminder that they themselves share a similar risk. Counselors' evasion and denial of their own and of their clients' feelings and situations subvert however the purpose of the counseling and risk further stigmatizing or re-traumatizing HIV-positive mothers. Defensive distancing also predisposes counselors to the mental health hazards of compassion fatigue and the syndrome of vicarious traumatization. Yet, those counselors who seek support to help them face their emotions or reactions are unlikely to find it. The reality of patriarchy, impacting as female sexism on the relationship between counselor and mother, is not sufficiently appreciated by the health services yet. To realize therefore the dream of an AIDS-free generation, counselors in southern Africa need better training and ongoing support that is grounded in gender awareness. The precondition is that health researchers, policy makers, and managers acknowledge the patriarchal realities in which mothers and counselors live, the existence of female sexism in the counseling relationship, and the dysfunctional counseling which results from this. Failing to acknowledge these dynamics exposes both mothers and counselors to risks which are harmful to them as human beings and which the region in its fight against HIV/AIDS can ill afford.