Becky Tinsley: A fear of offending African men is the worst of reasons for inaction on Aids

In rural Botswana, it is not unusual for the men of the village to pool their weekly earnings. They are not putting money aside in a mutual savings scheme for medical emergencies, schoolbooks for their children or in case of drought. Instead the men take turns to go into town and spend it all on prostitutes and alcohol.

In South Africa a minister who was in charge of the government's Aids policy told the press he had a shower after unprotected intercourse, so ensuring he did not become infected.

In many rural parts of Kenya, Zambia, Malawi and elsewhere, it is customary that when a husband dies, his wife is "inherited" by the man's family. All her possessions, including her children, become theirs. As soon as possible, a brother or another male relative has sex with the widow in order to "cleanse" her and exorcise the dead man's spirit. If she refuses, all further deaths in the village will be blamed on her. She and her children will be thrown out, destitute.

In some rural African communities girls are gang-raped as soon as they reach puberty. But when a woman gets HIV she brings shame upon her family, no matter that it was her habitually unfaithful husband or boyfriend who infected her. They may stop feeding her because "she is going to die anyway".

Obviously such attitudes are not shared by all men in Africa. The point is not whether the behaviour of African men is better or worse than elsewhere. Nor is treating women as inferior unique to Africa. There are few nations with true equality of opportunity, and even the right to contraception is now being challenged in the US.

But if we are serious about defeating HIV, then we must also defeat the customs and myths that make the battle against the virus so difficult in Africa. Human rights must come before our fear of causing offence, or risking political incorrectness.

Bill Gates told the international HIV/Aids conference in Toronto, "A woman should never need her partner's permission to save her own life."

Hardly revolutionary, but long overdue. Twenty-five years after HIV/Aids was identified, our response is dominated by treatment for a few (one million out of the estimated 60 million infected Africans) and a well funded abstinence campaign.

According to a health worker in Ethiopia, "the abstinence message is very popular amongst men, but they never apply it to their behaviour, only to women. Few African leaders want to challenge male voters to wear condoms, or stop sleeping around. They can all agree to blame the women instead."

"There's no such thing as consent as far as many African women are concerned," says an East African cabinet minister. "Women rarely have a choice. They work on the land all day, but the profit of their labours goes to the man because he owns the land. If a woman wants food and shelter she must give her man what he demands. It is no more complicated than that." A doctor at an HIV-testing clinic is equally prosaic: "Women cannot say no to men as long as they are financially dependent on them."

Diane, a lawyer and activist in Cameroon, is critical of British development groups who romanticise traditional habits: "Until the donors criticise men's sexual habits HIV will spread, because men will be under no pressure to wear condoms. It needs African leaders to assume responsibility and be the true fathers of their people and tell them to change their ways."

According to Linnet, a Kenyan social worker, this "pattern of control" goes back generations: "Our grandmothers never ate protein. The men had brainwashed them into thinking it was bad for them. And they were ashamed of their bodies, and prevented from defecating during daylight or hanging out their sanitary rags to dry properly."

Some NGOs and churches are curiously quiet about barbaric practices. In parts of Sudan, for example, brides are made to stand over sandalwood fires for three days before their wedding. The reason? The smoke dries out their vaginas, thus giving extra pleasure to their husbands.

On a more mundane level, any visitor to rural Africa witnesses the harshness of the average woman's life: she does all the domestic work, tends the sick, and labours in the fields. Her husband might plough, mind the sheep, or guard a water pump. According to Linnet, "We could double Africa's GDP overnight if only men worked as hard as women."

"It is a mystery to me what African men actually do all day apart from sitting around," says a Rwandan minister. There is nothing particularly chauvinist about Rwandan men: a World Vision project encouraging men to work on the land, helping the women, is succeeding because the Rwandan men are seeing their families' wealth increase.

However, it is no wonder micro-finance initiatives focus almost exclusively on giving small loans to women. A banker in Mozambique says: "African women are the entrepreneurial ones. They adapt and change and learn. Too many of their men are complacent. It comes from centuries of entitlement."

So, what can be done? A British NGO, Health Unlimited, produces a radio soap opera in Rwanda, modelled on The Archers, that educates people about women's rights, HIV and domestic violence. Its clever scripts and well drawn characters confront taboo issues; it is heard by 72 per cent of the population.

Anne-Christine d'Adesky of We-Actx, which runs HIV/Aids clinics in Rwanda, says men must be part of the solution. "Men are ready to be the leaders in speaking out on gender-based violence and HIV. They need to be actively involved."

However, power still resides with the headman or tribal elders in many African villages. Their traditional rights include having the pick of the virgins. What will make them become wise fathers? We must make it worth their while, says D'Adesky, letting them take credit for improvements in public health.

Aids has killed 20 million Africans and infected another 60 million. An estimated 20 million children are orphans because of the disease. Until Africa's politicians assume the mantle of true leadership and challenge their citizens to use condoms, the battle will not be won. Meanwhile, campaigns telling women to abstain will have little impact in societies where women cannot even say 'no'.

Becky Tinsley is director of the human rights group Waging Peace. She is building a girls' boarding school in Rwanda RwandaGirlsSchool.org