The Impact of HIV on Adolescent Girls & Young Women

World AIDS Day celebrates its 30th anniversary this year with the theme of ‘Know Your Status’.

Great progress has been made since the first World AIDS Day in 1988 – 3 in 4 people living with HIV today know their status.

However, the work is not yet done – especially for women. Women account for more than half of the people living with HIV worldwide. In particular, adolescent girls (10-19 years) and young women (15-24 years) are significantly affected by HIV and have high prevalence rates.

In Eastern and Southern Africa, women make up 26% of new HIV infections despite making up only 10% of the population. Statistically, young women will acquire HIV five to seven years earlier than their male counterparts.

Why are women and girls at high risk of infection?

HIV disproportionately affects young women and girls because of their unequal social, cultural and economic status in society. These challenges include gender based violence, laws and policies that undermine women, and harmful cultural and traditional practices that reinforce stigma and the dynamic of male dominance.

Here some other reasons why gender inequality leaves women vulnerable to HIV:

  1. Lack of access to healthcare services – women encounter barriers to health services on individual, interpersonal, community and societal levels.
  2. Lack of access to education – studies show that educated girls and women are more likely to make safer decisions regarding sexual and reproductive health and have lower risk of partner violence.
  3. Poverty – an existing and overarching factor that increases the impact of HIV.
  4. Gender-based violence & intimate partner violence – these types of violence prevent young women from protecting themselves from HIV.
  5. ‘Blesser/Sugar Daddy’ culture and transactional sex – sex with older men for monetary or material benefits, exposes young women and girls to low condom use, unsafe sexual practices and increased rates of STIs.
  6. Child marriage – girls who marry as children are likely to be abused by their husbands and forced into sexual practices.
  7. Biological factors – adolescent girls are susceptible to higher rates of genital inflammation, which may increase the risk of HIV infection through vaginal intercourse.

Importance of HIV testing

HIV testing in young women and girls is essential. Many receive access to treatment and care services after testing. Some important determinants of testing are:

  • Going through antenatal care
  • Being married
  • Having primary and secondary education

We need to aim for more young women and girls to being tested so that they know their status, and can access adequate care and treatment services. HIV testing is necessary for expanding on treatment and ensuring that people with HIV have healthy, productive lives.

Addressing the Impact

To address the impact of HIV on young women and girls we need to have approaches and interventions that incorporate the diverse perspectives of women and girls. This is needed on all platforms from campaigning and policy-making to program design. As the World Health Organization recommends, a woman-centred approach that includes women as participants is required, so that our needs, rights and preferences are considered.

Better strategies are needed across all health system to improve accessibility, acceptability, affordability, uptake, equitable coverage, quality, effectiveness and efficiency of services, particularly for adolescent girls worldwide.

To Prevent Abuse, Young People Must Know their Rights

Content note – this post refers to sexual violence and suicide.

Recently, a Twitter user named @twadi_doll shared her story fearlessly and curtly online – giving many people a reality check and leaving them feeling shaken.

Twadi narrated in her thread that at 13 years – orphaned and young – she found herself living with a pastor and his wife.

A respected…no, scratch that…a revered member of society, the man of God raped Twadi her on a regular basis. On other occasions, he would call his friends and they took turns exploiting her body. As if that wasn’t enough, the pastor would ask her constantly to seek forgiveness from God, for making him commit a sin.  

Since she had nowhere to go and was being blackmailed by the pastor for receiving food and shelter from him for 3 years, Twadi couldn’t escape the reach of the preacher’s hand. Even when she spoke out in church, she was called a liar and a demon who had been sent to tempt and disorganise the pastor in his job of shepherding the Lord’s people.

As a result of the continued sexual abuse, Twadi became pregnant and 6 months later, her teachers learnt of her story and offered her immediate support. They opened a case against the pastor, who in shame committed suicide. An abortion was arranged for Twadi and painful as it was, she took the option because she had long decided that either the baby dies or she commits suicide herself.

Twadi’s story calls upon us all to play our part in improving SRHR information and service access to young people.

This lack of access spirals into multiple other challenges, and sadly, it is the young person who suffers. Their untapped potential is heavily undermined.

For starters, we should always be able to come out and condemn what is wrong, no matter the position or reputation of the person in question. The pastor’s wife, years later after her husband’s death, wrote Twadi a letter saying she knew about the abuse the whole time, but found it better than her man going out to cheat. In Twadi’s own words, “she used me as a glue to hold her marriage together.” The pastor’s wife betrayed and failed Twadi, and her suffering falls as equally on her shoulders as it does on the pastor’s.

We need to pay special attention to young people’s voices on their reproductive health concerns with as open a mind as possible.

Sometimes we can’t understand young people by assuming we know who they are and what they want, especially if we aren’t young people ourselves. The pastor’s congregation was way off course in this case, defending the pastor simply because of his position and ignoring the truth Twadi was telling.

If even one of them had taken time to hear her out, it could have changed her fortune. We should seek virtual spaces where young people are free to talk about their challenges with no fear of judgement, and where they are sure they will be believed and helped.

It is critical that we provide young people with information on their rights so that they can know when to say no, how to say it and how to defend themselves against manipulation and abuse.

The more we starve young people of such information, the more we make them vulnerable to attacks and abuse and the multiple challenges that ripple from those.

Finally, we need to work with stakeholders who can put policies in place to ease the combatting of these challenges. In Uganda, for example, we have been advocating for an operational School Health Policy where we can provide sexual and reproductive health and rights information to young people that fits the context we live in.

Such a document is key, because then we can arm young people with knowledge, and we will have the backing of the law. It is something that policy makers and governments should consider, lest we see more young people come out with stories similar to Twadi’s.

This selfless story should be an eye opener.

Many young people are undergoing such horrific challenges, and the veils of religion and culture, which otherwise should be guiding us to a sane and loving society, are being used as defences and barriers against SRHR access. Such incidents are indeed present in our society and the best we can do is speak out against them, bring the perpetrators to justice and provide young people with information and services so that they can make informed decisions and protect themselves.

PS: Twadi has moved on and is strong now. However, is that what we want, for all young people to become strong like her and move on? Or is it better to stamp abuse out once and for all? Something must change in our communities, right here and right now.

Family Planning Realities for Young People in Nepal

In many developing regions, young people still lack access to safe and effective family planning methods, for reasons ranging from lack of information or services to lack of support from their partners or communities. Young people are still being prevented from making informed autonomous decisions about their lives and their bodies.

Speaking from my own experience in Nepal, values about sexuality vary and are defined by culture and religion. One common barrier is social stigma, which discourages young people from openly discussing their needs and seeking the necessary interventions.

Nepal is one of the countries with fairly high adolescent fertility rates. Age at marriage is an especially important variable shaping fertility levels in Nepal, since it is a society where premarital sexual involvement is strongly disapproved of. The high rate of adolescent childbearing is a result of early age at marriage among women.

Nepal Demographic and Health Survey data reports some encouraging trends, such as the progressively increasing age at marriage over the past 15 years. However, there has not been a similar increase in the age at which adolescent girls begin childbearing.

In Nepal, the level of unmet need for family planning remains high.

Some adolescents cannot afford to pay for services, and even if they can, many fear that they’ll be required to provide parental consent before they can actually receive those services.

Young people have the right to make informed decisions about their lives. Integrating their perspectives and helping them overcome the social, legal and practical barriers they face is critical to achieving the goals of Family Planning 2020 (FP2020).

The Government of Nepal is committed to improving health outcomes in the country, and several policies and strategies have been put into place. The recent initiatives by government to provide family planning services through satellites and mobile clinics as well as community health volunteers is commendable to expand the reach of services in area of low accessibility.

Despite significant efforts, the idea of offering family planning services to young people is still not well accepted and easy to advocate for in Nepal. 

In advocating for young people’s rights to access family planning, factors such as age, religion, livelihood and education need to be taken into account. It is also true that young people are often more likely to seek information about reproductive health from informal sources.

Accordingly, to advance progress, information should be provided through media, peers and informal sectors. Peer education can be an effective in facilitating young people’s access to sexual and reproductive health (SRH) services and influencing social norms. Providing adolescents with Comprehensive Sexuality Education (CSE) has been shown to improve adolescent sexual reproductive health knowledge, attitudes, and behaviors when implemented well.

Adolescents and youth constitute a large section of the population in Nepal. Given its size and likely trajectory of growth in the future, this population warrants a focused policy attention, especially when it comes to education, health and population. Adolescents make up a high percentage of Nepal’s total population, and so policies and programs in family planning and reproductive health will have to be expanded to meet the needs of these groups.

For adolescent SRH programs to be effective, we need substantial efforts from the government along with the non-governmental organizations and the private sector. Unproductive approaches should be abandoned, proven approaches should be implemented. New approaches should be explored that better respond to adolescents’ needs.

We must commit to providing young people with the tools to take action in their communities and identifying funding opportunities for youth-led efforts.

As we continue to build the framework for Universal Health Coverage, we must ensure meaningful and sustainable youth engagement on family planning at all levels.

Women in Rural Zimbabwe are Being Left Behind

Being a young woman living in a rural or remote community can be very daunting. You have to fight tirelessly to loosen yourself from the grip of sociocultural stigmatization to have any sense of autonomy over your sexuality.

The situation is worsened by the absence of easy access to modern family planning methods. The problem lies in the fact that when coming up with sexual and reproductive interventions for women and adolescents, our governments still rely on ‘a one size fits all’ approach.

But women in rural areas have different lifestyles and challenges than women living in urban communities.

When it comes to sexual and reproductive health, one size fits all really makes no sense. One size fits all isn’t good enough.

In Zimbabwe, the fact that young women and adolescents in rural and remote communities are still struggling to access modern family planning methods – or even comprehensive sex education – is overlooked. These issues are still regarded as taboo, and in my community you can’t talk openly about them.

It’s a different scenario for women and adolescents in urban communities within Zimbabwe. In urban areas, it’s possible to access both information and services through youth friendly centres, Non Governmental Organisations and other diverse forums.

I believe that women can only enjoy their sexual and reproductive health and rights if they have access to relevant services and supplies – including access to contraceptives and accurate information on how to use them – regardless of geographical area or socioeconomic status.

The government of Zimbabwe is committed to ensuring improved availability of and access to quality integrated family planning services for all women irrespective of age, marital status and their geographical location by the year 2020.

A sizeable number of interventions have been made. For example, we now have an ambassador for Family Planning to advocate for family planning. This is a great initiative, but in rural areas this ambassador is not visible, and so issues are misrepresented! This type of intervention is relative – it primarily benefits the adolescents and young women in urban areas the brand ambassador is engaging with – which makes it an unfit approach for women collectively.

I believe that this kind of intervention leaves a lot of women behind. 

A large percentage of Zimbabwean women are in rural communities. Adolescents and young women in rural areas need interventions they can relate to – services that resonate with their particular reality and their existing level of understanding.

As much as there have been family planning and contraceptive outreach services, it is still absurd that in rural areas adolescents and young women continue to have unwanted pregnancies and new cases of HIV infections. The reason behind this is a lack of positive and affirmative approaches towards women’s sexuality.

From my experience in a rural area, the healthcare service providers are not youth friendly and they tend to have a negative perception of young women trying to access family planning. As a result, adolescents and young women shy away from these health centres as they don’t trust the service providers.

This is very disturbing, as trust should be one of the core values health service providers should strive to uphold at all times. I believe that it would be a great idea for genuinely youth friendly centres to be established in rural and remote areas. This would encourage adolescents and young women to seek out sexual education and feel comfortable asking questions about the family planning methods that will work best for them. It would also help conservative rural communities to recognize family planning as not only a priority, but also a right.

Sexual and reproductive health and rights of women and adolescents in rural communities should be prioritized in Zimbabwe, and the government must be held accountable for delivering meaningful and diverse approaches in tackling the family planning challenges our country faces. Without this, achieving the FP2020 targets will not be possible.

If truth be told, rural women and adolescents have had enough of being left behind.