A young woman in South Africa is four times more likely to be HIV positive than her male counterpart – a staggering statistic given South Africa’s already high HIV infection rates. Globally, girls between 15 and 19 account for two out of three new HIV infections but in sub-Saharan Africa, the figure is nearly eight out of ten. According to UNAIDS and UNICEF, more than 800 girls in this age group are infected with HIV every week in South Africa. Women and girls are also much more likely to be caring for those infected and affected by HIV, limiting their education, work and life opportunities. Our girls are disappearing to this disease in huge numbers. Why are they so much more at risk? And, more importantly, what can we do to bring them back? (HSRC (2014) South African National HIV Prevalence, Incidence and Behaviour Survey, 2012)
According to the Center for Global Development: “Girls and young women are generally less educated, less healthy, and less free than their male peers. They face systematic disadvantages over a wide range of welfare indicators, including health, education, nutrition, labor force participation, and the burden of household tasks.”
In South Africa, there is little difference in HIV prevalence between boys and girls up to the age of 14, at 2.7%. But for youth aged 15-24, the prevalence jumps to 7%, and amongst girls the rate is 11.4%. It is widely accepted that gender inequality is a key driver of HIV transmission but how does this manifest for our young girls, in a country with one of the most progressive constitutions in the world?
Our constitution may be enlightened but society lags behind and in practice, gender inequality is very much a reality. Attitudes, social norms and harmful cultural practices exacerbate other HIV risk factors and impact negatively on young women’s sexual health, such as gender based violence, early sexual debut and early and unwanted pregnancy. In a LoveLife study in 2005, 15.5% of 15 to 19-year olds reported having been pregnant and 66% said the pregnancies were unwanted. (Pettifor et al 2005)
Poverty and the heavy burden of domestic care on women and girls mean that girls are more likely to engage in transactional sex (sex in exchange for money, goods or favours) and inter-generational sex (sex with older men), both of which are well-documented HIV risk factors. Girls in families affected by AIDS are even more likely to engage in sex in exchange for money, school fees, transport or shelter. (Cluver L. (2011)
Sexual violence is one of the biggest drivers of HIV in young women and South Africa has a significant and well-publicised problem with violence against women and girls. A 2009 study examined the presence of sexual assault in the murders of girls under the age of 18 and found that one-quarter of girls’ homicides (as opposed to 1.5% of boys’) were related to sexual assault. Other research in Gauteng found that one in four women had experienced sexual violence in their lifetimes.(Machisa et al (2010), The War at Home – GBV Indicators Project)
Care and treatment for survivors of sexual violence can prevent HIV infection and reduce the impact of trauma (which, unless addressed, can lead to mental health problems and risky behaviour in the future) but negative attitudes of health and justice workers towards survivors of rape reduces young women’s access to these vital services. There are few services tailored to the needs of young women and girls, making it doubly difficult for girls to access post-exposure prophylaxis (antiretroviral treatment given to survivors after being raped to prevent them contracting HIV), support, counselling and, ultimately, justice in the form of court appearances and convictions for perpetrators.
Although we have supportive legal and policy frameworks in place to tackle gender inequality and violence, the issue in South Africa is a lack of coordination and poor implementation of the laws and policies already in place to safeguard girls. Yet there are a number of well-documented solutions to the problem of young women and HIV; things we can do now to bend the trajectory of HIV in South Africa and bring our girls back:
- Reduce economic dependence and vulnerability by encouraging girls to stay in school, gain qualifications and skills and access the job market.
- Promote youth-friendly services that are responsive to the sexual and reproductive health needs of women and girls.
- Formalise home and community-based caring so that young women gain recognised skills and can earn an income from caring for those infected or affected by HIV.
- Sensitise and train frontline workers like the police, teachers, health and social workers and community care givers so that they provide compassionate and appropriate care to survivors of sexual violence.
- Provide financial and technical support for women’s movements and organisations – research across 70 countries found that “a strong, autonomous feminist movement is both substantively and statistically significant as a predictor of government action to redress violence against women”.
- Ensure quality sexuality education for all women, men, girls and boys (both in and out of school) with a focus on gender equality, human rights and social norms. (Htun and Weldon, 2012)
Everyone can get behind our girls and contribute to reducing HIV infection and improving the lives of girls and women in South Africa. Women’s organisations and shelters face extraordinary financial pressures just to keep their doors open and supporting these organisations with regular donations (even small amounts make a difference) is just one way that individuals can help. (Athena & HEARD 2015)
We can bring back our girls from high rates of HIV infection if we come together and work towards eliminating gender inequality for good.
NACOSA is helping to organise End it Now! Together in response to GBV and HIV – a national conference to promote linking, learning and action on the state response to gender based violence (GBV), the interaction between HIV and GBV and the impact of GBV on young people from 24-26 October in Johannesburg. www.enditnow.co.za