Young girls and women in SA between 15 and 24 continue to be most at risk of HIV, yet access to preventative measures and support remains low.
According to UNAIDS, young women in sub-Saharan Africa are twice as likely to become infected with HIV than males.
Peaceful Kgomo, 27, often leaves her local clinic empty-handed.
“Testing services and condoms are easily available, but PrEP (pre-exposure prophylaxis) isn’t. Most of the time when we go to the clinic, we are told that there isn’t stock,” said Kgomo.
More info on prevention needed
“General HIV information is available, but not on how to prevent infection. Most women and young girls are very ignorant. They have this mentality that since they aren’t infected, they don’t need to bother knowing about HIV,” said Kgomo.
She said that the lack of these services affects teenagers because it leads them to make uninformed decisions about their sexual practices.
“This contributes to unsafe sex. We need PrEP in our community,” she said.
A cyclical increase in risk for females
A 2021 research report found HIV prevalence increased from 4.2% in 2008 to 4.7% in 2012. In 2017 it increased by 5.7% among females.
The research concluded that interventions targeting young people and prevention programmes that addressed gender inequalities as contributors to driving HIV risk behaviours among adolescent girls were needed.
“The epidemic has continued to rage amongst young women in this age group since the 2000s. It is still very focused among young women,” said Professor Francois Venter.
Venter has focused on HIV research for more than 20 years. He is the Divisional Director of Ezintsha at Wits University, where they do clinical trials focusing on HIV drugs and COVID-19.
HIV Community Services Lead for BroadReach Health Development, Veni Naidu, said it is always important to discuss the prevalence of HIV among all groups with the associated behaviours. Naidu noted that one of the risk factors for young girls is peer pressure.
“This is because they want to identify with their peers. They want to be all-inclusive and have acceptance, which can lead them to participate in unprotected sex, inconsistent use of a condom, or also having multiple partners. Another risk factor is the patriarchal culture and economic dependence,” she said.
Naidu explained how economic dependence could lead to submissive behaviours or not having a voice to ask for the correct level of protection to protect one’s body.
She added: “There are usually also transactional relationships in HIV acquisition, especially when young adults are economically dependent on older men. This continues to remain one of the factors that sustain high incidence rates. food insecurity, poverty, and lack of education contribute to economic dependence.”
Naidu added that gender-based violence (GBV) is one factor that increases young people’s exposure to HIV.
“Children can be infected with HIV through sexual abuse and also rape. There is also intimate partner violence (IPV), which can be from a current or former partner. hen there’s also family violence which exposes women and children.”
Venter agreed that the worsening rate of GBV in South Africa and Africa is a contributing factor to the vulnerability of females to HIV acquisition. He, however, disagreed that the age disparities between young women and older men were significant drivers in HIV transmission.
Sugar daddies ‘aren’t a factor’
Venter expressed the concern that this notion turned young women into “vexes of the disease” that had their agency and their ability to make complex life decisions overlooked. While men were also turned into vexes of disease and monsters that society couldn’t do anything about.
“The sugar daddy comments ignore a lot of evidence that shows how age discordance is not a major driver of HIV transmission. T e real transmission dynamics is trying to understand what’s happening among young people in the sexual networks that they have going on. What is going on is probably a combination of viral. Like something to do with a virus or something to do with the genetics of the local population. And there might be other environmental issues we don’t quite understand until we go into communities and do this research.”
Venter noted that when people talk about age discordance as a major driver in SA or Africa, they need to acknowledge that they are not talking about a social phenomenon that is unique to the rest of the world.
“If it is such a big driver, a young woman in KwaZulu-Natal has a 3000 times greater chance of acquiring HIV than a young woman in Delhi or Melbourne. This can’t be the only explanation for her vulnerability. I can’t just be her relationship with sugar daddies.”
Venter added that another remaining challenge is the conservative and non-committal attitude of the government towards providing sexual reproductive health services to young girls and women.
Access to HIV support services
Dr Thato Chidarikire, Director of HIV Prevention Programmes for the National Department of Health (NDOH), acknowledged that there are still several challenges to accessing HIV support services.
“Some have stated that they are scared to go to nearby facilities because maybe their mother’s friends work there, and they don’t want to be seen. They have also reported unwelcoming attitudes from the health care workers themselves,” Chidarikire explained.
Chidarikire added that the opening hours and time to provide services are also inconvenient for school-going children.
She continued: “A young person needs to go to school. A d because they need to go to school, they cannot go to the clinic in school uniforms. Sometimes you may find that the trip to the clinic needs transport, and they don’t have it. sometimes, they may not necessarily have difficulty accessing the facility itself, but the service they are looking for is not available.”
Preventing HIV with PrEP
Dreams is an HIV prevention programme implemented by BroadReach in partnership with the NDOH. It also partners with the Department of Education. Naidu explained that the programme aims to reduce the rates of HIV amongst adolescent girls and young women between the ages of 15 to 24 by focusing on prevention methods like PrEP.
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PrEP is a single-dose medication that is taken once a day at the same time to prevent HIV infection.
“It is a multi-sectoral intervention. This means that we look at PrEP in the health facility holistically. W en a young girl comes to the health facility. She receives counselling in HIV prevention. S e would also be offered an HIV test so that she knows her status. She will be provided with sexual and reproductive health services to ensure she understands how to protect herself and get family planning advice. A so, she is screened, and then if she has got a sexually transmitted infection, she will be treated and issued with condoms,” said Naidu.
Adolescent girls and young women are also screened for IPV.
“Once we identify a child or a young girl affected by IPV, we provide psychosocial counselling at the facility level. W then refer that client to partners like the National Aids Convention of South Africa (NACOSA), who provide ongoing support services.
Naidu emphasised the importance of involving parents and guardians in education about PrEP.
“Often, the parents get upset if a child takes PrEP on their own, even if the child is over 12 years old and can make their own decisions about their health. When some parents find out, they stop them from taking PrEP, exposing the young girl. So, we try to make sure that information is provided to their parents, caregivers, and guardians so that they understand the importance of PrEP,” she said.
Naidu explained that one takes PrEP only when they are considered to be at risk.
“If you are having unprotected sex, then you take PrEP. But if you stop and you’re not in a relationship again, you can stop taking PrEP. Ho ever, we don’t advise the client to stop taking PrEP alone. It s much better to come back to the health facility and to engage with the healthcare provider because then they can explain and see the risk,” she stated.
Naidu said that this is because the client sometimes perceives themself not to be at risk anymore. But, if they are in a situation where there is partner violence or drug and alcohol abuse, they must remain on PrEP.
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— MyPrEP (@myPrEP_SA) June 25, 2022
Making it normal
PrEP is not a life-long medication, but it becomes long-term when a client is at risk.
“We don’t want PrEP to be attached to the stigma and discrimination we’ve experienced with HIV. Young adults must acknowledge it when they’re sexually active and don’t use condoms consistently. You can take a pill to prevent HIV, and we want young people to know that,” said Kgomo.
Kgomo has set up a foundation that provides prevention information and counselling support. The Peaceful Kgomo Foundation is a “non-profit organisation. It aims to improve the conditions of AIDS orphans, people living with HIV, and those affected by the virus”.
“More outreach is needed in my community, and awareness events are needed to educate young women about the virus. Our foundation will host a World AIDS Awareness event in December to include the community. We will have a dialogue where we will discuss issues we face as young women, HIV acquisition, and many other infections,” said Kgomo.
Kgomo added that the event would also have testing stations and other initiatives to encourage young people to know their status.
‘A work in progress’
Chidarikire said that the department plans to reduce HIV among young people by 50% by 2025.
“It is a work in progress. We are trying to work around issues young girls face when going to the clinic by establishing youth zones. This service is available at a time that is suitable for school-going children. Ma y provinces and facilities are doing it between 2 and 4 pm. They don’t have to queue with the adults, and they don’t have to answer questions that are difficult for them to respond to,” she said.
Chidarikire also said that the department has trained nurses and sensitised them to offer HIV support services to the youth.
“At the moment, we have about 1400 users. We started 18 months ago, and there are roughly 4 000 facilities. The plan is that just over half of them will be youth zones by 2025,” she added. “Young people are showing up at these facilities, and we need to continue to promote, communicate, and mobilise so that young people know where they are.”
Stigma remains a challenge
“The challenge with PrEP in some communities is great stigma. People think that it is some form of an ARV and feel that if they are already taking them, then they will be seen by others to be engaging in risky behaviour,” she explained.
Chidarikire admitted that this was only the start of the department’s plans to address the problem.
“Even though the incidents may not decrease as fast as we want them to, we plateaued and are on a downward trajectory. The challenge here again is that we continue to change and need to respond. Growth is something that comes at a pace. Five, ten years ago, we were confronted by different challenges compared to what is happening today,” said Chidarikire. – Health-e News