Gender inequalities drive the disproportionate rate of HIV infection among young South African women aged 15 to 24. Credit: Mercedes Sayagues/IPS

By Nqabomzi Bikitsha
JOHANNESBURG, Dec 1 2014 (IPS)

When she found out that she had human immunodeficiency virus (HIV), Thabisile Mkhize (not her real name) was scared.

She knew little about the virus that had been living in her body since birth and did not know whom to ask. Her mother had just died and she lived with her grandmother in rural KwaZulu Natal, where the HIV prevalence is the highest in South Africa, at 17 percent.

Today, at the age of 16,  Mkhize is an enthusiastic peer educator at her school,  discussing HIV prevention, safe sex and sexual rights. “I want young women to be safe, to make healthy sexual choices,“ she told IPS.South Africa has a perfect storm of early sexual debut, inter-generational sex, little HIV knowledge, violence, and gender and economic inequalities that lead young women aged between 15 and 24 to have a disproportionately high rate of HIV infection

South Africa has a perfect storm of early sexual debut, inter-generational sex, little HIV knowledge, violence, and gender and economic inequalities that lead young women aged between 15 and 24 to have a disproportionately high rate of HIV infection.

They account for one-quarter of new HIV infections and 14 percent of the country’s 6.4 million people living with HIV, according to the ‘South African National HIV Prevalence, Incidence and Behaviour Survey’.

Alarmingly, HIV incidence – the number of new  infections per year – among women aged between 15 and 24 is more than four times higher than among their male peers.

Professor Sinead Delany-Moretlwe, director for research at Wits Reproductive Health and HIV Institute (Wits RHI) in Johannesburg, describes the factors that put young women at higher risk.

“Structural drivers – gender, social and economic inequalities – interact in a number of ways and influence behaviour such as choice of sexual partner and condom use,” she said.

Explaining that young women find it difficult to protect themselves against HIV, she noted that they “end up with controlling partners and fail to negotiate condom use or are forced to have sex.”

Tumi Molebatse, a 20-year-old student from Soweto, is an example. Years ago she had an HIV test and would like to have another with her boyfriend of two years, or at least to have safe sex.  “But my boyfriend will think I am cheating on him if I ask for condoms,” she told IPS.  “He supports me financially so it’s better to not bring it up.”

In South Africa, one of the most unequal countries in the world, relationships with older men often pen the way for young women’s social mobility and material comfort.

According to Kerry Mangold from the South African National AIDS Council, inter-generational and transactional sex increase the risk of infection because older men have higher HIV rates than young men.

“It’s not rare to see a young girl sleep with an older man for food or a little bit of money,“ said Mkhize. “Young women aspire to have nice things in life but they don’t have money, they don’t have jobs, and they go for partners who can provide those things.”

According to the ‘South African National HIV Prevalence, Incidence and Behaviour Survey’, one-third of girls aged between 15 and 19 reported a partner five years or more their senior.

Risk and choices

“At its most extreme, gender inequality manifests as gender-based violence,” says Delany-Moretlwe.

In South Africa, young women who experienced intimate partner violence were 50 percent more likely to have acquired HIV than women who had not suffered violence, according to the UNAIDS Gap Report.

Despite decades of awareness campaigns, less than one-third of young women know how to prevent HIV.

Mkhize says that many girls hear about sex and HIV from friends and teachers, and often  the information is wrong. “I know girls who believe you cannot get HIV if you boyfriend has just come back from circumcision school and so they have sex without a condom,” she told IPS.

Mangold would like to see “an enabling environment for young women to make their own choices and reduce their risk.”

Since last year, the ZAZI initiative has been trying to do just that. A sassy campaign, ZAZI (from the Nguni words for “know yourself”) builds knowledge around sexual health through social media, video clips, poetry readings, street murals, music and fun activities that boost girls’ sense of self-worth.

“We hope to discourage them from opting for relationships with older men for material gain and give them confidence to negotiate condom use,” ZAZI advocacy manager Sara Chitambo told IPS.

ZAZI’s motto is “finding your inner strength”. On its website, girls can look up practical advice on what to do if they are raped, where to find contraception and how to prevent HIV.

(Edited by Mercedes Sayagues and Phil Harris)

Bosena, 25, sits on the side of a busy road in Addis Ababa, Ethiopia’s capital, with a baby in her arms. Ethiopia is among the countries listed as having made significant progress in reducing child and maternal mortality rates. Credit: Jacey Fortin/IPS

By Nqabomzi Bikitsha
JOHANNESBURG, Jun 30 2014 (IPS)

Every year, three million newborn babies and almost 6.6 million children under five die globally, but if the rest of the world looked towards the examples of two of Africa’s least-developed countries (LDCs), Rwanda and Ethiopia, they would perhaps be able to save these children.

At the 2014 Partners’ Forum being held in Johannesburg, South Africa from Jun. 30 to Jul. 2 – hosted by the Partnership for Maternal, Newborn and Child Health (PMNCH), the South African government and other partners – significant commitments in finance, service delivery and policy were announced that could put an end to these deaths. In total, there were 40 commitments from stakeholders, governments and the private sector who are committed to ending child and maternal mortality were revealed at the forum today.

It was noted that while remarkable progress has been made in reducing maternal and child mortality rates globally, over the last two decades the reduction in the rates of newborn deaths has lagged behind considerably.

However, Rwanda and Ethiopia were among 10 countries across the globe listed as having made significant  progress in reducing child and maternal mortality rates, according to a new global action plan launched at the forum.

The Every Newborn Action Plan (ENAP) provides evidence on the effective interventions needed to end preventable stillbirths and newborn deaths. It also outlines a strategy to prevent 2,9 million newborn deaths and 2,6 million stillbirths annually.

These countries invested in high-impact health interventions, including immunisation, family planning, education and good governance.

Tedros Adhanom Ghebreyesus, Ethiopian Minister of Foreign Affairs, told IPS that multi-sectoral investments, and not just direct investments in the health sector, would help reduce maternal and child mortality.

“If we don’t invest in agriculture, water and sanitation as well as the health sector then any gains we make in reducing child and maternal mortality will be futile.

“Community-based health care workers helped reduced Ethiopia’s mortality rates for mothers and children.”

According to the ENAP, newborn deaths account for 44 percent of all under five deaths worldwide, and investments in quality care at birth could save the lives of three million women and children each year.

“Now is the time to focus on action and implementation, to ensure more lives are saved,” said Graça Machel, co-chair of the PMNCH.

“Other countries have made progress and others have not, we need to learn from them, so we keep momentum.”

Accompanying the launch of the ENAP, was the launch of Countdown to 2015 report titled “Fulfilling the Health Agenda for Women and Children”, which serves as a scorecard of gains made in maternal and child health.

According to the report, which studied the progress of 75 countries in child and maternal mortality efforts, substantial inequities still persist.

“The theme of the Countdown report is ‘unfinished business,’” said Machel. “Too many women and children are dying when simple  treatment exists.”

Over 71 percent of newborn deaths could be avoided without intensive care, and are usually a result of three preventable conditions; prematurity, birth complications and severe infections.

Dr. Mariame Sylla, United Nations Children’s Fund (UNICEF) regional health specialist, told IPS that countries needed to learn from one another.

“Community-based approaches, where governments bring health services to the people and people to the services, have shown to be effective,” she told IPS.

“Monitoring of results is also very important to ensure accountability in the health sector.”

Dr. Aaron Motsoaledi, South Africa’s Minister of Health, said “having professional midwives would also help new mothers understand motherhood better and help reduce mortality rates among women and children.”

However,  Ethiopia’s Minister of Foreign Affairs pointed out that “these  efforts are are simple but often hard to deliver.”

“Least-developed countries like Ethiopia were able to make strides in curbing child and maternal mortality through their political will,” Dr. Janet Kayita, health specialist for maternal, newborn and child health for UNICEF, told IPS.

But she pointed out that “Ethiopia’s key to success, was not just about the leadership making the decision to reduce child and maternal mortality rates, but also organising at community level.”

“Ethiopia is one of the few LDC’s to institutionalise quality improvement in the health sector, using the mechanism of rewarding good quality health services and holding accountable those not performing.”

Kate Gilmore, deputy executive director of the United Nations Population Fund, says we have failed to protect our girls from early marriage, from gender-based violence and from early pregnancies. Courtesy: Livia Maurizi/UNFPA

By Nqabomzi Bikitsha
JOHANNESBURG, Feb 28 2014 (IPS)

“The future is today aged 10 and it’s an adolescent girl,” Kate Gilmore, deputy executive director of the United Nations Population Fund (UNFPA), said in an interview with IPS in Johannesburg.

Gilmore discussed the impact on African youth of the last two decades of action on sexual and reproductive health and equal access to education for girls, which are assessed in the International Conference on Population and Development (ICPD) Beyond 2014 Global Report.

The report was released on Feb. 12, the anniversary of the 1994 ICPD, where 176 countries agreed on a 20-year Programme of Action, also known as the Cairo Consensus. This is a good opportunity to assess the gains and challenges of the ICPD, said Gilmore.

Q: What has the global community achieved for young people in the last 20 years?

A: One of the really groundbreaking outcomes of the ICPD was the commitment to sexual and reproductive health, making it a human rights project and not a population control project, not a project about controlling women’s fertility but a project about empowering women to be in charge of their bodies. It was a really cool shift that created transformation in public policy.

The past 20 years has also seen 1,2 billion people lifted out of poverty, a 42 percent decline in maternal mortality, and 90 percent of children passing through primary school.

Q: What economic gains have been made in Africa?

A: We have not made much economic gains in terms of addressing disparities.The gap between the rich and poor has gotten bigger within countries and between countries.

The data we were able to examine, covering the period between 2000 and 2008, just before the most recent economic crisis, showed the world had experienced and benefited from economic growth. But 50 percent of the economic growth went to less than five percent of the world’s population and economic growth gave no benefit to ten percent of the world’s population, who are the poorest.

UNFPA is calling on Member States to commit to legislative and policy reform that says there is no place for inequality, discrimination and marginalisation in our society.

Q: HIV prevalence in adolescent girls has not decreased in the past 20 years. Has the ICPD failed adolescent girls in this regard?

A: Yes, but this is a shared failure, because states also have a responsibility. We have failed to protect our girls from early marriage, from gender based violence and from early pregnancies. Governments need to realise that, unless we change the trajectory of adolescent girls on their journey to adulthood, there will be no development that is more sustainable, inclusive and resilient.

When you change the trajectory of the adolescent girl, everything changes in a community. Looking at all the data from the past 20 years, we can see clearly that what happens to the adolescent girl in the next 15 years, that is what will make or break the future.

Q: How do we invest in young people?

A: By engaging with governments and saying, let us have a look at your national strategies and priorities, let us give you access to the best technical wisdom. We also look into the best way to get the best benefit from having a healthy young population: changing health systems, improving education systems, creating spaces for young people to hone their entrepreneurial skills in new sectors.

Q: How has Africa addressed adolescent sexual and reproductive health?

A: Through deliberations of the African Union, we have seen increasing attention to sexual and reproductive health and rights. However, I do believe it has not always been identified as a young person’s issues. But, as governments have become sophisticated in the analysis of demographic realities, it has become clearer that when we talk about maternal mortality, HIV and AIDS, unsafe abortion, early marriage, fistula, and female genital mutilation, we are talking about young people.

Q: Why is it important to address the youth bulge in Africa?

A: Africa is a young person’s continent. The median age in most countries is 30 years and in Africa it is 20 years. If you want to make the youth cohort the fuel for driving economic prosperity, social stability and good governance, give them access to education and keep them healthy.

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