Elisha Arunga Odoyo, a clinical officer within the PMTCT program at the Homabay County Referral Hospital. There is increasing fear that adolescents will be left behind in the efforts to reduce HIV infections. Credit: Joyce Chimbi/IPS

By Joyce Chimbi
Nairobi, Kenya, Jan 18 2022 (IPS)

The ominous warning came in 2019 through an anonymous message on her mobile phone to stay away from a man she met on social media.

At 18 years and freshly out of high school, *Nicole Kisi was in a relationship with a 45-year-old businessman.

“The message was clear. It said to be careful because of a rumour that the man’s wife died of HIV/Aids. I was shocked. I forwarded the message to my boyfriend, and he told me the person was jealous of him because he is successful,” she tells IPS.

“He looked healthy to me, and I believed that the message came from one of those jealous people.”

One year into the relationship, Kisi was in and out of hospitals. At first, she was treated for severe malaria, but her condition only worsened. Eventually, her HIV positive status was discovered.

As with other sub-Saharan Africa countries, government data shows AIDS is the leading cause of death and morbidity among adolescents and young people in Kenya.

Over the past decade, Africa’s fight to combat HIV has seen new HIV infections reduced by 43 percent and nearly halving AIDS-related deaths.

However, the Joint United Nations Programme on HIV/AIDS (UNAIDS) shows the continent is not on track to end AIDS by 2030 because key elimination milestones have not been met.

“There are 18,004 new infections and 2,797 deaths among adolescents 10-19 years annually in Kenya. Overall, 40 percent of new HIV infections in the country are among adolescents and young people 15 to 24 years,” says Damaris Owuor, an HIV activist based in Nairobi.

“The Prevention of Mother to Child Transmission (PMTCT) of HIV is extremely successful, and so we are greatly concerned about the HIV risk that our young people now face from cross-generational sex.”

More than 90 percent of HIV infections in children result from mother-to-child-transmission, says Elisha Arunga Odoyo, a clinical offer within the PMTCT program at the Homabay County Referral Hospital.

UNAIDS data shows that East and Southern Africa has significantly reduced this risk. Between 2010 and 2018, new HIV infections among children 0 to 14 years declined from 1.1 million to 84,000 across the region.

Odoyo points to Kenya’s Homabay County. Despite having the highest HIV prevalence in Kenya at 20.7 percent, over four times the national prevalence of 4.8 percent, mother-to-child transmission of HIV reduced from 16.8 percent in 2015 to 9.1 percent in 2019.

Owuor says poor sex and reproductive health education and, lack of access to adolescent-friendly reproductive health services is primarily to blame.

Further, UNICEF research shows transactional and age-disparate sex, peer pressure, stigma and discrimination, harmful social and gender norms, and unequal power dynamics contribute significantly to the bulging number of adolescents living with HIV.

The most recent Kenya Demographic and Health Survey shows three out of 10 girls have sex before age 15 and that one in every five girls, 15 and 19 years is either pregnant or already a mother.

Still, Owuor tells IPS that significant strides are needed to address the adolescents’ risk of acquiring HIV. Girls account for six in every seven new HIV infections among adolescents in sub-Saharan Africa.

“My friends and I worried more about getting pregnant than HIV. When you are young, you think about HIV as something that happens to older people. None of my friends has ever bought a condom, but we have bought P2 (morning after pill) so many times for fear of getting pregnant,” she tells IPS.

UNAIDS research shows adolescents and mothers are still disproportionately affected by HIV and left behind the global AIDS response.

Within this context, Owuor cautions that the youth bulge could significantly increase new HIV infections without a targeted approach to increase access to HIV prevention, HIV testing, care and treatment among adolescents and young people.

To achieve the 2030 global target to end AIDS, an analysis by the World Health Organization (WHO) indicates that by 2025, 95 percent of all people living with HIV know their status, 95 percent of those who know their status are on treatment, and 95 percent of those on treatment have a suppressed viral load.

In Africa, 87 percent of people living with HIV knew their status. Of those, 77 percent were on treatment, and 68 percent had a low viral load, according to statistics released in December 2021.

Only nine countries, including Kenya, Botswana, Cabo Verde, Lesotho, Malawi, Nigeria, Rwanda, Uganda, and Zimbabwe, were on track to reach the 95-95-95 fast track target to end AIDS.

Nonetheless, Owuor says while progress has been commendable, the ambitious target will not be achieved if crucial HIV/AIDS elimination milestones among adolescents are missed.

According to Kenya’s ministry of health, access to and uptake of HIV testing and counselling by adolescents is significantly low, as is antiretroviral therapy coverage compared to any other age group of persons living with HIV.

UNICEF research finds while there is increased awareness of HIV in general, adolescents still lack comprehensive knowledge of HIV and condom use remains low in the age group.

“Young people are among the least tested, and without targeted intervention, they also do not adhere to treatment and are often virally unsuppressed. A high viral load, or the amount of HIV in the blood, increases the risk of an adolescent transmitting the virus, so we have to break this cycle,” Owuor says.

Kisi agrees, adding that an adolescent’s journey to accepting a positive HIV result is a long road marred with denial, anger, and bitterness.

“Seeing your friends living a carefree life as you die inside is very painful. The biggest problem is that you lose hope and start to believe that there is no future,” she says.

“Even today, I struggle with accepting my status. I recently joined a peer support group, and I am smiling again. I feel more hopeful than I have ever before.”

Follow @IPSNewsUNBureau
  

Attendees at the 11th Congress on Adolescent Health in New Delhi, Oct. 27-29, 2017. Credit: Stella Paul/IPS

By Stella Paul
NEW DELHI, Oct 30 2017 (IPS)

Twenty-year-old Gogontlejang Phaladi of Mahalapye, Botswana is grateful she was never sent to a so-called “hyena” like scores of girls in neighboring Malawi were.

In a ritual approved by the community, a solo man (the hyena) would have sex with the adolescent girls of an entire village to “sexually cleanse” them so they would be considered fit for marriage."It makes sense to bring village and religious leaders in this conversation on violent crimes. After all, most of them are validated by the society and traditions.” --Gigi Phaladi

“I am so glad that in Botswana we do not have hyenas, but we face other forms of sexual violence such as stepfathers molesting stepdaughters and giving them HIV,” says Phaladi, founder of Pillar of Hope, a project that counsels, educates and trains local adolescents to tackle these challenges.

Violent Crimes Left Out

Last week, Phaladi attended the 11^th World Congress on Adolescent Health which was held in New Delhi and focused on different health aspects of youth in the age group of 10-24. Speaking to an audience that included diplomats, bureaucrats, researchers, doctors and activists, Phaladi stressed that if the problems of adolescents were to be truly addressed, they had to be involved in the process.

Talking to IPS on the sidelines of the Congress later, Phaladi said that there were adolescents who experienced the most heinous and violent crimes across the world such as sexual assaults, trafficking, violent social norms and religious practices of violent crime.

Aside from HIV, beating, molestation, and sexual exploitation at schools by teachers – the challenges faced by adolescents were multiple. But the adolescents directly affected by the violence and crime were not included in the process to address them.

“You see, the laws in these countries are not firm enough to protect the adolescents from these crimes. So, it’s not just a health issue, but a governance deficiency and we need to talk about this at such events, from the adolescents themselves,” she said.

Unfortunately, violent crimes like sexual slavery, hyenas, molestation at schools or breast ironing – another crime reported widely from Western Africa – were missing from the Congress on Adolescent Health, as were issues of cross-border sex trafficking of adolescent boys and girls in Asia and community-backed forced prostitution of young women in India. Mental health was discussed as a generic issue, but rising cases of mental illness in militarized and conflict zones were also missing.

Lack of Studies and Data

A big reason behind this could be lack of any data, said Rajib Acharya, a researcher from Population Council of India, a New Delhi-based NGO researching population issues across India. Acharya just conducted a study of 20,000 adolescents aged 10-14 in two states of India – Bihar and Uttar Pradesh.

Presented at the Congress, the study showed, among others, severe levels of anemia among the adolescents. According to the study, 1.2 million and 2.8 million are severely anemic, respectively, in these two States.

But it took four months and a team of 50 researchers to interview the adolescents on nutrition and sexual and reproductive health.  Three weeks were spent on training the researchers, and analyzing the data took another four to five months. To generate data on multiple issues would mean multiplying the investment of this time, effort and money, Acharya reminded.

He also said that if the issue was complicated, sensitive and involved  traveling to conflict zones, it was less likely to be taken up for research as gathering credible date would be incredibly hard.

Forums like the Congress should ideally be utilized to bring on the hard-hitting issues related to adolescents,  said Thant Aung Phyo, a young sexual and reproductive healthcare activist in Myanmar. Pointing out the severe restrictions on adolescents in accessing abortion care, Phyo said, “The rigid government policies and social traditions that restrict the rights of adolescents need to be brought up and discussed at forums like this.”

Myanmar is currently caught in a human rights  disaster where over a million Rohingyas had been forced to flee their homes, taking refuge in neighboring countries including Bangladesh, India and Thailand.  The refugees included hundreds of thousands of adolescents who are living in trauma, poverty, fear and uncertainty.

Decribing their suffering as “unfathomable” and “unprecedented”, Kate Gilmore,  Deputy High Commissioner of the UN Human Rights Commission, says that refugee and migrant adolscents  across the world must be provided  free and regular healthcare as a right.

“Migrant adolescents must have access to healthcare without the fear of being reported, detained and deported,” Gilmore said.

Improving World’s Largest Adolescent Program

India, home to the world’s largest adolescent population (253 million), launched  an adolescent-specific program in 2014 – the first country in the world to do so on such a scale. Titled Rashtriya Kishor Swasthya Karyakram (KRSK), the program aimed at improving health and nutrition of adolescents besides protecting them against violence and injuries.

It is currently run in 230 of the country’s 707 districts,  but even after three years, there was  little data available on the program’s impact. The data presented at the event by the health ministry of India at the Congress only specified the facilities built by the government so far (700 adolescent health clinics) and services provided (training over 20,000 adolescents as peer educators).

However, the selection of the peer educators and the skills of the field workers had been questioned by experts from the non government sector.

“The peer educator component is the most controversial aspect of the program. The skill of the workforce on the ground is also questionable,” observed Sunil Mehra, one of the pioneers on adolscent health in India and head of Mamta Health Institute for Mother and Child which coorganised the Congress.

Agreed Rajib Acharya: “If we spoke with community level  health workers, we would see  that only 5 or 6 out of  every 30 or 40 knew what they were supposed to say or do to adolescent patients.”

On Saturday, however,  the ministry  announced certain changes  to improve the RKSK program and monitor certain services  Said Ajay Khera, Deputy Commissioner (Adolescent Health) at the minsitry, the government would “now make the program  promotion and prevention-centric and monitorable”.

The ministry would particularly monitor its  Weekly Iron Folic Supplementation (WIFS) programme  on digital platforms to tackle anemea among adolescents. A special toolkit called “Sathiya” was also launched at the World Congress on Friday for better peer education. The Toolkit—available both in print and online – focused on six broad themes of the RKSK such as integrated child health , sexual and reproductive health, injuries and violence, nutrition, substance abuse and mental health.

Leveraging the Traditional  System

There are other instituions and systems that  India and other countries could make better use of  to address the “wicked problems” faced by the adolescents, reminded  Anthony Costello, Director, Department of Maternal, Newborn, Child and Adolescent Health at the World Health Organization (WHO).

“Promoting greater interaction among adolescents of different age and sex is one. Involving parents in learning of the health issues of adolescents is another. Talking of difficult and disturbing issues like breast ironing, rape, trafficking is yet another. We need to use all of these,” Costello told IPS.

Gigi Phaladi added that traditioonal and religious leaders  also must be roped in to talk about adolescents. In Botswana, she said, pastors in churches were urged to talk of gender violence, HIV and other gender-based crimes.

“People were surprised to hear their religious leaders talk about sex etc, but they also started paying attention. The general feeling among people was ‘if the pastors do not feel hesitant to talk about these issues, why should we?’ So, it makes sense to bring village and religious leaders in this conversation on violent crimes. After all, most of them are validated by the society and traditions,”she said.

The three-day (Oct. 27-29 ) 11^th Congress on Adolescent Health, which had 1,200 participants from 65 countries, concluded on Sunday.

Two Mexican teenage girls at their school. Investing in education for teenage girls in Latin America is regarded as the way forward for them to become future drivers of sustainable develpment in their societies. Credit: UNFPA LAC

By Estrella Gutiérrez
CARACAS, Jul 11 2016 (IPS)

Latin America’s teenage girls are a crucial force for change and for promoting sustainable development, if the region invests in their rights and the correction of unequal opportunities, according to Luiza Carvalho, the regional head of UN Women.

“An empowered adolescent will know her rights and will stand up for them; she has tools for success and is a driving froce for positive change in her community,” Carvalho told IPS in an interview from the regional headquarters of UN Women in Panama City.

Adolescent girls and boys will have a leading role in their societies when the Agenda 2030 for Sustainable Development has been completed, she said. One of the Sustainable Development Goals (SDG) is gender equality. Investing in today’s girls will have “a great transformative impact in future,” she said. “Investing in education and protection against violence are important tools for fulfilling the potential of teenage girls and young women,as wellas for promoting gender equality” -- Luiza Carvalho.

The world today has a higher proportion of its population aged between 10 and 24 years old than ever before, with 1.8 billion young people out of a  total population of 7.3 billion. Roughly 20 percent of this age group live in LatinAmerica and the Caribbean, Carvalho said.

According to data given to IPS by the regional office of the United Nations Population Fund (UNFPA), 57million of the region’s 634 million people are girls aged between 10 and 19, living mainly in cities.

The theme for this year’s World Population Day, celebrated July 11, is “Investing in Teenage Girls”, on the premise that transforming their present situation to guarantee their right to equality will not only eliminate barriers to their individual potential but will also be decisive for the sustainable development of their countries.

Women Deliver, an international organisation, has calculated the benefits of this investment in financial terms. For every additional 10 percent of girls in school, national GDP rises by an average of three percent; for every extra year of primary schooling a girl has completed, her expected salary as an adult grows by between 10 and 20 percent.

This is fundamental because, as Carvalho pointed out, “lack of economic empowerment, together with generalised gender discrimination and the reinforcemet of traditional stereotypes, negatively affects the capability of women in Latin America and the Caribbean to participate on an equal footing in all aspects of public and private life.”

Luiza Carvalho, regional director of UN Women for Latin America and the Caribbean. Credit: UN Women LAC

That is why “investing in education and protection against violence are important tools for fulfilling the potential of teenage girls and young women,as well as for promoting gender equality,” she said.

Teenage women, she said, “are an especially vulnerable group who face special social, economic and political barriers.” Their empowerment in the region may come up against difficulties such as unwanted pregnancy, forced early marriage or union, gender violence and limited access to education and reproductive health services.”

As an example of these obstacles, the regional director of UN Women said that a Pan-American Health Organisation (PAHO) study of women aged 15-49 years in 12 countries of the region “reported that for a substantial proportion of these women, their first sexual encounter had been unwanted or coerced.”

Carvalho stressed that “early marriage or union imposed on girls is a major concern in the region, and it significantly affects the exercise of adolescent girls’ rights developing their full potential.”

“It is a form of violence that denies them their childhood, interrupts their education, limits their social development, curtails their opportunities, exposes them to the risk of premature pregnancy at too young an age, or unwanted pregnancy and its possible complications, and increases their risk of contracting sexually transmitted infections, including HIV (human immuno-deficiency virus),” she said.

It also increases the girls’ exposure to “becoming victims of violence and abuse,” Carvalho said.

In Carvalho’s view it is very positive that all the countries inthe region have established minimum ages for marriage in their laws, but on the other hand, the laws fix different minimum ages for boys and for girls, and in certain cases such as pregnancy or motherhood, girls may legally marry before they reach the minimum age.

In Latin America, far from diminishing, teenage pregnancies have increased in recent years, due to cultural acceptance of early sexual initiation. As a result, the region ranks second in the world for adolescent birth rates, with an average of 76 live births per 1,000 women aged 15-19 years, second only to sub-Saharan Africa.

Furthermore, 30 percent of Latin American teenage girls do not have access to the contraceptive care services they need, according to UNFPA. Sexual and reproductive health face especially high barriers in this region because of patriarchal,culture, the weight of conservative sectors and the dominance of the Roman Catholic Church.

In Latin America, indigenous teenage girls, together with their rural counterparts, are the group most discriminated against in terms of opportunities and access to education. Credit: Rajesh Krishnan/UN Women

In contrast, the region has a good record on education. Over 90 percent of its countries have policies to promote equal access by teenagers to education. Ninety percent of teenage girls have finished their primary school education, although only 78 percent go on to secondary school, according to UNFPA.

The greatest educational access barriers are faced by rural and indigenous teenage girls, who have difficulties for physical access to some education centres. In the case of indigenous and Afro-descendant girls, this is added to inappropriate curricula or the absence of educational materials in their native languages (mother tongues). 

Carvalho highlighted as a positive element that education laws, especially those that have been reformed recently, “have begun to recognise the importance of establishing legal provisions that promote and disseminate human rights, peaceful coexistence and sex education.”

However, she regretted that “direct connections with prevention of violence against women and girls are still incipient.”

In her view, the school curriculum plays an essential role. Including contents and materials “related to human rights and the rights of women and girls, non-violent conflict resolution, co-responsibility and basic education about sexual and reproductive health,” will potentiate more non-violent societies, inside and outside of the classroom, she said.

Carvalho quoted a 2015 study carried out in 13 Latin American countries by UN Women and the United Nations Children’s Fund (UNICEF), which concluded that education systems are failing to prevent violence against girls.

“This is something that must be improved, because it is in the first few years of early childhood that egalitarian role modelling between girls and boys can occur and lay the foundations of the prevention of violence, discrimination, and inequality in all its forms,” she emphasised.

Carvalho said changes should start with something as simple as it is frequently forgotten: “Girls, teenagers and women are rights-holders and entitled to their rights.”

If girls are given “equal access to education, health care, sexual and reproductive education, decent jobs, and representation in political and economic decision-making processes, sustainable economies would be promoted and societies, and humanity as a whole, would benefit,” she concluded. 

Edited by Verónica Firme. Translated by Valerie Dee.