Solutions informed by evidence
“A RIGHT TO REFUSE” Sifuni took part in the Ishi Rural Initiative, a 13-session, curriculum-based course that promotes positive changes in HIV-related knowledge, attitudes, skills and behaviours among young men and women in the United Republic of Tanzania. Funded by UNICEF and USAID and implemented by Family Health International, the Ishi Rural Initiative uses peer volunteers to lead a number of other HIV-prevention activities in their schools and communities, including video presentations, group discussions with classmates and parents, conferences, forums for elders, festivals and other events on topics ranging from health to girls’ empowerment. Sifuni was not yet sexually active when she took part in the course. In her own words: “I learned that I have a right to refuse. I learned how to explain my feelings and show a man that once I say no, you have to understand I mean no. Once you accept one of those gifts, the boy thinks you agree to go with him. If you reject those gifts, you refuse him. “Nowadays, we are strong,” she added. “We can say no regardless of who it is.” Sifuni, 18, Makete District, United Republic of Tanzania
Sexuality education and sexual and reproductive health Sexuality and life skills education, particularly around the transmission of HIV, is as important a prevention tool for older adolescents, many of whom have started to have sex, as it is for very young adolescents (see Chapter 3). Early motherhood is a reality for many older adolescent girls. Childbirth and parenting, for most adolescent mothers, mean the end of schooling, work or career plans. At a further disadvantage because of their young age and a lack of income, adolescent mothers and their children are particularly vulnerable not only to ill health and poverty but to exploitation, neglect and abuse, which can contribute to their risk of HIV infection.72 Preventing adolescent pregnancy is a priority in Latin America and the Caribbean, where the proportion of adolescent mothers is the highest in the world: girls aged 15–19 accounted for 18 per cent of all live births in this region in 2007.73 Comprehensive, correct knowledge is fundamental to the uptake of HIV services and behaviour change. A closer look at indicators on knowledge, condom use and HIV testing in countries with generalized epidemics shows that more efforts are needed to increase access to testing. In an analysis of 11 sub-Saharan African countries with the highest numbers of new infections, eight have achieved a reported condom use rate of 45 per cent or greater among males and only three countries among females (see Figure 8). Knowledge levels remain low among both young men and young women, as do levels of access to HIV testing, particularly among young men, for whom there is no entry point comparable to maternal health programmes that provide testing and services for the prevention of mother-to-child transmission (PMTCT) for young women. None of the countries analysed are close to reaching the 95 per cent target set in 2001. The barriers adolescents often face in accessing sexual and reproductive health services and commodities are explored in Chapter 5.
Preventing HIV from early adolescence to young adulthood
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