Left behind in HIV response
A young girl wobbles into the maternity ward at Lulanga Health Centre in Mangochi North East. Her labour days have arrived and at 16, she is expected to become a mother.
“I fell pregnant because I could not access family planning commodities such as condoms. My parents sent me away, to my boyfriend’s home and that is where I am staying,” Hadija says.
At her school, where she had dropped out of Standard Seven, eight other girls her age—some even younger—had fallen pregnant in one year.
And there could be another crisis that is not mostly openly talked about.
“When young girls fall pregnant in such big numbers, you cannot completely rule out that they are having unprotected sex. In the process, they are also getting exposed to HIV,” says Frank Mkandawire who belongs to a committee tasked to help in ending child marriages in communities around Lulanga Heath Centre.
For over five years, he and six others have taken their message across villages, warning parents and guardians against pushing their children into early marriages and advising the children to remain in school.
They have also tried to convince healthcare service providers to be friendly to young people who seek condoms and other sexual and reproductive health services from the facilities.
But along the way, the bottlenecks are glaringly intractable.
“There are parents who force their daughters out of their houses after they fall pregnant. In the first place, we must strive to ensure the girls do not fall pregnant at all. But even those who go to school are at risk.
“While the children who are sexually active and are in school get messages to do with sex, it is illegal for them to access products such as condoms within the school. It is a very complicated phenomenon,” Mkandawire laments.
And fighting the spread of HIV and Aids becomes even more complex, he says.
Activists and HIV research experts point out that sustainably controlling the epidemic requires holistic approaches where “primary prevention must be brought into the picture full scale”.
They also posit that the HIV response should consider other aspects of global health and health access.
In Malawi, several HIV prevention strategies have reportedly significantly reduced the spread of the virus and the country is reportedly among six territories in the world that are set to end Aids by 2030.
Among others, the prevention of mother-to-child transmission and the test-and-treat policies are said to have assisted the country in its progress.
But there are fears that if young people such as those in villages which form Lulanga Health Centre’s catchment area are left behind, gains registered will be greatly undermined.
“It is disturbing that while we are talking about progress in treatment, still many girls and women are getting infected every day. Globally, every week, around 6,000 young women aged 15-24 years become infected with HIV.
“Four out of five new infections among adolescents in sub-Saharan Africa are girls and young women aged 15-25 are more than twice as likely as their male counterparts to be living with HIV, according to latest data from UNAids,” says Ulanda Mtamba, a biomedical HIV prevention advocate.
She also bemoans stigma, gender-based violence and other forms of inequality that persist as serious barriers to prevention for adolescent girls and young women.
Mtamba would rather see women and girls, wherever they are, being able to make their own decisions about their bodies and sexual and reproductive health and lives.
“But that is not the case. We don’t pay much attention to where women and girls’ needs are. Even condoms need negotiation for them to be used. It is men who often decide,” she laments
In 2016, Malawi committed to reducing new HIV infections by 75 percent by the year that begins just the day after tomorrow.
During this year’s World Aids Day commemorations, UNAids Country Director, Nuha Ceesay, called for more efforts to combat the epidemic, particularly dealing with the 38,000 new infections that occur every year.
And with the country’s new infections having been at 36,000 last year, Mtamba is worried that ending the epidemic by 2030 could continue being significantly threatened.
“As much as there are several interventions on HIV prevention and several prevention methods being used, the new HIV infections are not going down as expected.
“We were supposed to be talking about having reduced new infections to 11,000 in 2020 from 59,000 in 2010 but clearly we will not achieve this,” she says.
Mtamba, who is also Country Director for Advancing Girls’ Education in Africa, thus calls for an expansion of options for those who are at higher risk of contracting the virus.
According to the biomedical HIV prevention advocate, women, who continue to participate in different HIV research programmes, should not suffer to get the final results from which they can benefit.
She censures the “complicated and too slow” processes for implementing policies on products that would reduce new infections among these groups of people.
“We need to undertake some serious stock-taking. We have missed the train. We need to seriously think about what to do beyond 2020 to reduce new infections. Time is running out,” Mtamba says.
Mkandawire, too, is concerned that his group’s efforts to save adolescent girls from early pregnancies and marriage are being impeded by structural barriers which he argues have been there for decades.
He charges that some healthcare service providers put on parents’ robes and start counselling young people “not to engage in immoral activities” when they visit health facilities to access products such as condoms.
“Why should young people struggle to access condoms when we all know that they are engaging in sexual activities? We can’t continue pretending that they do not have sex. We need a serious and urgent shift to ensure we protect these people,” he says.
Mtamba shares such sentiments, positing further that breaking the transmission cycle will, among other interventions, also require embracing new technologies in HIV research.
She also wants to see laws adjusted to accommodate interventions which target key populations.
“We have laws which are not helping matters. Key populations [like lesbian, gay, bisexual, transgender and intersex persons] are arrested if they declare their sexual orientation. As such, they become vulnerable to HIV because they cannot access some services in health facilities,” she says.
For Hadija, there was only one product that would have prevented her from falling pregnant at 16.
While she is eager to return to school and reignite her dream of becoming a nurse, she is worried that more girls in her area are also contracting the virus as condoms, the commonest prevention tool, keep eluding them.
“Poverty is fuelling the spread of the virus in most lakeshore communities like ours,” she says before turning her eyes to the open space in front of the health facility where another underage girl has just arrived on a stretcher, heavily pregnant.
Alick Ponje is a features writer at The Times Group. He graduated from the University of Malawi with a bachelor’s degree in education, majoring in literature in English. Follow him on Twitter @aponje