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Satisfying youths’ quest for sexuality openness

In most African societies, talking about Sexual Reproductive Health (SRH) openly to the youth is taboo. JOSEPHINE CHINELE tells how this secrecy is exposing young people to pregnancies, STIs and HIV.

OBVIOUSLY a wedding is highly treasured and any news threatening its cancellation is a disappointment for the bride and the groom’s family.

But Farai, a Zambian citizen, swallowed this bitter pill when she tested HIV positive two months to her wedding.

The husband-to-be first accepted to proceed with the plans but later decided otherwise and dumped her.

“It was hurtful but I eventually accepted it. I suspect that it’s my ex-boyfriend that infected me. He broke my virginity and he was the only person I had sex with then,” tells Farai.

The relationship with this ex-boyfriend began in her late teens.

She learnt later he had a string of girlfriends but could not end the relationship.

Her grandmother had earlier advised that according to their culture, the man who breaks one’s virginity is for marriage.

But the relationship eventually ended, the boyfriend showed no signs of settling down, she says.

Farai later went into another relationship. She had never tested for HIV but insisted that they should go for testing before getting married.

She tested positive while the fiancé tested negative. After days of inner struggle for a lifetime decision, the wedding was called off.

Eighteen years later, Farai admits to have had little information about Sexual Reproductive Health (SRH), HIV and comprehensive sexuality in her adolescent years attributing this to why she got infected.

“I never discussed anything to do with sexuality with my mother or anyone after the initiation ceremony when I began menstruating. Otherwise I was just learning things on my own from friends,” she says.

Though she lives in Zambia, young people in Eastern and Southern Africa (ESA) including Malawi are facing similar challenges.

Eighteen year old Elizabeth of Mangochi also encountered a similar experience as she contracted HIV from a fisherman 12 years older than her.

“He told me he was divorcing his wife to marry me; so there was no need for us to use a condom,” she says.

But when she got pregnant, the man refused responsibility.

On her first antenatal visit at five months, she was diagnosed with HIV.

She too says she did not have much information about sexuality, contraceptives and Sexually Transmitted Infections (STIs) or where to go to access SRH services.

Young People today website reveals that 50 young people of ESA region are infected with HIV per hour translating to 430,000 young people getting infected per year.

The website also says young women like Farai and Elizabeth are still disproportionately affected compared to young men

It states that HIV knowledge levels among young people in the region remains below 40 per cent.

Elizabeth and Farai says they have been highly discriminated against among their relations and at health facilities.

“People had concluded that I contracted HIV because I was promiscuous. At one point, a service provider curiously asked where I contracted the virus from,” says Elizabeth who miscarried at six months due to suspected stress.

For Farai, the cancellation of the wedding due to her HIV status was a source of humiliation and discrimination in all aspects.

A United Nations E d u c a t i o n a l , Scientific, and Cultural Organisation (Unesco – 2013) summary report titled ‘Why adolescents and young people need comprehensive sexuality education and SRH services in ESA’ says among other practices, early sexual debut and child marriage (in adolescent girls), high school dropout rates, low transition to secondary school, age disparate and transactional sex combine to impact heavily on young people.

The report also notes that majority of young people in the region do not to access modern forms of contraception, condoms, safe abortion, STI/HIV testing and counselling or HIV treatment.

It suggests the need to review inconsistencies in policy or legislation which will reduce many of the barriers and provide a clear framework for health providers to receive adolescent and young clients, according to their need and based on good public health policy.

Youth Friendly Health Services (YFHS) are those that specifically seek to be always open, suitable to youths, and are located in places where young people feel safe and comfortable to access health services.

“…. Young clients should not face judgement or stigma from staff, and they should be able to trust that their confidentiality will be respected,” reads the summary report in part.

The report highlights that any service that is not catering to their particular needs or taking steps to ensure that the service is accessible is missing a large and critical segment of the population.

According to Population Reference Bureau (PRB) Malawi Youth Data Sheet (2014), more than one in four adolescent boys have had sex before age 15, twice as many as adolescent girls.

The Data Sheet suggests that providing family planning to young people reduces the risk of disease and unintended pregnancy, and promotes a healthy transition to adulthood.

“Given the high prevalence of HIV, it is important to reach young people with information about how to avoid infection,” it reads in part.

Due to sustained high fertility in the last 20 years, the age structure of Malawi’s population is extremely youthful.

Government says health and development experts in Malawi recognise that 66 per cent of Malawi’s population is under 25 years of age and the country presently registers a high number of adolescent pregnancies and high STI/HIV incidences among them.

Perhaps, the recently launched first ever YFHS strategy (2015- 2020) in Malawi will help address the said issues and provide the nation with a healthy generation.

The YFHS was launched on August 26, 2015, with support from United States Agency for International Development (Usaid) through Health Policy Project.

“This strategy was developed through a significant stakeholder consultative process and is based on the most up to date evidence available. This includes findings from a YFHS evaluation and study that was conducted in 2014.

“As such, this multi-sectoral strategy is expected to contribute to the country’s response to providing high-quality, integrated services that are relevant, accessible, attractive, affordable, appropriate and acceptable to the youth,” reads a press statement from the ministry published in The Daily Times on the day of the launch.

The Ministry of Health says the strategy seeks to increase knowledge, access and utilisation of YFHS for all young people aged 10- 24 years.

The report highlights that any service that is not catering to their particular needs or taking steps to ensure that the service is accessible is missing a large and critical segment of the population.

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