NO ONE SIZE FITS ALL!
We started going to Kauma about 3 years ago. We had a clear vision; mobilise girls, talk to them about the importance of education and go back to our normal lives. We were three young women passionate about girls’ education, feminism and creating safe spaces for other girls and young women. One thing we were sure about is we wanted to do something.
So we started. With the little we had. We started.
Throughout 3 years Growing Ambitions has evolved to just conducting talks with the girls once a month to an organization that provides so much more. We are reaching out 22 girls and young women in the peri urban area of Kauma, located on the outskirts of Lilongwe the capital city of Malawi.
Our passion to build the capacity of girls and young women from peri- urban areas to take full charge of their lives in all areas is at the center of this organization. When women and girls are given the opportunity, access and resources they need, they make informed decisions and choices that positively impact their own lives and that of future generations. Our focus is on offering mentorship and creating a safe space for girls and young women to interact. We envision a Malawi where girls, regardless of their socio- economic status or past negative experiences, take charge of their lives and thrive!
For the 3 years that Growing Ambitions has been in existence, one thing we’ve learned is that flexibility is key for programs that are working on HIV prevention for AGYW. Young women are diverse, so a once-off kind of program cannot expect to succeed. Organisations working on similar programs need more leg room. From our experience, when we officially launched our organization we had core activities planned, but with time we have had to learn, unlearn at the same time accepting how far we can stretch ourselves. We have moved from conducting monthly mentorship sessions to providing financial support to the girls through provision of scholastic materials, school fees, buying uniforms and even paying for day care services.
Some of the girls who are part of our program have children and simply need someone to take care of the child while they go to school. So we have found ourselves paying for day care services but also moving beyond that and involving the parents and guardians to get them to support the girls and the program as a whole.
Programs and organisations need to adapt. Fast!
It might not be easiest and most practical thing for formal structured organisations but leave some leg room.
No one size fits all when it comes to programs dealing with AGYW on HIV prevention.
Growing Ambition’s example can be modeled and here is a simple list of recommendations from our own personal experience.
1. There is need for a holistic approach when delivering programs; if you cannot do it all- COLLABORATE!
2. Learn from others; know what is working BUT most importantly be willing to bend a little and find what works for your context
3. MONEY! We need long term projects, nothing less than 5 years to see real change and impact on the ground.
4. Most importantly- invest and fund community based and young women led organisations, there is so much we are doing, models that we can scale up and amplify but no one wants to fund us.
5. Involve beneficiaries and all other relevant stakeholders from inception stage
BARRIERS TO HIV PREVENTION FOR ADOLESCENT GIRLS AND YOUNG WOMEN (AGYW) IN MALAWI
A national assessment of the impact of HIV in Malawi, carried out by
the Malawian ministry of Health in 2015-2016, found that HIV prevalence among
adult women (15 years old and above) was 12.8%, compared to 8.2% of Malawian adult
men, which indicates that women are more at risk (Malawi AIDS response, 2015).
The following are some of the barriers to HIV prevention for the AGYW in
Malawi which are leading to high HIV prevalence rates, despite government entities like the National Aids Commission taking a leading role in
Culture- this is especially true for AGYW in rural areas who do not
have access to HIV preventive tools like condoms because the decision must be
made by the husband, who culturally is the head of the family. So for a woman to
get a condom, she has to get consent from him, otherwise she would be considered
as a “prostitute”. And because of that, many AGYW are not exposed to
these tools and services, and don’t talk of sexual issues with our parents who would
otherwise be the best advisors whilst we are growing up. As a result, we live
in darkness and tend to get advice within our peers or media, which most of the
times is inaccurate and misleading hence putting most AGYW at risk of getting
Lack of professionalism amongst health workers- most health care
workers are judgmental. Instead of providing services, they take up the
advisory role more which ends up forcing AGYW to abstain and for the fear of
that, most of the AGYW just engage in unsafe sex hence exposing them to HIV.
Poverty- most of the population in our country is poor but most of us
AGYW want to live a life as if we are rich. We want high standard things
which we do not or can not afford on our own hence “Blessers” (Sugar daddies)
do the needful and in exchange they ask for unprotected sex which we always
give in for the fear of being seen too poor amongst our peers.
Peer pressure and ignorance- Most AGYW fails to make their own
decisions because of either what their role models, friends are doing or what
the majority around them is doing. The fear of being considered cheap amongst
WHATWOMENWANT: INVOLVE HIM & HER IN HIV PREVENTION
As an African young woman I take health, education, rights to be very important in my community. I have witnessed hardships in my community mainly with adolescents, girls and young people mostly in reproductive health discussions. Uganda falls among the 15 worst African countries with high numbers of child brides, at 46% of underage girls below 18 forced or lured in marriage.
In my response to the UNAIDS 2016 Guidance on HIV prevention among adolescent girls and young women, I speak as a young woman who is engaged in young women leadership initiative, Athena Network, UNYPA and currently engaged with different roles mainly advocating for safe environment for young women, girls and young people to access all kind of services for reproductive health. I have also championed different campaigns under ATHENA NETWORK like #WhatWomenWant which is not JUST a question from women but answers are also required through this campaign. I have gathered stories of how young women have been sexually violated, denied ownership and girls forced into marriage well as other women have been denied rights to access reproductive services follow the links below:
My opinion towards putting adolescent girls and young women at forefront in HIV prevention:
- Advocating for empowerment of AGYW and the promotion of AGYW in addressing current unequal gender norms that reduce AGYW ability to make informed choices about their own sexuality is key to reversing the dramatic upward trend of HIV infection among AGYW.
- Increase access to sexual and reproductive health services for all AGYW this is because there may be reluctant to seek advice, for fear of stigmatization cause some of young mothers give birth at an early age, so discriminatory attitude of staff in some centers keep them away.
- Sensitization program mes could help reduce stigma, for example, and training activities for health service staff could make services more user friendly
- Male and boy involvement, if we are to reduce HIV, GBV let’s not open our ears to one side. We should target on simple programs how we can engage male and boys in HIV prevention. This can be done through sports, music, empowerment talks male to male as well as using male role models.
My name is Kgomotso Moagaesi and I’m from Botswana. I currently work with the University of Botswana (UB) clinic as a student assistant and am part of the #WhatWomenWant campaign working group. This blog will highlight what works when it comes to HIV prevention for adolescent girls and young women (AGYW) in my own community, in response to UNAIDS’ 2016 guidance, HIV prevention among adolescent girls and young women: Putting HIV prevention among adolescent girls and young women on the Fast-Track and engaging men and boys.
Last year at my University, we held a stall during family planning week to sensitize and inform the student community on sexual and reproductive health (SRH) and HIV prevention services available to them from the UB clinic. It was an effective exercise, as many young people stopped to ask questions and watch condom demonstrations. One young woman mentioned that she didn’t know about the birth control implant, and was very grateful for the family planning information we provided.
Going forward, we need more informative pamphlets, colorful posters and stickers on sexual and reproductive health and rights (SRHR) and services, as well as HIV prevention methods to give to AGYW.
Talks and Presentations
The University of Botswana (UB) recently started a project to conduct daily SRH talks during lunch hours. The talks have proven to be helpful; young women attend in sizeable numbers for the opportunity to learn and ask the health personnel questions. A wide range of topics are discussed: vaginal discharge, signs of pregnancy, how to use a female condom and initiate the use of a female condom, amongst other topics.
Adolescent girls face similar challenges and need these messages as well, which is not an easy task due to lack of access. A heavy reliance on school-based education programs that cater to the needs of this age group has created a further challenge, as programs tend to be lessons rather than discussions where individuals feel free to comment, raise concerns and ask questions. More, these talks are carried out by older nurses, and girls don’t always feel free to express themselves and ask questions due to the age gap.
SRHR talks should be led by agemates to be most effective, creative and custom made for adolescent girls and young women.
This category covers a wide range, so for the sake of relevance it’s noteworthy to point out which aspects work best. Blogs, tweets, Facebook posts and Whatsapp chain messages are often used for advertising events and spreading the message about SRH services available nationwide. Social media efforts are hard to ignore, as young people spend most of their time on these applications. Last year there was a march for HIV and AIDS prevention at UB, advertised on Facebook with hashtags, pictures and freebies - participants were told that they would get free t-shirts and a certificate of appreciation. These efforts lured in many students and the march was highly successful.
Future efforts to engage the media should extend to the use of radio stations and television, like TV drama shows that depict the culture of a community vis-a-vi SRH and HIV prevention talks. Injecting a little bit of creativity can make a lasting impression in the minds of young people. It would be interesting to see young leaders in the community given a platform on the radio to host and facilitate diverse discussions around SRHR and HIV prevention methods, using young people’s experiences to call other young people to action through peer education.
Campaigns can be used to spread information on SRH and HIV prevention quickly and easily. If they are clear, non-technical, and simple to understand they can reach a wide geographic area. Memes of pictures with comical captions, or those relating to everyday life problems can be used to educate young people. It could be as simple as, “When the condom bursts you can trust the morning after pill”. Campaigns should follow and adhere to current youth circle trends to reach AGYW.
The challenge that seems to be prevalent in this area is the focus of campaign messages to AGYW as opposed to males. Young males seem to be excluded from SRH talks and discussions yet they too have a role to play.
Questionnaires distributed at information stalls can be a good way to collect information and improve SRH and HIV prevention techniques. A survey of this nature was carried out at UB, aimed at young women; it asked what they knew about SRH and whether they were aware of the clinic at UB. One of the suggestions made was to have SRH talks and services publicized and conducted frequently - not only on family planning week or occasionally.
All the above tools become ineffective when they do not reach AGYW most affected in rural areas due to lack of resources and education. They live far away from development such as technology. They spend normal days doing chores and have no time to listen to the radio or walk to the clinic for SRH education. As a result, when faced with challenges of sexual issues, they don’t know how to react. It is then evident that many unplanned pregnancies and new HIV infections exist in these areas due to lack of information and access to resources. The issue must be addressed by physically taking information to them.
The words used for HIV prevention and SRH programs are quite complex. An individual with an average education would find no interest in trying to read a SRH article. It is most likely that individuals will ignore these terms and assume they are meant for health professionals. Simple, clear definitions of the technical terms can be used to encourage people to learn more. Without this, more new infections will occur and people will cite ignorance as a reason.
Community members should also get more involved. Church leaders, role models, celebrities, non-governmental organization leaders and others have a strong role to play in ending HIV and AIDS and educating young people on SRH services. Involve them at foundational level before branching out to technical and health professionals. They should be trained and sensitized for more impact. They are influential members of the community and can reach far more AGYW than any other mechanism; therefore, they must be involved.
Other suggestions to reach AGYW:
• Have a color run or marathon for SRHR and HIV prevention
• Compile talks by AGYW on SRHR and HIV prevention into a book that can be easily accessed
• Involve males in these issues by asking them to pledge to assist.
• Conduct events, conferences, webinars and talks at national and international levels
It’s time to be inclusive, innovative and entertaining about SRH and HIV prevention techniques. With the age of technology and other 21st century developments, we cannot continue using an old yardstick to spread new messages. The only way to reach adolescent and young people is to talk like youth, interact like youth and be creative.
“If it’s not on its not safe” is one of the great media messages used by the Uganda Health Marketing Group (UHMG)
as a way of promoting condom use among young people. It is very important to
situate HIV prevention messages within a youth context to limit excuses like
“sweets are not eaten in wrappers” or “condoms are too small for us to use”. Factors
like gender based violence (GBV) resulting from an inferiority complex makes
many adolescent girls and young women (AGYW) more exposed to HIV infection. These
issues created my desire to find out what works well in preventing HIV:
For a young mother of twins like Mariam who was born with HIV, formal education was the only priority until her
desire to have a family surfaced. Mariam met her HIV negative partner, Francis,
at university and when the time came for her to conceive, she was quick to take
him to her ART access clinic. For Mariam, it was the best choice because of the
clinic’s youth corner with very youth friendly services and a one stop center
for anti-retroviral therapy (ART), ante-natal care (ANC), post-natal care (PNC)
and GBV services. Francis was given consistent and comprehensive answers for
each question he had, and was counseled very well before he started on
pre-exposure prophylaxis (PrEP). After conception, Mariam attended all the
required ANC visits while being supported by Francis until the day she gave
birth to her beautiful daughters, who were given post-exposure prophylaxis (PEP)
immediately after birth. The clinic was very successful at meeting Mariam’s demands and her need to keep the rest of
her family HIV free.
Just like Mariam, many adolescent girls and young women know that what works for AGYW includes media campaigns
and adolescent-friendly sections in health care facilities. These corners are
where young women can access the health services they need such as
contraception, GBV care and general sexual and reproductive health (SRH)
services. They help promote information acquisition and provide support to curb
the rates of new HIV infections for AGYW.
I believe that the same way we water seedlings to produce the best fruits, AGYW should be constantly mentored
to support empowerment and to improve their knowledge of HIV prevention. My own
mentor, Dr. Sabrina Kitaka, supported me to analyze situations. She helped show
me that there are better avenues with reduced risk of HIV infection to acquire things
like my basic needs and social norms like nice phones, shoes etc. She helped me
see my power to say NO to situations that make me uncomfortable, and improved
my knowledge on rights and responsibility to uphold them.
While focusing on UNAIDS’ 2016 guidance on HIV prevention in the #WhatWomenWant working group, I realized that
in addition to the above, we also need the following to make the guidance work:
male involvement in changing the norms around masculinity that comes from a
community level, peer to peer messaging, and meaningful involvement of girls
especially on leadership boards and service provision. This will create full
ownership for programs and support true dedication to a healthy society.