By Samkelo Mahlalela | 2019-08-22
In 2016, then South African Deputy President (and now President) Cyril Ramaphosa officiated at the opening of the International AIDS Conference in Durban in July.
Ramaphosa urged “As we work to provide testing and counselling to the general population, we need to ensure that adolescents – girls, boys, young women and men – receive information and advice and are able to access services such as condoms and PrEP, where necessary. We need to design and implement programmes that address the needs of key populations who are at risk.”
Currently, nearly half of new HIV infections occur among the youth, especially in sub-Saharan Africa. In Eswatini, though the HIV incidence had decreased by 44 per cent since 2011, incidence among persons aged 15 years and older is estimated at 1.4 per cent (1.7 per cent females and 1.0 per cent males).
The variation in HIV incidence is most pronounced among adolescents and young women aged 15-24 years old, with females having 1.9 per cent and males at 0.8 per cent incidence rates. The total number of new infections was estimated at 7000 in 2017, broken down to 6150 infections among people aged 15 years and older – with above 850 new infections among children 0-14 years.
In the ‘Last Mile’ to ending AIDS in Eswatini, the national response seeks to leave no one behind, especially key populations - who include adolescent girls and young women. To strengthen programming for adolescents and young girls, the national HIV response through NERCHA, supports the delivery of cultural or traditional responses to HIV prevention, at both community and national levels.
One such initiative is run by Khulisa Umntfwana working with the ministry of health and partners, with the support of UNFPA, who roll-out HIV prevention and sexual reproductive health services to the thousands of maidens that participant in the annual Umhlanga ceremony.
The Umhlanga, also known as the national Reed Dance, is a traditional event that takes place in late August to early September.
The first part, is concentrated at the Ludzidzini Royal Residence, running over an eight-day period; and then two weeks later, the Shiselweni Umhlanga is held at Mbangweni Royal Residence.
Umhlanga has grown exponentially, from being just a traditional event, to a tourist attraction that now sees multitudes of people, from outside the country and locals, come to witness the captivating traditional dances by the maidens. For the locals, many use it as a time to meet friends and relatives as the nation comes together to watch the nation’s pride.
Situation of young people
and HIV in Eswatini
Globally, gaps remain in responding to HIV and progress has fallen behind for adolescents and young women. In the country, the situation is dire for adolescents in rural areas as there are more susceptible than those living in the urban areas.
This is compounded by that there are more than double (77 per cent) the amount of poor adolescents in the rural areas than in the urban areas (34 per cent), while the reverse situation exists among adolescents who are not poor between rural and urban areas (66 per cent and 23 per cent) for urban and rural areas respectively.
In Eswatini, age at first sex predicts risky sexual behaviour in both males and female youth, while low socio-economic status predicts inconsistent condom use among females. Evidence shows that HIV transmission in Eswatini is mainly through heterosexual contact, and that male HIV prevalence peaks at 10 years older than female HIV prevalence.
This may mean that a young woman’s first sexual encounter, could potentially be her first exposure to HIV transmission, and with the HIV Incidence Measurement Survey 2 (SHIMS) 2016-2017 finding that in young people aged 15-24 years, 3.5 per cent had sex before the age of 15 years (4.5 per cent males and 2.5 per cent females), this may explain why there are more HIV positive rural adolescents in the country. Also, according to the SHIMS 2, among adults aged 15 and older, who had sexual debut before the age of 15 years, less than a fifth (18.7 per cent) of males were HIV positive, compared to about half (50.6 per cent) of females.
Key drivers of HIV
in Eswatini
Key drivers accounting for new HIV infections in the country include:
Low knowledge of HIV among adolescents and young people estimated at 49.1 per cent among males and 50.9 per cent among females. Knowledge levels among 10-14 years old is estimated at 34 per cent. Early sex debut with three per cent females having sex before age 15 compared to 2.8 per cent males while 48 per cent of the females and 34 per cent of the males begin sex by age 18.
Dropping out of school especially among adolescent girls. 80 per cent of girls aged 15-22 years who are out of school are sexually active compared to 30 per cent of girls in same age who are in school. Intergenerational sex between adolescent girls and young women aged 15-24 years and older men within age groups with high HIV prevalence.
Inconsistent condom-use during risky sex: condom use among persons aged 15-49 years during high risk sex declined from 82.6 per cent in 2014 to 66.2 per cent in 2017.
Gender based violence with 1 in every 3 women experiencing sexual violence by the time they are 18 years old and 4.6 per cent of married women aged 15-49 years reporting intimate partner violence.
Onward HIV transmission from persons recently infected and not yet on treatment: This group comprises a cohort of 15 per cent people living with HIV (PLHIV) who are not on ART and it has become harder to find, test and put them on treatment.
The Umhlanga HIV
prevention initiative
The objectives of the programme delivered during the Umhlanga include:
n To train peer educators who are involved in various communities by empowering them with up-to-date information to execute their duties better during the Umhlanga national cultural event and during their usual sessions in their communities – 100 were trained last year;
n To provide improved and intensified access to appropriate information on sexual reproductive health rights, safe sex behaviours, and sexually transmitted infections prevention, to maidens through peer education and edutainment at the reed dance – there were close to 30 000 reached last year;
n To increase comprehensive knowledge and information on the dangers of inter-generational sexual relations among maidens attending the cultural event; and
n To increase knowledge about multiple concurrent sexual partnerships and related factors by providing correct and comprehensive information.
The primary target populations are the 10 - 14 years and 15 - 24 years old maidens (Imbali Regiment) from all over the country and beyond the borders of Eswatini.
The younger maidens (below the age of 10) are also exposed to the campaign and benefit from the performances.
Older maidens beyond the age of 24 also gain from the group discussions and edutainment, while the women and men who accompany the maidens are secondary audiences that get information from the stage plays focusing on parenting skills and how they can play active roles in raising their children.
Last year, both the primary and secondary target audiences, listened with admiration as the groups took turns performing, confirming the power of visual information as a mode of communication.
The Umhlanga prevention programme involves numerous activities planned and delivered throughout the course of the Umhlanga Ceremony. For example, last year, the first activity took place in the communities where the Khulisa Umntfwana Peer Educators come from.
The traditional leadership allowed the young girls to educate their peers before being commissioned to go to the national event.
The peer educators were given an hour to talk to their peers on basic facts on HIV and AIDS; delayed sexual debut and taking care of their bodies.
The community sessions produced positive results as seen in the different songs that the maidens thereafter composed, which discourage early sexual debut, multiple concurrent partnerships and gender-based violence.
The Reed Dance Committee (Libandla Lemhlanga) led by Indvuna YeMbali, Ms. Nonduduzo Zubuko, speaking at one of the preparatory events for the roll-out last year, expressed her appreciation for the work done by the HIV response towards ensuring that the Imbali have healthy future leaders.
The Imbali slogan, “Siyimbali, Sichakazile, Sitoyinqoba i-AIDS!” is a positive in the country’s last mile to End AIDS by 2022.
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