Washington, DC — Young women in cross-generational relationships have a higher risk of HIV infection than their peers, panelists said during a session titled "Program Reponses to Cross-Generational Sex" at the Global Health Conference in Washington, D.C. last week.
Cross-generational sex is a major issue in many developing countries, panelists said in a discussion moderated by Kathleen Kurz of the International Center for Research on Women. There are many motivations and risks involved for both men and young women.
John Berman, senior director of the global AIDSMARK HIV prevention program at Population Services International, said young African women have a disproportionately high HIV prevalence rate when compared with men. In Kenya, 23 percent of young women are infected whereas only four percent of young men are, he said. By age 25, Berman said, the difference tends to even out.
One explanation for the difference in the number of infections is that girls are less informed about reproductive health, Berman said, and more likely to have relationships with older men.
Along with these factors, there is limited access to condoms as well as knowledge about their usage, Virginia Kamowa, project manager at CARE International/Malawi said. Many of the young girls do not know enough about condoms to protect themselves, and sexually transmitted infections, including HIV, were four to six times higher in females than in males.
Even when condoms were available, Kamowa said, people do not often use them.
Amy Weissman, youth reproductive health specialist at Save the Children, concluded that older men targeted young women because they are "easy" and are less likely to have contracted diseases.
The girls who take part in these "sugar daddy" relationships are motivated by a number of factors, Berman said.
Some of the girls depend on their older partners for basic needs - school fees, textbooks, health care, or food. Others, however, want luxury items they could not otherwise afford - fashionable clothes, cell phones, dinners at restaurants and trips to the hair salon - ambitions directly linked to peer pressure. Girls feel the need to live up to their friends' standards, Berman said.
"The research says that poverty is not the primary reseaon for cross-generational sex," Weissman said, explaining that a better way of describing these relationships is "economically rational sex."
Some even see their older partner as a surrogate parent or a mentor, Berman said, and most of the girls are largely unaware of the risks they are taking.
But girls and young women are only half of the equation.
Most of the older men in these relationships do not take the issue of cross-generational sex seriously, and they think it is completely voluntary on the girls' part, Weissman said.
But in some cases, men in a professional position will force or blackmail a girl into the relationship, she said.
One example of this situation is a male teacher telling a girl that if she does not have sex with him, then he will fail her on her exams, Weissman said. Other professionals, such as doctors, businessmen, and truck drivers, use their positions to manipulate and use the young women, she said.
Girls can call and report such activity to law enforcement, Kamowa said, but few do because they are afraid of the shame and negative attention it could bring to their family.
Current trends do not indicate this will change without massive intervention. "Norms aren't shifting very dramtically," Berman said. "It's very grim."
The age of the girls taking part in these relationships keeps getting younger and younger, Kamowa said.
"The older guys will assume that the younger the girl is, the less likely she is to be HIV-positive," Berman said.
Anecdotal evidence demonstrates that men seek out younger women because they are less expensive companions. "It's easier to take advantage of the younger women because they don't demand as much," he said.
However, girls are not always discouraged from these relationships by their families. The panelists said some mothers encourage cross-generational sexual relationships so that the girl will bring food, cooking supplies, and other necessities home to the family.
The panelists argued that behavior changes and different social norms would improve women's health. Development programs are needed to teach girls about HIV and the risks of being infected from relationships with older men, as well as the need for positive role models, Berman said. Also, he said that working directly with youth could greatly reduce the girls' risk of being infected.
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Weissman suggested an approach focusing on basic needs and poverty allievation. She said that if the girls were educated with life skills and trained in income generation, they would not have to rely on older men for financial support or benefits.
Along with educating young women, there need to be stronger consequences for men, Weissman said. If older men in such relationships were publicly shamed, then they would be discouraged from propositioning girls, she said.
Save the Children had recognized some best practices for combatting cross-generational sexual relationships, Weissman said. Instead of lecturing young women, she said providing support and praise for refusing male advances was more effective in preventing relationships with older men.
"It's an achievement that they feel good about," Weissman said. "The important thing to them is knowing that they did it by themselves."
The panelists agreed that more knowledge and information should be provided to girls and young women, so they have the opportunity to protect themselves from HIV infection.
