The Citizen (Dar es Salaam)
Sharon L. Camp & Eliya M. Zulu
12 December 2007
opinion
Despite the recent good news that fewer people worldwide are infected with HIV than previously thought, HIV remains one of the major public health challenges of our time. Even with life-saving drugs becoming available to more and more people, keeping people from being infected in the first place represents the only realistic way to curb the spread of HIV in the long haul. And the most logical starting point for any prevention effort is young people-especially those who have yet to become sexually active.
That's hardly a new idea, and major initiatives to provide youth with the information, skills and resources to protect themselves from HIV have been underway for many years. Now a major new study, conducted by the New York-based Guttmacher Institute and partners in Burkina Faso, Ghana, Kenya, Malawi and Uganda, provides a ground-breaking perspective on the effectiveness of these efforts through adolescents' eyes. The study, which was based on personal interviews with nearly 20,000 young people in four Sub-Saharan countries, is being released at the Fifth African Population Conference, Africa's premier gathering of academics and health experts, being held December 10 to14, in Arusha, Tanzania.
So what did these young people tell us? We were tremendously encouraged by their positive and hopeful outlook on life. But their verdict on our collective attempts to help them safely transition to adulthood is sobering. Adolescents in the four countries we studied- Burkina Faso, Ghana, Malawi and Uganda-told us that they often do not get the education and health services they need. Also, misinformation about sex and its potential consequences is common. We suspect that these findings go well beyond the four countries examined, and may indeed be broadly representative of young people around the world.
Based on our research, we identified a two-fold challenge for both developing country policymakers and their counterparts in industrialized countries (who help shape policies via foreign aid): First, they must strengthen and expand fragile education and health systems-an approach that enjoys widespread support, even though results often fall far short of the actual need.
The second recommendation though is hard for some people to swallow: Policymakers-and society at-large-must acknowledge and openly discuss the role that sexuality plays in the lives of many adolescents. Adolescents say that fear and embarrassment constitute the greatest barriers to their seeking information and health services. In many societies in Africa and elsewhere, sexual activity among young people prior to marriage, though common, remains stigmatized. Even talking about sex is often taboo.
Fearing they may be perceived as promoting promiscuity, policymakers are reluctant to support improved sexual health information and services for young people. But failure to do so is self-defeating and, quite frankly, totally unacceptable. The reality is that, by the age of 18, most teens have begun to have sex. Instead of being helped, they are often shamed into ignorance about their own sexuality-putting them at high risk of HIV infection or other negative outcomes, such as an unwanted pregnancy.
Again, let's listen to what adolescents say: They yearn for honest and reliable information and they strongly support sex education in schools. At most, however, only half of them get such sex education-ranging from 15% in Burkina Faso to 52% in Ghana. Here's what needs to happen: Because not all adolescents stay in school, age-appropriate sex education should begin in early primary grades. Developing effective out-of-school sex education programs - especially in countries with low rates of school attendance and high drop out rates - is also critical. Progressive faith-based groups and community based organizations can play an important role in these efforts. And, the quality of sex education must be improved-teachers, for example, need better materials and training.
Industrialized countries have an important role to play. They should support developing countries' efforts that promote a positive attitude and comprehensive approach toward the sexual and reproductive health of young people. A number of Western European governments are taking this route, and they should be commended for it.
In sharp contrast, the United States undermines such efforts, exporting to developing countries its rigid abstinence-only-until-marriage education programs. Recipients of U.S. HIV funds may provide teens aged 15 and older with information about condoms, but cannot use these funds to "promote or provide" condoms in most situations. Teens younger than 15 cannot receive any information in school about condoms.
To be sure, the United States has played a major role in development assistance as the single largest donor in the fight against AIDS. But its emphasis on abstinence has limited young people's access to sexual health information and services-and that should stop.
It is imperative that African governments focus on the evidence in devising their domestic policies and programs. They must withstand pressure from powerful outside forces that try to impose ill-conceived agendas and policies on the continent. We finally need to listen to adolescents to understand the specific challenges they face in their daily lives.
If we don't, we are sure to miss the best opportunity we have to win the long-term battle against the HIV epidemic. It's time we started protecting the next generation.
Sharon L. Camp is President and CEO of the Guttmacher Institute, an independent think tank in the field of sexual and reproductive health.
Eliya M. Zulu is Deputy Director and Director of Research at the African Population and Health Research Center, a non-profit, non-governmental organization committed to conducting high quality and policy-relevant research on population and health issues facing sub-Saharan Africa.
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