12 February 2013

Uganda: School Compound Not As HIV-Free As Most Think

Tom Tomusange*,26, had his first sexual encounter at 16.

It was during the school term and he admits to not using a condom. Asked why, he says: "I wanted to know the thrill of it". But even if he hadn't wanted to know the "thrill of it", it might have been a little difficult for him to use a condom. It was hard to sneak condoms into school (musical devices were easier to sneak in) and "at school, you don't think anyone has HIV".

But increasingly, students also carry HIV, the virus that causes Aids. ?According to the report, HIV Infection and Schooling Experiences of Adolescents in Uganda, a study done in 2007 among Ugandan adolescents aged 15-19 infected with HIV perinatally (at the time of birth), found that 70% of these adolescents were attending school.

Granted, Tomusange's first sexual encounter occurred before the above mentioned study, but that doesn't imply he wasn't at risk in a country where HIV/Aids has been a menace for more than 30 years. While Dr Stephen Watiti, an HIV activist, says that children born before the era of easier access to ARVs passed away, some survived and attended school.

With ARVs becoming more available, more and more HIV-positive children are living to adolescence (where sexual activity may begin). To minimize the spread of HIV, younger Ugandans are told to abstain. However, some of them don't.

A small-scale survey by this reporter showed a small percentage of students got sexually active between 16 and 19 years of age. Majority of these didn't use condoms because: they don't think fellow students are HIV positive, sexual rendezvous were impromptu leaving no time to buy condoms, shyness in purchasing condoms as no one expects young students to be buying them and for some, a lack of skill in using condoms.

Minimising the risk

If students are sexually active and aren't taking protective measures, they risk catching HIV, more so in this era where 20,000-25,0000 children are born with HIV each year. It isn't just the students at risk. Older individuals are known to seek out younger ones for sex, because they assume that they haven't had any or that many sexual partners, so they are unlikely to be HIV-positive.

Watiti advises sex education for all students. ?"Abstinence is good and the majority of young people are abstaining, but there is small number of young people who aren't. These young people need to be saved too and that is why we must tell the young about condoms".

Watiti believes that an individual who has been taught to use condoms from a younger age will not need reminding. ?"If you teach a child to wash their hands or pray before eating food, they won't need reminding. This will be the case also if we train young people to use condoms".

Mary* is now 24. Her parents died of Aids when she was only 3 years old and she too tested positive for HIV. At 15 years, she became sexually active and has become rather ruthless with her sex life. ?"She has always been bitter and angry for having to carry a virus she did not 'earn' and her way of getting back at fate is by sleeping with whoever is interested," her grandmother, who no longer knows Mary's whereabouts, says.

"She turns up every few years when she is very sick. The moment she gets back on her feet, she disappears again. It has been like that for years."

Another couple in Kampala adopted a teenager who had just lost his wealthy father and was on the verge of dropping out of school. ?In 2011, the adoptive parents were summoned to the boy's affluent boarding school because he was very sick.

Tests in a Kampala hospital confirmed he was HIV-positive and after a stint in hospital and successfully getting him back on ARVs (he confessed that he knew his status and was born with the virus, but had not asked for more of the lifesaving drugs in order not to scare off his benefactors) he went back to school. ?So school compounds are not entirely HIV-negative. Sex education is necessary.

Research done among 300 HIV positive adolescents attending Baylor Uganda-Mulago hospital, TASO Kampala, Reach Out Mbuya and Nsambya Home Care clinics showed that they not only had a negative attitude towards condom use, but they also lacked skill.

The negative attitude stemmed from the belief that condoms limited pleasure, were a waste of sperm for those interested in child-bearing and would not stop infections because they were porous, among others.

These attitudes would have been stemmed had the adolescents accessed sex education from the right channels. ?Since comprehensive sex education is sometimes frowned upon (the president has been quoted advising against it), adolescents are left to learn from peers, TV and other inexpert channels about sex.

Uganda is aiming at achieving zero new infections. To achieve this, a number of innovations say pre-exposure prophylaxis, Prevention-of-Mother-to-Child (PMTCT) and circumcision among others are promoted.

Watiti points to another important intervention, the stemming of stigma against HIV-positive individuals. If there was less stigma, HIV-positive individuals might easily disclose their HIV status.?If this was done, then discordant couples would take sufficient protective measures. The research done among the 300 HIV-positive adolescents showed that some feared to disclose their HIV status.

Counselling of young HIV positive individuals, according to Watiti, is of paramount importance if Uganda is to minimize HIV spread, because as the research mentioned, some HIV-positive adolescents were angry and belligerent; they wanted to spread HIV to others to get even.

*Not real identity

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