Integrate SRHR in HIV/Aids programming to curb new infections among girls, young women

A recent study by the Centre for Sexual Health and HIV/Aids Research Zimbabwe (CeSHSR), which found that more than 7 600 pregnant girls between the ages of 10 and 19 tested HIV-positive in the last three years, is a stark reminder of the challenges being faced by young girls in the country particularly those into commercial sex work.

According to the report titled National Assessment on Adolescent Pregnancies, out of an estimated 50 957 HIV-positive pregnant women, 0,1 percent (51) were adolescents aged 10 to 14 years, while 15 percent (7 644) were among the 15 to 19 year age group.

The report indicates that HIV prevalence is highest among young people in Zimbabwe, with 29 percent of 20 to 24-year- olds and 25 percent of 25 to 29-year-olds testing positive for HIV.

Prevalence decreases with age, with 18 percent of 30 to 34-year-olds, 11 percent of 35 to 39-year-olds, and three percent of those aged 40 and over testing positive for HIV.

The report also found that 2021 had the highest number of pregnant adolescent girls aged 10 to 14 years, 21 percent of Antenatal Clinic bookings from 2019 to

2022 were among adolescents aged 10 to 19 and 23,7 percent of 1 532 maternal deaths were recorded over the same period.

Statistics from the report are a clear indication that although Zimbabwe has over the last three decades scored major gains in the HIV/Aids response programme as evidenced by a sharp decline in new cases and deaths, the risk of HIV infection among adolescent girls and young women in the country is of particular concern.

This is because despite those gains, there have been no significant reductions in new HIV infections among adolescent girls and young women and the country continues to be the hardest hit by the epidemic in the region highlighting the need to place stronger emphasis on HIV prevention and sexual and reproductive health and rights (SRHR) services such as family planning, nutrition, prevention and management of gender-based violence.

It is also important to note that ending Aids as a public health threat and ensuring universal access to sexual and reproductive health are two key targets for Sustainable Development Goal (SDG) 3.

While the SDGs call on the global community to “leave no one behind”, efforts need to be redoubled to address the needs of key and vulnerable populations such as adolescent girls and young women within treatment, and care services in emergency settings.

According to UNAIDS, a majority of young people (aged 15 to 24) living with HIV/Aids are in low and middle-income countries, with 84 percent of them being in sub-Saharan Africa.

Heightened vulnerability among women and girls is closely linked to threats to their sexual and reproductive health and rights including the inability to access effective and integrated health services and to endemic levels of gender-based and intimate partner violence.

While a growing number of organisations and financing mechanisms as well as the Government are working to respond to this challenge through policy frameworks, pragmatic interventions, and funding initiatives specifically targeted at adolescent girls and young women, UNAIDS which has been a leading voice on the integration of services as a central theme in its global strategies encourages linking HIV and SRHR services as a key element of strengthening health systems, empowering women and improving the effectiveness of Aids responses worldwide.

Additionally, effective integration of HIV and SRHR services requires not only behavioural change interventions for health care but also increased understanding of beneficiaries to respond adequately to their needs based on their knowledge, attitude, and risk perception.

Studies have shown that around the world, sexual and reproductive health and rights are consistently at the forefront of the struggle for girls and young women’s human rights.

According to Dr Patricia Fadzayi Mandima who is an HIV Prevention Research expert with the University of Zimbabwe’s Clinical Trials Research Centre, the HIV burden has always been higher in young women which is why many programmes towards HIV prevention targets girls and young women.

“This is because of cross-generational HIV transmission. Younger women are involved with older men who give them HIV. The HIV burden has always been higher in young women which is why many programmes towards HIV prevention targets girls and young women.

“Although information on SRHR is available, access to it is limited for those below the age of 18. While they are involved with older men, they don’t have strong negotiation skills for safe sex and they all have limited access to SRHR services like PEP, PrEP, condoms and contraception, unlike the older women.

“As parents, it’s hard to accept that our young girls are engaging in premarital sex. I think those who make the laws need to hear this information and see that the girls are at high risk. They also need to see that advocates of access to SRHR are not encouraging early sex debut but are just reacting to an unpleasant reality on the ground,” said Dr Mandima.

Community Working Group on Health (CWGH) executive director, Mr Itai Rusike said although the policies, institutions and programmes were in place to respond to prevention, treatment and care needs of adolescent girls and young women, the gap however, lies in resourcing the level of scale up needed and investing in additional measures to promote uptake in vulnerable and marginalised groups.

“The risk of HIV infection among adolescent girls and young women is of particular concern.

“Adolescent girls’ sexual and reproductive health and rights (SRHR) can be improved by increasing coverage of SRHR services in schools and strengthening the participation of adolescent girls in health decision-making at all levels,” said Mr Rusike.

Clinical pharmacologist Dr Tariro Chawana-Mutingwende echoed Mr Rusike’s sentiments, underscoring the importance of integrating sexual and reproductive health and rights in HIV/Aids programming as a way to curb the prevalence of new infections among adolescent girls and young women.

“Not only will it prevent new HIV infections, it will reduce unwanted pregnancies and improve early detection and treatment of sexually transmitted infections. This also improves pregnancy outcomes. One-stop shops reduce the number of visits made to health centres and may improve uptake of SRHR services as well as HIV prevention and treatment services, and adherence to treatment and care. However, issues of age of consent and policies around this for minors come into play because for minors (less than 18) it’s difficult for them to access SRHR services without a parent or guardian’s consent,” said Dr Chawana-Mutingwende.

Bringing sexual and reproductive health and rights and HIV services together will no doubt improve access to services and provide a model for rights-based, people-centred public health practice.

It is also important to note that the call on SRHR and HIV integration is guided by several groundbreaking commitments. For example, the 2006 Maputo Plan of Action, adopted by 48 African countries, recommended integrating SRHR and HIV to promote the universal right to health, recognising that investment in SRHR programmes and services is a key entry point for HIV prevention.

Integrating SRHR and HIV was also central to renewed commitments such as the Maputo Plan of Action 2016-2030.

Signed by health and education ministers from 20 countries in the Southern region, a 2013 Ministerial Commitment put the interests of adolescents and young people high on the regional political agenda. The Commitment pledges to ensure access to youth friendly SRHR services and comprehensive HIV and sexuality education.

National Aids Council chief executive officer Dr Bernard Madzima said although adolescent girls and young women have access to SRHR information, positive sexual behaviour needs more than just information.

“We need to address the gender dynamics that pre-determinants to HIV infection. The National Aids Council is working hard to ensure effective community involvement in HIV prevention among adolescents.

“Integration of SRHR programmes in HIV response and reproductive health is the way to go and NAC is working hard to educate the girls in schools, colleges and universities about sexual life skills. Those out of school are reached through Sister to Sister programmes,” said Dr Madzima.

It is clear from Dr Madzima’s observation that there is an urgent need for dramatically increased investments in SRHR information and services to address the global SRHR challenges and the reproductive rights of populations and, particularly, the most vulnerable.

This also demonstrates that bringing together SRHR and HIV will require deliberate interventions and political commitment that places the individual at the centre of service delivery.