From HIV prevention to HIV protection: addressing the vulnerability of girls and young women in urban areas

Abstract

This paper argues that there is a need to revisit prevention methodologies with regard to HIV/AIDS, especially in relation to urban areas. Unlike in other epidemics, where it was recognized that the physical and social environments had a key role, HIV/AIDS has become the terrain of moralists, who insist that individual behaviour drives the epidemic and who pour millions of dollars into individual behaviour change programmes. This is done regardless of the obvious truth that HIV/AIDS flourishes in a situation of poverty, compounded by inequity and lack of social cohesion, and that those most affected by an epidemic are precisely those who are affected by that environment. In the case of HIV/AIDS in Africa, these are adolescent girls and young women, especially in urban areas. The paper also looks at how the physical environment (including the effects on the immune system of malnutrition, helminths and bilharzia) and social environment affect the vulnerability of adolescent girls and young women, who have often migrated to town, live and work in squatter areas, are isolated, and are victims of sexual exploitation and abuse. The very high number of orphans that existed before HIV/AIDS, and that has increased further as a result of the epidemic, compounds the situation. The highest number of child-headed households is in informal settlements in urban areas, which have the most sexual abuse and the highest HIV prevalence. This paper builds on the above to highlight the inadequacy of current behaviour change interventions, quite apart from the fact that the most vulnerable are not even reached by these interventions. It argues for deliberate and systematic attention to be paid to these girls and young women, to ensure that they are identified, included and allowed to participate in developing the protective environment and safe spaces in the community, in schools and in livelihoods which will enable them to protect themselves from HIV infection. This requires addressing the underlying and basic causes, including the impact of globalization, for the continued spread of the epidemic.