Few things are more rejuvenating than working with young people and I am privileged to be doing just that. I work for Baylor College of Medicine Children’s Foundation in Uganda as an Advocacy and Communications Specialist. I have been at Baylor-Uganda for over six months and while much remains the same in terms of how I see my work and professional goals, a lot has changed.
I came across a study at the beginning of my fellowship, when I had no idea of the impact it would have on my fellowship. The study was on the “Sexuality of young people perinatally infected with HIV: A neglected element in HIV/AIDS programming in Uganda”.
To be honest, the title alone threw me off as I realized I had never considered the sexual desires and needs of people living with HIV. As a young African woman adding ignorance to a cocktail of factors that put me at high risk of contracting HIV is a dangerous faux pas. As an HIV/AIDS advocate I realized how like many in the field, I had neglected an important part to the puzzle in fighting HIV/AIDS–the people living with HIV.
Before I read the study I was interested in finding out more about positive prevention. I viewed positive prevention in terms of encouraging people living with HIV to contribute to ‘getting to zero new infections’ by playing an active role in preventing of the spread of HIV/AIDS. It was the moral thing to do, but as human beings we all have priorities and the reality of it is, these priorities put ourselves before others. This is all the more reason for programming and messaging to focus more on personal responsibility for protecting oneself.
There is a strong emphasis on ‘abstinence’ when it comes to messages targeting young people in Uganda, because a) ‘They shouldn’t be having sex at their age’ b) It is culturally unacceptable to openly promote condom use c) Premarital sex is not Christian. I have heard these arguments in the course of my work, but refuse to accept them because a) Young people the world over will have sex no matter what the older population says b) Culture is meant to evolve with the times and I cannot think of a better reason than to save lives c) Religion does not come into play in the heat of the moment but condoms can.
Young people living with HIV/AIDS in Uganda at the time of the study were “among 732 (15–19 year olds) who contracted HIV vertically and were drawn from different HIV programs in Uganda, 33% had initiated sex and only 1/3 used condoms the first time they had first sex”. Could this be borne out of ignorance? I have never heard or seen a public health message encouraging people living with HIV to use condoms to protect themselves, yet one cannot ignore that when faced with a concept like positive prevention, some will say “what is in it for me?” A worrisome saying that’s been voiced by some young people living with HIV/AIDS when confronted about their risky behavior is “I didn’t want it either”. The assumption that young people living with HIV/AIDS are asexual or should be is quashed by the same study which concluded that 52% were and 34% were sexually active.
A newspaper article titled “Youth living with HIV prefer negative partners” (Newvision April 2007) may have shocked some, but when you see this from the point of view of a young person living with HIV, it may be easier to understand. Many young people with perinatally acquired HIV prefer HIV negative partners. The main reasons being the preference to avoid re-infection(1) and the need to birth HIV negative children(2). According to a TASO Uganda/Population Council survey involving 732 young people with HIV aged 15-19 years, 90% of the boys and 87% of the girls expressed a strong desire to have children in the future.
I am left to wonder, however, if the lack of information on sexual and reproductive health is a deliberate attempt by society to protect people living with HIV/AIDS from a culture that blames and discriminates. The first right in the Universal Declaration of Sexual Rights is the right to sexual freedom, which is currently not guaranteed in Uganda. But the reality remains that young people living with HIV/AIDS have the same sexual and emotional needs as their negative partners but are particularly vulnerable to a society that is susceptible to violence should it perceive a threat. They are vulnerable to their ignorance on reinfection and they are vulnerable due to additional demands their chronic illness exposes them to, be they financial, medical or social. The deal is that young people living with HIV/AIDS are sexually active and require sensitization programmes adapted to their condition along with sensitization programmes for the general public on this reality.
1 Bakeera-Kitaka S, Nabukeera-Barungi N, Nostlinger C, Kekitinwa A, Colebunders R. Sexual risk reduction needs of adolescents living with HIV in a clinical care setting. AIDS Care. 2008;20(4):426–433. [PubMed]
2 Birungi Harriet, Mugisha John Frank, Nyombi Juliana, Obare Francis, Eveka Hamphres, Nyinkavu Hannington. Sexual Behaviors and Desires Among Adolescents Perinatally Infected With Human Immunodeficiency Virus in Uganda: Implications for programming [PubMed]