Heterosexual intercourse among adolescents is the primary method of HIV transmission in South Africa, with the majority of new infections occurring in the 21 ? 25 year age group. An HIV-prevention campaign promoting abstinence among young people would seem to be an effective barrier to further infections. However, a policy promoting abstinence approaches the problem only superficially, and would not take into account all of the factors driving adolescents to engage in sexual relations, specifically unprotected sex, in the first place.
Abstinence is not a viable method of HIV/AIDS prevention within the social, political, and economic context of South Africa. A more appropriate strategy would be a comprehensive program aimed at the de-stigmatization and prevention of the disease. A campaign promoting the use of condoms in all sexual encounters, backed by education and the expansion of HIV care and prevention services, and accompanied by policies addressing destructive economic conditions and gender inequality would be the most effective strategy.
Countries such as Uganda and Senegal have had success when taking a direct approach to HIV prevention, we should follow their example and confront the epidemic on the terms on which it is striking our populace ? through the unfettered, unprotected, and unhealthy sexual practices of our youth. Education is of primary importance in the war against HIV/AIDS. It is the most efficient preventative weapon in our arsenal. Most young adults are at risk because they lack the most basic information on HIV and how to protect themselves from infection.
There is confusion about methods of transmission, cultural myths about the disease’s curability, and, perhaps most damaging, skewed perceptions of self-risk. In addition, there are high levels of denial of HIV’s prevalence in communities that have yet to experience AIDS-related deaths. This results in adolescents convincing themselves that they can filter out dangerous partners through appearance or reputation. AIDS is externalized as a disease striking only at the margins of society, and is not seen as sufficient enough of a threat to change one’s risky sexual behavior.
HIV/AIDS education should be a community-wide occurrence. Scare tactics should be used to depict HIV in a realistic manner – as a disease incorporated into every community that can and will infect you if you do not take the correct precautions. Limiting education to the schools keeps HIV/AIDS as a medicinal, sterile topic, and disassociates parents who are unwilling or unable to talk to their children about issues of a sexual nature.
Bringing HIV/AIDS out into the open with posters and television and radio spots, possibly with the endorsement of sports figures or community leaders would make HIV and sex in general more acceptable, comfortable subjects. In order for individuals to change their behavior they need not only basic knowledge of HIV and their own personal risk of infection, they must perceive their environment as being supportive of safe behaviors. The more that adolescent sex and HIV, and the prevention of HIV through the use of condoms are aired on the public wavelength, the less stigmatized they will become.
There is an association of condoms with people already infected with STDs or HIV, with women who “sleep around”, with untrustworthiness and a lack of pleasure. Education about condoms needs to be tied directly to prevalence rates of HIV/AIDS, which are at 43. 1% among 21-25 year olds in some areas. Peer pressure can be manipulated by using well-liked, respected peers to convince others of the intelligence and normalcy of HIV-preventing behavior. Counseling of individuals and couples together is important in initiating the use of condoms, which is why community-wide education is imperative.
For women especially, abstinence is not a socially or financially acceptable option, but neither do women have much control over alternative ways to protect themselves from infection. Girls’ involvement in premarital sex is often an attempt to provide for basic needs, school fees, and luxuries or to find a husband. “Sugar daddies” represent a definitive threat, as the power imbalance between a school girl and a wealthy, older, sexually experienced (and thus with a higher probability of being infected with HIV) man, who presents an opportunity improve one’s socioeconomic status, is especially dangerous.
Masculine sexuality is associated with multiple partners and power over women, and attempting to control sexual behavior by women would endanger their relationship, chances of marriage, and even their physical and mental well being. Unprotected sex is also often a result of cultural and social norms that stress the importance of fertility. When a child does not lead to marriage it can reduce a woman’s chance to marry another man and increases the likelihood of lifetime of relatively short sexual relationships.
Programs that explicitly seek the active participation of teenagers have a limited effect unless there is, in the wider society, change directed at the empowerment of women and the breaking down of gender stereotyping in sexual behavior. Because there are no other economic avenues open to young women, they are forced into financially-motivated sexual relationships. Efforts should be made to correct this imbalance. Government programs aimed at the employment of women, especially young women, should be initiated and accompanied by press fighting against stereotypes of gender power.
Increasing women’s social and economic opportunities would raise the opportunity cost of having a child, and lead to a decline in the importance of “proving” one’s fertility. Men control the use of condoms, and a high regard for the preservation of reputation renders women powerless to demand condom use. In addition to schooling boys and men in sexual responsibility, health clinics should be stocked with women-controlled methods of prevention, such as microbicides.
Health infrastructures should be expanded to provide the necessary materials and support for public policies and campaigns. Men and women alike need to be informed about and tested for sexually transmitted infections (STIs), which affect women disproportionately and can increase the probability of HIV-transmission by 10-fold. Poverty prevents young people from purchasing condoms, thus they should be dispensed without admonition and with instruction on their proper use and preventative capacity in a variety of accessible locations.
The increased availability of treatment and services will help to destigmatize the disease and encourage people to seek help. Structural deficiencies such as economic insecurity, displacement caused by conflicts and disasters, illiteracy, violence, abuse, and social exclusion deprive people of the ability to protect themselves. Migrant labor and endemic poverty enforce social norms justifying extramarital sexual relations as necessary. Young people enter multiple relationships to achieve specific goals, often of an economic nature.
Economic, political, and social policies promoting stability, literacy, and support systems, will ultimately play a major role in controlling HIV/AIDS transmission. However, sex and risky sexual practices are a product of society as it stands now, and thus a social and economic necessity for adolescents. Social changes leading to a reduction in partners and abstinence will take a long time to take effect, and more immediate reduction in HIV-infection rates can be achieved through the promotion of condom use, accompanied by policies fomenting social change.