“One of the biggest challenges is reaching men,” writes Jon Crisp from the Baylor College of Medicine Children’s Foundation in Malawi, as he reflects on Differential Service Delivery (DSD) during the International AIDS Conference in July.
But we are also told that almost 47% of new HIV infections take place in predominantly the following four key populations:
Men who have sex with men
People who use drugs
Transgender people and
Yet when we consider the high levels of new infections among adolescent girls and young women (15-24) others might argue that our challenge is to urgently reach and empower young women!
The South African National Strategic Plan on HIV, TB and STIs 2017-2022 states:
“A strong focus of this NSP is improving the prevention of HIV infection among adolescent girls and young women because of the extremely high rate of infection in this section of the population. Not only does early infection irreversibly shape the lives of hundreds of thousands of women from their teens and early 20s onward, but reaching our national targets for reducing HIV is unthinkable without putting young women first.”
Is the question then, who should we put first? But how do we put young women first without engaging men? Should we not rather ask, how do we manage to meet different target groups in a meaningful way?
Canon Gideon Byamugisha from INERELA+ was one of the early voices that urged faith communities to acknowledge that we need different prevention messages to reach different target groups, because one approach does not speak to all people.
Differential Service Delivery (DSD) refers to the concept that we need different prevention methods, different approaches to care, support and antiretroviral therapy services to reach different people and different groups.
As service providers and churches we are therefore challenged to understand the vulnerabilities of different key populations, but at the same time a generalized epidemic demands that we also seek to find differentiated methods to address the needs and challenges faced by women and men.
Though we might prioritize one group above the other in a given project or initiative, we can never exclude one group in our thinking and planning.
“It (Gender Based Violence – GBV) is a social issue that must engage, involve and mobilise the whole of society. We must be prepared, as government, to acknowledge where we have failed our people. Where we have made mistakes, we will correct them.” With this quote of President Cyril Ramaphosa about GBV, Amy Green closes her article about the She Conquers and DREAMS projects.
It left me with a question: Will a focus on this most vulnerable segment of our communities on its own lead to a decrease of HIV infections and teen pregnancies?
A visit to the She Conquers website gave a few answers. Yes, there is indeed much that can be done to support young girls and women. The information made available through this website is commendable. I applaud every effort to help girls to stay in school and to find a job!
However, will this effort in itself be a game-changer in the HIV epidemic?
Can the trajectory of the HIV epidemic be changed through a focus on young women and girls alone?
Just as the whole of society needs to be mobilised to change the situation of Gender Based Violence, the whole of society needs to be part of the solution to the HIV epidemic.
The statement, “young women aged 12 to 24 bear the burden of the current HIV epidemic”, has a logical counterpart: Men take advantage of the vulnerability of young women aged 12 to 24.
If we want to change the fact that there are still 2 000 new HIV infections every week amongst young women and girls in South Africa, we need to also engage men.
Dr Olive Shisana said as recently as 2017: “The HIV epidemic is raging and we say we have conquered HIV. We think we can treat ourselves out of the epidemic. But there are still new infections”.
Therefore, I do not ask “Have we conquered HIV?”
My question is only – are we at least doing the right things to move in the direction of eventually conquering HIV?
I am not sure! To be honest – I do not think so.
What do you think?
At a recent CHABAHIVA Trust workshop Lyn van Rooyen from CABSA presented an overview of the current situation of HIV in South Africa. The picture she sketched was so alarming that I’ve asked her to adapt the PowerPoint for a wider audience.
This has been uploaded on our website and you can read it here.
Do yourself a favour and have a good look!
Then do people living with HIV and specifically those most vulnerable to HIV infection a favour and comment on what you’ve learned on the CHABAHIVA Trust Facebook page.