Who do we put first?

by Aneleh Fourie Le Roux, CABSA Director

“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
  • Sex workers

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.