The World Health Organisation (WHO) reported in 2016 that more than one million sexually transmitted infections (STIs) are contracted worldwide every day. STIs, therefore, have a profound impact on sexual and reproductive health worldwide. Despite considerable efforts to identify simple interventions that can reduce risky sexual behaviour, behaviour change remains a complex challenge. Research has demonstrated the need to focus on carefully defined populations, to consult extensively with the identified target populations, and to involve them in design, implementation and evaluation.
The impact of sexually transmitted infections came to the forefront with the outbreak of the HIV/AIDS pandemic. The severity of HIV/AIDS in Africa is clearly illustrated by statistics reported by UNAIDS in 2017. These reveal that Sub-Saharan Africa accounts for 69% of all people living with HIV/AIDS, of which 59% are women and girls in southern and eastern Africa, and 56% in western and central Africa. Sub-Saharan Africa further registered 74% of all HIV/AIDS deaths in the world in 2016. However, there is cause for optimism. UNAIDS reveals that new HIV infections declined by 29% in eastern and southern Africa between 2010 and 2016, and by 9% in western and central Africa. Between 2010 and 2016, the number of AIDS-related deaths fell by 42% in eastern and southern Africa and by 21% in western and central Africa.
Although HIV/AIDS can affect anyone. Young people and women are the most vulnerable and, because women are often powerless to insist on safe sexual relations, they are vulnerable to infection by HIV-positive partners. When people have other diseases like sexually transmitted diseases, TB or malaria they are also more likely to contract and die from HIV/AIDS.
There was, therefore, a clear imperative for the NEPAD Spanish Fund for African Women Empowerment to channel a significant proportion of all disbursements towards projects that address HIV/AIDS and sexually transmitted infections (STI) in Africa. The projects funded by the NSF, consequently, directly benefitted over 75,000 women through the provision of sexual and reproductive health and HIV/AIDS prevention services. These interventions include, inter alia, workshops on contraceptive use and other safe sex initiatives; facilitating HIV/AIDS testing; providing financial and psycho-social support to women infected with HIV/AIDS; initiatives centred around generating awareness about women’s sexual and reproductive rights; facilitating the creation of employment opportunities (and therefore income generation) for women infected with HIV/AIDS; training women in midwifery; the provision of specialist equipment and facilities for surgery on obstetric fistula.
The interventions by of the NEPAD Spanish Fund for African Women Empowerment in the field of HIV/AIDS prevention services and improved sexual and reproductive health of women were aligned with the Strategic Objectives of the Beijing Platform for Action as well as Article 12 of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), which aims to eliminate discrimination against women in the field of health care and access to health care services. These goals are of particular importance, given the high degrees of maternal mortality among African women; the high number of youth pregnancies; and the fact that – on a global scale – African women are the demographic which suffer the largest incidence of infant mortality.
Key lessons learned from projects:
- Utilise communication and training as essential tools in the fight against HIV/AIDS
- Engage and sensitise community and religious leaders regarding HIV/AIDS
- More projects need to provide free HIV/AIDS testing, especially in rural areas
Utilise communication and training as essential tools in the fight against HIV/AIDS
The worldwide stigma and sensitivity that is associated with HIV/AIDS provides a clear imperative to break the silence and remove the shame that surrounds it. People who are infected fear rejection and discrimination from those around them and try to hide their illness. Effective communication and training are therefore essential tools in the fight against HIV/AIDS. Women are the most affected and they should be informed of how to prevent infection. Social attitudes that make women vulnerable should thus be changed, specifically regarding the attitudes among many men that lead to woman abuse and sexual violence. Furthermore, projects should try to include additional considerations when targeting HIV/AIDS, as it is associated with numerous, unrelated phenomena. For instance, tuberculosis (TB) infection is often considered to be an indicator of having HIV/AIDS. This inaccurate perception, along with the stigma associated with HIV/AIDS, leads to innumerable individuals not receiving treatment for TB, due to fear of stigmatization.
The project leaders of the DIMOL (Reproductive Health for Safe Motherhood) project in Niger realised that behavioural change is a key factor in addressing reproductive health problems, averting unwanted pregnancy, and preventing the transmission of STI/HIV/AIDS. They further concluded that the most successful way of achieving such change is through effective communication and training. Each month, the facilitators of the DIMOL project organised motivation sessions involving the rural communities in 30 areas in Niger. These took the form of discussion debates facilitated by peer educators. Topics included reproductive health and the promotion of the rights of women and children, gender equality, family planning, preventing unwanted pregnancy, and prevention of the transmission of STI/HIV/AIDS. Over the project period, an estimated 55,320 people attended these sessions. Such sessions are vital to the implementation of behavioural change, as they engage community members while, simultaneously, educating them. This improves the effectiveness of these programmes, when compared to simple information campaigns, which frequently report fast deterioration in efficacy.
Another project that realised the importance of effective communication and training regarding HIV/AIDS prevention and sexual reproductive health issues was implemented by the Health and Development (SADEV) NGO in Niger. SADEV conducted several awareness-raising activities covering sexually transmitted infections (STIs) and HIV/AIDS prevention in selected schools in Niger. These reached some 12,390 young people. These activities included educational lectures, cultural evenings for young girls and boys as well as debates and screenings of HIV/AIDS films. The project, additionally, included a training element covering gender and HIV/AIDS aspects, and communication skills for behaviour change.
Engage and sensitise community any religious leaders regarding HIV/AIDS
Another effective method of diminishing the taboo and social stigmas surrounding HIV/AIDS and sexually transmitted infections (STIs) and to prevent these diseases, is to actively engage with and sensitise community and religious leaders regarding these issues. These leaders set the norm and are the role models that communities follow. Both the DIMOL (Reproductive Health for Safe Motherhood) and the Health and Development (SADEV) projects in Niger realised the importance of engaging these leaders in their campaigns against the diseases.
More projects need to provide free HIV/AIDS testing, especially in rural areas
The World Health Organisation (WHO) strongly recommends the regular testing for HIV and other STIs. Most often these tests provide same-day test results, which are essential for swift diagnosis and early treatment and care. HIV can be suppressed by administering antiretroviral therapy (ART) and although ART does not cure HIV infection, it allows an individual's immune system to strengthen and regain the capacity to fight off infections. Furthermore, the Centre for Disease Control in the United States of America confirmed in 2017 that effective treatment of HIV prevents transmission of the virus to uninfected individuals.
The importance to provide free HIV/AIDS testing, especially in rural areas and among the poor, surfaced in many of the NSF projects. The project implemented by the Ministry of Education, Science and Technology (MEST) in Sierra Leone realised the value of free HIV/AIDS testing and offered the women beneficiaries the voluntary opportunity to undergo and HIV/AIDS testing.