As the 19th International AIDS Conference ends in Washington DC, Africa Public Health Alliance welcomes highlighting of “treatment as prevention” strategy, and emphasizes importance of a dual strategy with basic ‘preventive’ prevention.
•To underline this, Africa Public Health.Info launches new Youth and Women focused 2012 Africa Reproductive and Sexual Health Scorecard and Summary Factsheet- Highlighting multifaceted interaction between Health, Human and Social Development Issues – especially Population Dynamics, Adolescent and Youth Development, HIV, Child ‘Marriage’, Education, Reproductive, Sexual and Maternal Health – as part of its initiative for implementation of an African RMNCH Multisectoral Strategy.
•The scorecard and accompanying factsheet underline that amongst the several keys to long term sustainable HIV prevention, include improved and targeted investment in adolescent, youth, and women’s health; investment in girl child education; and protection of young girls from Child ‘Marriage.’
Factsheet and highlights of research and analysis, with the new Scorecard by the Africa Public Health Group, and the Africa Coalition on Maternal, Newborn and Child Health indicate as follows:
•Adolescents (15-19 years of age) constitute roughly a quarter of the population in 44 out of Africa’s 54 countries; and women at least half or more in all countries, but with no cohesive and clearly targeted public policy, and improved investment in youth and women’s health.
•African countries constitute 20 of the 25 countries globally with highest adolescent fertility of between 123 per 1,000 births, and 199 per 1,000 births amongst young girls aged 15-19 years - with Niger, Chad, Mali, Mozambique and Liberia as top 5 most affected African countries
•Higher Adolescent fertility can also serve as a tracer indicator for early sexual debut, and unprotected sexual activity amongst young girls - including forced sex through so called Child ‘Marriage’. In countries with highest adolescent fertility such as Niger, 36% of girls are ‘married’ by age 15, and 75% by age 18. In Chad 35% are ‘married’ by age 15, and 72% by age 18 etc.
•Child ‘Marriage’ irreparably damages development of young girls - by imposing restricted access to reproductive and sexual health on them; exposing them to higher separate and combined risk of HIV, and lifetime risk of maternal death; stunts their educational potential, and contribution to African development.
•In the 10 countries globally with the least adolescent fertility, the rate is only between - 1 per 1,000 births, and 15 per 1,000 births amongst young girls aged 15-19 years. The countries with 5th joint lowest adolescent fertility are Democratic Peoples Republic of Korea and San Marino at 1 per 1,000; Republic of Korea at 2 per 1,000; Algeria, Libya, Lichtenstein and Switzerland at 4 per 1,000; Japan and Netherlands at 5 per 1,000; and China and Tunisia at 6 per 1,000. They also have significantly lower though mixed levels of maternal death risk compared to countries with highest adolescent fertility.
•Various sets of social factors often have similar effect on women’s health. In Swaziland, Botswana, Lesotho and South Africa, where overall adult HIV prevalence is a high 25.9%, 24.8%, 23.6% and 17.8% respectively, HIV prevalence amongst women is 59%, 57%, 62% and 62% respectively – While in Niger, Chad, Mali and Liberia where overall adult prevalence is a lower 0.8%, 3.4%, 1.0% and 1.5% respectively, but with highest adolescent fertility HIV prevalence amongst women is also high at 53%, 61%, 61% and 61% respectively.
•By contrast in countries like Algeria, Morocco and Tunisia with low adolescent fertility of between 4 and 18 per 1,000; and also low adult HIV prevalence of between <0.1% and 0.1% - HIV prevalence amongst women is at a lower 31% to 32% - similar for instance to Sweden, Switzerland and UK – also at 31% to 32%.
•Across Africa, % prevalence and absolute numbers of women living with HIV is mostly higher than that of men - and must guide investment and policy interventions for Prevention of Mother to Child Transmission (PMTCT) of HIV.
•In general Child ‘Marriage’ including increased possibility of exposure to HIV is a bigger factor in maternal death amongst young girls and women in Central and West Africa; In general HIV and AIDS are a bigger factor for maternal death amongst adult women in Eastern and Southern Africa.
•In countries such as South Africa, Swaziland, Lesotho and Botswana with HIV prevalence of between 17.8% and 25.9% - HIV is associated with between 41.5% and 67.3% of maternal deaths.
•Underlining the need for special investment in women’s health - There are more HIV positive women in Nigeria and South Africa (about 5 million HIV positive women) with a combined population of just about 200 million - than there are in China and India (about 1.5 million HIV positive women) both with more than tenfold combined population of 2.5 billion.
•In general, countries with highest adolescent fertility dominate the list of countries with biggest lifetime risk of maternal death.
•Not surprisingly, in general the countries with highest Child ‘Marriage’ are amongst countries with higher lifetime risk of maternal death.
•In 10 of the 15 countries with highest adolescent fertility, boys outnumber girls in secondary education - underlining the role of girl’s education in combating Child ‘Marriage’, and early childbirth.
•In 27 countries, secondary school net attendance for girls is less than 25%, and less than 50% for 47 countries – out of 54.
•In 16 out of 54 countries secondary school net attendance for girls is equal to, or slightly higher than for boys.
•The 10 African countries with highest lifetime risk of maternal death are closest to the risk level in Afghanistan - a country that has been in conflict for the better part of 30 years.
•Key Recommendations Include: Investment in girl’s education; Legislative, community and social protection of girls from Child ‘Marriage’; Investment in overall Reproductive and Sexual Health Education; Improved production and distribution of Commodities for Reproductive, Sexual and Maternal Health, and also Prevention and Treatment of HIV are crucial to current and future survival of young African women.
Speaking to the new Youth and Women’s Health focused 2012 Africa Reproductive and Sexual Health Scorecard and Factsheet Rotimi Sankore Coordinator of the Africa Public Health Alliance stated:
“We welcome the “treatment as prevention” highlight of the 19th AIDS conference, but believe that for this to be effective, it is equally necessary to stress the importance of improved investment in the fundamentals of basic ‘preventive’ prevention which is more cost effective in resource challenged settings.
This research, analysis, scorecard and factsheet demonstrate the complex interaction between a range of health, and apparently non-health indicators and their impact on especially health of adolescents, young girls and women. Africa is the only continent projected to double in population from 1 billion to 2 billion by 2050 and a failure to develop and effectively implement a cohesive adolescent, youth health and development policy will cost us very dearly.”
“HIV especially remains a deadly infectious disease which has latched on to the biological core of human survival – the reproductive and sexual process, and body fluids. We must not forget that in the absence of a cure, without effective interventions, and given enough time it retains its capacity to potentially infect anyone without discrimination.”
He further emphasized that: “Importantly, HIV and other health issues will not be resolved by investment in medical interventions alone especially in Africa, which remains the region hardest hit by HIV precisely because of underdevelopment.
African policy makers and governments need to urgently play a lead role in unraveling and tackling the complex threads between health, human and social development issues that continue to undermine the continents development, with a view to improved multisectoral evidence based policy making and investment.”
Examples of these issues include poor investment in education of the girl child, and so called Child ‘Marriage.’
So called Child ‘Marriage’ is a global problem that African governments need to take a lead in eradicating. In countries like Niger, Chad, Guinea, Central African Republic and Mali with adolescents making up roughly a quarter of their populations and standing at 3.6 million, 2.6 million, 2.2 million, 1 million and 3.6 million respectively - 75%, 72% 63% 61% and 55% of girls are given into so called ‘marriage’ before or by age of 18 which the evidence shows is more or less a captive situation placing them at higher risk of maternal death, from both HIV, and non HIV causes.
“Even worse, in as many as 18 African countries, including Central African Republic, Chad, Eritrea, Ethiopia, Guinea, Liberia, Mali, Mozambique, Niger, Nigeria, Sierra Leone, Sudan, Uganda and others between 10% and 36% of girl children are ‘married’ off before or by their 15th birthday. By our estimates that is roughly 11.4 million girl children 15years and younger ‘given’ into domestic sexual slavery and work in just 18 countries alone. If millions of adult women have difficulty negotiating and accessing reproductive, sexual and maternal care, it is not unreasonable to say girl children held in hostage ‘marriages’ have little or no hope of doing so.
“Aside from the psychological, physical and health damage, girls of 15 years of age should be in school getting the education required to help fulfill their potential, and contribution to African development.
Adding that: “There are good reasons why 11, 13 or 15 year old boys are not given out in marriage to women 10, 20 or 40 years older than them - these same reasons, and more apply to girls - teenage girls are 5 times more likely to die at child birth than adult women – and if they survive, their children are twice more likely to die than children of adult women – the physical injury of fistula arguably one of the most damaging and undignifying pregnancy related injuries suffered by millions of young girls - and the seriously increased chances of exposure to HIV.
“For too long this hostage situation where girls are taken into social captivity has been described as a form of marriage. Such descriptions attempt to legitimize domestic slavery, through state certification of multiple count offences against children.
“All African governments need to join those that have outlawed so called child ‘marriage,’ and amongst those that have, better law enforcement and public education is needed, including provision of schools and places for girls. Countries like Tunisia, where not only has so-called child marriage been abolished – but also there are designated community focal persons to promote reproductive, sexual and maternal health for youth should be emulated.
In addition to “treatment as prevention”, campaigners returning from the 19th International AIDS Conference need to factor in these, and other expanded prevention paradigms in their work to ensure the 19th AIDS Conference of slogan of “Turning the Tide” is sustainable.”
He added that: “As our work transits from mainly health and social determinants to interlinked issues of health, human and social development, we will expand our spotlight to focus on a range of interconnected issues that must be resolved to ensure all Africans especially children, youth, women, the vulnerable, the discriminated against and marginalized have an opportunity to fulfill their development potential.
Direct Link to 2012 Adolescent / Youth and Women Focussed Reproductive and Sexual Health Scorecard
For further information please contact
Ogechi Onuoha, Partnerships and Communications Officer