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In early August, the international news agency, Reuters, reported that families in Kenyawere selling their daughters into marriage, sometimes for as little as $168.00 dollars, in an attempt to ease the economic burden caused by drought. The story about the “child drought brides” gathered international attention. Sadly, the situation inKenya is not unique. Climate change, and its detrimental effects on the environment, disproportionately affects adolescent girls and is increasing girls’ risk for school dropout, early marriage, sexual violence, and other negative outcomes.
“Climate change and local environmental change may destroy all of my dreams and aspirations,” 15 year-old girl from the Philippines
Drought and natural disasters often increase the economic burden felt by vulnerable households. In the aftermath of natural disasters, families may experience job loss, home damage, and loss of crops and livestock. Girls are often the first pulled out of school to help supplement the household income.
Girls may also be forced to leave school in order to shoulder some of the burden of increased household responsibilities. Girls may be expected to care for sick or injured relatives or to provide childcare for younger siblings when parents are traveling to collect aid or food. Furthermore, drought, deforestation, and natural disasters often cause adolescent girls to spend more than half of their days looking for wood and clean water; this results in less regular school attendance. When a girl is forced to leave school, not only is her education jeopardized, but she faces increased risk of early and unintended pregnancies, and HIV and other STIs.
The economic burden of climate change also increases a girl’s risk of early marriage. Many families arrange marriages for the “bride price” and to ease the burden of having to feed and care for girls. Early marriage often results in girls leaving school and increases the risk of early pregnancy.
In disaster situations, women and girls are more likely to experience all types of violence including sexual violence. Girls are at risk of sexual violence while staying in relief shelters, on the way to the shelters, and when collecting water or firewood while staying in a shelter. Sexual violence leads to poor health consequences for its victims including unintended pregnancies, HIV and other sexually transmitted infections, and death. Also, because families perceive shelters as unsafe, girls may be left at home, making them unable to benefit from the reproductive health services offered there.
Programs and policies need to place a greater focus on the potentially catastrophic effects of climate change on the reproductive health of adolescent girls. In a recent report called “Weathering the Storm: Adolescent Girls and Climate Change,” Plan International makes the following programmatic and policy suggestions.
Programs should ensure that girls have:
- Greater access to quality education
- Greater protection from gender-based violence
- Greater participation in activities related adapting to climate change and reducing risk
- Prescribe gender-sensitive strategies for adapting to climate change
- Address gender inequality as a root cause of vulnerability to climate change
‘‘Young people are the key in the fight against AIDS. By giving them the support they need, we can empower them to protect themselves against the virus. By giving them honest and straightforward information, we can break the circle of silence across all society. By creating effective campaigns for education and prevention, we can turn young people’s enthusiasm, drive and dreams for the future into powerful tools for tackling the epidemic.’’ —Kofi Annan, former United Nations Secretary
Every day 2,500 young people are infected with HIV. In fact, almost one quarter of all people living with HIV are less than 25 years old. Young people remain at the center of the HIV epidemic in terms of rates of infection, vulnerability, impact, and potential for change. Nearly half of all new HIV infections occur among young people between the ages of 15 and 24. Ninety-seven percent of these new infections occur in low- and middle-income countries, where young people have limited access to HIV information and care.
These daunting statistics highlight the need for effective HIV prevention programs among young people. When young people are provided with effective prevention strategies and adequate knowledge of HIV risks, they can change their behavior and reduce their vulnerability. There are many effective services and programs that have successfully increased prevention knowledge and encouraged young people to make positive behavior changes. We want to highlight such programs, and we are looking to our readers for help.
On behalf of the UNAIDS Inter-Agency Task Team on HIV and Young People, FHI 360 is putting out a call for programs or interventions that illustrate best practices in HIV interventions for young people. Submissions will be assessed by a team of experts. Those that most compellingly illustrate best practices will be included as a case study in a UN publication and disseminated globally. Please visit our Web site for more information on how to submit your program for consideration as a best practice today!
This is part two of a posting by Laura Engelman, an intern for the Male Circumcision Consortium at FHI 360. You can read part one here.
Some of the tensions that can arise when MMC is introduced were felt in Kenya when a national VMMC program was launched there. FHI 360 works closely with the Government of Kenya (GoK) on its national VMMC program. This program, launched in November 2008, focuses primarily on Nyanza Province, which has the highest HIV rates in Kenya coupled with the lowest rates of MC. The Kenya VMMC program shines light on the value of community-building and open dialogue when discussing controversies involving MMC.
In order to quell fears about MMC among skeptics of the intervention, GoK officials and the program’s partners held two large forums in Kisumu, Kenya before the official launch of the campaign. Community members and stakeholders at these forums voiced concerns over introducing the medical intervention in a traditionally non-circumcising community. Through honest discussion and a thorough presentation of the facts and the positive randomized control trial results, the GoK and their partners reassured the community leaders that circumcision is a strictly medical, rather than cultural, intervention. Reframing it in this way led to the community’s acceptance and endorsement for the medical procedure.
Similarly, discussing the medical benefits of the procedure with stakeholders in communities that practice traditional circumcision as a rite of passage for adolescents is important in reassuring concerned community members. In these communities, partners are exploring ways in which traditional MC can be made safer. There is also discussion about how other rituals can be combined with medical circumcision so that a rite of passage ritual survives. In addition to community discussion about the procedure, peer-to-peer communication also helps to allay fears about the procedure. One adolescent in Kenya reported that the youth in his community thought of traditional circumcision as a “brutal” practice until one of their friends underwent MMC. After hearing from the trusted friend that the procedure did not hurt, other boys his age opted for the medical intervention.
Adolescents throughout sub-Saharan Africa undergoing MMC receive counseling along with “the cut.” Counseling must be tailored to an adolescent audience to reinforce the idea that MMC is only partially protective from HIV and that other protective behaviors, such as correct and consistent condom use, must also be employed. Counseling must discourage sexual disinhibition after undergoing MMC. Circumcision only provides men with partial protection from HIV and is by no means a free pass to engage in unsafe sex. Though medically circumcised men are 60% less likely to contract HIV from an HIV-positive woman, it is imperative that these men do not counteract the benefits of MMC by engaging in risky sexual behavior. MMC should be viewed as part of a comprehensive HIV prevention package that includes use of condoms, regular testing for STIs and HIV, open communication about sexual behavior and sexual health, and reducing the number of sexual partners.
Through research, communications efforts, and collaboration with other organizations, FHI 360 is working to improve and expand access to safe, VMMC services in sub-Saharan Africa. Kenya’s national VMMC program is the most comprehensive to date and has led the way for others to engage in national VMMC scale-up programs as well.
Laura Engelman is an intern for the Male Circumcision Consortium at FHI 360, where she collaborates with a team to conduct research and apply findings on male circumcision as a biomedical tool in the fight against the spread of HIV in sub-Saharan Africa. In this two-part piece, she discusses the benefits of and controversies surrounding medical male circumcision.
Voluntary medical male circumcision (VMMC) has been proven to reduce men’s risk of HIV acquisition and is recommended as part of a comprehensive HIV prevention strategy for communities heavily affected by HIV and with low rates of male circumcision. Three randomized controlled trials (RCTs) conducted in Kenya, South Africa, and Uganda (published between 2005 and 2007) showed overwhelming evidence in favor of male circumcision as a risk reduction strategy against female to male HIV transmission. These studies found that removing the foreskin of the penis, where HIV receptor cells thrive, reduces a man’s chances of contracting HIV through vaginal sex by approximately 60 percent.
VMMC is especially important for males in their late teens and early 20s as many men in this age group have recently or will soon become sexually active. Also, because many men in this age group are not yet married, they may have multiple sexual partners. Furthermore, adolescents might not yet have learned ways to reduce their risk of acquiring HIV or other sexually transmitted infections. The counseling component of a comprehensive package of MC services is thus especially relevant for adolescents.
Medical male circumcision (MMC) does sometimes raise some controversial questions and concerns, particularly in regards to adolescents. For example, many non-circumcising communities view MMC as an affront on their cultural traditions. Other communities hold circumcision sacred as a rite of passage or religious tradition and do not want this ancient ritual taken over by medical professionals.
Whereas infant Jewish males are typically circumcised on their eighth day, Muslim boys can undergo the procedure anytime between birth and puberty. In many sub-Saharan African communities, circumcision is not performed for religious reasons but rather as a cultural rite of passage for adolescents. Combined with other rituals meant to test maturity, strength, and wisdom, circumcision represents a passage from boyhood into adulthood. This traditional circumcision, however, oftentimes involves only a small cut to or partial removal of the foreskin and may not effectively reduce the risk the HIV acquisition. Furthermore, these traditional circumcision ceremonies can be associated with unsafe practices and negative health outcomes.
On Monday, September 12, we will post part two of this piece, which illustrates how community concerns over VMMC can be allayed and how community members become valuable advocates of the procedure.