Patricia Mashiri for The PACT
It’s around 7.00 pm and life in the Central Business District (CBD) in Harare, Zimbabwe, seems to be gradually fading out as vendors prepare to call it a day. At the same time, life in the high-density suburb of Hopley, south of the CBD, has just begun as young girls prepare to parade themselves at the famous drinking spot KwaAntony.
Most vulnerable young girls from the ages 10 to 24, who are involved in sex work for survival in Hopley, find themselves at high risk of contracting HIV or getting re-infected, having unintended pregnancies and Sexual Transmitted Infections (STIs).
According to the Zimbabwean government, the country recorded almost 5,000 teenage pregnancies between January and February 2021 and about 1,800 early marriages, majority of these emanating from high density suburbs where sex work hotspots are mushrooming.
Zimbabwe Population Based HIV Impact Assessment (ZIMPHIA) of 2020 found that 86.8 percent of adults living with HIV were aware of their status and of those aware of their status, 97 percent were on antiretroviral treatment. Among those on treatment, 90.3 percent achieved viral load suppression. Also, the rate of annual new HIV infections among adults in Zimbabwe is 0.38 percent or approximately 31,000 persons over a year.
A visit to Hopley shows that teenage girls are often pregnant without knowledge of who the fathers are. This dilemma befell Benhilda Manyava (22).
“I was born living with HIV and lost my parents when I was still young. My grandmother is the one who took care of me after my parents passed unfortunately, she also passed away when I was 15. I had noone to look after me because of my condition, I was always sick. A friend from Epworth, another high density suburb in the Western side of Harare, took me in and introduced me to sex work as the only way of survival.
“The problem was she did not tell me that I was supposed to use protection during the work. I suffered from STIs from because I was not using of protection. At the age of 16 I fell pregnant and did not know who the father of my child was because I was sexually intimate with a lot of people without protection,” said Benhilda.
She however, believes that her current situation was due to general lack of adequate Sexual Reproduction Health Rights (SRHR) information.
“Now that I know that I have a right to protect myself from STIs, I encounter a lot of challenges at health facilities because the healthcare providers do not respect privacy and they have attitude towards sex workers, especially us the young sex workers. They limit the condoms they give. Sometimes we will be taking many so that we will help the young recruits. When we are deprived of these services, we go back to sex work without being treated, without protection, which endangers both the sex worker and the client. This results into mutation of the STI, spread of HIV and unwanted pregnancies,” said Manyava.
“It is very difficult for us young sex workers to negotiate for safer sex. The economic situation here in Zimbabwe is becoming bad every day and we will be forced to earn a living and the only way of doing it is through sex work. Sometimes, we meet older men who are called sugar daddies and they refuse to use protection and, because we want the money, we end up risking our health by having unprotected sex with them.
“The sad part is you will be only given ZWL$ 70 equivalent to USD 0.50. If you try to negotiate for safer sex, you are the one who ends up losing the money; yet you will be needing it to buy the basics at home. I want to take care of my child so I have no choice than to do it unprotected.”
Manyava at times locks up her five-year-old alone during the night when she goes for her work because she will be having no one to take care of the child when she’s away. She added that improved access to SRHR services could reduce the burden of HIV/AIDS among sex workers. She also highlighted that if she becomes lucky and finds projects to do which can help her to sustain herself and her child, she is willing to quit the sex work profession.
Tino (26), who prefers to be identified by her pet name, lives with HIV and also encounters difficulties when it comes to accessing SRHR services in health facilities. She mentioned that the major root cause which was leading to the surging up of HIV incidences amongst young people was the lack of these critical services such as contraceptives and treatment of STIs.
“As young people, we want to have sexual intercourse but the challenge there is limited access to condoms and other important services and as a result they we end up indulging with different people without using protection and it leads to recurring of HIV, STIs and unwanted pregnancies.
“It is very difficult to come open about our HIV statuses especially for young ladies like me because of the stigma and discrimination which comes after it. At times we end up in uncomfortable relationships were our partners would be wanting unprotected sex and us knowing our status, it will be very difficult,” said Tino.
She stressed that it was imperative for government, civil society organizations, and other relevant stakeholders to assist young people to get contraceptives. Tino mentioned that if the information gap which exists amongst young people, especially for girls to manage SRH issues is not dealt with, the HIV pandemic and teen pregnancies will continue to be rampant.
Stigma and discrimination
Tino indicated that because she lives with HIV, she is subject to negative community perceptions, stigma and structural vulnerabilities. Problems with mental health tend to be more common among a lot of people living with HIV and many young people suffering from anxiety.
“As a young girl living with HIV, I face the dual burden of living with HIV and dealing with the challenges of adolescence. Most of the time people always say adolescents living with HIV would die early and because of this, it leads to neglect regarding general welfare and educational opportunities. Sometimes I feel like I’m not even productive and sometimes I feel like I’m not worthy to live,” observed Munyava.
Attitudes and barriers to employment
It is a difficult task to get a job in Zimbabwe and retain it when you are living with HIV. Most companies require an HIV test as part of the medicals for one to be employed.
“I once wanted a job at a famous food outlet in Zimbabwe. I was asked to do HIV tests before the interview and they told me point-blank that the only job I was qualified for if I was living with HIV was to be a cleaner because I could not handle their food.
“It is wise to keep your HIV status a secret if you want employment in most of the organizations in East and Sothern Africa. People haven’t embraced that we are people like they are, we have feeling and we need basic stuff like food, school fees for our children and parents to look after,” Tino said as she sobbed.
A recent report released by International Labor Organization (ILO) revealed that myths and misconceptions about HIV/AIDS continue to fuel stigma and discrimination at the work place with nearly four out of 10 people becoming not comfortable to work with colleagues who have HIV. The level of discrimination is shocking that even after 40 years after the AIDS epidemic begin the misconceptions are still so widespread this might be linked to lack of education programs on HIV/AIDS when out comes to the world of work.
Challenges in ending HIV epidemic
Zimbabwe is one of the countries in East and Sothern Africa working to eradicate new incidences of HIV through ensuring that it keeps renewed focus on keeping HIV positive people in care and adhering to their treatment. Although it has reached the 95-95-95 targets by UNAIDS, there are still gaps in terms of adherence, stigma, and discrimination.
The COVID-19 pandemic has been fueling HIV incidences as a lot of people defaulted because of the induced lockdowns. A lot of people could not get to health facilities because of roadblocks which were mounted and many were forced to disclose their HIV status to those mounting roadblocks.
“I felt like I was undressed at the police roadblocks during the COVID-19 induced lockdown,” said Keith (18). “When I divulged my HIV status to them because I wanted to be given permission to go to the health facility for my monthly dose.”
Hamida Ismail-Mauto, Country Operations Manager, SRHR Africa Trust (SAT), said due to the worsening economic situation in Zimbabwe, the majority of young women were selling sex and there was a need for government and other institutions to proffer solutions aimed at safeguarding their future.
Mauto there was need for health professionals, parents, and the community at large to accept the reality that young girls were engaging in sexual activities, mentioning that easy access to contraceptives will protect them from contracting STIs, early marriages, and unwanted pregnancies. She bemoaned stigma and discrimination by healthcare practitioners when offering services to these young women, indicating that deprivation of SRHR services was worsening the situation in as much as increase of HIV and STI cases is concerned.
“As we all know and understand due to the deteriorating economy, there is poverty in the country and we do know that children are selling sex and also young women are also selling sex. There are major issues around access and actually to do with the attitude of health professionals. Access to health is allowed by our Constitution and we are actually calling out to the health professionals to when adolescent girls present themselves
“Issues around age of consent is a huge barrier for adolescents to access SRHR services because policy allows only those who are 16 and above to access health services without parental or guardian consent because the major challenge in our country is that adolescents are selling sex and therefore require services for STI treatment or HIV testing,” said Mauto.
As an organization, Mauto said SAT was committed to ensure prevention of unintended pregnancies, STIs, and HIV transmission.
“SAT is also making concerted efforts in trying to improve issues to access where they have programme called School Health programme where they working together with the Ministry of Education and, school heads other stakeholders especially in rural areas developing the health booklet aimed at monitoring the health of adolescents in schools and ensuring their access to HIV services.
“Condoms should be made available to the young people and adolescent who are sexually active. They should be able to access condoms without any stigma, fear and discrimination. We also call out to the young people, if you are sexually active, please prevent yourself, go and seek SRH services, we have a Constitution which talks about health for all,” she said.
Meanwhile, Mr Chikanya highlighted that in as much as ending HIV in Zimbabwe is concerned, it was imperative for government to increase domestic resources and resources for young peoples’ activities and programs without leaving the key populations behind.
“Let’s look at different age groups and different people, let’s target the young who more vulnerable. It is important to focus on young people with disabilities, young sex workers among others. Creation of these programs in communities as well as engaging the young people is critical in the planning, monitoring and evaluation.”
Ending HIV/AIDS needs concerted efforts from different stakeholders and increased access to SRHR information and services especially for the youth. UNAIDS and other HIV/AIDS oriented organizations pointed out that endemic HIV requires a paradigm shift, from a vertical response to an integrated health systems response, to provide services according to need.
They also emphasize that unrelenting political commitment and increased, sustainable funding is required from both national and global sources, towards health systems strengthening.