"They recommend that we always carry condoms, but then they tell you: 'Hey babe, you can't eat a banana with the peel, you need to peel it, you know ...". With this phrase, Sisanda Khuzami, 22 years old, gives an idea of the attitude of boys of his age towards condoms. He describes it with self-confidence, gesturing exaggeratedly and imitating the voice of a male with a badass point. His teammates Zipho Sithandathu (21) and Nihlali Nolokwe (23) laugh, but they agree with him. “Most think the condom is boring; They only look at that, and not that it saves lives ”, considers Sithandathu.
These three young South Africans are very well educated when it comes to sex education because they collaborate with Doctors Without Borders as advisers for children and adolescents in the schools and institutes of their neighborhood, Khayelitsa, one of the poorest and largest in Ciudad del Cape.
They know about the risks of not using protection, such as unwanted pregnancies and diseases such as AIDS.
But their example is not the majority: in South Africa, HIV increases more in the age group 15 to 24 years, with 38% of the 200,000 new infections in 2017, according to the latest data provided by the National AIDS Council of South Africa (Sanac).
More information
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The 'normal life' of HIV-positive youth
Sugar boyfriends for poor girls
Forty years after HIV was first described, it remains a major problem in South Africa. It is the country with the highest figures in the world, up to 7.6 million people live with the disease, almost 14% of the population, and still 72,000 died in 2019. But it is also where important achievements have been made, since mortality has fallen by 60% in the last decade and the country is approaching the United Nations goal of 95-95-95 for 2030: 92% of the HIV-positive population knows their status, 70% of them are on antiretroviral treatment and 92% of the latter do not have a viral load, according to the UN Agency for the fight against AIDS (Unaids).
There is no single cause that explains the poor results among the young population. On the contrary, the analysis of this situation provides hours of talk, at least for the three young people from Khayelitsa, who reflect on the phenomenon from a modern
hipster
cafe
in their neighborhood, the kind where they serve cappuccinos and hamburgers with bread. sourdough. Sisanda Khuzami shoots himself for two reasons: “One: When young people go out to drink they forget about condoms, they sleep with people they just met. And two: gender violence is on the rise; We are being raped and you do not know if the person who did it had HIV ”.
The data supports his thesis: 3,224 women were murdered in 2018, one every three hours, in a trend that has increased in recent years. Between 2018 and 2019, the police registered an average of 114 daily rapes, almost 5% more than the previous year. In fact, an investigation carried out in the same Khayelitsa in 2016 found that 35% of girls in primary and secondary school had suffered a sexual assault in the last year. At the same time, South African women and girls between the ages of 15 and 24 are the most vulnerable group to the disease, as up to 180 of them are infected daily. In 2018, they were almost 65,000 compared to just over 19,000 men of the same age, according to Sanac.
View of the rooftops and informal dwellings of Khayelitsa, one of the largest and poorest settlements in Cape Town, South Africa. It is the country with the highest HIV figures in the world: up to 7.6 million people live with the disease, almost 14% of the population, and still 72,000 died in 2019. But it is also where important achievements have been made, since mortality has decreased by 60% in the last decade
"It is understood that intergenerational relationships between older men, a group with a high HIV prevalence, and young women are driving a cycle of infections", describes a report by Sanac in reference to the so-called "sugar dadies", a term referring to adult men who have sex with girls and very young women from impoverished backgrounds in exchange for financial protection. It has been observed numerous times by Phumeza Runeyi, a health promoter at Doctors Without Borders in Khayelitsa for 15 years and a mentor to the three young people gathered in the cafeteria. The last time, a couple of weeks ago: “I have a case of a 12-year-old girl. During the quarantine, the mother was left without a job and no income, so she decided to sell her daughter to a man who owned a store.She could take food from him in exchange for the merchant to sleep with the girl, "he says between sips of his soda. Both the mother and the abuser were arrested and custody of the child has been removed from her.
One of the clearest certainties about HIV is that condom use is the most effective way to prevent infection during sexual intercourse.
South Africa invested more than 2.2 billion euros in the fight against the disease in 2019 alone and has a robust program of free condom distribution, with one billion distributed annually according to the Ministry of Health and another 27 million for women.
But not everyone uses them: 63% of young people between 15 and 24 years say they use them regularly.
Phumeza Runeyi (left) answers the doubts of a young mother.
She has been a health promoter for Doctors Without Borders in Khayelitsa for 15 years.
Provides counseling on family planning, sexual health, HIV ...
That young people do not protect themselves is something that is largely attributed to the fact that the information still does not arrive as it should, since less than half (45.8%) of South Africans between 15 and 24 years old have sufficient knowledge about how to prevent HIV infection, according to UNAIDS. And this is something that MSF adviser Phumeza Runeyi does not enter into her head. "When I started, young people did not know anything about HIV, they only knew that it amounted to death, and yet they kept contracting it because there was nothing to prevent it." As time has passed, with awareness, activism and a lot of funding, huge strides have been made in controlling the disease. "I make sure that when we speak about HIV, at conferences and elsewhere, we also speak for young people, because they are the most vulnerable." states Runiye,who recognizes, however, that the campaigns have been relaxed during the last year as a result of the covid-19 because the message has focused on the pandemic and HIV has lost prominence. “We raise awareness about condoms a lot. But covid-19 is coming and we focus more on informing about masks. You spend 20 years talking about HIV on a daily basis and then people forget it in a day. I don't understand it ”, laments the expert.
For Khuzami, the efforts made to inform the population about the new coronavirus could well be used for HIV as well.
“If you want information on covid-19, you don't even have to search, the Government sends you SMS just to remind you to take precautions.
But with HIV you never get an SMS saying 'hey, put the condom on, stay safe'.
Does not do that.
And it would be useful, "he says.
"They recommend that we always carry condoms, but then they tell you: 'Hey babe, you can't eat a banana with the peel, you need to peel it, you know ...".
With this phrase, Sisanda Khuzami, 22 years old, gives an idea of the attitude of boys of his age towards condoms.
At about 25 miles, life looks luxurious and inviting. Among the docks, gardens and manicured shops of the Victoria & Alfred Waterfront, one of the most exclusive places in Cape Town, three teenagers practice the noble art of skateboarding. They are Wiley, Morné and Olivier, 17, 15 and 16 years old respectively and they think that HIV does not go much with them. "It is something that happens more in the suburbs and rural areas because they do not receive much education, it is related to poverty," says Wiley, the most talkative. “People are not educated on the subject or do not have money to buy condoms. It happens to the less educated people in those communities, I don't know anyone who has HIV, ”he says. His two friends nod.
It is precisely in a rural area that Simangele Dube, a community health worker on the outskirts of Eshowe, a city in the Kwazulu-Natal region, on the other side of South Africa, can speak. "There is a lot of misinformation among young people, they come with many questions and incorrect ideas, other times they do not want to take medication or be tested," says this nurse, who among other tasks is in charge of offering advice on sexual health or family planning, and who it also offers support for the diagnosis and treatment of HIV and tuberculosis. In his small cabin, at the foot of a rural road, he offers this information using a plastic vagina, a penis of the same material to teach how to put on a condom and another to explain circumcision,another of the practices recommended by the World Health Organization to prevent HIV. “The most difficult thing is for them to understand how important it is to protect themselves; They are afraid of the treatment, they are afraid to go to the hospital to get the medication and to be recognized and they are also afraid of dying ”, he says.
A plastic penis and vagina on the table in the office of Simangele Dube, a community health worker in the city of Eshowe.
She uses them to answer the questions young people ask her about sexual health.ALFREDO CALIZ
Also Runeyi, from Cape Town, assures that they have observed a decrease of the kids who follow the treatment.
In fact, a third of South African adolescents with HIV do not, according to a study published in
The Lancet
in October 2019. Government data confirms that only 66% of young people follow therapy well.
On a street in the center of Eshowe, three schoolgirls in uniform downplay the problem and, contrary to the opinion of the Cape Town skateboard boys, they claim that the information is sufficient in their environment. Their names are Oratile, Ahmale and Nomcebo, they are 20 years old and study at a vocational training institute. “Yes, there is information; They have come to our school several times to talk to us about it, ”exclaims Ahmale nonchalantly. What city boys and country girls do agree on is that the stigma is still there, somehow. "I do not know if I know someone with HIV, but that is not told, it is like a secret," says Nomcebo. The three teenagers on the docks coincide: it's not something they talk about with their friends, because “it's not interesting,” Morne says.
Nocembo, Oratile and Ahmale, classmates, walk along the main street of Eshowe, in Kwazulu-Natal.
They consider the information they receive at school about HIV "sufficient".
Women between 15 and 24 years old in South Africa are more infected than men of the same age group.ALFREDO CALIZ
That fear of being singled out is disguised with a nonchalance that, after all, is nothing more than a facade.
“I asked a boy why he did not use a condom, if he was not afraid of contracting HIV and he told me that he knew that you can take a pill.
That ignorance or lack of importance is because they know that they have options and that they are not going to die ”, suspects Zipho Sithandathu, the young MSF adviser in Khayelitsa.
"It does not mean that they have lost the fear of being singled out, because the stigma still remains," completes his partner Nolokwe.
On the other hand, the family is not always a support because there is no trust between parents and children to speak freely about sex. “A fluent conversation with the parents? Not with an African mother. Well, if you want to live on the street, do it! " the two girls exclaim at the same time and with almost the same words. "That doesn't happen with uncles, if you're a boy you can talk to your father, but we don't ...". Sithandathu agrees with them. "If you tell them that you want to talk about HIV, they are alarmed because they already think you are positive," they say.
Nihlali Nolokwe (23 years old, left) and Sisanda Khuzami (22 years old), explain from a cafeteria in Khayelitsa why they believe that HIV is so high among young people between 15 and 24 years old. Khuzami cites two main reasons: that many do not want to use a condom and the increase in sexual violence against women.
The classic messages that worked so well in Runeyi's first years of work are no longer pervasive and new formulas are needed for new infections among adolescents and young people to decline. In this context, social networks are becoming a tool that is already working in the prevention of HIV and AIDS, since from them messages can be broadcast that reach millions of users who pay more attention to an
influencer
than to a doctor . Much better if you exercise both functions, like the
tiktokeros
South Africans Doctor Siyamak Saleh, Alana Beau or Adora Blendoda, with thousands of followers. On this platform there are hundreds of users who speak openly about the matter with a freedom and naturalness that is not always found at home. "We do not have time to take a pamphlet on the street and read it, we are too busy with our phones, so it is better to share information about HIV on Tiktok, Facebook, WhatsApp ..." reflects Nolokwe, who has not taken off the mobile of his hand throughout the afternoon.
Social networks are present in the strategies of humanitarian organizations and governments to promote health messages, as has already been seen with covid-19.
But before this pandemic, some campaigns have already been launched: Color My HIV and
MTV Shuga
(a television series) are two of the most recent.
At the Mongolowane Rural Health Post in Eshowe, an adult male and a teenage girl wait for the community health worker who is in charge of counseling on sexual health, family planning and HIV, among other matters, to arrive.
On the table are a variety of male condoms that can be taken free of charge.
The South African government distributes one billion annually, according to the Ministry of Health.ALFREDO CALIZ
MSF also uses the networks, as Nikola Nkhoma, from the communication department of this organization in South Africa, explains. From his office in Pretoria, he explains how this tool can promote a change in the behavior of society and how to design a campaign like the one he is about to launch, on adherence to antiretroviral treatment in this case. “It will be a two-way campaign with which we will send a message about the importance of taking medication. There will also be a button that can be pressed so that whoever wants more information can contact us, and then we can direct them to the clinics where they can obtain their medication, ”he describes.
It is important to clearly define the user profile to which the campaigns are directed: if it is for parents, for children or for young people.
“The key to research the context.
Is it culturally appropriate?
Is it linguistically appropriate?
Will the message be understood?
Is it simplified?
Speaking about HIV among adolescents, you would have to differentiate between the message you send to their parents and the message you send to children and young people.
It is important that they feel identified ”.
Zipho Sithandathu collaborates with MSF with a sexual health advisor.
“I asked a boy why he did not use a condom, if he was not afraid of contracting HIV and he told me that he knew that you can take a pill.
That ignorance or lack of importance is because they know that they have options and that they are not going to die ”, he suspects.
For Nkhoma, digital health promotion has become a way to take into account during the pandemic, and when it passes, it will continue to be strengthened to end these other older epidemics that do not seem to have an end.
“There are times when people cannot physically go to a healthcare facility or meet someone face-to-face to get the medical information they need.
In those cases, digital health promotion can reach hard-to-reach people and help get a message across in hard-to-reach places. "
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