By Dr Seithati Molefi, Deputy Chief of Party at Right to Care
Every woman has the right to a sex life that is safe and satisfying, to say no if she does not want sex, to choose to use condoms and/or other preventive methods, to have a partner that respects her choices, to enjoy a non-violent relationship and to make a choice about having a child. Unfortunately, many South African women don’t enjoy these rights. This not only exacerbates the spread of HIV and the complications related to it but also drives unintended pregnancies.
Every woman deserves access to both information and services for HIV testing as well as contraception. If she is HIV negative, she needs access to pre-exposure prophylaxis (PrEP). If she is HIV positive, she needs to be on treatment to keep herself healthy, prevent HIV transmission to her sexual partner/s and lower the risk for transmission to her baby during pregnancy, labour and breastfeeding.
A basket of care for women
Right to Care supports the Department of Health in two rural districts where we see the benefits of providing comprehensive health services in health facilities. These include:
● HIV testing services and immediate initiation onto antiretroviral treatment or PrEP,
● Family planning and contraception,
● Vaccines, including the HPV vaccine,
● Screening for cervical cancer,
● Ante- and postnatal care,
● Screening for other diseases like hypertension and diabetes and
● Linking women with mental health and social support services.
Yet many women still don’t have the final say about their own sexual health. Traditional gender roles, patriarchal beliefs, HIV stigma and gender-based violence (GBV) are disempowering and preventing them from accessing support and health services and driving HIV infections. They struggle to negotiate condom use and many are being infected with HIV during their pregnancies.
Young women bear the brunt of the continuing spread of HIV. USAID reported that every week, 3 100 females aged 15 to 24 in sub-Saharan Africa become infected with HIV. At the South African Aids Conference this year, the high rate of teenage pregnancies and HIV among young women took the spotlight. Right to Care is a partner of the USAID-funded DREAMS programme which supports and empowers adolescent girls and young women. The programme follows a multi-stakeholder approach to address the root causes of the challenges young women face.
GBV and stigma
GBV is one of the drivers of HIV infections because a woman is unable to establish her perpetrator’s HIV status or negotiate condom use. It undermines her ability to report abuse and access support. If she knows her abuser and is financially dependent on him, she is often scared to leave the relationship. Many women hide their antiretroviral treatment from their partners because they are shunned for taking it and others are stigmatised when taking PrEP because people think they are taking antiretroviral treatment.
Treatment as prevention, HIV testing
Right to Care, in line with global goals to end HIV, is building understanding about HIV treatment as prevention and the importance of treatment adherence and viral load monitoring among the patients we serve. When someone living with HIV is on treatment, it lowers the level of HIV (the viral load) in the blood down to an undetectable level meaning the person is virally suppressed and cannot pass on HIV during sex. Viral suppression also reduces the risk of passing HIV on during pregnancy, childbirth and breastfeeding.
Women need to be empowered with accurate information about sexual and reproductive health and their rights so they can make informed decisions about family planning and HIV prevention. As well as health services, they need mental health and social support services.
We need to engage men more effectively so they play their part in women’s sexual health and safety. Women benefit when their partner is circumcised as HIV and STI infection rates are lower in circumcised men and their partners.
Community outreach is helping to boost HIV testing and treatment initiation. We help our patients keep their appointments and follow up when they don’t arrive. Medicine pick-up points like Collect&Go smart lockers make medicine collection quick and support medicine adherence.
More can be done. Greater focus is required to remove societal challenges that women face when accessing support. They need to better understand their rights. Improved access to legal and other supportive services for women in abusive partnerships is also needed. We need to offer more adolescent and youth friendly services as well as open days for young people to access services and information.
