ADOLESCENT PREGNANCY CHALLENGES IN THE ERA OF HIV AND AIDS:
A CASE STUDY OF
A SELECTED RURAL AREA IN ZIMBABWE
Naomi N. Wekwete
Zimbabwe is one of the countries in Southern Africa worst affected by the HIV and AIDS pandemic. The Ministry of Health and Child Welfare (MOHCW) (2007) estimated that 1.3 million people were living with HIV and AIDS at the end of 2007. HIV prevalence rate among adults aged 15-49 years was 15.6 per cent in 2007 (MOHCW 2007a). Zimbabwe recorded a decline in HIV prevalence - from 29.5 per cent in 2001 to 24.6 per cent in 2003, and to 20.1 per cent in 2005. A further decline of HIV prevalence rate to 18.1 per cent was reported in the 2005-2006 population-based Zimbabwe Demographic and Health Survey (CSO 2006). Similarly, The 2006 MOHCW National Survey of HIV and Syphilis among Women attending Antenatal Clinics reported a further decline to 17.7 per cent in 2006. Zimbabwe is the first country in Southern Africa to experience a decline in HIV prevalence and second in Africa after Uganda.
The decline in the prevalence rate is a result of a combination of factors that include lower infection rates, sexual behavioural changes, increased mortality, as well as collaborative efforts by the government, UN, donor agencies and NGO partners (UNICEF 2007; MOHCW 2006). Although a notable decline in HIV prevalence rate has been recorded in Zimbabwe, the rate is still high. Also, the rate of new infections and HIV and AIDS related mortality remains high, thereby making the attainment of the country’s Millennium Development Goals (MDGs) more challenging (MOHCW 2007). Again, while the decrease in HIV occurrence is encouraging, overall, more than one-in- seven Zimbabweans is still being infected with HIV. One of the challenges is sustaining these positive behavioural changes in the midst of widespread poverty and vulnerability.
About 2,500 AIDS related deaths are estimated to occur each week and 780,000 children are orphaned as a result of AIDS; this is projected to reach 1,400,000 by 2010 (NAC 2004; MOHCW 2003a). As noted by Whiteside and Sunter (2001), the pandemic induced high mortality and morbidity rates among the most economically productive and reproductive age groups meant that virtually all levels of socio-economic development have been negatively impacted upon in the country. The recognition of the disastrous development impacts the pandemic continues to have on the nation has prompted government and other development partners to advocate for, formulate, as well as implement various prevention, control and mitigating interventions addressing the various facets of HIV and AIDS vulnerability in the diverse socio-economic sectors.
Women in general have been identified as a high-risk group as regards HIV infection. This is because they are more vulnerable and susceptible to HIV infection biologically, economically, and culturally than men (PRF and IDS 2003; Whiteside and Sunter 2001; UNAIDS 1999; Ng’weshemi et al. 1997). Socio-cultural stereotypes have been noted by the 2003 ZHDR, as having disempowered women from negotiating, and insisting on safer sex, hence increasing their vulnerability to infection during unprotected intercourse. According to UNAIDS, four out of five new infections in Zimbabwe in the 15-24 year old age group in 2005 were among girls. More specifically at risk of infection within the group are adolescents, as evidenced by the MOHCW (2000) study in which girls in the 15-19 years age group had an infection rate about five times that of males in the same age group. Subsequent studies, for example the 2001 Zimbabwe Young Adult Survey, the 2003 National HIV and Syphilis Prevalence Survey, as well as Gregson et al. (2002) also served to confirm the reality of higher risk among younger women. The 2005-06 ZDHS also reported a higher HIV prevalence rate among females of 15-19 years age (6.2 per cent) than among males (3.1 per cent), and also among females in the age group of 20-24 years (16.3 per cent) compared to their male counterparts (5.8 per cent). In Zimbabwe, as in many other African countries, gender roles and social norms as well as economic and legal factors; contribute to risky sexual behaviour (Munodawafa and Gwede 1996; Bassett and Sherman 1994).
1.2. Problem Statement
Women are disproportionately affected by HIV and AIDS and continue to be the most vulnerable group. The 2005-06 ZDHS reports that, while HIV prevalence is 21.1 per cent among women of 15-49 years age it is 14.5 per cent among males age 15-54 years. It further illustrates that women are infected earlier than their male counterparts. The gender gap is even wider amongst young people. HIV prevalence rate at the younger ages of 15-19 years is higher among females (6.2 per cent) than in males (3.1 per cent). An examination of other data sources (PSI 2006; Gomo et al. 2005 ; 2001-02 Young Adult Survey ) do show the same pattern and suggest that women are infected earlier than their male counterparts. According to the PSI VCT (2006) records, at younger ages of 19 years and below, women are six times more likely to be infected than their male counterparts, which is even higher than the ZDHS. This higher risk largely emanates from involvement in intergenerational sex with older partners (higher chances of infection) who are most likely to be already infected.
Despite the fact that most young people in Zimbabwe are aware of HIV and AIDS and the risks of pregnancy, they still continue to engage in high risk sexual behaviour, namely unprotected sex, which may lead to unplanned pregnancies and HIV infection. Although 96.5 per cent of women age 15-19 years had heard of HIV or AIDS, 67.8 per cent of the sexually active were not using condoms (CSO and Macro International Incl. 2000). The proportion of adolescents who have started childbearing serves as evidence of unprotected sexual activity among adolescents. The 2005-06 ZDHS reported that 21.1 per cent of the youth between ages 15-19 years had started childbearing . However, childbearing also occurs among girls below 15 years, ages not covered by the ZDHS. Evidence exists in other studies that sexual debut begins at ages as low as 12 years (see UNAIDS 2004; Child and Law Foundation 2002). Unprotected sex by adolescents consequently results in pregnancies, which may contribute to their dropping out of school, marrying early, abandoning babies and obtaining abortions illegally (Boohene et al. 1991). Sexually active young people also face the risk of contracting HIV and other sexually transmitted infections (STIs). Exposure to unprotected sexual intercourse increases the risk for both pregnancy and HIV infection. According to MOHCW (2006), women who had two or more pregnancies reported higher HIV prevalence compared with women who were pregnant for the first time.
Despite the above facts, however, the 15-19 years age group has been considered as part of the ‘window of hope’ in the fight against HIV and AIDS. While children are an increasing part of the HIV and AIDS problem, they are also a critical part of the solution. It is therefore important to protect this 5-15 years age group, because of its lowest infections rate, as they move into the 15-24 age group, which has the highest infection rates. Adolescents are at the epicentre of the pandemic in terms of transmission, impact and potential for change in the attitudes and behaviour underlying the disease (PRF and IDS 2003). Reaching them through the educational system would therefore ensure a future generation of people conscious and prepared to tackle the scourge. Such a premise has therefore inspired government and other development partners to reach out to the adolescent age groups through various information, education and communication (IEC) strategies. This study, then, was aimed at investigating the challenges that are faced by adolescent mothers in this era of HIV and AIDS by documenting lived experiences, with the view to recommending ways of alleviating the problem.
1.3.1 Overall Objective
The overall objective of the study was to explore the challenges that adolescent mothers face and why they engage in risky sexual behaviour, despite the high levels of awareness and prevalence rate of HIV in the country.
1.3.2 Specific Objectives
The aim of the study was to achieve the following specific objectives:
1.To document lived experiences of adolescent mothers during the era of HIV and AIDS;
2.To establish factors and circumstances leading to early indulgence in sexual activity, pregnancy and HIV infection among adolescent girls in rural settings in Zimbabwe;
3.To find out the range of unprotected sexual partnerships that adolescent girls engage in and, the concept of sex networking, which are risk factors of HIV infection;
4.To determine the role played by families and the community in HIV and pregnancy prevention among adolescents as well as encouragement of adolescent pregnancies;
5.To establish the coverage and extent of intervention programmes seeking to mitigate pregnancy and HIV infections among adolescents (such as educational materials, condoms, contraceptives, youth friendly services, and
6.To come up with alternative approaches and practices for policymakers and stakeholders on adolescent pregnancy in the context of HIV and AIDS.
1.4. Research Questions
The following were some of the questions that guided the study:
1.What are the challenges and problems of HIV and AIDS faced by adolescent mothers? What factors are associated with adolescent pregnancy in Zimbabwe?
2.What are the circumstances leading to the engagement in early sexual activity among adolescent girls which are risk factors of HIV and AIDS?
3.With whom are young adolescent girls engaging in sexual activity? Who is more likely to be putting these girls at risk of HIV infection?
4.What roles do parents and community play in discouraging or encouraging risk behaviours that may lead to HIV infection among adolescent girls?
5.What intervention programmes are in place to prevent HIV and AIDS and pregnancy as well as to mitigate adolescent pregnancy in this time of HIV and AIDS?
1.5. Significance of the Study
The study findings are expected to have an impact at community, programmatic as well as policymaking levels. Because adolescents tend to have multiple sexual partners (in succession, if not concurrently), they do not use condoms consistently, and are vulnerable to coercion, the behaviours of adolescents and young adults will play a crucial role in the course of the HIV epidemic. The establishment of the challenges faced by adolescent mothers in this time of HIV and AIDS pandemic would assist policymakers and planners of programmatic interventions to enhance capacity in their programmes. Evaluation of already existing programmes would help in the adoption of best practices in planning of future interventions. An assessment of community perceptions and attitudes with regard to teenage pregnancy would also help in the creation of programmes, while discouraging early engagement in sexual activity and parenthood among adolescents, that would at the same time provide safety nets for those already in the predicament to discourage behaviours like illegal abortions and baby-dumping. The study findings will also contribute to existing literature by filling in the gap of knowledge on adolescent childbearing, namely the actual experiences of adolescent mothers, challenges faced, and the low behavioural change despite the high levels of awareness.