Girls Take HIV Risk into Their Own Hands

ICRW project offers promising model for adolescent girl programs

Girls Take HIV Risk into Their Own Hands

A pilot program designed by ICRW in Tanzania begins to shift social norms that make adolescent girls more at risk of HIV infection and unwanted pregnancies. It offers a promising – and needed – model that can be applied in a variety of settings.

NEWALA DISTRICT, Tanzania – In Tanzania's remote Newala District, adolescent girls are met with unwanted sexual advances on their way to the neighbor's house, to the water well, to the store. They feel forced to give in. Sometimes, they're raped. Girls are even scared to go to school because, they say, some teachers "just want to have sex with you."

The girls of Newala are not alone in their predicament. It reflects the experience of girls in many sub-Saharan African communities, where nearly 60 percent of all people living with HIV are women, according to UNAIDS. Sexual violence – along with early marriage, sex for pay with much older men and multiple, concurrent partnerships – are everyday realities for teenage girls. It's an environment experts say is fueled by numerous factors, including poverty, a breakdown in family and harmful norms that define girls' place in society.

All of this puts 12- to 17-year-old girls in Newala at greater risk of being infected with HIV. Unfortunately, HIV programming for vulnerable children gives little attention to teenage girls, whose needs tend to be eclipsed by those of very young children who lack basic food and care. And because of this, research evidence on adolescent girls' specific vulnerabilities and how to reduce their HIV risk remains insufficient.

Experts at the International Center for Research on Women (ICRW) are working to change that.

ICRW was tapped by U.K.-based ViiV Healthcare's Positive Action program to study the variety of ways in which girls are susceptible to HIV in four Newala communities, and then design a pilot project to address the most pressing risks. Working in partnership with local nongovernmental organization Taasisi ya Maendeleo Shirikishi Arusha (TAMASHA), ICRW found that long-held social norms can begin to shift when girls are encouraged to talk about their experiences and when others, including boys, reflect on their own behaviors.

Called "Vijana Tunaweza Newala" or "Vitu Newala," which means "Newala Youth Can," the project in Tanzania adds to ICRW's ongoing research about best practices to serve youth, particularly girls, and provides a model that can be applied in other settings. It also places ICRW among a small subset of organizations globally that focuses on girls – instead of institutions, such as schools – to drive community-based social change.

"Too often, programs targeting vulnerable girls are created without actually talking to the girls," said Jennifer McCleary-Sills, an ICRW social and behavioral scientist who led the project. "What makes the approach ICRW designed for Vitu Newala unique is that it didn't treat adolescent girls as passive beneficiaries of a pre-packaged HIV prevention program. Instead, it empowered girls to define their own needs, lead and interpret research on the issues that affect them and educate their peers with activities they developed."

Meet them where they are

Located in southern Tanzania, Newala District is comprised of 28 rural, predominantly Muslim communities where families make a living farming cashews. It has one paved road. Mobile phone networks just developed more of a presence this year.

Women and girls here are expected to stay at home, and if they veer from that space, they risk harassment or sexual violence. The chances that girls will be sexually abused are so great that parents don't want to send their daughters to secondary school. Even taking part in Newala's traditional dance to mark girls' transition to womanhood has become risky. These days, young men attend. It's not uncommon for groups of them to fondle or sexually assault girls on the way home from the celebration.

"It all comes down to how gender is socially constructed – women are meant to live their lives primarily in the private, domestic sphere, whereas men control the public sphere," said Katherine Fritz, director of ICRW's global health research and programs. "When girls circulate in the public sphere, it can be seen as something that's outside of the norm and potentially provocative. If a girl is assaulted while moving around by herself, many people draw the conclusion that 'she asked for it.'"

Further fueling the situation, very few girls and boys grow up with two parents at home, in part because they have died from AIDS. When one or both parents die or separate, children often are left with grandparents or on their own. Researchers found that a number of teenage girls in Newala are heading households and providing for their siblings, a trend that has plagued girls across sub-Saharan Africa for years in countries where HIV-rates are high.

Such fractured families and the lack of adult presence in girls' lives contribute to their vulnerable state: Many are wooed by much older men who pay the girls for sex and help provide for their basic needs as well as those of their siblings. Sometimes, girls will have a series of such partners over time.

To better understand and address teenage girls' risks in Newala, ICRW designed an approach that allowed girls and the community to turn a mirror on themselves, analyze what they saw and determine the changes they wanted to make. Here's how it worked:

Risk mapGirls ages 18 to 24 were trained by TAMASHA to be youth researchers who aimed to better understand younger girls' lives in Newala. Researchers talked to 12 to 17 year olds about their aspirations and roadblocks to achieving them. They asked them to draw maps identifying spots in their communities where they felt unsafe. Girls were then encouraged to come up with ways to reduce the risks they faced.

Meanwhile, project researchers spoke with parents, community leaders and service providers in Newala to hear their perspectives. ICRW found that many adults put the onus on girls, accusing them of not making "better choices." Girls were expected to wait until they were adults – or ideally, married – to have sex. At the same time, researchers found that men and boys were not being held accountable for their actions.

Girls also told researchers they didn't feel as if anyone in the communities took responsibility for keeping them safe. Many were frustrated that they were blamed for not avoiding risks from which no one helped protect them. With that, TAMASHA asked the girls to suggest community members who should be responsible for making dangerous areas in their communities safer.

"The protective factors that used to be there in all African cultures have broken down," which is in part why men's behavior goes unchecked and girls' risks increasingly rise, said Richard Mabala, executive director of TAMASHA. "And there's nothing that has really taken its place."

"This is why we believe by young people coming together they can start creating what takes its place."

Youth lead social change

Indeed, young people were the driving force behind Vitu Newala, which essentially sought to empower youth to advocate for themselves and reduce their vulnerability to HIV. The program included activities created by adolescent girls and boys, such as dramatic plays, to learn about and discuss everything from reproductive health to goal setting. Together with adults, they figured out how to better protect the community's young people, especially girls.

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Such communal reflection by boys and girls had never happened before in Newala. For most girls, it was the first time they'd been asked their opinion or share their experiences. McCleary-Sills said this required a delicate balance – after all, men and boys perpetuate the forms of violence that increase girls' vulnerability to HIV. But she said they had to be involved if the environment for Newala's girls was to change.

"It was a matter of bringing boys and girls together on equal footing – not as good and evil, or victim and aggressor – and empowering them all to be agents of social change in their communities," McCleary-Sills said.

Anecdotal evidence from Vitu Newala shows that the pilot program made a difference in a short time: With the exception of school, girls reported that they felt safer at some of the most risky locations identified in the formative research. Communities are now supporting Vitu Newala to create youth centers and some are rewriting bylaws to limit boys' participation in girls' initiation ceremony. And young people said they now think and act differently about sex, relationships and their future.

Even if limited in reach and scope, Vitu Newala offers a promising model that can be applied to other efforts targeting vulnerable girls in sub-Saharan African communities and elsewhere.

"Although what we know so far is a small amount, it does appear to be moving social norms in the direction we want," ICRW's Fritz said. "But we need continued support to document and measure the impact at the individual and community level over a longer period of time."