Seventeen-year-old Natalie Mlambo* has two good reasons to get tested for HIV.
She has two boyfriends and has unprotected sex with them. One is a high school classmate. The other is older, works in a bank, and can afford to give Mlambo small gifts and some money.
“Yes, I sleep with both,” says Mlambo. And, since she has sex only with them, they have stopped using condoms, she explains.
But Mlambo is terrified of getting an HIV test. “I’m afraid,” she says.
“It is better to stay in the dark than to know I’m facing death; treatment doesn’t eliminate the disease.”
Mlambo, a final year high school student from Harare’s Kuwadzana high density suburb, is not unique — neither in engaging in transactional sex and having multiple sexual partners, nor in fearing an HIV test.
Felicia Chingundu, an activist with Shingai-Batanai HIV and Aids support group in Masvingo, a town 300km southeast of Harare, sees teen resistance daily.
“Teenagers engage in risky sexual behaviour, but you hardly see them at testing centres,” says Chingundu.
Zimbabwe set up early and robust prevention programmes in the 1990s that are credited with bringing the prevalence rate down from 24% in 2001 — one of the highest in the world — to less than 15% in 2012, according to the Joint United Nations Programme on HIV and Aids.
Although a series of political and economic crises after 2000 clipped many programmes, Aids awareness is still widespread.
One result is that more than half of young people aged 15 to 24 have comprehensive knowledge about Aids, according to the 2011 Demographic Health Survey (DHS), a figure higher than the regional average.
However, knowledge does not necessarily translate into action.
The ministry of health has set up mobile testing facilities that visit schools and testing centres in clinics. But young people say the centres are not youth-friendly.
“Most teenagers stay away from these places, saying they are congested with adults,” says Mavis Chigara, co-ordinator of the Young People Aids Network in Zimbabwe’s Mwenezi district in Masvingo Province.
In 2012, her organisation surveyed 12 500 young people in the district; only 5% had tested for HIV.
“Testing for HIV amounts to seeking a death warrant and taking antiretrovirals is a lifelong burden,” says 19-year-old Terrence Changara, from Harare’s low-income suburb of Highfield.
Stigma plays a role. In spite of a widespread epidemic, and massive treatment programmes and information campaigns, pockets of discrimination remain.
“My two boyfriends speak mockingly about people who suffer from HIV and Aids,” says Mlambo.
Their attitude indicates they must be Aids-free, she explains, or they would otherwise be kinder.
The 2011 DHS found prevalence rates of nearly 4% for young males and just over 6% for young females. Census data estimates that there are 3.1-million young people between the ages of 15 to 24 in the country.
Benefits of testing
Testing can be scary, and disclosing to a counsellor that one engaged in risky sex may be embarrassing, but the advantages are many.
“It is important for young people to know their HIV status because it will enable them to start treatment early and improve their health,” says Judith Sherman, HIV and Aids specialist for the UN Children’s Fund in Zimbabwe.
“For older adolescents, it will reduce the risk of passing on the virus to another person,” she adds. “Finally, it helps adolescents who do not have HIV to keep themselves from being infected.”
In spite of fear, four out of 10 sexually active girls aged 15 to 19 reported taking an HIV test in the last 12 months, according to the DHS.
But one frequent reason for testing is that the girls got pregnant and are attending antenatal clinics.
“Going for HIV testing is rare among teenagers,” says Mandy Chiwawa, an Aids counsellor in Harare.
“They really need support to get tested.”
Nonetheless, more people aged 15 to 24 are testing, compared to the 2006 DHS.
The percentage of sexually active young males who have tested tripled to 23%, while females increased five-fold to 45%. This is higher than the regional average of 22% for females and 14% for males.
Still a long way to go, still many Mlambos who need help to overcome their fear, but the trend is encouraging.
*Not her real name
This article forms part of a supplement paid for by Unicef. Contents and photographs were supplied and signed off by Unicef