Let's talk about sex

There is great shock value in surveys of HIV and sexual behaviour among teenagers.

Half of all young people claim to have had sex by age 17, and one in 12 is HIV positive before her 20th birthday. I say ‘her” because most HIV infection among 15- to 24-year-olds (77%) occurs in women.
At current rates, one in two teenagers will contract HIV during the course of his or her life.

These statistics lead to a sense of resignation over the future of our country. Sometimes it is as if we are willing to write off a whole generation of young South Africans. In doing so, we lose sight of the opportunity to reverse the course of HIV/Aids over the next decade.

Here it is: more than 95% of 16-year-olds are HIV-negative. If they stay that way, the HIV epidemic will collapse within a decade. There is evidence — albeit tentative — that the HIV infection rate among teenagers have peaked and is decreasing. This decline is not yet enough to trigger sharp changes in overall rates, but does suggest a turning point in the epidemic. The biggest bubble of infection, however, continues to work its way into older age groups, growing smaller as more people die of Aids, but nevertheless ‘topping up” infection rates among 25- to 40-year-olds.

We are at a critical point now. If we do not capitalise on the early gains, HIV/Aids is likely to gain fresh impetus as its fuel — new infections among teenagers — is replenished. On the other hand, if we can accelerate the momentum for change, we could reach the ‘tipping point” in the next five years.

loveLife’s national survey of nearly 12?000 15- to 24-year-olds provides some direction on how this could be achieved. There is a strong and significant association between participation in loveLife programmes and lower rates of HIV infection, taking into account other likely explanatory factors.

This finding underscores the importance of sustained, face-to-face interaction in achieving behaviour change.

In this regard, educators could be critical agents for change. Too often, though, the opportunity is missed. For example, although teenagers rate ‘school” (teachers and classmates) as their biggest source of information on HIV/Aids (32%), school ratings plummet as a source of knowledge on dealing with pressures to have sex (13%). So, learners get to hear about H-I-V, but not about S-E-X!

Even when sex is discussed, there is often such discomfort that it becomes a biology lesson and does not address the main drivers of high-risk behaviour, such as coercion and low self-esteem. The problem is compounded by a growing level of Aids-education fatigue — teenagers say that they have had ‘Aids rammed down their throats” since primary school.

The challenge today is not so much about information as it is about mobilisation: creating a new social movement of healthy lifestyle and sexuality. It is time for a different approach to HIV prevention in schools that recognises that in many respects, teenagers lead the transformation of our society.

They refuse to be slaves to political loyalty or hide behind traditional taboos. They are sassy, self-confident and more optimistic about future prospects than any previous generation of South Africans. They are free of political baggage, better educated and aware of their place in the global world. They have gone furthest in bridging the racial divide; they understand technology and the power of communication. Growing up in post-apartheid South Africa has made them pragmatic, not cynical. When we ask them for moral regeneration, they say: ‘Stop the hypocrisy.”

In the Western Cape, the departments of education and health have commissioned loveLife to implement its ‘loveLifestyle” programme in all high schools. Educators and 18- to 25-year-old groundBREAKERS work together to make schools sites of social transformation. loveLifestyle combines motivation, healthy sexuality, sports and recreation, problem solving and debating.

Of course, the one risk of this upbeat approach to HIV prevention is that teenagers may come down to earth with a bump when their dreams do not materialise. The beauty of working in schools is that HIV prevention can link directly with the top priority expressed by teenagers and the key to their aspirations, namely a good education.

David Harrison is CEO of loveLife

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