If not now, later: Women's vulnerability to HIV risk

Associate professor Dr Mzikazi Nduna works with her students. She argues that to reduce new HIV infections in young women, we need to do more than keeping them at school

Associate professor Dr Mzikazi Nduna works with her students. She argues that to reduce new HIV infections in young women, we need to do more than keeping them at school

From adolescence, black women report a higher prevalence of HIV compared with men of the same age. Keeping girls at school is encouraged to ensure they receive an education and are empowered to make safer lifestyle choices, protect themselves from risky behaviours, partners and relationships. Basic education would increase literacy and lay a foundation for receptivity to sexuality education. The longer girls stay at school the more the chances that they will receive comprehensive sexuality education — and the less likely that they will be involved in sexual relationships because their commitment to their futures will be paramount.

Keeping girls at school will hopefully empower girls with skills that will open opportunities for them to earn adequate incomes. These economic fortunes should decrease dependency on men and empower women to leave abusive relationships. This framework is designed for cisheterosexual women and bears no reference to girls in same sex relationships, the transgender community and those who have HIV from birth.

The sequential model

In the traditional sequential model, young women are expected to sequence their expectations and wait on their material desires. Those who manage school without “modern” needs delay “buying”, focus on school, put off relationships and consumption for later or until they are working and can afford. This reduces the need to enter into transactional relationships with older working men. Disappointingly, literacy and numeracy have no relationship with sexual safety because of teachers’ discomfort in discussing sex and so keeping girls at school may empower them with skills for the labour market, but not health skills. The moral judgment that youths’ sexuality is subjected to results in failure to deliver the part of Life Orientation that talk about sex. There are no guarantees that basic education will increase access to education about safe choices for relationships, safer sex and HIV. In this context, girls would graduate from high school with myths about sex, sexuality and sexual expression.

Commitments to education and romantic attraction, which may involve sexual activity, are not mutually exclusive. Puberty sets in motion curiosity around romance and some girls will want to explore. There is danger when this exploration happens with no knowledge of how to choose a partner, how to engage romantically (with or without sex) and no education about sexually transmitted infections: how to prevent and treat them. Prevention of HIV is a personal health matter entangled in complex social relationships, which trap women into circumstances that make it difficult for them to protect themselves. Girls and young women who opt for the sequential model gamble that delaying sex will pay off. I argue that some young women who follow the sequential model may be at risk of HIV infection, albeit later because vulnerability to HIV awaits them in the world of work from older sexual partners, sexual harassment and sexual exploitation. There’s gambling involved in either model. Ironically, the end of school will result in loss of family support and unemployment or low paying employment will limit their ability to accomplish consumption. They will find a man to support them and realise that the wait was not worth it.

The combination model

Education has numerous benefits, with the most obvious being “modernisation” and the cultivation of “gendered needs”. Research suggests that whether during or after school women are rendered vulnerable to HIV risk by gender inequality. Most of these needs can be satisfied by material acquisition. The need for social stature, which is earned through access to financial capital, forms the basis for romantic and sexual relationships for some. The need for food, education, shelter, and other needs motivate sexual relationships underpinned by provision. These needs, as is a woman’s ability to attain them without a partner’s assistance, may vary at different ages. For many young women, education continues to be important, and so are relationships with providing men because this could be their only means to pursuing and completing their education. So they combine relationships, school and consumption. Young women who face financial difficulties may find ways to enable them to finish school through assistance from an older and working male partner; his older age implies exposure to sexual risk for HIV infection. There’s gambling involved in this model too. Young women who are sceptical and disillusioned about the material returns of education, who ‘hold a major in loxion management’: they are not in education, employment or training,  (NEETs), for whom black tax is a reality, who should repay their education loans or support their families while trying to make a decent living for themselves opt for the combination model and gamble on not getting pregnant, on not losing the providing man, and on not acquiring HIV in the pursuit of education and consumption.

Should we keep girls at school?

Yes. Education is a basic human right for all. Getting educated is the right thing to do, for personal goals and advancement. Education is, to a large extent, an answer to South Africa’s development because when you educate a girl you educate a nation.

Does keeping girls at school help prevent HIV?

To answer this question it is important to think about which girls are likely to benefit from this intervention. It may not be those who are already sexually active and for whom sexual relationships serve a purpose. This strategy will prove to work when we examine the outcome on those who principally delay sexual debut, or preserve virginity for religious or cultural reasons. Also the group that will contribute this positive outcome would be those who are provided for by their families. This strategy is unlikely to work for those who are most vulnerable.

To realise the benefits of keeping girls in school we need to move beyond the arguments about whether transactional sex is for subsistence, survival, or livelihood, or whether it is for essential versus non-essential goods. We need to refrain from stigmatising taxi queens and slay queens, for whom recalibrating needs maybe at odds with the current tide and trend for increasingly sophisticated consuming femininity.

We need to strengthen and diversify income opportunities for both young men and women. Adequate income for young men with lower HIV risk would enable them to provide for the needs of their age-matched girlfriends. We need to strengthen families, including single and women-led families, so that they have adequate resources to provide for the modern needs of their daughters and keep them in school. Finally, we need to relook the price tag of education: it is unaffordable to many.

Dr Mzikazi Nduna is associate professor and head of the School of Human and Community Development, Faculty of Humanities, at the University of the Witwatersrand