Is poverty a driving force in HIV infection among women?
Mirirai Nsingo
For 19-year-old-Margaret (not her real name), transactional sex is her only source of income.
She is not oblivious to the dangers that come with her undertaking.
But, says a number of factors forced her into the world’s oldest profession after completing her ordinary level.
Residing in Harare’s Hopley suburb, Margaret joins several other young girls and women who rely on the trade to put food on the table.
According to the latest United Nations Aids programme report, Margaret is six times more likely to become infected with HIV than her male counterparts.
But the 19-year-old doesn’t seem concerned.
“I came to Harare just before the 2020 Covid-19 lockdown from my rural home in Madziwa to look for a job. I was hoping to get a job even as a maid to help my grandmother back home to support my siblings.
“Our parents died years back and left me and my three siblings under the care of my grandmother who is now old and frail to continue supporting us, so I had to do something to help her,” chronicles Margaret.
The eloquent Margaret shares with the writer how she struggled to get a job as a maid, noting how time was running out as she had to help her friend who had accommodated her in a small room, with rentals and food.
“I was struggling to get a job yet I had to help my friend who had accommodated me. My friend joined sex work when she moved to Harare and given the financial struggles I was facing, I had to join her.”
Margaret, through the Tariro Clinic and Youth Centre in Hopley was introduced to Centre for Sexual Health and HIV AIDS Research Zimbabwe (CeSHHAR), an organisation which support girls like her with sexual reproductive health education and services.
The youth centre, is a government initiative supported by various partners which aims to ensure young people like Margaret have access to friendly sexual reproductive health services while integrating SRH, skills development and economic empowerment
The organisation gave her financial support to go through her advanced level which she completed and attained five points.
“I was introduced to the organisation by other sex workers during one of their mobile clinics. The organisation supported us with friendly health care services including provision of condoms and Prep.
“It was through one of our engagements that I was identified among other girls who had finished their ordinary levels but did not have money to go for A Level. They supported me through the two years until I finished school.
“Their support was overwhelming but I still worked as a sex worker at night as I needed to send money back home,” adds Margaret.
Unfortunately, due to funding constraints, the partner could not find her through to tertiary education.
Margaret believes pursuing her education is the only way she can get out of sex work
Until she finds a sponsor, she says she will continue with the trade for survival.
“My prayer is to go for tertiary education so that I can be able to support my siblings and grandmother.
“Sex work is such a very risky job as I sometimes meet with men who don’t want to use protection, some of them will even attack you after receiving services just to avoid paying.”
Worldwide, a quarter of all new HIV infections are among women aged between 15 and 24.
A majority of these young women live in sub-Saharan Africa, where six out of every 10 people living with HIV are women.
According to the latest Zimbabwe Population-based HIV Impact Assessment survey (ZIMPHIA) 2020 report, the prevalence of HIV among adults was 12.9 percent with an HIV prevalence higher among women than men standing at over 15 percent versus 10 percent.
AIDS is still the biggest killer of women of child-bearing age in Africa. While scientific interventions such as Pre-Exposure Prophylaxis, female condoms have been developed to reduce women and girls’ vulnerability to HIV, young girls like Margaret remain susceptible to HIV due to socio-economic catastrophes.
Margaret is not alone in this struggle for survival.
24-year-old Felistus from Hopley joined sex work at the age of 15.
Apart from risking HIV infections she says physical and sexual violence are a staple in her trade.
But Felistus braves it as this is her only way of putting food on the table.
“Sex work is my only means of survival. Where do I get a job? I was even supported by CeSHHAR to do training in hairdressing but when I do not get clients, I still need to put food on the table.
“I have two children who need my support, so sex work is my quick way of making money. It is not always rosy, sometimes I meet with very violent clients who do not want to pay for services, some will even tear the condom in the process.
“It is tough out there but we soldier on,” shared Felistus while showing scars she has as a result of the violence she always encounters in the trade.
Felistus further adds while as sex workers they are often attacked by their clients; they hardly report the assault cases to law enforcers citing attitude issues.
“I have had incidences of violence that I have reported to police but it is really a waste of time because they label us all names and even blame us for inviting the violence on ourselves by being sex workers. Some of them even ask for sex so that they can pursue the reported cases.”
The odds are stacked against women like Felistus and Margaret in the fight against HIV.
Women’s biological make up, social, cultural and economic factors combine to make them more vulnerable to the virus than are men.
According to the UNAIDS, women like Margaret and Felistus continue to bear the brunt of the HIV epidemic. In sub-Saharan Africa, young women are twice as likely to become infected with HIV as their male counterparts. And in sub-Saharan Africa, three out of four new HIV infections among 15–19-year-olds are among young women. Approximately 6900 adolescent girls and young women aged 15–24 years are newly infected with HIV every week around the world.
Health Law and Policy expert, Tinashe Mundawarara argues while Zimbabwe has made remarkable gains in its HIV response over the years, enough has not been done to address gender imbalances in HIV prevention.
“HIV prevention policies have not solved gender imbalances in HIV prevention to address access, uptake and acceptability of HIV prevention products by women and girls. When people ask if it was protected sex, most of the time they are asking if the man used a condom. Where is the woman’s role in this story?
“Health policies should promote prevention services that are designed for women like female condoms and PreP, vaginal ring to give women more leverage and negotiating power,” argues Mundawarara.
United Nations Population Fund country representative, Dr Ester Muia insists countries in the region should come up with education policies which ensures girls from marginalised communities are supported to stay in school to reduce their vulnerability to HIV and other society vices noting scientific interventions alone are not enough to fight HIV.
“We need to ensure countries build a policy enhancement that keeps girls in schools. Socio-economic challenges increase the vulnerability of women and girls and it is only through education that girls can be empowered.”
Director in the AIDS, TB Unit in the Ministry of Health and Child Care, Dr Owen Mugurungi concurs bi-medical interventions alone are not enough to ensure young girls and women like Felistus and Margaret’s vulnerability to HIV is reduced.
“Scientifically interventions alone are not enough, there is a need to tackle other socio-economic challenges predisposing young girls to HIV.
“It is all about educating and empowering these young girls and women so that they are empowered to make good and informed decisions. When girls are educated, they know when to protect themselves and can stand up and voice when they know that their lives are at risk,”
Until Margaret, Felistus and their peers are empowered enough to protect themselves and reduce their vulnerability, more and more women will continue to be the face of HIV.