Because of poor access to contraception and HIV testing in South Africa, 15% of the country’s young women and 5% of young men aged 15 to 24 are HIV positive and 50% of new HIV infections affect the wellbeing of people under 29. This is according to Vuyiseka Dubula, general secretary of Treatment Action Campaign, who says that although sexual health education has been greatly improved in recent years, schools still need to do more for sexual wellness and make condoms and health advice available on site.
‘Young people have to wait until school finishes to access health services, and then the clinics are shut,’ she says, adding that even if young people do take time off school to go to a clinic, they could still be turned away because of lack of resources. To tackle this problem, the South African department of health is to launch 11 mobile health clinics that will test for HIV and other sexually transmitted infections. ‘The plan is for everyone to know their status. We hope that this will change behaviour,’ Dubula explains.
However, for Naomi Lince, from the reproductive health organisation Ibis, lack of access is just the tip of the iceberg for South Africa’s sexual health problems. She says that there are other major issues at work in the country, such as alcohol abuse, violence against women and transactional sex (sex in exchange for food, money or shelter). ‘Young women often cannot negotiate condom use because they are reliant on men for money, food and shelter,’ she says, noting a 2005 study which found that 10% of young women questioned had been physically forced to have sex on at least one occasion.
Dubula also claims that some staff at clinics ignore government policy because it contradicts their own beliefs. The abortion cut-off point, for example, is 20 weeks by law in South Africa, although strict criteria are imposed after 12 weeks. However, Dubula says Treatment Action Campaign workers often find nurses have refused to carry out terminations even before 12 weeks. ‘Girls go to the clinic for an abortion and they are told, “come back next week”. When they go back they are told “come back next month”. The 12 weeks pass and they are told “it is too late, now you must have the baby,” she explains. ‘Termination of pregnancy is still a taboo.’
Betsi Pendry, executive director of Sexual Health and Rights Initiative, adds, ‘Policy in South Africa is good, but we are struggling to enact the policy, and much of the population is not behind the policy. Our teachers and our nurses have strong cultural norms and because of that some will refuse to supply birth control. Many young people don’t know they have the right to contraception and abortion, and older people say: “You’re having sex, you shouldn’t be. I’m not giving you access to contraception”.’
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