Throughout the world, the vast majority of people who are HIV-positive – 80 per cent – contracted the virus through unprotected sex - that is, by not using a male or female condom. This raises a crucial question: Since condoms are the only form of contraception that effectively prevents HIV and other sexually transmitted infections, as well as unintended pregnancies, why don’t more people use them consistently? And what tactics can people employ to encourage their partners to use condoms?
These are the questions that UNFPA, the United Nations Population Fund, seeks to answer through a series of interviews with condom promoters – and users – worldwide. On World AIDS Day 2013, we report on an organization in Guyana that is giving young women the means and the courage to protect themselves, both through access to female condoms and by instilling in them the confidence to assert themselves in what may be life-threatening situations.
Women everywhere are more vulnerable than men to HIV because of biology. But for young women in particular, the vulnerability is also a psychological one. In the balance of power that characterizes any relationship, young women – whose partners are often considerably older – rarely feel that they have the upper hand when it comes to preventing HIV and unplanned pregnancies. The results of this powerlessness can be catastrophic. According to the World Health Organization, the failure to support effective and acceptable HIV services for adolescents has resulted, world-wide, in a 50 per cent increase in reported AIDS-related deaths among youth aged 10 to 19 from 2005 to 2012 – the same time period that saw a 30 per cent decline in such deaths in the general population.
In Guyana, the HIV prevalence rate of 1.1 per cent is relatively low. Yet 0.8 per cent of women are HIV-positive, compared with 0.6 per cent of men; 54 out of every 1,000 young women between the ages of 15 and 19 becomes pregnant. According to UNFPA’s Assistant Representative in Guyana, Patrice La Fleur, adolescent pregnancy should not be seen as the result of recklessness or of a deliberate choice, but rather as an absence of choices caused by circumstances beyond a young woman’s control. “Actions must be implemented that empower girls, that uphold their basic human rights and put them on an equal footing with men,” she says.
Empowering young women to make the right choices is a major focus of Women Across Differences (WAD), a Guyanese grassroots network that works with the country’s diverse ethnic groups. WAD is one of a dozen governmental and non-governmental organizations in Guyana piloting the use of the female condom with support from UNFPA.
Empowering adolescent mothers
Since 2008, WAD has offered a year-long course to young mothers, the Comprehensive Empowerment Programme for Adolescent and Teenage Mothers, funded entirely by UNFPA. The participants are referred to WAD by the Georgetown Public Hospital and by the Child Protection Agency of the Ministry of Human Services and Social Security, which handles cases of rape and abuse.
As of December 2013, 229 girls between the ages of 12 and 19 have taken the course. “The demand has been overwhelming,” says WAD coordinator Clonel Boston.
The classes, averaging between 30 and 40 students, meet twice a week for three hours and cover topics such as reproductive health, personal development, entrepreneurial skills, and functional literacy. “We especially stress the importance of condom use because most of the girls’ partners are older adults,” says Ms. Boston. “We want to make sure they have negotiation skills. We don’t want them to be abused or taken advantage of again.”
Most of the participants dropped out of school when they became pregnant and were rejected by their families. Because of the stigma attached to adolescent pregnancy, many lost all sense of self-esteem. The overall goal of the course is to prevent further unintended pregnancies and HIV infections.
The record is impressive. Since joining the programme, none of the 229 participants has contracted a sexually transmitted infection, including HIV, and only one became pregnant.
“A very important aspect of the programme is the psychosocial support we provide,” says Ms. Boston. “In collaboration with UNFPA we have trained our personnel to be coaches, mentors, and even surrogate mothers to the girls, even after they finish the course.”
From adolescent mom to peer educator
Delicia Ireland gave birth at 14 and joined WAD at 15. The father of her child was much older than she was. “I assume he knew about condoms, but he chose not to use one,” she says. “He could have educated me about condoms, instead of encouraging me to have sex without one.”
Today at 17, Delicia has become an educator. As part of the WAD programme she hands out male and female condoms - and leaflets on how to use them - to her friends and to the girls she meets on Georgetown’s crowded mini-buses. She used to be painfully shy, but now her own experience and WAD’s support have enabled her to speak with authority. “I share my experience and everything I have learned at WAD,” she says. “I tell these girls that having sex without a condom is a big risk. I educate them about STIs and things that can happen without a condom.”
Not only is Delicia now committed to using condoms, but she has found a new boyfriend who feels the same way. He is very aware of the threat of HIV, and always insists on using a condom. “He loves to use those things,” she says. “It’s very hard to find a young man like that these days. He is also proud of me and glad I’m on the same track with him.”
Shortly after the programme was launched, WAD introduced the female condom and began teaching the girls to use it with their partners. Dionne Frank, Head of the Sociology Department at the University of Guyana, is actively involved in WAD. She says the programme gives young women the confidence to say ‘no,’ or to insist that a male or female condom is used.
“Many girls, because of the way they were brought up, simply don’t know how to say no to their partners,” she says. “If he won’t use a condom, the girls don’t know how to say, ‘Well then, we won’t do it’. "So we tell them, ‘If you want to protect your health and prevent another pregnancy, you have an alternative. You can use this female condom,’” says Ms. Frank.
“I can speak up for my rights”
Tiffiny Tyrell-Hunte had two children by the time she was 17, when she joined WAD. “I never really knew about contraception until I started the WAD programme,” she says. “I never really thought about pregnancy. If it wasn’t for the support of this programme, I would probably be a mother of five children by now, struggling to survive.”
Tiffiny says that the most valuable thing she learned from WAD is that she has the right to take charge of her life, and that she can help her partner – now her husband – to act responsibly. “I know my rights and I can speak up for my rights,” she says. “Because I am empowered, I can communicate better with my partner. I let him know why it’s important to use family planning.”
Tiffiny has also learned that when it comes to contraception and HIV prevention, knowledge is power. “You need the right information about how to use a condom correctly,” she says. “It can be challenging to convince your partner to use one, but if you have the information, it will be easier.”
Since WAD also teaches the young women how to use female condoms, and provides them free of charge, this can further empower them if their partners resist using male condoms. “Your partner doesn’t even have to know that you have on a female condom,” says Tiffiny. “If he doesn’t want to use a condom, you can still protect yourself!”
Self-protection is a right
Through its experience in working with young people, WAD has found that a weak link in the chain of women’s empowerment is lack of self-esteem. Amid the confused mixture of passion and apprehension, lust and fear that often characterizes love-making in the age of AIDS, it is hard for even the strongest girls to assert themselves.
According to Ms. Frank, the effectiveness of the WAD programme hinges on convincing the girls that they have the right to an equal say about how sexual intercourse takes place. But in male-dominated societies, applying this often radical concept can be enormously challenging. “Throughout history, in virtually all societies including this one, women have, as a matter of tradition and law, been expected to obediently submit to men sexually,” says Ms. Frank. “It is only in recent decades that this has begun to change.”
Although asserting their rights can be particularly difficult for inexperienced and uneducated young women, “It is also surprising how quickly the attitudes of these girls can turn around,” Ms. Frank says.
WAD has found that the availability of a female condom can be pivotal. WAD contracted a facilitator from the Guyana Responsible Parenthood Association to demonstrate how to use a female condom, using an anatomical model. But the manner in which the girls introduce the condom to their boyfriends is just as crucial.
Initially, says Ms. Frank, many young men object to the idea that their girlfriend is the one equipped with a condom. “But the girls have to learn to deal with that,” she adds. “We encourage them to say, ‘No, it’s not me taking the initiative. It’s not because I have ideas or I want to be prepared in case somebody comes along. It’s because it’s the responsibility of the two of us."
The importance of education, support, and self-care
A whole set of factors contribute to unintended pregnancies among Guyanese teenagers. Many of the girls in the WAD programme come from poor, often dysfunctional families, where no one ever explained the risks of unprotected sex. “They tell us, ‘You know, I never had a relationship with my parents where we could talk freely,’” says Ms. Frank. “‘They never told me what I should do and what I shouldn’t do.’”
Even in stable families in Guyana and elsewhere, discussing sex may be extremely difficult or taboo. “In most households, talking about sex is to suggest the unthinkable,” says Ms. Frank. Ignorance about sex and its consequences means that some new participants arrive at WAD with untreated sexually transmitted infections. Only as they learn to trust WAD counsellors – often the first adults they have ever been able to confide in – do the girls reveal that they have an infection.
In addition to providing information on hygiene and reproductive health, WAD works on issues of low self-esteem by emphasizing ‘self-care’ – improving the girls’ sense of identity, self-confidence and personal worth. The change that takes place can be remarkable, says Ms. Frank. “For the first couple of months these girls can’t smile, but after a while, we start to see smiles on their faces.”
“When they first come they’re so shy, they never speak,” adds Ms. Clonel. “Now they’re talking all the time. They want to go back to school to make sure other girls don’t get into trouble like they did,” she says. “They want to share what they’ve learned.”
— Feature story by Kristin Helmore for UNFPA, the United Nations Population Fund
UNFPA supports several user-friendly, multilingual global resources to encourage the use of condoms, including the website All About Condoms .