Mozambique: More Than a Lifeline

An eruption of laughter, then silence as the girls looked nervously at each other. Finally, with an awkward smile and glance back at her friends, one young woman stood up and grasped the purple wrapper. With a deep breath, she ripped open the package.

“This is how you use a female condom,” she said, giggling briefly before beginning a clear, confident explanation of how to insert and remove the condom.

Helana Ernesto, 19, is participating in an education session with five other girls aged 15-19 to learn about HIV prevention, safe sex, and their health rights. It’s part of a nationwide approach using community health workers, or activists as they’re called in Mozambique, to reach groups that are most risk of HIV and TB.

In Mozambique, as in much of East and Southern Africa, young women and adolescent girls are disproportionately affected by HIV.

On average, girls are likely to acquire HIV eight years earlier than boys, and infections among girls are rising at a terrifying rate. In the hardest-hit countries, girls account for more than 80 percent of all new HIV infections among adolescents. More than 7,000 girls and women aged 15-24 are infected with HIV every week.

“Girls and young women have been the face of the epidemic. The best opportunity we have is to focus on them so they become the face of hope, the face of the turning of the tide,” said Graca Machel, the leading voice in the fight against HIV among young women and girls in Mozambique. “There is no substitute to prevention. If people are infected and start treatment as adolescents, then they will be on treatment until their 60s and 70s. Our health systems are not going to cope unless we prevent and stop the infections at the source.”

Enter the activists, like Amelia Luis Zandamela. Activists are from the communities where they work, and they’re usually not much older than the girls themselves. Zandamela, who was leading today’s session in a community just outside the capital, Maputo, meets with 12 different groups of girls, six at a time, to explain HIV and how to protect themselves. She then arranges individual follow-up meetings with each girl every three months to answer specific questions, to see if the girls are following safe behaviors, and to arrange testing for HIV or sexually transmitted illnesses if needed.

The program is focused on HIV, but it’s more than that – it’s a message of empowerment, of encouraging them to take control of their own health. In a country where health services often discriminate against adolescents – male or female – who seek treatment or information about sexual health issues, this is a critical part of the session.

“Don’t be afraid to express yourself,” Zandamela said to the girls. “Go to the clinic if you have questions or if you want to be tested. Even if it’s a male doctor, don’t be afraid. You have a right to be there, and to understand what’s going on.”

This is the first group session for these girls: the initial risk assessment to see how much they know, to hear their experiences and answer their questions. There’s also a hotline, called “AlA Vida” (Lifeline), that girls can call if they have questions. If they’re in school, as these girls are, they also receive HIV prevention education there.

The message seems to be getting through. While all the girls at today’s session have boyfriends, they are adamant that health comes first.

“We have serious discussions about HIV,” said Helana about her 21-year-old boyfriend. “He’s very open – and I’ve been very clear. I have to go to school and do my homework, and I like to play football and volleyball. I don’t want anything to stop me from doing that.”

Source: Global Fund to Fight AIDS, Tuberculosis and Malaria