Women's Health Opinion South Africa

Let's talk about sex that is safe and satisfying

Every woman has the right to a sex life that is safe and satisfying, to say no if she does not want sex, to choose to use condoms and/or other preventive methods, to have a partner that respects her choices, to enjoy a non-violent relationship and to make a choice about having a child. Unfortunately, many South African women don't enjoy these rights. This not only exacerbates the spread of HIV and the complications related to it but also drives unintended pregnancies.
Source: Supplied. Seithati Molefi, deputy chief-of-party at Right to Care.
Source: Supplied. Seithati Molefi, deputy chief-of-party at Right to Care.

Every woman deserves access to both information and services for HIV testing as well as contraception. If she is HIV negative, she needs access to pre-exposure prophylaxis (PrEP). If she is HIV positive, she needs to be on treatment to keep herself healthy, prevent HIV transmission to her sexual partner/s and lower the risk for transmission to her baby during pregnancy, labour and breastfeeding.

Yet many women still don’t have the final say about their own sexual health. Traditional gender roles, patriarchal beliefs, HIV stigma and gender-based violence (GBV) are disempowering, and are preventing women from accessing support- and health services and driving HIV infections. Moreover, women struggle to negotiate condom use and many are being infected with HIV during their pregnancies.

Additionally, it is young women bearing the brunt of the continuing spread of HIV. A recent USAid report has uncovered that every week, 3,100 females aged 15 to 24 in sub-Saharan Africa become infected with HIV. At the South African Aids Conference this year, the high rate of teenage pregnancies and HIV among young women took the spotlight.

Right to Care is a partner of the USAid-funded Dreams programme that supports and empowers adolescent girls and young women. The programme follows a multi-stakeholder approach to address the root causes of the challenges young women face.

GBV and stigma

One of the drivers of HIV infections is gender-based violence because a woman is unable to establish her perpetrator’s HIV status or negotiate condom use. It undermines her ability to report abuse and access support. If she knows her abuser and is financially dependent on him, she is often scared to leave the relationship.

Many women hide their antiretroviral treatment from their partners because they are shunned for taking it and others are stigmatised when taking PrEP because people think they are taking antiretroviral treatment.

Treatment as prevention, HIV testing

Right to Care, in line with global goals to end HIV, is building understanding about HIV treatment as prevention. It supports the Department of Health in two rural districts.

Its basket of care includes HIV testing services and initiating HIV-positive women on antiretroviral treatment or PrEP. This is in addition to the provision of family planning and contraception services they provide, as well as screening for cervical cancer, among other provisions of support.

The NGO is also fostering comprehension around the importance of treatment adherence and viral-load monitoring among the patients it serves.

When someone living with HIV is on treatment, it lowers the level of HIV (the viral load) in their blood down to an undetectable level meaning the person is virally suppressed and cannot pass on HIV during sex. Viral suppression also reduces the risk of passing HIV on during pregnancy, childbirth and breastfeeding.

The supplementary steps supported by the NGO encompass:

  • Empowering women with accurate information about sexual- and reproductive health and their rights so they can make informed decisions about family planning and HIV prevention, and reach out for mental- and social support.
  • Engaging men more effectively so they play their part in promoting women’s sexual health and safety. Women benefit when their partner is circumcised, as HIV and STI infection rates are lower in circumcised men and their partners.
  • Promoting community outreach as a means to help boost HIV testing and treatment initiation.
  • Helping patients keep their appointments and following up when they don’t arrive.
  • Advocating for medicine pick-up points like Collect&Go smart lockers to make medicine collection quick and support medicine adherence.
  • Improving access to legal- and other support services for women in abusive partnerships
  • Offering more adolescent- and youth-friendly services as well as open days for young people to access services and information.

More can be done. Greater focus is required to remove societal challenges that women face when accessing support. They need to better understand their rights.

About Seithati Molefi

Seithati Molefi is the deputy chief-of-party at Right to Care.

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