A human rights-based approach to HIV prevention: An experiment among

adolescents in KwaZulu-Natal

Population CouncilHEARD - UKZN

Isihlangu Health and Development AgencyRegional AIDS Training Network, Nairobi

Countdown to 2015: Challenging orthodoxies related to SRH and HIV

London May 17, 2010

The Siyakha Nentsha program

“Building with young people”

Program experimentRecognizes linkages among adol HIV risk and

……..family/household demographics……..social connections/isolation……..economic status……..gender role attitudes/mores

Randomized experiment

Recent local female/male secondary matriculants: each trained as facilitator, confidant, advisor ……..to local secondary learners

Randomized program design – 3 arms1. HIV educ + social support + financial educ2. HIV educ + social support3. control (standard lifeskills)

The case of Lindiwe

Meet Lindiwe, age 15. Lindiwe (not her real name) is participating in a program at her school to develop her skills and knowledge to transition into a healthy and productive adulthood.

Lindiwe is a student in the Engonyameni district of KwaZulu Natal, in South Africa. She is the eldest of three siblings, and like many young people in the area, her life has been severely affected by AIDS. The children lost their mother in 2004, and have never known whether their father was dead or alive, having never had any contact with him. Since their mother’s death, the three children have been living with relatives.

As part of the program at her school, students keep a workbook in which they record their feelings and experiences. One day Lindiwe wrote in her workbook that she wanted to die. Alarmed by this workbook entry, the young person leading the program for her class went to find out why.

Lindiwe’s caregivers receive old-age pensions from the South African government that they use to see to the needs of the children and other family members. Recently Lindiwe learned that financial problems mean their caregiver is no longer going to be able to care for her or her siblings. She and her siblings could end up with nowhere to live.

There are thousands of young people like Lindiwe in South Africa who have lost at least one parent. South Africa has social protection programs in place for young people in this situation, but many in the most disadvantaged situations do not know how to access them.

Circumstances like these put already vulnerable young people at risk for desperate decision making. The many who live in impoverished communities lack access to skills-building programs, recreational opportunities, job and saving mechanisms and do not receive the information and skills necessary to access social benefits, further education, or training opportunities. Without knowing their options or how to exercise their rights, young people resort to strategies like trading sex for survival or may feel lost enough to end their own lives.

The program Lindiwe and her classmates are participating in is called Siyakha Nentsha, isiZulu for “building with young people.” Siyakha Nentsha goes beyond traditional HIV prevention programs to build the knowledge and practical skills that young people in a heavily HIV and AIDS-affected area need to succeed as adults.

Pairing participatory activities with mentorship from a young person who leads the program in each classroom, Siyakha Nentsha is part of a new movement to address HIV using a comprehensive approach, addressing the underlying causes of risk, and to focusing on the needs and special circumstances of the most vulnerable adolescents.

The Population Council is working with their local partners, the Isihlangu Health and Development Association and the University of KwaZulu Natal, to provide evidence that multi-faceted programs like Siyakha Nentsha help young people in precarious circumstances dream and achieve their goals.

Siyakha Nentsha staff are intervening in Lindiwe’s case, and with the skills she is acquiring in programme, next time Lindiwe (and many more like her) will not have to feel so hopeless because she will have the skills and information to get help herself.

Lindewi poised for

• Escapism – social withdrawal, drinking, drugs• Exploitive girl-dominated menial labor• Sexual relationships with men that may

provide economic assistance to her & sibs

…….all associated with unsafe sexual experiences

Attainment & safeguarding rights

• Government as duty-bearer weak among this group (age, rural, isolated)– Respect: refrain from interfering w enjoyment of right

– Fulfill: institutions/procedures to enable/encourage rights holders to claim rights

– Protect: mechanism to prevent violation of the right

SN striving to fill duty-bearer’s gaps

Increase rights-holders’• awareness of reproductive, social, economic rights• skills to claim rights and access entitlements• knowledge that non-receipt of right/entitlement is

violation and redress can be legitimately claimed

KZN DOE (Umlazi) very interested in results with eye toward scaling out program