The truth that adolescent girls occupy the lowest rank in the hierarchy of gender power relationships and its effect on their holistic development is an issue of utmost importance and urgency. My mind went down memory lane and remembered an experience I had some years back while working with a health facility supported by the World Bank to provide care and treatment on HIV/AIDS in one of the North Central states, very close to Abuja the Federal Capital of Nigeria.
There was a time we noticed in the HIV counseling and testing unit that so many of our clients coming from a particular village within the suburb were testing positive for HIV. The incidence became of concern to me and my colleagues and we were curious to know why this was happening in a village that has little or no social infrastructure. Our curiosity was further strengthened when a middle-aged man from the same village came in on a particular day for an HIV test and the result was reactive. My colleague who conducted the test couldn’t hold back when the man said he had three wives–one is dead, with two remaining. She then requested that he seek the consent of the wives to come and know their status. The gentle man obliged and on a later day he brought the women. After the running the test one of them tested positive while the other was non-reactive.
With this case in hand my colleagues and I, three of us, resolved to go and visit this village, and do a mini-study of the environment to help us to understand better what really put them at risk... Off we went on a motor bike, hip hop, and hip hop winding the tortuous path. The road was really bad... For about an hour and a half we were still journeying through the pathways on Motorbike... Along the way we saw some small settlements and my attention was caught by the sight of a Primary Health Care centre (PHC). I heaved a sigh of relief commending the Government for situating such a facility in this remote place. My excitement was cut short when my bike driver told me that the centre was built many years back and was never operational. There we go again, I said to myself, only God knows the number of such facilities wasting away across the country. Often times Government officials are quick to award such contracts to make money and forget the building is useless if the primary functions to be performed there are lacking.
Shortly, we could behold our final destination from a distance. The view of mud-made houses with a mix of thatch and iron roofing sheets proved that we were truly in a rural environment... a calm settlement with a population less than a thousand. We saw a small wooden shop where some patent medicines were displayed and a government school with a few blocks of classrooms. We were later informed that the teachers seconded by the Government to the school only show up 2-3 times a week and not always regularly.
We located our contact person who happened to be one of our clients and whom we had earlier informed of our coming. He received us warmly and the first statement he made was an instruction: “Please don’t tell anybody here that you are HIV/AIDS workers, just simply say you are health workers. If not they will start suspecting me to be infected and risk expulsion from the village as a result of stigma.” Here again we have to deal with the issue of stigma! I think a second wave of the HIV epidemic in developing nations that we really need to fight is HIV related stigma. Many HIV positive people have died not because of the virus but stigma.
As our host took us around I couldn’t help but notice a number of teenage girls with protruding stomachs- I mean they are pregnant. I couldn’t hold back but ask the man if teenage pregnancy is a norm in the village. His reply was more shocking–“Teenage pregnancy is not a norm at all, but it’s common here because young boys and girls always have free sex during school hours. Most times when classes are not holding what some of the young ones do to keep themselves busy is sex.” This may sound light or funny, but I saw it as a big cause to worry when you consider some attending implications and consequences. It means many young people there are engaging in unprotected sex. What about the risk of HIV and other Sexually Transmitted Infections? There was one of the girls who tied a wrapper around her chest and as I looked through her eyes, all I saw was a young girl not prepared for motherhood. How will this girl have access to ante-natal care? What will become of the child? What about the future of the mother? These were many questions waiting for answers.
As we moved around with our host, we suddenly sighted a well-built estate with many blocks of flat. It has a water reservoir, power generator, well structured but looked deserted. We couldn’t help but ask–“Are there people living inside there and who are they?" We were told nobody is living in there at the moment, but the place was occupied until some months ago by workers of a particular company that deals in solid minerals. The workers were both Nigerians and foreigners. They worked in the community for about two years extracting solid minerals. We then learnt that their presence brought in some commercial sex workers (CSW) into the community. These CSWs were patronized by both the company workers and indigenes of the community.
With this revelation our inquisitiveness into why there is high incidence of HIV in the community was almost satisfied. It is possible that many of the company workers engaged in protected sex as most of them are educated, but for these villagers, they embraced the risk out of ignorance. And here again the women were the most vulnerable. We were told of how some of their women died from what they called mysterious sicknesses. In fact, we were shown the grave of a woman that was buried few weeks to our visit and playing around there was a little boy she left behind. I wonder the number of children that are of the same status in the community.
The interaction at the company’s estate actually concluded our visit. We thanked our host and we embarked on the journey back home. Afterwards, my colleagues and I drew up a plan of action for the community and also contacted the Local Government in charge of the area. Not quite long after the visit, we all moved on from the job to another and could not really follow-up on the interventions that took place in the community.
Facing the reality, we are only few years from that time and I will say the health challenges in our rural communities are still daunting. People in the rural areas are still more vulnerable to diseases. It is more challenging for sub-groups of the population like women, adolescent girls and young people. They have little or no access to information and resources they need to protect themselves from HIV, and unintended pregnancy. Pregnant women in the villages lack adequate access to healthcare services.
What about young mothers? We need to scale-up programs that will help develop their full potential. While a lot of HIV/SRH interventions are going on in the urban areas, programmers, Government at all levels, policy makers and donor agencies should begin to pay more attention to the unreached and under-served. Our government must know that whether you are living in a urban or rural area, there should be equitable access to healthcare. The right to health for all citizens must be upheld. Let us call into remembrance the ICPD PoA and ask the Government how far has this been implemented? Women, adolescents and young people are critical instruments for sustainable development. We need to take action now!