Youth and Sex in Gauteng - Gauteng Education

DEPARTMENT OF HEALTH
YOUTH AND SEX IN GAUTENG
COLLOQUIUM
12 TH MARCH 2013
LIZ FLOYD

INTRODUCTION
1. Adolescence and youth:
• Rapid development and learning
• Multiple risks – sex, substance abuse, trauma, violence
2. Extended youth – unprotected sex HIV and pregnancy
• Adolescence starting at 10 years
• Late marriage (30 years) / half unmarried
3. Rapid urbanization
• Poverty, unemployment, inequality
• New social norms – less accountability
• Substance abuse and violence
2

HIV Prevalence (all HIV infected) : South Africa
Females
Males
• HIV prevalence is highest in females aged 25-29 yrs
• HIV prevalence increases in females aged 15-29 yrs peaks at 33%
• HIV prevalence in males peaks aged 30-34 yrs at 25%
Ref: HSRC National Household Survey 2008.
3

New HIV (incidence) 15 to 20 years : 2002/08 SA
• There was a big drop in new HIV infections (incidence) in teenagers
aged 15-19 yrs from 2002 to 2008
• New HIV infections (incidence) did not reduce significantly in 20
year olds.
• New HIV infections increase rapidly after youth leave school
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Percentage youth started sex under15
PROVINCES
START SEX UNDER15YRS(%) : 15 TO 24 YRS
15 – 24 2002 2005 2008
Western Cape 6.0 10.4 9.3
Eastern Cape 7.7 6.7 7.8
Northern Cape 3.6 4.6 7.3
Free State 0.9 7.8 9.6
KwaZulu-Natal 4.9 4.5 4.9
North West 2.5 12.7 8.5
Gauteng 6.3 10.2 7.8
Mpumalanga 4.9 10.1 15.0
Limpopo 5.5 10.1 11.2
• 7.8% (under 10%) of Gauteng youth started sex before 15
years : later than other provinces except for KZN
• Girls under 15 years have very high risks for HIV and
pregnancy. Limited confidence intervals
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Behavior and HIV : sex before 15 years
SA
• An average of 8% of youth started sex before 15 years in 2008
• More boys (12%) start sex under 15 years than girls (5,5%);
• There is a small reduction in males from 2002 and 2008 (not
statistically significant) : National HSRC surveys
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Condom Use
Condom use “at last sex” : age and gender SA
100
90
86
80
70
72
69
60
58
57
50
40
49
46
51
47
44
41
41 40
35
Males
Females
30
20
26
21
10
0
16-19 20-24 25-29 30-34 35-39 40-44 45-49 50-55
• Young people aged 16 -29 years report the highest condom use at about 80%;
• Young males report higher condom use than young females : 74% M 70% F
• Condom use reduces with increased age.
Ref: National Communication Survey 2012
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More than one sex partner in the past 12 months
• Males aged 15-24 years have 5 times more sex partners than females : HSRC
• Multiple sex partners are highest for males aged 20 – 24 years at 30% :NCS 2012
• Multiple sex partners in young females increased from 2009 to 2012 : NCS
Refs: (I) HSRC National Household Survey 2008
(II) National Communication Survey (NCS) 2012
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Behavioural drivers of HIV : trends
Behaviour
1. Age of first
sex
2. Regular
condom use “at
last sex”
3. Number of
sex partners
4. Inequality in
sex
relationships
Alcohol and
gender violence
5. Know HIV
status
Males are
circumcised
Objectives & targets Trends - Progress
Increased % start sex
after 15 years of age
Increased to :
100% for youth
100% for sex outside
marriage
Consistent condom use
Reduced to one
Reduced inequality :
Age gap (less than 5
years), Economic
Gender violence
Increased to over 90%
Over 80% (check)
No significant change
More males start under 15
Males > females (all ages)
Adults : doubled
Teenagers highest at 80%
Youth high at %
Men with multiple partners not
3 to 10% of women : multiple
25% of men 20 to 24 yrs
Increased sex for “benefits”
High : young women, older men
Young poor women
(To add)
66% in the campaign (M & F)
90% of GPG officials
Half of men in GP
Half traditional, half medical.
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Social risks 1
1. Start sex early Examples : OVC, abuse
– Girls : HIV, pregnancy, multiple sex partners, cancer of the
cervix
2. Alcohol increases unsafe sex (F) and violence (M)
Drugs: males do crime, females do sex work
– Tik: hypersexual, nyaope: aggressive, whoonga: violent
Prisoners profile: 97% are male, half are under 25 years,
low school / drop out, about half use drugs
3. Lower education, training and access to jobs
Informal settlements
Informal sector jobs
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Social risks 2
4. Older sex partners (5years +) = unequal relationships
• Financial: Mobile Men with Money = “3Ms”
• Gender: control, violence, rape
• 50% females 16 to 24 years have older partners
• 15 to 19 years: 72% higher HIV
5. Sex for benefits = “transactional sex” increasing
• Social norms and multiple sex partners: Males
• Sex for survival, sex for status : Females
• Aspirations: media, peer pressure
6. Gender based violence:
Abused women have higher HIV
• Rapes: most are young women, about 3% of boys
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WHAT WORKS ? 1
1. “Combination prevention”: Strategic Plans on HIV and TB
a. Social and structural = consensus on social drives. How to
change them?
b. Behavioural = safe sex. Youth = abstain / condomize
c. Health services = medical. Family planning, male circumcision
Note: Build on existing systems = develop, monitor and respond
2. Lifeskills training: United Nations,
“research shows no increased sex”
a. Skills training = skills per age group
b. Content addresses problems = gender, drugs, sex, violence
c. Add peer education = higher risk schools
d. Extra curricular = sports, NPOs, drama, choirs, ? clubs
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What works ? 2
3. School support systems = SBMT with local service networks
a. Identify needs = poverty, social, psychological, health: ? Screen
b. Information: add “self help” = websites, phone lines etc
c. List of services with contacts = referrals with follow ups, home visits
d. Coordination with problem solving : ? Confidentiality
e. Emergency support = social workers : individual and social factors
4. Community response
a. Socialization = family, school, faith based, media
b. Social support systems = family, friends, neighbours, faith based
c. Faith based = youth clubs. Encourage earlier marriage
d. Traditional = men as fathers, socialization of boys e.g. initiation
e. Safety = community patrollers and SAPS zones
f. Community service volunteers : wards, OVC, HBC, CHWs
g. Media : TV, radio, social media : Local role models (not celebrities)
h. Sports = Lifeskills, Media = Artists
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Profile of needs of children
NEEDS %
estimate
SERVICES
Poverty 50% Free schools, uniforms, food
Social grants (CSG), stipends
Abuse (tbc) Emotional, physical
Violence, sexual
Alcohol 30+% Alcohol abuse
Drug abuse 20+% Drugs: Dagga, tik, nyaope, whoonga
Orphans
(OVC)
Health 5%
Under half
of one %
13% Social workers, carers, meals,
Aftercare, child care, donations
HIV positive, screen for TB. 1% treatment (ARV)
Pregnancy ? 2% : FP /TOP / antenatal care
Psychological ? Depression, trauma, anxiety e.g. suicide
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What we can do 1
SCHOOL COMMUNITY: LIFESKILLS TRAINING
ACTIVITY STATUS RECOMMEND
1. Lifeskills
training
in curriculum
2. Curriculum
content:
information,
materials
3. Peer education
for higher risk
schools
4. Extra curricular
sports, NPO,
drama, clubs
High
implementation
? Reduced time
• Increase educator skills
• Measure results : surveys
? Updated • Up to date content
• Social media and materials
• Add “self help”, help lines,
websites
Experience by
GDBE
? Sustained
“Patchy”
• Select with LRC
• Train and support
• Prioritize and coordinate
• Set minimum standards
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What we can do 2
SCHOOL COMMUNITY: LOCAL SERVICE NETWORK
ACTIVITY STATUS RECOMMEND
Education
Identify & refer
Problem solving
Health
services
Social
Development
services
•SBMT
• ? Screen
• School support
• Clinics
• School services
• Mental health
• Social workers
• NPOs for OVC
• Poverty relief
List of all services, train schools
Develop support network : committees?
School support teams
Condoms, FP, ANC, : attitudes
Test and treat HIV, TB, and STIs, PEP for rape
Mobile services for schools
Community health workers visit homes
OVC services through NPOs
Children’s Act : social workers eg abuse /
neglect
SASSA for social grants
Counseling, substance abuse (limited)
Other services Indigent Register Subsidies, houses, poverty relief
Ward based door to door with referrals
Stipends :CWP, EPWP, community carers ,
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What we can do 3
COMMUNITY RESPONSE
ACTIVITY STATUS RECOMMEND
1. Family,
friends,
neighbours
2. Faith based
organizations
Networks.
Wards 50%
Youth groups
3. Traditional Male leaders
Male initiation
Strengthen support for OVC
Home visits, referrals, tracing
Youth clubs with leaders
Involve OVC
Increased “men as fathers” e.g. Sonke,
POMESA
Safety with CONTRALESA e.illegal
4. Sports Community Sports Extend by SACR. Role models e.g. SMYN
5. Arts:
• Drama
• Murals
NPOs
e.g. prisons
6. Youth media TV, radio, social
Local role models
Educational drama e.g. prisons
Peer communication, participation
TV soaps include lifeskills e.g. Isidingo,
Social media, website, info
Develop local role models
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What we can do 4
COMMUNITY RESPONSE
ACTIVITY STATUS RECOMMEND
7. Volunteerism
• Community
service
• Stipends
• Training
8. Safety
• Control crime
• Safety at
schools
Over 20 000
>Half are youth
Through NPOs
Ward door to door
Some access jobs
Community
patrollers
SAPS zones
Women, men,
FBO sectors
Role models
Add: Donations campaigns for
OVC e.g. shoe boxes
Youth development agenda
Stronger management of
volunteers
Reach youth, unemployed & men
Identify high risk areas
Safe schools = continue
Control of drugs & alcohol :
increase
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Acknowledgements
1. Department of Basic Education: Lifeskills team, M & E
2. Not for profit NPOs : educators and carers, managers, Boards
3. Department of Health : HAS, primary health care
4. Department of Social Development : Children’s services for OVC
5. Other Departments: Sports, Correctional Services, Community Safety
6. Municipalities : Ward educators and coordinators, Councillors
7. Sector representatives: Youth, men, FBOs, traditional, women, etc
8. People living with HIV: NAPWA, TAC, Positive women
9. Multi sector AIDS response led by the Gauteng AIDS Council, Metro
and District AIDS Councils
THANK YOU
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