Care and support for people living with HIV/AIDS

What makes people vulnerable?knowing it. Moreover, given the very high infection rates now being seen in girls (seeFigure 18), it is unwise to expect young partners to be free of HIV.Whether sexual initiation is consensual or coerced, it may occur at a very early agein particularly marginalized communities. In a survey of 1600 children and adolescentsin four poor areas of the Zambian capital, Lusaka, over a quarter of childrenaged 10 said they had already had sex, and the figure rose to 60% among 14-yearolds.In South Africa, 10% of respondents in a study in six provinces said they hadstarted having sex at age 11 or younger. The study, commissioned by the SouthAfrican Department of Health, recommended that sex education be introduced tochildren around the age of 12 if it was to reach most of them before they becamesexually active. Clearly, though, it is important to complement education on AIDSand life skills with vigorous action against sexual abuse and rape and campaigns todiscourage older men from seeking out young girls for sex.Box 8. Working with vulnerable girls in NepalIn Nepal, the Maiti Project has targeted children and young women who are subjectto sexual exploitation and abuse, including girls who are at risk of being sold intoprostitution in India. The project has established camps in high-risk areas, eachcamp functioning as a shelter for about 30 girls rescued from traffickers or who arein danger of being sold. The camps provide education and vocational training, as wellas support and counselling. The project has worked in conjunction with colleges,local pressure groups, village leaders, medical officers, lawyers and the police. Anevaluation suggested that Maiti Nepal prevents approximately 180 girls from beingsold into brothels in India each year. In addition, 105 people have been imprisonedas a result of the project’s efforts to expose child traffickers. In 1997 alone, 60 girlswere repatriated from India and three-quarters of them were subsequently reunitedwith their families. Taking account of the daily challenges faced by vulnerable youngpeople, the project is remarkable for its integrated approach to their needs for shelter,food, education, health care, legal protection and supportive adult networks.Violence against womenViolence directed against girls and women – in a sense, the most egregious sign ofmale domination – makes them vulnerable to HIV infection in a number of direct andindirect ways.Violence in the homeDomestic violence reduces women’s control over their exposure to HIV. Obviously,in settings where violence is regarded as a man’s right, women are in a poor posi-49