HIV Prevention for Vulnerable Adolescent Girls

The programme is being implemented in peri-urban areas in the Amhara region, and uses existing religious and community structures to reach adolescent girls and their husbands, families, and communities. Ethiopian orthodox and Muslim religious leaders are trained to provide information to their congregations. So far, more than 1,000 religious leaders in the region have been trained and are providing information to their congregations.

The project also involves the formation of clubs made up of married girls and headed by trained female mentors from the community. Girls participate in a curriculum that includes HIV and reproductive health education and referrals, non-formal education, and livelihoods training. Currently, over 16,000 married girls are participating in these clubs.

In addition, community and religious leaders have been trained as educators and referral advocates for voluntary counselling and testing for HIV and antiretroviral therapy. These community advocates promote premarital voluntary counselling and testing for HIV, educate community members on the availability of antiretroviral therapy, and refer those interested in premarital voluntary counselling and testing to existing centres using a coupon referral system.

Reproductive Health, HIV/AIDS, Child Marriage, Maternal Health, Gender-based Violence

According to the Population Council, in the Amhara region an estimated 46% of girls are married by age 15. Girls who marry are exposed to reproductive health risks; they experience sexual initiation earlier than unmarried girls and have first births at a young age, among other risks. Very early first births are associated with maternal risks, including fistula. Amhara also has among the highest rates of divorce in the world, with 17% of rural young women aged 15-24 currently divorced. Many girls migrate to urban centres because of the stigma of divorce, with anecdotal evidence suggesting that in order to survive they often become domestic workers or, as a last option, sex workers.

There are a number of factors that may increase HIV risk among married adolescent girls, including the inability to abstain or use condoms. Also, young married girls tend to have husbands who are much older, and this age gap may intensify the power imbalance between husbands and wives, discouraging the open communication required to encourage voluntary counselling and testing for HIV, sharing of test results, and planning for safe sexual relations throughout marriage. According to the Population Council, few programmes for adolescents reach this large group of girls, and very few programmes have been implemented in rural areas of Ethiopia.