Women and girls like Fauza now occupy the front line of the war on HIV in Uganda and much of sub-Saharan Africa. There are other high risk groups but, by weight of numbers, it is this group – the young female poor – that are most vulnerable and numerous.
The data are startling. Despite major declines in the number of new HIV infections globally, the HIV epidemic among women between 15-24 in several sub-Saharan African countries remains uncontrolled, with two thirds of all new infections across the region occurring in young women and girls – an estimated 280,000 new infections annually. In some countries, girls are 14 times more likely to become infected than boys of the same age. In Uganda, nearly nine per cent of women live with HIV, compared to about four per cent of men.
Reasons for the disparity lie in what one study refers to as a “perfect storm” of entrenched gender inequality, poverty, physiology and powerlessness. The result is that transactional sex – on a continuum between the terror the girls in Jinja are trapped in, to a more survivable polyamory – is endemic in Uganda, as it is in much of the developing world.
Bridget Ndagaano, a medical social worker who specialises in HIV prevention, points to Kampala’s booming university campuses as a case in point. “The girls all have ‘blessers’ – older men who look after them in return for sex. You might have one for shoes, one for the hair salon, one for [mobile] airtime… at the universities the blessers are an epidemic.”
Ndaganno is not judgmental but worries. Her mother is HIV positive, so to her it’s personal. She says 15-25 year olds – a generation that is set to almost double in size in sub-Saharan Africa over the next 20 years to 400 million – never witnessed the terrible toll of the region’s HIV/Aids epidemic at its height and don’t fully appreciate the risks.
“Poverty is so damaging, the vulnerability it creates is terrifying,” she says. “These girls know they need to get educated to get on – and that’s right – but the risks they take are huge. Most worry more about getting pregnant than HIV. At the universities everyone just uses the morning after pill. Messages about prevention are getting lost.”