Opinion piece on equitable investments in HIV/SRHR services for adolescent boys and young men in Botswana

Opinion piece on equitable investments in HIV/SRHR services for adolescent boys and young men in Botswana

The Botswana government must  equitably invest in HIV/SRH programming for both adolescent boys and young men and adolescent girls and young women

My name is Goabaone Tshegofatso, and I’m 32 years old. I have been working with adolescent girls and young women (AGYW) under the DREAMS Program for the past three years. Before that I worked for about nine years to provide psychosocial support to young people. I am a young woman myself and know firsthand the challenges young women face in accessing HIV and sexual and reproductive health services in Botswana. As of 2019, 380 000 people are living with HIV out of this population 20.7% where adults (15-49). Even though, females have a relatively higher prevalence rate of 19.2 percent compared to 14.1 percent of males.

There has been a lot of focus on AGYW in the country in our HIV/AIDS programming. Rightly so. This is because out of every four new HIV infections, three are among AGYW. Those infections are too many. We must do everything we can to change this. That said, I’m not convinced that as a country we’re doing enough for adolescent boys and young men to help realize the goal of zero new infections across all groups by 2030. Most of the funding is directed to AGYW. After all these years of working in this space, I’m aware of only one program focusing solely on adolescent boys and young men (ABYM) – Stepping Stones International. We need more of this now.

Because of the limited investment in HIV/SRH programming for ABYM in Botswana, they are lagging behind in accessing HIV prevention and SRH services. For so many years, assumptions have been made about men and boys in regard to their health. We all assume that they are doing well and that they have fewer needs as compared to their counterparts (women and girls). In addition, assumptions have been made that men are always difficult to work with, are aggressive, and are unconcerned with their health. In addition to this, men are often seen as perpetrators of violence – against women, against other men, and against themselves. There is some validity to this, but have we have pondered to understand how our socialization of boys and men might lead to and enable this? The answer doesn’t lie in leaving them aside or behind. If we continue to do this, we risk losing the benefits from all the hard work we’ve done to empower AGYW. This is because, at the end of the day, we all live in the same communities, therefore empowering one group and leaving the other behind may be detrimental to everyone. Engaging men and boys more extensively on HIV prevention and SRH has tremendous potential to reduce women’s risk for HIV. This is why I have decided to engage them in the fight against HIV.

Some may question if this can be done or if it’s beneficial at all. A review on programing for male involvement in reproductive health, the World Health Organisation (2002) established that while traditional health care provision and research in the area had always focussed exclusively on women, prioritization of male involvement would be crucial to achieving reproductive results for both women and men and the wider society. For example, a study conducted by UNICEF Malawi had identified low involvement of men in PMTCT, sexual and reproductive health activities, and antenatal clinics and family planning services as undermining the program, problems disclosing their HIV status to their partners, only five men had participated in the program by accompanying their partners for the Prevention of Mother-to-Child Transmission of HIV (PMTCT) related activities, which also made treatment of HIV positive women challenging. Men were not effectively supporting women in accessing and utilizing PMTCT services. In addressing these challenges UNICEF Malawi in collaboration with the Ministry of Health initiated the Male Companion Project which yielded positive results as men started supporting their partners, going for clinical checkups with them, stigma and discrimination were also discussed amongst couples.

I want to think that we can do the same here in Botswana. It all starts with a commitment on the part of our government and our development partners like PEPFAR, the Global Fund, and other stakeholders like us in the civil society who are committed to equitable investment in HIV prevention and SRH programming for both ABYM and AGYW. 2030 is not far. If we’re serious about achieving our 2030 goals, we must start now.