Married adolescent girls missing out on the HIV message

Kenyan HIV/AIDS awareness programmes for young people are bypassing those who are married, raising their risk of contracting the virus. Azina, 19, from the downmarket suburb of Ziwani in the Kenyan capital, Nairobi, was married and expecting her first child by the age of 17. She is barely literate and depends on her husband's family for economic and social support. Beyond the social and economic disadvantages, marriage can expose adolescent girls to a significantly higher risk of HIV infection because they have more unprotected sex. A 2004 study by the Population Council, a US-based research body, showed that 57 percent of married girls in southern and eastern Africa had unprotected sex, compared to just five percent of sexually active unmarried girls. A 2005 Unicef survey found that about 16 percent of Kenyan girls married between the ages of 15 and 19 were in polygamous unions. This contradicts long-held notions that marriage protects girls from sexually transmitted infections, including HIV, premarital sex and pregnancy.

MORE RISKS OF EARLY MARRIAGE:

Married girls often have much older partners - in Kenya, the mean age difference between girls married before they turn 18 and their husbands is eight years. Married girls have less mobility than their unmarried counterparts or married women. They are less exposed to modern media, and often less knowledgeable about HIV/AIDS and general reproductive health. They are often isolated, have fewer social networks, and cannot join other young people in group activities where they could learn about HIV/AIDS. Maternal health services are generally designed with older married women in mind, so the needs of married girls are not addressed. Their youthfulness and limited schooling has tremendous implications for power and decision-making in the marriage, making it difficult for the girl to stand up for herself if she feels her welfare is threatened. SOURCE: POPULATION COUNCIL

"We know that getting married too early makes girls vulnerable to all sorts of problems and even exposes them to reproductive health risks, but our people still marry girls off," said Dr Pamela Godia, programme manager for adolescent reproductive health at the Ministry of Health. According to the United Nations Children's Fund (Unicef), in 2003, 24.6 percent of girls were married by the age of 18, and about 3.5 percent by 15 years. Most of them live in patriarchal communities where they have little or no say in making life decisions. When Azina wanted to start using contraception she had to get her husband's consent, even if she thought he was unfaithful. "If you want to be beaten and chased away, just mention condoms or VCT [voluntary counselling and testing] to your husband." Her friend Halima, also married at 17, confirmed this. "That [asking about condoms] is so bad that he can throw you out of the house forever!" The same misconceptions about the benefits of early marriage have led to HIV/AIDS programmes that focus on unmarried youth, a dangerous practice in a country where most communities are polygamous, and women with husbands who have more than one sexual partner end up exposed to infection. Considered too young to fully mix with older married women, the girls also lack adequate information about general reproductive health, with service providers also not being sensitive to their needs. Fatuma, another of Azina's friends, recalled, "When I first went to the clinic, I was wearing trousers and didn't have a leso [sarong] - I didn't know you had to carry one [to cover yourself during the gynaecological exam]. The nurses chased me away." Some organisations have begun to take the plight of young married people into consideration. In western Kenya's Rachunyo District, a group of nongovernmental organisations is trying to help married girls form clubs to break their isolation, while promoting VCT for newlywed couples and those intending to marry. "We have youth centres around the country, and we would like to think that married girls can also benefit, but we know that they rarely use them," said the ministry's Godia, acknowledging that more resources were needed to ensure that young married people receive adequate information about HIV/AIDS.