KIGALI, Rwanda, International Conference on AIDS and STIs in Africa (ICASA)—As the pillars of our communities, girls have the agency to bring about change for themselves and those around them, said Jeannette Kagame, Rwanda’s First Lady.

Girls remain one of the most vulnerable groups affected by HIV and AIDS.

“Yet despite this tremendous potential, girls remain one of the most vulnerable groups affected by HIV and AIDS. Girls account for three of every five new HIV infections among 15 to 19 year olds in sub-Saharan Africa. Adolescent girls and young women are twice as likely to be living with HIV than young men of the same age,” she said. 

She encouraged youth, especially young women, to take the lead in the fight against HIV and AIDS among their peers. Young people should not be left behind; they should be involved in every initiative and programme, and should be counted as decision-makers as change will begin with young people, she added.  

She was speaking at the session on “Ending the HIV epidemic among adolescent girls and young women in Africa: what will it take?” The status of Africa’s response to the HIV crisis among adolescent girls and young women was reviewed, and home-grown solutions and ways in which the trajectory of the HIV epidemic in Africa can be changed were showcased. Among them is the need to make sexual and reproductive health (SRH) and rights information accessible.

We need to accept that our young people are sexually active, and thus ensure they have access to SRH information and services.

Innocent Modisaotsile, UNFPA East and Southern Africa Regional Adviser for HIV and AIDS, said denialism needs to be addressed. “We need to accept that our young people are sexually active, and thus ensure they have access to SRH information and services.”

Implementation of commitments is key to ending HIV among young people, he added: “Translating our commitments into reality is our biggest problem. Rwanda is one of the countries where what is said is put into action. Other countries should learn from this.”

Said youth representative and AIDS activist, Zandile Simelane, 23, from Eswatini, who was diagnosed with HIV when she was 17: “It takes us (youth), including young women and adolescent girls, to end HIV and AIDS among ourselves.”

Effective partnerships for cervical cancer prevention and innovations in treatment

A panel discussion on “Effective partnership for cervical cancer prevention” looked at innovations in cervical cancer treatment, as well as sensitive aspects of women’s health and shared responsibilities to invest in interventions aimed at eliminating diseases, particularly cervical cancer.

Discussions included a cervical cancer programme that will focus on screening and treating adult women living with HIV and AIDS.

“Women living with HIV are up to 10 times more likely to develop cervical cancer, making cervical cancer a major threat to the health of women living with HIV,” said Rwanda’s First Lady Jeannette Kagame. “This new cancer prevention programme will screen more than 70,000 women aged 30 to 49 using HPV-DNA testing, as well as visual inspection with acetic acid while treating cervical precancerous lesions with thermo-ablation devices.”

“We often refer to lack of fancy equipment as the main challenge but there is a lot we can do within our means. It requires organization. Over the last nine months, we’ve treated 300 cancer patients, 25 per cent being cervical cancer cases,” said Dr. Pacifique Mugenzi, Head of the Cancer Centre at the Rwanda Military Hospital.

New innovations in the fight against cervical cancer, including US $1 screen and treat solutions, and artificial intelligence screening tools, were also discussed.

Youth participation is a right, not a favour

Hundreds of youth representatives agreed that young people deserve to be part of sexual reproductive health and rights programmes from conception to implementation, at a satellite session entitled “Meaningful youth engagement towards an AIDS-free Africa: youth lead the way”.

“Youth participation is a right, not a favour,” said Safeguard Young People Programme Regional Coordinator, Renata Tallarico, a speaker and panelist. It is high time young people are seen as partners and as equals, rather than as beneficiaries.

Key to the discussions was the varying definition of young people and youth in countries, the African Union and the United Nations. The African Youth Charter defines youth as an individual between 15 and 35 years of age while The United Nations defines youth as persons between the ages of 15 and 24. Many countries have their own definitions, which is a challenge to meaningful youth engagement.

Resolutions from the session included:

• Young people seek to make a difference from policy level to implementation.
• There needs to be effective participation of young people as opposed to the homogenous way in which they are currently being treated.
• Currently, efforts towards meaningful involvement of young people are disjointed. There is a need for a more coordinated effort and the resources for young people to do so.
• Young people need to be ready to take a seat at the table, know who they are talking to and to make meaningful contributions.

Ending HIV and AIDS in Africa by leaving no one behind – including persons with disabilities

Marie-Antoinette Kanfoudy was two years old when she became physically disabled as a result of a poorly administered injection. Born and raised in Senegal, her father taught her how to walk despite her disability. In 2005, while pregnant with her third child, she learned that she was HIV positive. She struggled to cope mentally and miscarried her baby. Her loved ones helped her pull through. “With the support of my husband, I was able to undergo treatment,” she said.

More than 1 billion people (15 per cent of the world's population) live with a disability, according to WHO and the World Bank. People with disabilities often have limited access to HIV services and SRHR information, making them vulnerable to contracting HIV.

UNFPA hosted a session to raise awareness of the need for increased access to HIV and AIDS prevention, as well as SRHR services, and looked at interventions for those with disabilities. The gaps between access, implementation of national policies and global strategies are evident in many Africa countries.

Brown Niyonsaba, a youth volunteer with VSO in Rwanda, uses her deafness as a point of entry to encourage other young people to access SRHR services.

“We train peer educators to go into the community to talk to young people about SRHR,” Ms. Niyonsaba said. “We train community health workers on HIV prevention and STIs among deaf people.” Through sensitization, people with disabilities are empowered to make better health choices for themselves and their partners.

If HIV is to end in Africa, no one must be left behind. A combination of domestication of strategies and guidelines, community engagement and a skilled health care workforce are frontline interventions that UNFPA and its partners must employ across the continent. UNFPA is conducting studies at country, regional and global level to guide policies and programming.

UNFPA’s global guidelines offer practical guidance on gender-based violence and SRHR services that give full effect to the rights of women and young people with disabilities.

“UNFPA’s global guidelines offer practical guidance on gender-based violence and SRHR services that give full effect to the rights of women and young people with disabilities,” said Maria Bakaroudis, Comprehensive Sexuality Education Specialist and Disability Focal Person for UNFPA East and Southern Africa. In her recommendations, she advocated for the development of costed national plans, policy analysis, research, reporting and programmatic implementation.

The untapped power of young people as change agents

UNFPA Regional Director for West and Central Africa Region, Mabingue Ngom, met with youth leaders about themes, discussions, challenges, solutions and lessons learnt that have emerged at ICASA.

Young people should be put first, he said. “Not a step without young people – this is something that should be internalized, and should be part of our DNA.”

Regarding the gaps in rural areas, where young people often don’t have access to SRH information and services like those in the cities, and where youth programmes reach young people in urban areas only, he urged the youth representatives to ensure their organizations invest in decentralized structures so that that young people in every part of their countries are included.

Youth were well represented at the Nairobi Summit in Kenya in November. “We should learn from that model. Every single initiative, every single movement, [we should] make sure we bring young people.”

Ruth Chavula, a youth representative from Malawi, raised the issue of commitments: “We should stop adding more commitments and start implementing what is already there. Young people need to be courageous and push institutions to implement what they committed to,” said.

Muleta Kapatiso, representing AfriYAN Zambia, urged for the inclusion of young people who have been forgotten. “There are young people in correction centres and prisons who have no access to HIV or SRHR information. We all tend to forget them. We should do our best to engage more young people.”

- Cleopatra Okumu and Marie France Uwase Ntaganira