Sexual health, sexual education and gender equality in Africa – A plea for more small-scale approaches

With a huge worldwide AIDS epidemic, still most serious in Africa, a thematic journal issue on sexual health should contain an article on sexual education to youngsters. Many will agree that ignorance of sexuality is dangerous for youngsters, who have to cope with pressures of falling in love, changes in their bodies, and finding a partner in the present-day African environment with an AIDS threat in the background.

Sexual education

A plea for more reflexion on the role of sexual education and gender equality in prevention activities should include more attention to the ‘quality’ of sexual education – both on what quality is and on how it can be best achieved. Even if it is agreed that meaningful prevention without sexual education is impossible, that means little if the quality thereof is not defined.

Possible changes in the AIDS situation in Africa are another reason to demand again more attention to sexual education.

At present it is widely accepted that visible AIDS has diminished, mainly due to the increased availability of Highly Active Anti Retroviral Therapy (HAART). But the arrival of HAART also led to a reduced feeling of urgency for the need of sexual education.

‘SEX’ REMAINS ONE OF THE MOST SENSITIVE SUBJECTS AND EVERYTHING RELATED TO IT IS DIFFICULT TO DISCUSS, MOST CERTAINLY SO IN AFRICA

PROMOTE GENDER EQUALITY AND EMPOWER WOMEN

That was a regrettable if perhaps unavoidable development and it may have to change. There are dark clouds on the horizon, due to uncertainty about the continuing availability of HAART caused by a combination of increasing resistance of HIV to treatment with a rise in costs and the worldwide financial crisis.

In a recent seminar in Amsterdam (AMC), specifically on this subject, some persisting alarm bells were sounded. The problems associated with lifelong daily treatment and in particular the ever-present problem of discontinuation of therapy by infected people, with its associated risk of resistance development, do not show signs of diminishing.

Strategy

HAART does not cure, and the number of People Living with HIV and AIDS (PLWHA) is still considerable in many countries. Therefore it will have to be considered, what will happen if HAART would be seriously interrupted because of these financial and/or resistance problems? No ‘worst case’ scenario is needed to demonstrate once more that prevention must remain a very, if not the most important strategy in the fight against AIDS. That means a return of the old problems around sexuality and sexual education. Most reports on sexual education still highlight the well-known problems: resistance of parents, unwillingness of teachers, unhelpful attitudes of most churches with their continuing emphasis on abstinence only, etc. Worldwide ‘sex’ remains one of the most sensitive subjects and everything related to it is difficult to discuss, most certainly so in Africa.

Small scale approach

In brochures and booklets on prevention, the emphasis in sexuality is often on promoting the use of condoms to the extent that sexuality appears to be reduced to either ‘don’t do it’ or ‘do it with a condom’. Obviously that does not do justice to this most important life issue for teenagers!

The addition of the issue of gender equality to both sexual education and AIDS prevention, further complicates what can be called an enormous clash between rationality and emotions. Rational arguments to protect against infection fight emotional feelings about ‘right’ and ‘wrong’ in behaviour. This is complicated by the notion of traditional (but often church stimulated) ‘African’ values against the ‘wicked West with its free sex and tolerance of homosexuality’. While a plea for ‘African values’ may in fact be more a plea to justify and maintain traditional male dominance in all things sexual, it has an appeal to many. And we have to realize that we know little about many aspects of the AIDS epidemic. Why no reports of increases in incidence in areas with massive upheavals due to war (sometimes with big increases in rape) or natural disasters? What are individuals and communities themselves doing to prevent infections? Are we not underestimating their own resourcefulness?

Such considerations must lead to a recognition of the potential of small-scale approaches, to be more flexible and create a better environment for finding innovative as well as locally acceptable solutions.

Many advantages

In three MT articles in 2009 and 2010, Miranda van Reeuwijk and Steven Smits stated separately, that a lack of understanding rather than insufficient knowledge, prevents youngsters to bring their knowledge into practice in their own lives. They made a plea for an ABC ‘Plus’ approach, where the ‘Plus’ stands for sexual education and gender equality. Based on their experience, they also stated, that sexual education should connect much more with the realities, experiences and perceptions of the youngsters themselves and should be provided in an environment, where youngsters feel free to discuss sexuality and gender equality among themselves. Another important goal should be to involve more parents in sexual education, by convincing them how important it is for their children if they really help them find their way. Sexual education by parents, if done rightly, avoids almost all of the problems associated with sexual education given by others. Smits reported on his successful discussions on sex and gender equality with traditional healers at the request of a Tanzanian NGO. The aim was to convince them of the need to assist parents to discuss sex with their children. To use peer educators is beneficial, provided also the limitations of this important concept are recognized!

Based on this and other experiences with NGOs in Cameroun, Tanzania and Kenya, Smits made a plea for more attention to such small-scale approaches. Support should preferably not only be financial, but should include technical advice for African NGOs, engaged in prevention activities for youngsters.

That, as stated above, while not a panacea for all problems, has the best potential for achieving accepted sexual education in the right environment and context. It provides more possibilities for a joint development of presentations on sexual education as well as tools and techniques to promote and facilitate discussions with and among youngsters.

Small-scale development activities with relatively small amounts of money have many advantages when compared with large programmes. This holds in particular for promoting changes in behaviour, both the most necessary and the most difficult issues in prevention. Results are often disappointing. But should that cause us to stop trying?

Could more readers come forward with their experiences with African NGOs on this subject?