PROJECT
HIV Prevention for Vulnerable Adolescent Girls

Marriage is a feature in the lives of many adolescent girls in Ethiopia. In Amhara region an estimated 46 percent of girls are married by age 15. Girls who marry are exposed to reproductive risks, experiencing sexual initiation earlier than unmarried girls as well as first births at a young age. Very early first births are associated with maternal risks, including fistula. Amhara also has among the highest rates of divorce in the world, with 17 percent of rural young women aged 15–24 currently divorced. Many girls migrate to urban centers because of the stigma of divorce, with anecdotal evidence suggesting that in order to survive they often become domestic workers, involving long hours and low pay or, as a last option, sex workers.

A number of factors may increase HIV risk among girls married at a young age in areas with high HIV prevalence. At marriage these girls make a transition from virginity or infrequent sex to a very high frequency of sex. The most common HIV-prevention strategies—abstinence and condom use—are not options for married adolescents, who are under tremendous pressure from family and society to bear children. Girls married young tend to have husbands who are much older than they. This age gap may further intensify the power imbalance between husbands and wives, discouraging the open communication required to ensure voluntary counseling and testing for HIV, the sharing of test results, and planning for safe sexual relations throughout marriage.

Few programs for adolescents reach this large group of girls, and very few programs have been implemented in rural areas of Ethiopia.

This project aims to delay sexual initiation by promoting social change, delaying marriage, and increasing awareness of the risks of HIV transmission, and sensitizing people to the negative health outcomes for married adolescent girls. The project also encourages couples to learn their HIV status before marriage through voluntary counseling and testing for HIV. In addition, the project aims to improve HIV and reproductive health knowledge among married and unmarried adolescent girls and their husbands and families.

The program is being undertaken in periurban areas of Amhara region and utilizes existing religious and community structures to reach adolescent girls and their husbands, families, and communities. Ethiopian Orthodox and Muslim religious leaders are trained to provide information to their congregations on early marriage, HIV, voluntary counseling and testing for HIV, prevention of mother-to-child transmission of HIV, safe motherhood, gender-based violence, and other reproductive health issues. More than 1,000 religious leaders in Amhara region have been trained so far and are providing information to their congregations.

Married adolescents are often missed by programs designed to reach married women with information about HIV infection. Married girls typically also have little education and no schooling options, limited control over resources, restricted mobility, and little or no power in their new households. Thus, they face significant challenges in negotiating safe sexual relations. This project is hosting the formation of clubs made up of married girls and headed by trained female mentors from the community. Girls are participating in a curriculum that includes HIV and reproductive health education and referrals, nonformal education (i.e., basic literacy and math), and livelihoods training. Over 16,000 married girls are participating in these clubs. In addition, community and religious leaders have been trained as educators and referral agents for voluntary counseling and testing for HIV and antiretroviral therapy. Community advocates promote premarital voluntary counseling and testing for HIV, educate community members on the availability of antiretroviral therapy, and refer those interested in premarital voluntary counseling and testing to existing centers using a coupon referral system.

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Location

Amhara region, Ethiopia

Duration

September 2006–ongoing

Population Council researchers

Annabel Erulkar, Tekle-Ab Mekbib, Elshaday Kifle, Abebaw Ferede

Non-Council collaborators

Ethiopian Orthodox Church

Ethiopian Muslim Development Agency

Ethiopia Ministry of Youth and Sport

Donors

President’s Emergency Plan for AIDS Relief

US Agency for International Development

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See Also

• Ethiopia
• Child Marriage
• Safe Spaces
• HIV and AIDS/Prevention
• HIV and AIDS/Youth

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