Last year, while I was in Johannesburg and Cape Town to meet with women’s groups, I spoke with young South African women. They described the challenges they faced in public health clinics, where they had gone to seek contraceptives.

They would go to the reception desk of the health clinic, where a male security guard would ask them in a gruff tone why they were there. Many would run out at this point, scared and embarrassed. The braver (or older) ones would make it to the intake nurse, who typically asked, in a loud voice so that everyone could hear, “Are you engaging in relations? How old are you?” One of them, Millicent, was so intimidated that she lied to the nurse: “No, I just want information.” To which the nurse replied: “If you are not engaging in relations, you don’t need information.”

Millicent left. Three months later she was pregnant.

In a few days, South Africa will host the 16th International AIDS Conference in Durban. While the country has made astonishing progress in HIV treatment since the conference was last held there in 1992, HIV prevalence in adults aged 15-49 is still an appalling 19%. In particular, the number of new HIV infections in South African girls aged 15-19 remains alarmingly high. Nearly 2,000 girls and young women are newly infected every week in the country. By the time they reach age 20, young South African women are four times more likely to have contracted HIV than young men their age.

The reasons for this state of affairs are no secret. One-third of South African girls aged 15-19 have a sexual partner who is at least five years older than them, the so-called “blessers” or sugar daddies. The girls hope for love, attention, or protection, and need cash to pay for school fees, food, or other basics. The circumstances of these relationships are not fully under these girls’ control. Sexual violence is rampant in South Africa: 40% of girls aged 15-19 report at least one instance of sexual violence in the previous year. Teenage pregnancy is also very common: nearly 30% of adolescent girls report having been pregnant at least once. From love and transactional sex to sexual coercion to rape, from unwanted pregnancy to HIV infection, each story has its own twists, repeated hundreds of times a week all over the country. The common denominator is gender inequality and unequal power in sexual relationships.

To end the HIV epidemic in girls, two changes are urgently needed – in health clinics, and in schools.

South Africa remains a conservative, patriarchal society, where adolescent girls are not supposed to be sexually active or seek contraceptives, much less demand that their male partners use condoms. Girls are shamed by health providers when they come and seek advice and medical care in connection with their sexual activity.

The very places and people who are supposed to support these young women are failing them. The cycle needs to be disrupted if HIV is to end. South African clinics should welcome these young girls, not drive them away.

The health sector, however, cannot address this problem on its own, because its roots are not medical. South African schools must also step up, as this is where it is possible to reach young people on a mass scale to change social norms about masculinity and femininity, and associated misconceptions about dominance and submissiveness. The Ministry of Education should be urgently providing comprehensive sexuality education to all young people; that is, education that challenges harmful gender norms, addresses unequal power in sexual relationships, and provides girls and boys with the information and communication skills they need to navigate their sexual lives freely and safely.

Some may ask: South African schools are already failing, so why burden them with another task? Because comprehensive sexuality education has the potential to transform education itself. To be properly taught, comprehensive sexuality education requires teachers to be trained in participatory and interactive teaching methods, such as Socratic debates, role plays, and art. These approaches enrich all aspects of teaching, no matter the subject. Teachers must also examine and challenge their own, flawed notions of masculinity and femininity, thereby making classrooms more welcoming spaces for girls and boys alike. We’ve seen how effective such education can be; teachers in Nigeria who went through these programmes report a significant transformation in their own views, and a heightened sense of competence.

The impact of these programmes on curbing HIV transmission is impressive. A recent Population Council review of sexuality education programmes worldwide found that programmes that addressed gender and power were five times more effective at reducing HIV infection and unwanted pregnancy in young girls than programmes that did not. So why is the current national Life Orientation curriculum silent on these crucial topics, while investment in teacher training and support lags?

On June 27, the South African National AIDS Council (SANAC) launched its National Campaign for Young Women and Girls. Cyril Ramaphosa, Deputy President of South Africa and chair of SANAC, called out gender inequality as a key driver of the national AIDS epidemic and urged girls to assume leadership in schools and in society.

This is an important statement, and the campaign has several good features, including much needed investment in youth-friendly health services and support for girls to complete secondary school.

But it leaves out comprehensive sexuality education, a glaring gap. Without large-scale programmes to equip girls with the self-confidence and skills they urgently need – and to make schools truly girl-friendly – the root causes of HIV will not be addressed, and the South African HIV epidemic will rage on.

This is what we must tackle in Durban, for Millicent and the millions of girls and young women like her. DM

Photo: A woman walks past Aids awareness posters in Durban, South Africa, 01 December 2011. EPA/NIC BOTHMA