In her budget vote speech delivered on 15 March Eastern Cape Health MEC Nomakhosazana Meth expressed concern over the number of teenage pregnancies in the province. She called on young people to abstain from sex until they are at least 21 years old.

But  some health activists in the province believe a more comprehensive intervention is needed and are calling for a strategic plan to combat the high number of teenage pregnancies and HIV infections in young people.  

According to Wongeka Xatasi, chairperson of the Eastern Cape AIDS Council Women’s Sector, there are huge gaps in the province’s existing sexual and reproductive healthcare services and interventions for vulnerable age groups. 

Xatasi says some teen pregnancies occur because there is no convincing plan to make contraception and other pregnancy prevention strategies available to adolescents. This, she says, was evident during the Covid-19 lockdown when some teenagers said it was difficult to access contraceptives.

She says that children are told to use contraceptives to avoid pregnancy but might not be able to access them, or might not be informed about how the different contraceptives work and affect the body. She adds that among the teenagers who fall pregnant are 12-year-olds who don’t know about condoms or using contraceptives.

“Some teenagers do want to take these prevention methods but they are not accessible to them due to a lack of clinics. In order for these children to be able to access this prevention, the department needs to work hand in glove with the NGOs,” she says. 

She also says there is a need for an improved programme to provide pre-exposure prophylaxis (PrEP), especially in rural areas where people struggle to access healthcare facilities. PrEP refers to medicines taken to prevent HIV infection. Currently the only form of PrEP available in the public sector in South Africa is a pill (taken daily) containing the antiretroviral drugs tenofovir and emtricitabine.

Several young people interviewed by Spotlight say they need better education campaigns and youth-friendly healthcare facilities to raise awareness about sexual health.

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Healthcare facilities are unpleasant places for teenagers to visit

Sivenathi Ngcalwana (16) says “it is easy to access condoms, contraceptives, and PrEP at Nelson Mandela Bay clinics, but in some cases, healthcare workers mistreat us by asking embarrassing questions. This makes young people feel neglected and makes healthcare facilities unpleasant places to visit.” 

When asked about HIV prevention methods, Thubakethu Windvoel says “condoms are the only HIV prevention method I know.” He adds that talking about HIV and sex with his parents remains a taboo and he only talks about it freely with his friends.

“I believe access to proper information about prevention remains the biggest barrier for us to access these services and protect ourselves against HIV and teenage pregnancy,” he says. “I don’t know anything about contraceptives and how they work. Some people say they ruin female wombs. Education campaigns are needed to address these beliefs and misinformation as it becomes difficult to go and take something that you are not well educated about.”

Sinazo Zitokoza (16) of Nelson Mandela Bay said the prevention methods she knew about were condoms, contraceptives, abstaining and PrEP.  

“Sometimes there is a mobile clinic that goes around, and in some cases, it stops outside school premises or on the sports fields where we play netball, where they educate us about the benefits of using PrEP. We are given available options to protect ourselves against HIV and getting pregnant,” she says. 

“We do have school-based interventions,” she says “but I feel and believe that we still need to be provided with adequate sexual education. We don’t have enough knowledge about HIV prevention because of the clinics that operate inconveniently.” She explains that by inconveniently she means that there is often not enough time to go to the clinic after school.  

Eastern Cape AIDS Council Civil Society advocates for a sexual awareness campaign in schools

The provincial secretary for the Eastern Cape AIDS Council Civil Society Youth Forum, Phumlani Ngceza says there are ongoing interventions in the province supported by international donors that aim to educate young people and prevent new HIV infections. 

“These prevention programmes are addressing the issue of HIV and access to prevention services. It is mostly implemented in Alfred Nzo, OR Tambo, Buffalo City Metro, Amathole, and Nelson Mandela Bay districts,” Ngceza says. 

“We are also advocating for a comprehensive sexual awareness campaign in schools as a means of preventing the spreading of HIV and teenage pregnancies. We want young people to be equipped with information that has to do with prevention. The department really needs to make condoms accessible and roll out Prep to all public clinics.

“The other pressing matter is the promotion of the youth zone or happy hour in health facilities for young people. This might promote access and consistent use of contraceptives and other prevention methods for the youth. There is still a need to be more engaging with young people on the use of condoms. In rural areas, in most cases, condoms and contraceptives are only available in clinics and people have to travel long distances to get them,” Ngceza says. 

Stigma and discrimination are barriers to teenagers accessing contraception

According to Treatment Action Campaign (TAC) Research Officer Makhosazana Mkhatshwa, most young people know they can access prevention tools at public clinics, but barriers such as stigma and discrimination keep them from using those services, leading to poor knowledge about condoms, PrEP, and PEP [Post-exposure Prophylaxis]. PEP involves giving someone antiretroviral medicines shortly after a potential HIV exposure to prevent HIV infection. 

“We are not happy with the uptake of HIV prevention tools by young people, particularly adolescent girls and young women. New HIV infections remain high among adolescent girls in the province,” she says.

According to the Thembisa model, the leading mathematical model of HIV in South Africa, there were an estimated 7,659 new HIV infections among girls aged 15 to 24 in the Eastern Cape in 2020.

‘Myths and misinformation’

“The hiring of younger nurses in the youth zones and youth-friendly healthcare facilities could be beneficial in encouraging young people to use these services. Outreach programmes targeting the youth should be expanded in communities to reach both in-school and out-of-school youth,” says Mkhatshwa.

“Due to a lack of adequate sex education in our community settings, we ended up believing myths and misinformation about sex and HIV,” says a young man who has been living with HIV since last year and who chooses not to be named. “Most of my peers don’t know about the benefits of condoms, how to use them correctly, and how to negotiate condom use in their relationships.  

“Some young people are still in denial about HIV and believe that if they are dating, their peers are not at risk, not knowing that some of them were born with HIV. They believe the risk is only when they are in a relationship with an older partner. These problems underline the need for clear, ongoing public HIV-awareness campaigns and education to prevent poor decision-making,” he says.

Provincial Health Department’s plans 

The provincial Health Department acknowledged receipt of Spotlight’s requests for media comment on these issues but did not respond by the time of publication. However, in her budget vote speech Meth gave an outline of their approach to addressing teenage pregnancies. 

“The Departments of Health, Education, and Social Development have signed a Memorandum of Understanding to improve the coordination of services provided to our youth,” she says. “Working with these departments, we successfully launched the renewed Integrated School Health Programme (ISHP) at ET Thabane Primary School in Ugie last year.” 

Meth says the department has contracted 112 enrolled nurses and 82 professional nurses to provide the ISHP through a ward-based outreach approach.

Clinics with Youth Zones are being established

According to her, all primary healthcare facilities are promoting adolescent and youth-friendly services. “Clinics with Youth Zones are being established after the programme was launched in December 2021 in Whittlesea during the commemoration of World AIDS Day. Such clinics have a dedicated room and nurse for sexual reproductive health services aimed at the youth,” she says. 

“The United Nations Population Fund is currently supporting OR Tambo and Alfred Nzo districts, as they have a high delivery rate among children aged 10 to 14 years. This is done in collaboration with the Department of Education,” she adds. 

9,396 girls aged 15 to 19 gave birth in Eastern Cape health facilities in 2020/21

Citing figures from StatsSA, Meth says 34,587 teenagers gave birth in the 2020/21 financial year, of which 319 were children aged between 10 and 14 years. A total of 9,396 girls aged 15 to 19 years gave birth at Eastern Cape health facilities. 

Reflecting on HIV prevalence and treatment, Meth says there are 559,063 people living with HIV in the province who are on antiretroviral treatment. She says the number of children who remained on ART “improved significantly from 25% to 75% [since the previous financial year] while the number of adults who remained on ART also improved from 38% to 62,5%”. (Spotlight has been unable to verify these figures.) 

According to Meth, the province has now allocated R1-billion from the HIV conditional grant to “ensure that 90% of clients who are currently on treatment are retained in care, tracking and tracing those that have defaulted treatment, as well as initiate 68,000 new patients on ART”.

Note: A representative from the TAC is quoted in this article. Spotlight is published by SECTION27 and the TAC, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council. DM/MC

This article was published by Spotlight — health journalism in the public interest.