If there is one notion that has proven to be unrealistic, and is posing a huge risk to everyone, including those who champion it, it is the abstinence-only approach to management of HIV and other Sexually Transmitted Infections (STIs) among adolescents.
It has already backfired in view of the constant rise in teen pregnancies in the country over the years — from 17,337 in 2017 to estimated 23,000 last year, as per official data.
Even more concerning is the fact that HIV has ranked second leading cause of deaths recorded among the youth and adults (aged 15-59) in 2021, after Covid-19.
This is according the 2021 Rwanda Vital Statistics Report released last month by the National Institute of Statistics (NISR).
However, some parents, educationists and religious groups are adamant to adjust the approach to adolescents and sex education from the longstanding abstinence only notion.
Most possibly think the approach is working since sexual activity rarely takes place in the open. But they are wrong, and there is overwhelming evidence to suggest that the approach has failed big time.
Data by sexual and reproductive health activists and organisations like AIDS Healthcare Foundation (AHF) are indicating that between 14 to 27 per cent of the teens have sexual initiation by age of 18.
In fact, it has emerged that teens start engaging in sex at as young as 15, yet they face legal, cultural, and religious limitations that bar them from accessing vital information about sexual health and services that keep them safe.
Research have indicated that teens start engaging in sex at as young as 15, yet they face legal, cultural, and religious limitations that bar them from accessing vital information about sexual health and services that keep them safe.
No to condoms, sexuality education
To begin with, government adopted the comprehensive sexuality education (CSE) in the curriculum but very few schools, if any, genuinely implement it.
Sexual and reproductive health activists say majority of school facilities (over 60 per cent) are fully owned by faith-based organizations or the catholic church while others are run under partnership with government.
So for these religious groups they cannot fathom out an approach to adolescent sex education other than abstinence in their jurisdiction. This, activists say, explains exactly why even the longstanding push to avail condoms in schools hit a wall.
The church, just like conservative parents and educationists, are still worried that talking openly to adolescents about sex and giving them access to tools and services that protect them would be synonymous with encouraging them to indulge in sexual intercourse.
Their position has not changed even in the face of rising rates of teen pregnancies, a clear evidence that already these adolescents are having sex, and could be sourcing sexual health information informally from sources no one ensures are credible and reliable.
Age restrictions
Secondly, there are still age restrictions when it comes to access to things like condoms, screening and treatment for STIs that potentially expose minors who are sexually active to these infections.
Existing regulations require medical professionals who provide healthcare services to teens under 18 years to seek prior consent from their parents or guardians.
This makes it hard because adolescent girls and boys looking for condoms, screening, or treatment in case they contract STIs would try all they can to ensure that none, let alone parents or guardians, get to know about it.
The above legal, cultural and religious restrictions imply efforts to fight HIV and others STIs definitely exclude a section of at-risk sexually active population.
This has sexual and reproductive health activists worried because thousands of sexually active teens are ill-equipped about sexual and reproductive health information, thereby are unable to engage in safe sex and seek care services amid spread of HIV and other STIs.
Athanase Rukundo of Health Development Initiative (HDI), a local non-governmental organization that advocates for improved quality and access to healthcare, says they have got to devise ways to circumvent the limitations in a bid to reach out to the teens, and in most instances it hasn’t been easy.
The organisation expects faith-based organisations to change position with time, “just like it took the church over 100 years to embrace that C-section be performed on women giving birth, and a lot more years to accept organ transplant in their health facilities.”
Mr. Rukundo was speaking at a recently concluded journalists’ training on the coverage of STIs organised by the Rwanda Journalists for Sustainable Development (RJSD) and partners.
He, however, says that evidence suggest that there is urgent need to act differently because preaching abstinence only has not worked.