What were you more afraid of when you were a teenager: getting pregnant or getting HIV? Your response to the question obviously depends on when you were born, since only we children of the 1970s and beyond have faced a choice between the two. For my mom's generation, unwanted pregnancy was the fear of fears—abortion was illegal, and getting pregnant and/or having a baby in your teens was even more stigmatized than it is today. These days, folks don't exactly make life easy for pregnant and/or parenting adolescent girls—just last week, for example, the NY Department of Education announced plans to shut down all four schools that serve pregnant teens in New York City (contact the awesome Bronx-based Sistas on the Rise for more info). But for me and my girlfriends in high school, HIV trumped pregnancy by a long shot. In a just-post-Reagan and just-pre-access-to-ARVs world, HIV felt like a death sentence. As for pregnancy, it didn't exactly sound like a walk in the park, but I had no intention of becoming a mother, and I knew how to get a safe, legal abortion if I needed one. Luckily, thanks to comprehensive sexuality education, none of it became an issue, since I knew how to protect myself against both pregnancy and HIV. I wish I could say the same for many adolescents growing up in the United States today (soon to be even more thanks to the worthless, worthless, worthless Democratic "leadership").
But what about girls growing up in places where information is scarce, and risks—in terms of both pregnancy and HIV—are even steeper? A recent study conducted by the Family Planning Association of Tanzania (UMATI) in Tanzania's Arumeru District offers a fascinating glimpse into the fears that structure young people's lives and decisions in a country where abortion is only legal if a woman's life is in danger, and where (according to UNFPA) 1,500 women die from pregnancy- and childbirth-related causes for every 100,000 live births (compared to 12 per 100,000 in the United States), about a quarter of women have their first child between the ages of 15 and 19, and 8.8% of 15- to 49-year-olds are living with HIV/AIDS. UMATI's study, which was conducted with nearly 400 adolescents in Arumeru, showed that unwanted pregnancy—not HIV—is the "most scary" thing both girls and boys face. Specifically, the study found that:
- 38% of girls expressed terror at getting pregnant, and 37% of boys expressed terror at getting a girl pregnant.
- 46% of young women who were interviewed said they already had a child/children. On average, young women had their first child at the age of 18, with several girls reporting that they had had their first child before they turned 16. About 49% of young men said that they had gotten someone pregnant.
- 16% of young people had their first sexual intercourse at the age of 14 or below. 11% of girls and 14% of boys had had more than three sexual partners in the previous six months; 10% of girls and about 12% of boys had had three; and at least 21% of girls and 24% of boys had had two.
- The young people surveyed rarely used condoms. Instead, to avoid pregnancy girls commonly drank a compound of Sodium Bicarbonate mixed with water after sex—often at the urging of their male partners. Many reported drinking a substantial amount, just "to be sure." In large doses, Sodium Bicarbonate can cause congestive heart failure.
- Many of the young people interviewed (both girls and boys) had experienced some form of sexual violence.
The study reveals many things we already know about adolescent sexual health, women's reproductive health, and HIV/AIDS: first, young people are sexually active, and not always on their own terms. Second, unprotected sex is the norm, and as a result, pregnancy is common. Third, accurate information is scarce, and misinformation abounds. And fourth, risk perception (at least of HIV) is low. In a country where 15- to 24-year-old girls face HIV prevalence rates 2 to 3 times higher than their male counterparts, it is distressing that girls did not consider HIV a major risk. Then again, it's understandable that pregnancy would be a more immediate fear for them, especially in a place (among many) where pregnancy can be so fatal.
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In a landscape like this, integrating accurate, comprehensive reproductive health information and services with accurate, comprehensive information and services on HIV seems like a no-brainer. People don't face issues in isolation: they live them all at once, together with all of the other challenges, concerns, and desires that structure their daily lives and decisions. So why not take advantage of the opportunity to give people access to information and support that reflects the holistic way they experience their lives? Plenty of others agree—including several hundred civil society organizations from around the world who called for the integration of reproductive health and HIV/AIDS services (among other things) in their 2006 Compact to End HIV/AIDS, presented at a 2006 UN meeting. Given these realities, why is the Bush administration obsessed with efficiently integrating its efforts to "combat trafficking and prostitution" with its efforts to "end HIV/AIDS," but couldn't care less about merging efforts to promote reproductive health and address HIV/AIDS? Oops, sorry. Stupid question.