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Helping Girls Stay HIV-Free

By David Freedman

When it comes to educating children in less-developed countries about HIV prevention, it isn’t realistic to think they can go it alone in avoiding risky behavior, says Carol Underwood, PhD, assistant professor of Health, Behavior and Society

“Girls in particular often live in environments that aren’t conducive to safe behavior,” says Underwood, a senior research associate at the Center for Communication Programs.

In parts of Botswana, Malawi and Mozambique, girls are often pressured by authority figures to engage in “transactional sex”—sex for favors. Some teachers demand sex for passing grades, and some mothers send their girls out to “bring home dinner.” Such arrangements are often viewed as consensual. Laws and school regulations to the contrary are ignored.

“It’s important to place some of the responsibility [for HIV prevention in children] on the larger social structure,” says Underwood.

To do that, she and her CCP colleagues created a yearlong program for promoting HIV safety for girls in three regions. It emphasized community, school and parent involvement. The results were encouraging. “We ended up with both statistical and anecdotal evidence that the interventions took hold, and were making a difference in the girls’ lives,” she says.

“Girls in particular often live in environments that aren’t conducive to safe behavior… It’s important to place some of the responsibility on the larger social structure.” —Carol Underwood

The CCP program—called Go Girls!—worked with local schools to make sure teachers understood they could be fired or criminally prosecuted for having sex with students. The program also pressured families to stop pushing daughters into transactional sex and prevented girls from illegally entering the many bars where they are typically welcome. Go Girls! also established “mobilization groups” of community members who, in some cases, confronted adults taking advantage of girls. Underwood’s team also tried to connect adults and girls with local agencies that could provide financial assistance and job training.

To reach the children, Go Girls! assisted schools in weaving “life skills” like safe behavior, reproductive and relationship information into existing classes. It produced a radio show that featured local people telling personal stories that reinforced the program’s themes. And groups of parents were trained in listening and talking skills.

In Botswana, about 60 percent of participating schools reported a decrease in teachers offering favors for sex, compared to a decrease of 35 percent in non-program schools. And in Malawi, about 90 percent of the daughters of mothers who had participated reported improved relationships with their mothers, versus an improvement for half the girls whose mothers didn’t participate.

Though Go Girls! has ended, many of its school- and community-based elements have become self-sustaining.

Mary Ellen Duke, gender adviser for the U.S. Agency for International Development in Mozambique, credits that encouraging sign to the program’s community emphasis. “It engaged the community from the very beginning,” she says. ”That let local groups take ownership, instead of feeling that this was yet another project being imposed on them.”