The Other Half

Babatunde Osotimehin is chairman of the National Action Committee on AIDS in Nigeria.
Op-Ed Contributor Published: August 19, 2005, New York Times

Abuja, Nigeria
THE world knows that Africans bear the brunt of the AIDS pandemic and that nearly two-thirds of the people infected with H.I.V. live here. The disease is devastating households and crippling economies across the continent. Though data show that girls and women are far more vulnerable to infection than men, we have yet to summon the courage and the political will to empower and protect them.

In Nigeria, and across sub-Saharan Africa and the Caribbean, epidemics are already feminized. For example, nearly 58 percent of Nigerians with H.I.V. are female. What's more, in virtually every region of the world, infections among girls and women are rising sharply.

Unless we urgently address this trend, we will fail to end this scourge. Recognizing the reality in their own countries, some national governments, including Nigeria's, have taken important steps to prevent infection in girls and women. It is critical that donor governments and agencies coordinate to support and encourage our efforts. Furthermore, our partners' policies must be in tandem with Africa's realities. Otherwise, they may endanger the very people they seek to protect.

For example, a major partner, the United States government, enthusiastically promotes abstinence until marriage as the main way for young people to avoid H.I.V. infection. Abstinence is one critical prevention strategy, but it cannot be the only one. Focusing on abstinence assumes young people can choose whether to have sex. For adolescent girls in Nigeria and in many other countries, this is an inaccurate assumption. Many girls fall prey to sexual violence and coercion. Many others are married off very young, as young as 13 or 14, long before they are psychologically or physically ready. Abstinence is not an option for these girls, nor is getting their partners to use condoms. It is unacceptable for a woman or girl to ask her partner to use one in our part of the world. In Nigeria, only 23 percent of the men and 8 percent of women use condoms regularly, and, as elsewhere, almost none of them use condoms with a spouse or primary partner.

In Nigeria, we are painfully aware that girls and women typically cannot negotiate when, where or with whom they have sex; that far too few have access to affordable health services; and that sex education is not available or accessible to many girls. When dealing with AIDS, we must address these realities and use a multipronged approach to improving education and health systems, one that can reach all of our people.

A crucial element of our national program is the Family Life and H.I.V.-AIDS Education Program, developed in partnership with community organizations that have years of experience working with the young people of Nigeria. In a country of more than 250 ethnicities, cultures and languages, the program is designed for adaptation according to the specific needs of each of the 37 Nigerian states.

The program runs from primary school through university and focuses on such core issues as self-esteem and the ways boys and girls relate to each other, while also providing factual information about their bodies, pregnancy and disease. Only by educating Nigerians at an early age and in a comprehensive way will we begin to end the patterns of violence and sexual coercion, early marriage, and unsafe sexual behavior. This approach can help young people to respect and protect each other and, eventually, to help their own children.

We are also aware that we must invest far more in comprehensive reproductive health services, including those that address problems of H.I.V., in order to reach the girls and women who are not likely to use separate H.I.V. services for fear of stigma and violence.

In addition to youth education and access to health services, we are investing in practical tools that women can use to protect themselves. For instance, we are working with the United Nations Population Fund to reintroduce the female condom in ways that will make it more acceptable and affordable. We also have research programs to examine the possibility of using microbicides in our communities.

Protecting women and girls from AIDS requires true and effective partnership with international donors who are willing to undertake honest, open dialogue about what works in each of our countries. It is vital that development partners not impose their ideological or political views as a condition of partnership. National governments must have the freedom to employ the very best strategies at our disposal to help our people.