On March 12, 2022, 12-year-old Akosua (not her real name) was sent on an errand by her mother in Nima, a suburb of Accra. On her way home, an unknown man believed to be in his 30s asked her to buy a recharge card for him, which she did.
Upon her return, he asked Akosua to get his phone from his room, and the moment she entered the room, he followed and raped her.
When Akosua’s mother, Madam Cecilia (not her real name), noticed that her daughter had been gone too long, she decided to look for her. After searching for a while, she saw her daughter come out of a room not far from where they live, and on interrogating Akosua, she narrated the ordeal.
They reported to the Police, but the man is still at large, and all efforts to bring the culprit to justice have yielded no results.
Madam Cecilia did not have money to take her daughter to the hospital for a medical checkup. Instead, she treated her daughter at home for four months by making her sit in hot water every morning to ‘repair the vaginal tears.’
“I am worried because, I do not know the extent of the damage or the HIV status of my daughter,” said Madam Cecilia.
Madam Cecilia is worried because sexual violence increases the risk of HIV infection in women and girls due to the abrasions caused by forced penetration, which aid the entry of the virus. UNAIDS notes that this is especially true for adolescent girls because their reproductive tracts are still not fully developed.
Moreover, a growing body of evidence suggests that gender-based violence increases the risk of HIV infection directly and indirectly. Researchers have reported that survivors of gender-based violence, particularly those who have survived repeated abuse, have a reduced sense of self-worth, which predisposes them to behaviour and practices associated with a high risk of HIV infection.
According to the World Health Organisation (WHO), one in four women experiences sexual violence by an intimate partner in her lifetime. In Ghana, a national survey conducted in 2015 found that one in three women had experienced sexual violence in their lifetime. The incidence of violence was higher among younger women and girls, with 38 per cent of teenage girls aged 15 to 19 reporting having experienced sexual violence.
While there is no data on the link between gender-based violence and HIV in Ghana, Dr Kyeremeh Atuahene, the Director-General of the Ghana AIDS Commission told the Ghana News Agency that it is an established fact that gender-based violence and intimate partner violence increase the risk of HIV infection in adolescents. However, he said that Ghana is yet to analyse the correlation between child marriage and abuse and HIV infections among girls.
“What we know is that a lot of adolescents are involved in casual sex, multiple concurrent sexual partners, transactional sex, commercial and sex, age mixing (Sugar Daddy and Sugar Mummy), which expose them to likely infection,” he said.
The references to sexual contact with adults, commercial sex, and transactional sex point to child sexual abuse, given that the age of consent in Ghana is 16 years. This abuse could be driving some HIV infections among adolescents.
Data on HIV published by UNICEF showed that adolescents and young people represent a growing share of people living with HIV worldwide. In 2020, 410,000 young people aged 10 to 24 were newly infected with HIV, of whom 160,000 were adolescents aged 10 to 19.
In Ghana, the National and Sub-national HIV and AIDS Estimates and Projections Report by the Ghana AIDS Commission (GAC) indicates that of the 18,928 new infections, a total of 5,211 were in the 15-24 age group, and 4,348 (83 per cent) of those infections were in girls. HIV prevalence in adolescents aged 15-19 years is 0.7 per cent (compared to the national prevalence of 1.7 per cent), while new HIV infections among youth aged 15-24 years account for nearly a third (28 per cent) of all new infections. Among children aged 0-14 years, new infections account for 15 per cent.
Gender-based violence is a significant driver of HIV/AIDS infections in women, which is why international organisations focus on eliminating violence against women and girls as key in the battle against the spread of the epidemic.
Mrs Mercy Acquah-Hayford, the National Coordinator of the International Network of Religious Leaders Living with or Personally Affected by HIV and AIDS (INERELA+Ghana) told the Ghana News Agency under the Journalists for Human Rights under the Mobilizing Media to Fighting COVID-19, that people do not understand the correlation between gender-based violence and disease because HIV/AIDS reports do not focus on it.
She observed that, for instance, during the lockdown to contain the COVID-19 pandemic, there were instances of child sexual abuse through transactional sex, where girls were exchanging sex for food and shelter, putting them at risk of HIV infection. She added that the culture of silence due to persistent stigma and discrimination makes matters worse. Even when there is free HIV testing, people do not go for testing, and teenage girls who are HIV-positive shy away from talking about it.
This culture of silence means that many cases of gender-based violence, teenage pregnancy, child marriage and other abusive practices often go unnoticed or unreported, yet they are associated with HIV infection among adolescent girls.
To remedy the situation, Mrs Acquah-Hayford recommended that the Ghana AIDS Commission work with the media to sensitize the public on HIV/AIDS and the factors, including gender-based violence, that lead to infection.
“INERALA+ Ghana is doing its part by educating the people, especially young girls, but more needs to be done,” she said.
Dr Stephen Ayisi Addo, the Programme Manager, National HIV/STIs Control Programme, stated that health authorities are no longer making noise about HIV, leading to public perception that it is no longer a problem.
He said that this lack of awareness and complacency was responsible for higher HIV prevalence and new infections among adolescents.
“Some youth today do not know anything about HIV. Some know, but they have assumed it is gone. People are now more afraid of COVID-19 and the Marburg fever than HIV/AIDS,” he said.
Preventive interventions, including interventions to deter gender-based violence, are important because HIV and AIDS are one of the world’s most substantial public health challenges. It is also one of the leading causes of death among adolescents (10-19 years) in Sub-Saharan Africa.
Moreover, young people living with HIV face psycho-social difficulties that have a bearing on their health and well-being. Some studies have established that youth living with HIV in Sub-Saharan Africa struggle with depression, low self-esteem, stigma, and social pressure.
While research focusing on the mental and psycho-social well-being of adolescents living with HIV is minimal, a 2020 report published by SAGE Journals indicates that a patient’s well-being is influenced by several factors including psycho-social and environmental factors, current health status, and response to treatment.