Why I'm Investing in Women and Girls, with Condoms
While traveling through the shantytowns of Uganda as a photojournalist, I met Josephine. Next to makeshift homes of corrugated metal, she lived in a dark and cool room that she shared with her siblings. It consisted of a mat and a torn magazine page of Beyoncé in a backless shimmering diamond top.
Josephine had thick brows that naturally furrowed and expressed a sort of outward fearlessness. Around her neck was a rusting necklace with a heart-shaped pendant that matched her skin almost perfectly. Though she didn't know her birth date, she told people she was 17. Josephine was the eldest of three children who were orphaned when their mother died of AIDS and had taken care of her family ever since by selling snacks like roasted corn on street corners.
Five months ago from the time I had met her, she found herself unable to afford her younger sister’s school uniform. A well-dressed man offered her 3,000 shillings ($1.15 USD) in exchange for sex. She thought of her sister, and like many women in developing countries, was aware that an education could ensure a brighter future for her. She took the deal. Unable to rely on a local clinic that only occasionally carried free condoms, and unable to afford the market cost of a condom on her own, she had unprotected sex. The well-dressed man did not seem concerned.
Josephine was stoic as she told me she was pregnant and feared checking her HIV status.
I have worked for the Red Cross and the United Nations documenting earthquakes, tsunamis, hurricanes, fires and floods — and many other forms of natural and man-made humanitarian crisis. Photographing the effects of HIV/AIDS on women and girls was different. Today, the number one killer of women aged 15 to 44-years-old is sexually transmitted HIV. The number two killer: Maternal death. Meanwhile, arguably the most basic form of contraception and HIV protection is not being made available to women. I was shocked — not by the enormity of the numbers (AIDS has killed more people in Africa than all the wars, famines, floods and deadly diseases on the continent combined), and not by the fact that women and girls are increasingly becoming the face of the epidemic, but by the reality that this disaster, unlike others I have photographed, is preventable. Josephine’s story, and the story of many girls and women who lack access to condoms, changed the course of my work.
It’s fair to ask: if made widely available in poor countries, would condoms even be used? Frankly, there is some truth to this concern. It’s my take that we can’t afford to not make the most effective tool of prevention available to everyone. At our current rate, we’re not even close. The barriers to condom use are varied and differ from region to region. There is not one AIDS epidemic in Africa, there are hundreds. I suggest we support the organizations on the ground who are dedicated to offering condoms as part of comprehensive family planning programming. Let’s give these groups the tools they need to close the gap in condom availability.
Ninety percent of countries in Africa with high HIV/AIDS prevalence rates face condom stock-outs, but it is women and girls who disproportionately suffer the effects. It’s increasingly becoming a point of agreement that investing in women and girls is the most effective way to fight global poverty and extremism, yet too often we’re excluding reproductive rights and sexual health from the agenda. Will we provide women with the tools to be safe, to stay in school, to decide when and how many children they want, to lead healthy productive lives—or will we shame them?
The good news is:
Development organizations have created integrated approaches to stop the cycle of HIV transmission and empower women globally. Some examples of scalable models of community healthcare include bringing services to the doorsteps of underserved communities through peer-to-peer education, providing women with micro-credit, and training them as healthcare providers who later sell health products below market cost. Many of these programs integrate a way for women to make a living wage so they not only assist in the process of increasing access to basic healthcare, but enable participants to become breadwinners in their own communities—ultimately giving women more say in key decisions such as those surrounding safe sex.