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Crisis Report - Issue 237
Crisis in Zimbabwe Coalition
November 12
, 2013

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STIs in Tertiary Learning Institutions, SAYWHAT Speaks Out

Following recent media reports claiming that there has been an outbreak of Sexually Transmitted Infections (STIs) in colleges such as the Great Zimbabwe State University (GZU), the Crisis Report (CR) interviewed Jimmy Wilford, Director of SAY-WHAT a non-governmental organisation that deals with sexual health matters among students. Wilford, below, speaks at length about this issue.

Question: Do the recent media reports pointing to an outbreak of STIs among tertiary students ring a bell, or confirm any trends that you have noticed in students’ sexual health matters in the past?

Answer: The recent media trends that have sighted an increase in the number of STIs both new and repeat cases amongst tertiary institutions are a cause of concern to SAYWHAT. Unfortunately, most of the media cases have not pin pointed in figures an increase in the number of STIs at college clinics which information was going to be critical to give a more reflective analysis on the prevalence of STIs amongst college students in Zimbabwe. The cases that were reported in two local papers the Herald and the Standard with a particular example of 10 000 cases of STIs over a period of 3 months gave a more quantitative reflection. However they failed to relate the figures to either the college clinics or the times when the colleges are open to students. The same story goes on to say most affected districts were Chiredzi and Gutu and these do not host any tertiary institutions of note. It is even more difficult to make a sound conclusion when most of these Universities do not house students on campus. It makes it difficult to track and attribute any trends noted to a specific college as data collected at clinic level (T5 forms) does not require the client to indicate their profession, but age and weight, amongst other personal indicators. Although this data is relevant in directly tracking the number of unprotected sexual contacts as well as other spill over effects like unplanned pregnancy, it falls short in giving comprehensive analysis on the state of STIs amongst college students.

Question: From your assessment, how able has been the Zimbabwean government in dealing with student health matters in general and sexual education for tertiary institutions in particular?

Answer: To start with, college clinics are not under the custody of the Ministry of Health and Child Care, but under the Minis-try of Higher and Tertiary Education, where respective colleges are left with responsibilities to select and recruit nurses as well as the procurement of other essential drugs. This kind of arrangement makes it difficult for college clinics to provide essential drugs that treat SRH related cases as most of them are not certified to provide such. For example, some University or college clinics do not test for HIV, a procedure that can be done by a primary care nurse in a clinic that is outside campus. Sexuality education is differently tackled by different colleges with some only limited to HIV, a situation which makes it difficult to enhance the capacity of students to make informed choices. At national policy level, there are no clear guidelines on how sexuality education will be imparted to student trainees as part of their social development, a situation that has resulted in some colleges, using lecturers who are not trained in a sexual and reproductive health field to conduct these lectures with student trainees. Most colleges are operating with limited government support hence all the operational costs are being derived from the fees paid by students, and with such a scenario very little in terms of budget allocation trickles the way of social development of students were SRH related programs are supposed to be funded, thus competing with other social development is-sues like sport and entertainment. From the general assessment of SAYWHAT, there is greater unmet need to be fulfilled by government to ensure comprehensive sexuality education as well as the provision of youth friendly SRH services, which might go a long way in the primary prevention of reproductive health challenges like STIs, unplanned pregnancies, and unsafe abortions amongst others.

Question: What do you think would cause STI outbreaks in tertiary learning institutions if the recent media reports were accurate, and do you believe poverty is one of them?

Answer: STIs might probably be a symptom of other underlining political and socio-economic factors, which if not addressed will continue having these symptomatic challenges resurfacing. The past immediate budget for example allocated to health only 9% of the 15% required by the Abuja Declaration, and this will directly have a bearing on the amount that will trickle to support SRH services and related information, knowing fully well that 70-75% of funds allocated to ministries will be gobbled by salaries and allowances. Sexuality education by nature is a social expression of a biological drive and heavily depends on society’s preparedness to tackle some of these SRH challenges as they emerge. The inability by most portions of our society reflects as STIs at college level, simply because the young people were not developed to be assertive and resilient in the face of a wide range of challenges, including those of a sexual and reproductive health nature. It will be incomplete to associate poverty with the increase in the number of STIs, but there are so many other factors that deal with the software development of the students. For example, sexuality education at f.amily level, which needs very little money, but only the accurate information, correct attitude and sparing some time to remember that family time is talking time. Poverty at a macro level affects the ability of government to tackle preventable health related problems, and at a micro level affects the families’ ability to access quality services on SRH. For example, Zimbabwe today has the highest maternal mortality rates i.e. 960 per every 100 000 live births due to the high cost of maternity fees, leaving most families with no option, but to have home deliveries. Early marriages that force teenage females to resort to marriage as a way of dodging poverty related challenges has resulted in more SRH challenges that are even more fatal than the STI cases. For example, 30% of all maternal deaths are amongst teenagers in Zimbabwe. Reflecting on tertiary institutions, most risky behaviours are fuelled by the vicious cycle of poverty as students will be trying to meet the high costs of living on campus, which includes tuition fees, accommodation costs, food, transport and clothing, which in their own regard are basic needs not wants, and in the fullest rights, and not privileges. The symptom that we will all observe by not fulfilling these rights is the high cases of STIs as reflected by media reports.

Question: How has SAYWHAT been filling the gaps in sexual health education for university students?

Answer: SAYWHAT has employed a three pronged approach as defined by its strategic plan of 2009-2013. Firstly, SAYWHAT has been conducting activities and initiatives that seek to generate and share information on sexual and reproductive health rights, services and commodities. Secondly, SAYWHAT has been the rallying factor in networking and advocating for the rights of students on all matters to do with their sexual and reproductive health rights. Lastly, SAYWHAT has provided support and developed the capacity of students to meaningfully mobilise their communities at all levels and challenge SRH related issues, targeting young people in Zimbabwe.

Question: What are your recommendations for other stakeholders, including government in dealing with such problems of potential STI outbreaks in universities?

Answer: SAYWHAT recommends inter-ministerial dialogue and responses to ensure effective co-ordination and implementation of all blue prints, targeting young people by line ministries e.g. Ministry of Youth Development, Indigenisation and Employment Creation, Ministry of Higher and Tertiary Education, Ministry of Health and Child Care, Ministry of Primary and Secondary Education et cetera. SAYWHAT recommends increased efforts by government to address under-lying causes of SRH challenges such as youth unemployment, addressing students’ grants and scaling up of the health budget. SAYWHAT recommends the meaningful participation of young people in the designing, implementation, budgeting as well as monitoring and evaluation of initiatives targeting them. SAYWHAT recommends evidence based responses by both government and stake-holders as youth needs are dynamic especially with regards to SRH. SAYWHAT recommends a more defined curriculum as part of social development that provides age appropriate sexuality education, services and information, targeting young people from primary to tertiary institutions, including youths out of school. SAYWHAT recommends the capacity building of strategic government institutions (in service and pre service) that deal with young people on youth friendly service provision. SAY-WHAT recommends tailor made programs, targeting key populations among young people such as adolescents living with HIV, youths living with disabilities, orphans, youths in rural and resettled areas as well as youths in learning institutions – colleges, police, army et cetera.

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