Removing Gender-Related Barriers in the access of HIV Services in Mozambique

Training of Community, Traditional and Religious Leaders to enhance community engagement and response to gender norms and harmful practices in Chongoene, Gaza

28 July - UN Women Mozambique, in close collaboration with the District Services for Health, Women and Social Action (SDSMAS), and Civil Society Organizations AREPACHO and FONGA, conducted a skills-building session for community, traditional and religious leaders in the district of Chongoene, Gaza Province, Mozambique.

Gender inequality contributes to the spread of HIV, increasing disproportionately infection rates, and reducing the ability of women and adolescent girls to cope with the epidemic at the community level. Adolescent girls and young women face barriers to the negotiation of safer sex because of unequal power dynamics with men.

The overall objective of the session was to renew the commitment of local leaders and enhance their knowledge to ensure community engagement and response to negative gender norms and harmful practices to remove gender-related barriers to accessing HIV services.

Mozambique is among the 10 highest affected countries in the world. The gendered trends of the epidemic are concerning as evidenced. According to 2020 UNAIDS estimates, in every hour 3 adolescent girls and young women, aged 15 to 24 years old, are infected by HIV, whereas 1 adolescent boy or young man is infected. every 20 minutes, an adolescent girl, and young woman is infected by HIV in Mozambique. 2.1 million people live with HIV, of which 63% are women and adolescent girls. Adolescent girls and young women in the age group of 15 to 24 years old represent 30% of all new HIV infections in the country, despite forming only 10% of the country’s total population. The Province of Gaza registers the highest HIV prevalence, at 24.1% against the 11.5% national prevalence. (UNAIDS Spectrum Estimates, 2021)

The training session took place at a crucial time, in the context of the national campaign "Somos Iguais" (We Are All Equal), launched by the Mozambican Government to fight discrimination against people living with HIV and AIDS, and increase the uptake of testing and treatment, particularly among men.

Sessions in the training fostered participant discussions concerning prevailing negative socio-cultural norms that are hindering progress towards full access of HIV services by women and adolescent girls. They also strengthened participants’ knowledge on gender dynamics in sexual relations, positive models of masculinity, and the importance of guaranteeing HIV services for young women and adolescent girls. 

As a result of the 3-day sessions, fifty local leaders, including 16 women, are better equipped to exercise gender-transformative leadership in their function as role models and key change agents in the governance of HIV and AIDS response systems.

The feedback from participants was positive and they have reiterated their commitment to tackle gender-based barriers to accessing health services in Chongoene.

Alda Ernesto Vilanculos, a Community Leader in Madoene Neighbourhood, reflects on the root causes of the increased vulnerability to HIV infection and limited access to services by young women and adolescent girls in Chongoene. Among them, she highlights intergenerational sex, as well as the economic dimension informing the choice and decision-making on sexual and reproductive health rights (SRHR).

"We are living in a country under absolute poverty. Even though we have health services, available information and free contraceptives, people still lack some of the most basic economic opportunities. Young girls who are economically disadvantaged and especially vulnerable engage in risky sex in order to gain access to material benefits."

Francisco Eugénio Mambo, a Community Leader in Machingane Neighbourhood, Chongoene points to migrant labour to the neighbouring South Africa as a key factor to be considered in the prevention of new infections.

"Unprotected sex is one of the key reasons why we have such high infection rates here in Gaza. Some young men who are working in neighboring South Africa engage in unprotected sex and contract the virus as a result. When they return, they engage in unprotected sex with their partners and end up infecting them as well, making our community even more vulnerable."

Dorca Francisco Langa, Social Activist and Coordinator at AREPACHO, assesses the impact of scattered population distribution, and the role of women’s movement in bringing forward transformative change in the accessibility of HIV services to the further left behind women and adolescent girls in rural areas, in alignment with the Global AIDS Strategy principle of Community-Centred Services (2021-2026).

"As Civil Society, we come in to support the existing health services, which are not always accessible to every person. We go door to door to mobilize and encourage people to test and adhere to the treatment. There are still a lot of stigmas, and many people end up abandoning the treatment. Making time to talk, explain and clarify people's concerns has been essential."

Tomás Felisberto Massingue, a Religious Leader and Pastor at the Zionist Pentecostal Church of Mozambique in Chongoene, shows concern with the high rate of new infections and reaffirms the instrumental role of religious leaders in closing the gaps that are preventing progress towards ending AIDS in Gaza. For that, he works closely with the health facilities in Chongoene, building synergies between health professionals and faith leaders as they contribute to the development of the same community. He is against any attempt by religious sects to prevent their members from accessing HIV treatment.

"The role of the church is to heal the soul. We work closely with the health services because we understand that their role is to heal the body. For this reason, I call on all religious leaders, to mobilize our congregations, and to ask the community to go to the health posts and take advantage of the HIV treatments."

Laura Albino Cossa, Pastor at the Igreja de Narazé (Church of Nazarene) in Chongoene, echoes the aforementioned sentiments on the impact of faith in promoting or preventing access to HIV services by community members. For her, the awareness on the complementarity between the spiritual life and beliefs, and the conventional health treatments is an essential factor that explains the frequent abandonment of HIV treatment.

She observes that most of the church goers, among them women and adolescent girls as the majority, understand that their HIV status and diagnosis requires immediate attention and support, and see existing health services as the appropriate place to secure it.

"It is common for men in our community to associate HIV with witchcraft. For this and other reasons, it's difficult to mobilize them to seek services at the hospital. Since women are more active church goers and believers, they tend to visit the hospital right away, which explains why women in our community adhere more to HIV treatment."