This article draws upon a comparative survey of young people’s vulnerability to HIV and primary research conducted in two wards of Dar es Salaam, Tanzania, by two Tanzanian organisations, Tamasha and Tanzania Development Research Group (TADREG), into the social and economic sources of vulnerability to HIV infection of adolescent girls and young women.
Two wards were chosen, Magomeni and Azimio, and in each ward, three neighbourhoods were selected: one relatively better off, one relatively worse off and one average. In each neighbourhood, after a participatory mapping, 200 households were given a household questionnaire, resulting in a household sample of 1,200. After the survey, focus group discussions were held with groups of 10–20 girls and young women aged 12–24 in each neighbourhood, and one further discussion was held with girls who had migrated into those neighbourhoods. Overall, more than 100 girls participated in these discussions, which were conducted by young researchers who were the peers of their subjects.
At its simplest, vulnerability can be defined as a likelihood of being harmed. In the case of vulnerability to HIV infection, this relates to the chances that an individual will be put – or put her/himself – in a dangerous situation (e.g. unprotected sexual intercourse, or intravenous drug use with shared or unclean injecting equipment), that this exposes her/him directly to the virus, and the risk that this hazardous contact will lead to HIV transmission (a product of biological and epidemiological factors). In addition, if a person becomes infected, there is a high likelihood that she/he will encounter further harm in several ways (physically, economically, socially, emotionally etc.), which is often thought of as vulnerability to the impacts of HIV or AIDS. This article focuses mainly on vulnerability to becoming infected.
Vulnerability is also often more broadly defined in terms of risk of social and economic adversity such as unemployment, homelessness, physical abuse, or impoverishment, which may stem from various sources of misfortune – including from HIV infection or, becoming affected by the impacts of AIDS-related mortality or morbidity. There is an overlap between these two uses of the term vulnerability to contracting HIV and to socioeconomic distress and deprivation of rights, which can in turn lead to risks of contracting HIV. Girls’ vulnerability is a combination of: higher biological susceptibility at younger ages, lack of individual decision-making power, sociocultural and economic gendered disadvantages that precipitate risk, as well as the extent to which existing policies and programmes do or do not protect adolescent girls and young women. These vulnerabilities and lack of protection are major contributors to the risks of contracting HIV.
However, it would be an error to assume that the two kinds of vulnerabilities always coincide or that one entirely explains the other. For example, we might assume that the risk of contracting HIV for a young migrant woman who has fled rural poverty and become a commercial sex worker in the capital city is significantly higher than the probability that a city-born secondary schoolgirl from a non-poor household becomes infected. But this assumption may be wrong in individual cases. The better off schoolgirl may be exposed to infection by being an unwitting member of a complex sexual network involving her sexual partner or partners. One of the major findings from the study in Dar es Salaam was that almost all adolescents face a risk of HIV.
This article comes from the IDS Bulletin 39.5 (2008) Adolescent Girls’ Vulnerability to HIV Infection in Dar es Salaam: The Need to Link Protection with Prevention Beyond Behaviour Change