Adolescent Girls in Urban Ethiopia: Vulnerability and Opportunity

This 37-page baseline survey, published by Population Council, consists of interviews with over 1,000 out-of-school adolescent girls in low income and slum areas of Addis Ababa, Bahir Dar, and Gondar, Ethiopia. The survey seeks to broaden understanding of the experience of the poorest and most marginalised girls, focusing on individual as well as structural and social factors that may increase girls' vulnerability to HIV and other negative health outcomes. It serves as a baseline for HIV prevention programmes designed and implemented jointly by the Ministry of Youth and Sports, Regional Bureaus of Youth and Sports, and the Population Council.

According to the report, the majority (77%) of participants did not live with parents, largely because of migration, although some were orphans. Sixty-nine percent of respondents had worked for pay, whether cash or in-kind. Of these, most (72%) were in domestic work, followed by sales in a shop/kiosk, or restaurant/bar work (6% each). A few girls reported engaging in sex work. The research found that sex workers appeared to have more income and greater control of their income compared to girls in other professions, although they were more likely to report harassment at work and feeling their work could cause harm to their health.

Just over 20% of respondents were sexually experienced, with the majority initiating sex within marriage. Levels of coerced sex were high, and, for most girls, transactional sex involved feeling obliged to "pay back" gifts or favours from boys and men. Of married girls, divorce rates were high, with those who married early more likely to be divorced.

The research showed that respondents were highly knowledgeable about basic information related to HIV/AIDS; 91% knew that a healthy looking person can still be infected, and 87% knew that there is no cure for HIV/AIDS. Overall 40% knew someone who was sick with or had died of AIDS. Respondents also revealed the widespread stigma related to HIV/AIDS. Roughly 40% did not want to be in the same room with people living with HIV/AIDS (PLWHA), 39% would not allow their children to play with PLWHA, 38% would be afraid to take care of a family member with HIV/AIDS, and 34% would not like to spend time with friends who have HIV/AIDS.

Exposure to HIV prevention messages was relatively low: 52% of respondents had seen a television spot and 50% had heard a radio spot on HIV in the last year, while peer education had reached only 8%, and only 6% had visited a youth centre. Older and more educated respondents were significantly more likely to have been exposed to messages for all medium mentioned.

The study provided valuable direction for programmers interested in supporting adolescent girls. It highlighted that out-of-school adolescent girls are not only vulnerable, but also hard to reach. Mechanisms to reach this population may include going door-to-door to identify the most marginalised girls and negotiating with gatekeepers, such as guardians or employers, for their participation in a programme.

Explicit messaging is also needed on non-consensual and transactional sex. At the same time, messages must also address the risk of HIV transmission within marriage and promote condoms as an appropriate family planning and disease prevention method within marriage. Programmes should also address social and contextual factors that exacerbate girls' risk of negative reproductive health outcomes, including HIV infection.