Background
The fight against HIV/AIDs has come a long way and to sustain the positive gains the efforts put must be unrelenting. The war has been fought from different thematic facets which include campaigns against stigma towards the infected and affected, establishment of comprehensive care centers as a one stop shop for the PLWAS where they get all the services needed, campaigns to abstain and be faithful for those already in sexual relationships and championing of responsible sexual behavior through use condoms correctly and consistently.
Studies
Menarcheal age is the age at the onset of the first menstrual period, this event in the life of a girl has been surrounded by myths and misconceptions one of the being considered mature and ready to engage in sexual activity. Over the years studies have shown that the menarcheal age has decreased by at least 1-2 yrs in the last 5 decades from between the ages of 13-14 to 11-12 years. In the U.S. the average age at menarche dropped from 14 years in 1900(Chumlea et al. 2003) to 12.8 years Pinyerd and Zipf 2005). Average age at menarche in Israel has declined from 13 to 11 years (Chodick et al. 2005), from 14 to 12 years in Poland (Hulanicka and Waliszko 1991), in Scotland from 13.2 to 12.7 years (Okasha 2001) and, in Northern Europe, age at menarche is about three years earlier than it was 100 years ago (Parent et al. 2003) as stated by Meghan in study Trends in age at menarche, sexual debut, and oral contraceptive use among Swedish and Swedish Sámi women in 2010. The study show has been caused by climate change, instable status of the modern family, diet etc. In Kenya a study conducted in Nairobi, subjects being primary school girls age range (12-17) years. The mean menarcheal age was 12.5 ± 2.8 years with peak at 12–14 years. A substantial number of girls (10.8%) attained menarche before the age of 11 years, with 2% of them attaining it before 10 years. None attained menarche before nine or after 16 years.
Sexual debut is the initial sexual activity in this case and for purposes of understanding this paper is define as ‘the penis of the male entering the vagina of the female’. The age at sexual debut has been a critical indicator in the fight against HV/AIDS. This has been informed by studies showing the age at sexual debut when delayed could positively impact the on number of partners one engages sexually in their life time, “The age of sexual debut directly impacts the number of sexual partners an individual has over time. Young people who participate in first intercourse before age 14 are significantly more likely to have more lifetime sexual partners. Fifty seven percent of girls who initiate sex before age 14 report six or more lifetime partners, compared to 10 percent of girls who initiate sex at age 17 or older. Likewise, 74 percent of boys who initiate sex before age 14 report six or more lifetime partners compared to 10 percent of boys who initiate sex at age 17 or older”(IYD,1999).
There is minimal or no documented evidence indicating age at menarche as major determinant in the fight against HIV/AIDS. This has relegated the all important indicator to be quoted only in relation and reference to support sexual debut, but this aspect has been studied widely in western world and has helped in the prevention of STIs and use of contraceptives but not HIV/AIDS in specific. The reviewed studies in africa point to an early age at menarche e.g (9-12)yrs always leads to an early initial sex activity and consequently increased number of sexual partners and puts girls at high risk of contracting HIV/AIDS and other STIs.
For purposes of this review or essay age 9-12 is defined as early menarche and ages 14-15 is later age at menarche.
The lack attention required for girls at menarcheal age may have a direct relationship with disparity in the male and female HIV/AIDS prevalence biological reasons not withstanding. This disparity in male and female HIV/AIDs prevalence is a further indication that the female population requires extra attention in the fight against the scourge. Currently prevalence among young women 15 to 19 years of age (2.7 percent) is nearly four times higher than prevalence among young men of the same age (0.7 percent); prevalence in 20- to 24-yearold women (6.4 percent) shows a similar fourfold increase compared to that of their male counterparts (1.5 percent), though the national stands prevalence rates for HIV stand at 7.8% (KDHS, 2008—2009)
Increased self efficacy and intention to abstain from sex have been noted as to two important determinants of delayed sexual debut, but an equally important determinant that has been missing is age at menarche commonly “seen as a sign of maturity and readiness to engage in sex” (Glynn et al, 2010). The understanding of the interplay between menarcheal age and sexual debut would be a step towards continuous gradual decrease in HIV/AIDS infections. The empowerment of the girl at the onset of the menstruation period will be helpful. This empowerment will come in what I want to refer as the “Chill Freedom package” for the vulnerable girls (the urban poor, the rural poor, those in displacement camps) at this age. The basic care package will have brochures on abstinence, self esteem topics, two pants, and sanitary pads. This will ensure that positive behavior is maintained and delayed sexual debut will be achieved and ultimately the fight against HIV/AIDS will be enhanced. This can be supported by the Malawian study that shows “early menarche could lead to early sexual debut via school drop-out, or more directly, in response to individual and societal pressures” (Glynn et al, 2010). It goes further to support this claim indicating more than half the girls with menarche before 14 fail to finish primary school, have sex before they are 16 and are married before 17, whereas 70% of girls with menarche at age 16 or older finish primary school, many going on to secondary education, start sex after the age of 18 and marry after the age of 19. The schooling level reached by girls with late menarche is similar to that of boys in the community. That reached by girls with earlier menarche falls far short of this (Glynn et al, 2010).”
Conclusion
The provision of the care package will reduce the chances of the girl either from dropping out of school or to the said individual and societal pressures, the conclusion of the study states and I quote “Women with early menarche start sex and marry early, leading to school drop-out. It is important to find ways to support those who reach menarche early to access the same opportunities as other young women” (Glynn et al, 2010).
The media campaigns and other tailor made interventions should be enhanced with messages targeting the parents, mentors, icons and policy makers. Efforts already in place should be reinforced by those involved targeting family as unit and specific messages developed targeted at the girl aged 10-17 years on self efficacy and menstrual period management as well as delayed sexual debut. Reason being the sex sick society we have become, coupled with a case of broken social support system has been an impediment towards a clear shot victory against the HIV plague. Earlier age of menarche was found to be associated with adverse childhood experiences and earlier sexual activity. Negative family behaviors which include family abandonment by either parents lead girls to earlier menarche and sexual activity and less stable relationships.
For the war to be won we must win the battle first and this new battle front should not be ignored. An integration of sort between efforts on delayed sexual debut and those to delay and manage the age at menarche should be reinforced. The government and those in with interest in the girl child and the community as whole should join hands and fight as one.
References
Kenya Census Bureau UNAIDS ***KDHS 2008—2009
WHO/UNAIDS/UNICEF Towards Universal Access report, 2008 recent national surveys, including the 2007
