Bumb’INGOMSO – isiXhosa for ‘mould the future’ – is a multi-faceted HIV-prevention project that combines behavioural, biomedical, social and economic interventions to inspire, support and motivate girls and young women to reduce high-risk behaviour and make healthy life choices. Its design reflects international evidence that multi-faceted prevention measures, sustained at sufficient scale and intensity, can significantly reduce the incidence of HIV1Bekker L-G, Beyrer C, Quinn T. 2012. Behavioral and Biomedical Combination Strategies for HIV Prevention. Cold Spring Harb Perspect Med. 2012 Aug; 2(8): a007435. doi: 10.1101/cshperspect.a007435 PMCID: PMC3405825.
Bumb’INGOMSO is a development project of the Department of Health (DoH) and is co-financed by the Federal Republic of Germany through KfW and DGMT, which is also the executing agent. It is currently implemented across 18 wards in the Buffalo City area in partnership with the Small Projects Foundation, Beyond Zero, Masimanyane Women’s Support Centre, Harambee Youth Employment Accelerator, DreamWorker, Masibumbane Development Organisation and Rural Education Access Programme.
Buffalo City College students in between lectures at the main campus in East London.
More than 8 million South Africans live with HIV, amounting to 13.7% of the total population. And, among 15–49-year-olds, an estimated 19.5% of the population is HIV positive 2 Mid-year population estimates, 2021, Statistics South Africa. Access it here: https://www.statssa.gov.za/publications/P0302/P03022021.pdf . If you look closer at the statistics, it’s clear that women bear the brunt of infection in young adulthood, accounting for the majority of infections among 15–24-year-olds.
This is largely the result of sexual relationships with older men. The high incidence of HIV infection among young women in the five years after they leave school suggests that this age group is not as amenable to behaviour change programmes for a variety of reasons. This may be due to adolescent girls and young women experiencing family pressures, such as the expectation to contribute financially, or societal expectations around womanhood. When not in school, adolescent girls and young women are also more vulnerable to the spectrum of gender-based violence – from subtle sexual coercion to full-blown domestic violence3loveLife. 2012. Talking Points: A survey on HIV, sexual risk behaviour, and access to opportunity among young people in South Africa. Johannesburg: loveLife..
And, young people in South Africa live in a highly polarised country where for the majority, day-to-day choice and opportunity are severely constrained and prospects of real improvement are poor4Harrison, David & Richter, Linda & Desmond, Chris. (2007). Changing Perceptions of Opportunities: Hope for Young People in High HIV-Risk Environments. Access it here. Available here. Feeling trapped at the bottom of the pile can predispose young people to high-risk sexual behaviours, such as inconsistent use of condoms and relationships with older men.
The majority of South Africans are stuck in an inequality trap with wealth concentrated in the hands of a few. Most are stuck in intergenerational loops of exclusion with few chances to escape. Breaking this cycle requires a fundamental change in life trajectories, starting in the womb.
Think of a Möbius strip – just one twist in the circle allows you to trace a completely different pattern. Instead of being stuck on the inside of a loop, you emerge on the outside. In the same way, escaping the inequality trap requires a fundamental twist to set South Africa on a new path.
Bumb’INGOMSO uses an innovative approach to HIV prevention that combines traditional HIV prevention mechanisms, such as behaviour change communication and biomedical interventions, with interventions that tackle the underlying individual, social and structural drivers of the epidemic among vulnerable groups, particularly adolescent girls and young women.
Launched in 2016, Bumb’INGOMSO addresses the individual, interpersonal and structural factors that drive the vulnerability of girls and young women in a specific locality – the Buffalo City Metropolitan Municipality – through programmes that include leadership development, tackling gender-based violence, improving the delivery of youth-friendly health services and connecting young people to economic opportunities.
Through these interventions, Bumb’INGOMSO aims to build self-efficacy and a sense of real and imminent possibility that shifts the social and structural dynamics shaping young women’s lives.
Bumb’INGOMSO aims to reduce the incidence of new HIV infections in 15–29-year-old women in the Buffalo City Metropolitan Municipality and Amathole District Municipality by a third. This involves reducing HIV infection and teenage pregnancies by delaying their first sexual experience, reducing the frequency of changing sexual partners and increasing the consistency of condom use.
To support and empower girls and young women to navigate factors that make them tolerant of risky sexual behaviour, Bumb’INGOMSO works with partners to provide the following interventions:
1. Create a positive change in risky behaviour
For behaviour change to happen, Bumb’INGOMSO believes that young people must be able to understand themselves and have a sense of community, connectedness and the ability to make informed choices in their lives.
2. Promote accessible health services for young people
Effective health services enable young people to make informed choices about their bodies and sexual health. Bumb’INGOMSO aims to increase access to youth-friendly care, to public health facilities in Buffalo City and the Amathole District Municipality to strengthen youth-friendly services.
3. Respond effectively to gender-based violence
Given young women’s greater physical and social vulnerability to infection with HIV, Bumb’INGOMSO seeks to mobilise and engage communities to be actively involved in the prevention of gender-based violence (GBV). Reducing domestic violence is at the heart of tackling GBV because much of it is perpetrated in the home 5 Wessels, I, Mikton, C, Ward, C.L, Kilbane, T, Alves, R, Campello, G, Dubowitz, H, Hutchings, J, Jones, L, Lynch, M, Madrid, B 2013. Preventing violence: Evaluating outcomes of parenting programmes. Geneva, Switzerland, World Health Organization.
4. Enabling access to economic opportunity for young women
In the Eastern Cape, information and mobility barriers seriously impede the life choices of young people. Therefore, Bumb’INGOMSO empowers young people by improving their access to skills training and information about available opportunities through its economic opportunities intervention.
5. Shaping equal gender norms among adolescents aged 10–14
Early adolescence (10–14 years) is an especially crucial phase where young people undergo physical, emotional, social and cognitive changes, including socialisation into prevailing gender norms. The IKHWELOLethu intervention focuses on shaping equal gender norms during early adolescence for boys and girls. This intervention addresses harmful gender norms that result in women having low levels of personal power and limited choices while experiencing high levels of gender-based violence.
Learn more on the bumb’INGOMSO website: https://bumbingomso.co.za
Trying to change life trajectories is ambitious and profound. It requires us to radically influence the lives of individuals and to be part of changing the circumstances in which they live.
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For more about the prevalence of HIV and the health behaviour of young people in Buffalo City, click on the research reports below.