Young people aged 10-24 make up over 30 percent of the population in Southern African Development Community (SADC) countries and are among the most affected by HIV, yet continue to have unequal and inadequate access to comprehensive sexual and reproductive health care.
Reforms that address legal and policy barriers to sexual and reproductive health access are key to achieving health equity, said participants at a satellite symposium organized by the United Nations Development Programme (UNDP), the African Men for Sexual Health and Rights (AMSHeR), and the Health Economics and HV/AIDS Research Division (HEARD) of the University of KwaZulu-Natal at the AIDS 2018 International AIDS Conference in Amsterdam.
“Despite significant progress being made in reversing the HIV epidemic and improving provision of sexual and reproductive health services, there remain deep inequalities in access to health care – especially for young key populations,” said Farai Chirongoma, Young Key Populations National Officer, AMSHeR. “The HIV response has largely neglected young key populations. There is a need for stronger efforts and funding for prevention, treatment and care, as well as research, that is specific to these groups.”
The symposium, titled ‘How do we achieve health equity for young key populations?’ featured a panel discussion with public health policy experts and representatives from key populations groups, civil society, government and development partners.
Members of ‘key populations’ (sex workers, people who inject drugs, transgender people, prisoners and gay men and other men who have sex with men, and their sexual partners) are disproportionately affected by HIV, unwanted pregnancy and other adverse SRH outcomes. Criminalization of same sex sexual behaviour, sex work and drug use can amplify risk for HIV and co-infections by creating barriers to accessing services.
Young people, who are also members of these key population groups, have added vulnerabilities just because of their age. For example, age restrictive laws and policies limit independent access to sexual and reproductive health services such as HIV and pregnancy testing, contraceptives, abortion services and pre- and post-exposure prophylaxis. Mandatory parental consent and notification requirements also prevent younger people from accessing the relevant information, education and sexual and reproductive health services they require. Additionally, young people often have limited access to sexual and reproductive health services and commodities in places such as schools, detention centres, reform schools and prisons.
“What we have learned is that punitive laws and discriminatory practices in countries are continuing to undermine progress on ending the AIDS epidemic,” said Dr. Mandeep Dhaliwal, Director of the HIV, Health and Development Group at UNDP. “Vulnerable and marginalized groups, in particular young men who have sex with men, transgender people, people who use drugs, sex workers are being left behind. The stigma, discrimination and violence they are facing is preventing their ability to receive prevention, treatment, care and support services. This must end if we’re going to end HIV and achieve the health-related goals of the 2030 Agenda for Sustainable Development.”
"Isigogo sigoqwa simanzi – You can only change someone’s mindset before something else occupies their minds,” said Hon. Ruth Labode, Zimbabwe Member of Parliament. “Parliamentarians come to parliament with their minds already influenced by certain religious, cultural, social and political perspectives. Hence, advocates must strike while the iron is hot, start building capacity and informing parliamentarians as early as possible.”
The symposium provided an opportunity to share and discuss lessons drawn from the Linking Policy to Programming project, a regional initiative implemented by UNDP, AMSHeR and HEARD that is working to reduce HIV risk and improve sexual and reproductive health outcomes for young key populations in SADC countries (Angola, Madagascar, Mozambique, Zambia and Zimbabwe). Funding for the project is provided through the Netherlands Ministry of Foreign Affairs.
“Our central task is to convert the high ideals and laudable goals expressed in legal and political innovations into a real and sustained difference in the lives of those most at risk,” said Professor Nana Poku, HEARD. “All of the participants recognized the need for a holistic and multi-pronged approach that engages the community as fully as possible – parents, educators, medical professionals, traditional and religious leaders – and of course, young people themselves. The challenges are considerable, but so too is the shared determination to ensure the safety, health and well-being of the most vulnerable among us as well as our larger communities.”
The Linking Policy to Programming project has focused on strengthening the capacity of national governments to put in place appropriate policies and laws that promote equitable access to HIV prevention and sexual and reproductive health services for young key populations. The project is also developing mechanisms that enable the engagement of young key populations in national and regional policy processes, generating robust evidence-based research to inform policy and practice, and applying human rights and HIV and sexual and reproductive health related indicators and milestones for young key population focused interventions.
“The evidence is clear – if we want truly effective HIV responses, then it’s crucially important that the young key populations communities, including young women and girls, are actively involved,” said Natasha Chama, Women’s Alliance for Equality (WAFE) Zambia. “Community-inclusive and human rights-based approaches are much more likely to be sustainable and deliver good health outcomes, which at the end of the day is what we all want to see.”
“Time for deciding the best interest for communities and young key populations without their say and agency has passed. It is only though involvement and empowerment that the double vulnerability will be compensated by youth-led and friendly interventions that provide skills and resources for better access to SRHR services by those left far behind in Southern Africa, namely young key populations”, said Berry Nibogora, Programme Manager at AMSHeR.