Increasing Access to Services

1. Providing clinic services that are youth-friendly, conveniently located, affordable, confidential and non-judgmental can increase use of clinic reproductive health services, including HIV testing and counseling.

A review of HIV prevention interventions among youth from 80 developing countries found evidence that youth-friendly services increase young people’s use of health services.  

A survey of 445 young women with access to a youth-friendly clinic in Mozambique demonstrated high levels of knowledge to avoid risk of HIV acquisition and low rates of HIV compared to HIV prevalence in the same city. In 1999, Adolescent and Youth Friendly Services (SAAJ) was created in the capital city, Maputo. The service was part of a multidisciplinary project that provides young people with sexual and reproductive health services with a no cost clinic. In October 2001, the clinic offered HIV testing and counseling. From 1999 to 2003, approximately 23,000 adolescents attended the clinic. In 2002, a sample of 435 young women completed a questionnaire and lab exams. The level of HIV knowledge was high, with correct answers about the effectiveness of condoms at 96% and 74% knowing that healthy looking people can transmit HIV. Of the young women, 44.4% had sexual intercourse with occasional partners. Of the young women, only 4% tested positive for HIV, while the general seroprevalence for Maputo City was 17.3%.

A survey conducted between 2000 and 2002 in Madagascar evaluating the development and promotion of a network of youth-friendly, private sector clinics offering HIV testing, STI treatment, and other reproductive health services, found that the number of youth seeking services at these clinics rose dramatically, from 527 to 2,202 youth (predominately female), over two years. In addition to offering confidential, convenient, and affordable services by nonjudgmental providers to attract youth to the clinics, mass media and face-to-face communication campaigns using peer educators, television and radio spots, television talk shows, films, and mobile condom use demonstration teams were also effective in increasing use of the clinics. 

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2. Youth-friendly condom distribution can help young people feel more comfortable accessing condoms.

A study in Mexico evaluating a program that made condoms available in schools found that 570 high school students used the program at least once during the three months in which the program operated in each school. More than 27% (158) used the program three of more times. On average, students used the program 2.09 times. Most stated that obtaining printed educational materials was one of the reasons to visit the program, however, sexually initiated students were more likely to report that obtaining condoms was one of the reasons to visit the program. The majority was satisfied with the program but 27.6% felt that more educational materials should be provided. In addition, significantly more males than females accessed the program. Nearly 33% of female users were planning to have unprotected sex compared to 12% of their male counterparts.

Two social marketing interventions conducted between 2000 and 2002 in Cameroon and Rwanda promoted the use of community-based, youth-friendly condom sellers, which contributed to a decrease in reported ‘shyness’ by both sexes in purchasing condoms.  In Cameroon, youth-friendly condom sellers were trained and identified as youth-friendly condom ‘outlets’ and sold more than 40,000 condoms to youth in 2002.  In Rwanda, peer educators collaborated with the community-based condom sales agents to identify and promote youth-friendly condom sellers in the rural areas, resulting in a significant increase in youth reporting “knowledge of a nearby condom source,” and a decrease in reported shyness to buy condoms, from 79% to 56%, among females.

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3. Young women living with HIV can safely deliver HIV-negative infants with appropriate treatment. [See also Safe Motherhood and Prevention of Vertical Transmission ]

A study in Brazil with eleven HIV vertically infected adolescents who were followed from 2002 to 2009 at six medical centers and became pregnant single or multiple times and gave birth to 14 HIV-negative infants with one infant lost to follow up. Between 2000 and 2008 in Brazil, 4,900 HIV-positive pregnant adolescents aged 10 to 19 were reported. Disclosure of diagnosis occurred at a median age of 12 years. Of the mothers of these pregnant adolescents, six were still alive but only one had received antiretroviral drugs during prenatal care. Many of the HIV-positive pregnant adolescents were born before HIV prenatal screening became a standard of care for pregnant women. The eleven perinatally acquired HIV-positive pregnant adolescents had their sexual debut at a median age of fifteen years, similar to the general adolescent populations. The median duration of antiretroviral use was 7.8 years. Ten of the eleven patients had previously been exposed to zivudine during childhood. Antiretroviral drugs were used in 14 of the 15 pregnancies. The median CD4 count during pregnancy was 394. Antiretroviral management of these HIV positive adolescents was similar to that of women whose HIV is first discovered during pregnancy. All the pregnant adolescents had cesarean section prior to labor and before ruptured members. All newborns received zivudine during the first six weeks of life and none were breastfed. “…This third generation of HIV-exposed infants needs to be addressed within HIV-1 specialized adolescent care settings” (Cruz et al., 2010: 2729).

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