Increasing Access to Services

1. Interventions are needed to increase community involvement and investment in programs that promote the introduction and utilization of youth-friendly services. A literature review found that in order to increase utilization of youth friendly services, efforts to change community attitudes on adolescent sexuality were needed.

Gap noted, for example, in a literature review of youth-friendly service programs (Speizer et al., 2003).

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2. Laws and practices that obstruct adolescents’ access to services, such as parental consent requirements, age, and marital status requirements, must be reviewed and revised. Studies found that legal requirements restricted adolescents from getting tested for HIV even if they were sexually active and at risk for HIV.

Gap noted, for example, in Kenya (Agbemenu and Schlenk, 2011); Zimbabwe (Ferrand et al., 2011); Tanzania (Ferrand et al., 2010); India, Botswana, Kenya, Malawi, Mozambique, Rwanda, Tanzania, Thailand, Trinidad, Uganda, Zambia and Zimbabwe (McCauley, 2004) and South Africa (HRW, 2003a).

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3. Adolescents living with HIV need information and services through adolescent-friendly HIV and family planning services. Studies found that health providers were unprepared to discuss HIV and contraception with adolescents who acquired HIV through perinatal transmission, despite the fact that significant numbers of these adolescents were already sexually active. Another study found that these adolescents need skills to disclose their HIV-positive serostatus to sexual partner.

Gap noted, for example, in Uganda (Baryamutuma and Baingana, 2011; Birungi et al., 2011b; Obare et al., 2009); Uganda and Kenya (Birungi et al., 2009a; Birungi et al., 2009b; Birungi et al., 2009c). 

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4. Increased efforts are needed to reduce stigma against adolescents living with HIV. A study found that adolescents living with HIV kept silent about their HIV status to schools, friends and family so as to not experience stigma and discrimination.

Gap noted, for example, in Botswana (Thupayagale-Tshweneagae, 2010: 262) and Uganda (Birungi et al., 2011b; Obare et al., 2009).

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5. Mandatory pre-marital HIV testing may increase HIV stigma. A study found youth believed that mandatory pre-marital HIV testing would increase stigma against those who test HIV-positive with significant numbers believing that they were not personally at risk of acquiring HIV.

Gap noted, for example, in Nigeria (Arulogun and Adefioye, 2010).

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6. Actions are needed to increase young people’s knowledge of when and where to access health services, including access to contraception and condoms. A UNESCO review found that young people lacked knowledge of where to access health services to meet their needs. Adolescents in numerous countries are sexually active yet have low rates of contraceptive use. [See also Meeting the Sexual and Reproductive Health Needs of Women Living With HIV]

Gap noted in sub-Saharan Africa (Fatusi and Hindin, 2010); Ethiopia (Lindstrom et al., 2010); numerous countries (UNESCO, 2009b). 

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7. Increased efforts are needed to address the needs of adolescents living with HIV who are pregnant and to create linkages between HIV centers and maternal health clinics. A study showed that use of maternal health services to prevent vertical transmission was lower than the proportion who attended prenatal care. In this study, less than half of pregnant adolescents attending four antenatal care visits. In addition, use of skilled attendance during or after abortion or miscarriage was low. [See also Safe Motherhood and Prevention of Vertical Transmission and Structuring Health Services to Meet Women’s Needs]

Gap noted in Kenya (Birungi et al., 2011a). 

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8. Increased training is needed for providers to discuss sexuality and pleasure with adolescent youth who need reproductive health services. A analysis of fictional narratives written by young people aged ten to 24 concerning HIV found that young people criticized the lack of skills by providers to discuss issues of sex and pleasure as well as conceptualizing rape as a punishment for girls who do not abstain from sex.

Gap noted, for example, in Senegal, Burkina Faso, Nigeria, Kenya, Namibia and Swaziland (Winskell et al., 2011a). 

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9. Increased access to HIV testing and counseling for youth is needed. Studies found that youth aged 15 to 24 were at high risk of either acquiring HIV or testing HIV-positive, yet less likely to report having been tested for HIV. Increased knowledge that HIV-positive infants can survive to adolescence is also needed so that these young people can get tested for HIV and access services.

Gap noted, for example, in Zimbabwe (Ferrand et al., 2011); South Africa (Venkatesh et al., 2011a) and Nigeria (Yahaya et al., 2010). 

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10. Youth-friendly services are needed within schools to increase access to condoms for those who are sexually active. A study found that youth in numerous countries do not have information or access to condoms within school systems.

Gap noted, for example, in Zimbabwe (Ferrand et al., 2011); South Africa (Venkatesh et al., 2011a) Nigeria (Yahaya et al., 2010); Antigua and Barbuda, Bahamas, BoliviaColombia, Costa Rica, Chile, Dominica, Ecuador, El Salvador, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Venezuela, Dominican Republic, Santa Lucia, Suriname, Trinidad and Tobago and Uruguay (DeMaria et al., 2009). 

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