By Aurelio Orta Resendiz, 2017 IAS Youth Ambassador and Generation Now Co-Chair
Sexual and reproductive health (SRH) and HIV prevention and care have changed dramatically over the past 45 years. Technological advances in both fields have given women modern birth control methods, including safe abortion services, and ushered in an era of HIV prevention and treatment so effective that a daily pill can provide protection or ensure a long and healthy life.
But despite progress, these dual landscapes not have evolved together. Nor have they done so with youth in mind. New generations of young people across the globe still live in situations where unintended pregnancies, sexually transmitted infections (STIs), HIV and gender-based violence occur every day, even though we have the tools to prevent it.
As the largest-ever generation of young people age into adolescence and adulthood, without a revolutionary re-thinking of how to fully incorporate sexual and reproductive health and rights with HIV prevention and treatment, we are likely to see a resurgence of the HIV epidemic and increases in STIs and unintended pregnancies. So how do we address this now? Easy. We start by zeroing in on what young people really need in our real lives.
Of course, all of this revolves around the fact that young people have sex, which can be an uncomfortable notion for many adults and policy makers. And because young people live in a world created by adults, they typically struggle to obtain sexual and reproductive health services that are adolescent focused and comprehensive sex education that is fully inclusive. Whatever the reasons, the effect of lacking services and education is the same. It puts young people’s health and well-being at risk.
Accessing the full array of services that we need in a single location is the most user-friendly way to make sure that young people have the tools we need and, more importantly, that we can take advantage of them. Evidence has demonstrated that when young people have access to comprehensive SRH care and education, it dramatically reduces incidences of unintended pregnancies and STI and HIV infection, and can even delay the start of sexual activity. And even when young people do become sexually active, these tools empower them to do so responsibly.
Yet, even though integration of services like HIV and SRHR is a no-brainer, it seldom happens. This isn’t just a bureaucratic detail. When young people, who already have few service options, are expected to search from place to place for services, the typical outcome is that they never receive the services they need. The result leads to needless new HIV and STI infections and unintended pregnancies, which in turn leads to preventable illness and death among young people.
Even as AIDS-related death rates have fallen worldwide, they have climbed among adolescents in recent years. And the number one cause of death among girls aged 15-19 is complications during childbirth worldwide (WHO, 2016).
But knowing what young people need leaves us with the question: how do we get it? It actually isn’t really hard to figure out the answer. All you have to do is ensure that young people have a seat at the table to help guide your programme. But this International Youth Day, I would like to provide a big picture of what “meeting young peoples’ needs” really looks like.
Education is just the first step to empower young people about our own health. We need good information about how to avoid acquiring HIV, STIs or unintended pregnancy. And we need access to effective HIV prevention tools, including pre-exposure prophylaxis (PrEP), as well as the full range of modern contraception, including safe and legal abortion. We also need comprehensive sex education that is inclusive of all forms of sexual and gender identities.
To fully address the health needs of young people, health services must be complemented by progressive economic and social policies that address our lived realities. That means we need opportunities for education and employment. This is important for all young people, but especially so for girls, as educational attainment and economic independence work as a social vaccine against gender-based violence. Meaningful programmes should also be in place to address gender-based violence and its links to HIV, including interventions that educate young people on sexual consent and teach how to build healthy sexual and romantic relationships.
We need this all together, no matter where we live. We shouldn’t have to search for the services we need or make do with partial or fragmented care. We need programmes that operate at times that suit our needs, such as after work or school hours. Young people should be actively involved in the development of service delivery strategies and in peer support activities.
Programmes for young people should speak to young people in a language they understand, and they should use modern communication technologies and mobile approaches to reach them wherever they are. Services for young people should speak to youth in all their diversity, including comprehensive approaches for men who have sex with men, sex workers and transgender people.
Integration of HIV and SRH rights in easy-to-use, youth-tailored, co-located service sites makes sense for young people. When services are integrated, young women seeking family planning and antenatal services can routinely be tested for HIV. Young women living with HIV can obtain screening for reproductive cancers during their regular HIV care appointments. And people seeking STI services can be tested for HIV and, depending on the HIV test result, initiate antiretroviral therapy or PrEP on the very same day. Young people often live in vulnerable settings and environments that increase their risk of STI and unintended pregnancies. Social and psychological support should not be left out of the equation.
But even the best-integrated clinic won’t address the needs of young people if the providers working there aren’t well trained. Far too often, people living with HIV can feel stigmatized in reproductive health services. And sexual minorities may not always feel welcome in services that are primarily designed for pregnant women and their children. That’s why health worker training and sensitization are so essential if we hope to make integrated services accessible for all young people.
Far too often, politics gets in the way of serving young people. I’ve seen this in my own region of Latin America and the Caribbean, where the reinstatement and expansion by the US government of the global gag rule has put service providers in an untenable position. In order to retain US financial support, programmes have to withhold information and services to which young people have a human right.
Through platforms like Generation Now and the International AIDS Conference, we are starting to see more opportunities where young people are meaningfully engaged in real policy conversations to drive change. In order to take full advantage of these opportunities and move young people’s agenda forward, we must demand policies and programmes based on what we believe: that our bodies and our pleasure are our own. Only then will we be able to address the fact that a third of all new HIV infections worldwide are people between the ages of 15 and 25.
Young people must continue to serve as our own best advocates for gender and economic justice. Through programme advocacy and meaningful roles within political structures, we can achieve our full sexual and reproductive health and rights.