Despite global efforts towards ending AIDS by 2030 progress has been uneven and fragile. Evidence shows that entire regions and populations, including young people, are being left behind in the response to HIV/AIDS. About one third of all new HIV infections globally occur among adolescents and young people between the ages 15 and 24. Adolescents, aged 10 to 19, are the only age-group in which AIDS-related deaths are increasing. Yet, access and uptake of HIV services among young people, particularly among adolescents, is reported to be lower than among older groups. Around the globe, young people are raising their voices and demanding access to youth-friendly, affordable and confidential SRH and HIV/AIDS services as well as comprehensive information on these matters.
Exploring Young People’s Experiences with HIV Services
CHOICE conducted research into young people’s experiences with integrated SRHR and HIV services, capturing the experiences of youth-led organisations working in SRHR programmes in 11 countries across Europe, Sub-Saharan Africa, South and Southeast Asia. This project was supported by Generation Now, an initiative by Women Deliver and the International Aids Society. 480 young people between the ages 12 to 30 from more than 20 countries shared their experiences with STI/HIV testing services. The findings were devastating. In many countries young people, diverse in their identities and situations, face significant barriers in accessing SRH and HIV services.
From the 480 young people who participated in this research, 47 per cent reported significant barriers to their STI/HIV testing experiences.
Barriers to accessing SRH and HIV services include, but are not limited to, harmful societal and gender norms, punitive and discriminatory laws, age based stigma from health workers, lack of youth-friendly and affordable services, long waiting hours, confidentiality issues and the constant fear of being stigmatised or discriminated against. These barriers are the strongest for young people in marginalised groups including young key populations, young people with disabilities and girls and young women in rural areas. For instance, in countries like Nigeria and Uganda, where same-sex relationships are criminalised young members of the LGBT community are often faced with stigma from health-care providers and denied access to services. Similarly, young women are denied access to SRH and HIV services in countries with high age of consent and spousal consent laws such as is the case in Indonesia.
The knowledge, tools and strategies are their to end AIDS by 2030. However, getting there requires knocking down barriers and galvanising action to scale up access and uptake of treatment for all, including young people.
Human Rights in the HIV Response
In February 2019, CHOICE took to the United Nations headquarters in Geneva to participate in the Office of the High Commissioner on Human Rights’ (OHCHR) Consultation on Human Rights in the HIV response. The findings of this research were used to advocate for meaningful youth participation in the HIV response. The outcome report of the consultation can be found here.
The consultation heard that stigma, poor access to justice, punitive and discriminatory laws, policies and practices pose significant barriers to the most vulnerable people accessing HIV/AIDS services. Other important topics included funding for human rights in the HIV response, working closely with communities and civil society through national, regional and internal accountability mechanism including the Universal Periodic Review (UPR) and Voluntary National Review (VNR). Both panelists and civil society representatives called on governments to listen, take action, lead, reform and fund human rights in the HIV response. In his opening statement, Mr. Tim Martineau, Deputy Executive Director a.i., UNAIDS said that:
“human rights are key to ensuring people are not left behind. We know that addressing laws, policies, gender inequality and discrimination in all its forms is key to ending HIV. The human rights norms, the frameworks, the commitments are all in place: we have the treaties, the SDG agenda, the political declaration. What really remain is very real action.”
Ensuring Young People are not left behind
During the consultation,CHOICE made an oral statement and a written submission calling attention to the grim prospects of HIV/AIDS among young people. The only way to truly end the HIV epidemic among young people is by putting young people at the forefront of the HIV response.
Better laws, policies and programmes are needed to improve young people’s access to youth-friendly, affordable and confidential SRH & HIV/AIDS services and reduce the high rates of HIV among young people. However, without the meaningful participation of young people in the design, implementation and evaluation of such initiatives it is impossible to guarantee their effectiveness. Best practices in this regard can take various forms. In India, for instance, our partner the YP Foundation works to strengthen the adolescent and youth-friendly capacity of adolescent friendly health clinics (AFHCs) by conducting audits with young mystery guests. In Uganda, Reach a Hand Uganda establishes youth spaces at SRH services to increase health-seeking behaviour among young people.
To end the epidemic we need to work in partnerships that include young people. Young peoples’ involvement in decision making processed must shift from tokenistic to meaningful youth engagement and must be acknowledged, nurtured and resourced.