This is the second post in our series, Adolescent Girls, Microbicides, and HIV Prevention Trials. Ms. Anna Kaale, study coordinator; Ms. Doreen Bangapi, community recruitment officer; and Dr. Sylvia Kaaya, local principal investigator,  are with the Muhimbili University of Health and Allied Sciences (MUHAS) and work with FHI 360 on the Adolescents, Women, and Microbicides Trial.

An essential component of the “Adolescents, Women and Microbicides” trial is creating clinical spaces where adolescents feel comfortable.  The Infectious Disease Centre (IDC) in Dar es Salaam,Tanzania, offers dedicated hours for youth-friendly HIV and reproductive health services to young people ages 12 to 24. They provide voluntary HIV counseling and testing, HIV care and treatment services, prevention and treatment of other sexually transmitted infections, and counseling for prevention of unintended pregnancy. We asked two nurse counselors from this site to share their experiences providing these services and working with adolescent and young women (ages 15-21 years) who are participating in the trial.

The nurses noted the following challenges in providing youth-friendly services (YFS):

  • Standalone YFS are often not well known within communities; thus, young people often do not know they exist.
  • Providers face challenges in creating dedicated space and time for YFS.
  • It is difficult to segregate young people and adults in the same clinical care environment.  Young people often report discomfort when meeting adult patients in the clinic.  They worry that their parents, guardians, or other adults they know will discover their use of SRH services.
  • The clinic faces stock-outs, particularly of HIV testing kits. As a result, nurses must either refer young people to another clinic or ask them to wait until supplies become available.  Young people might not have transportation to other health services and also might fail to return once HIV kits are back in stock.
  • Stock-outs of drugs used in treatment of STIs were also not uncommon, and the nurses highlighted the higher impact of such stock-outs on youth compared to adults. Many young people do not have the financial resources to purchase drugs privately and may be unable to request assistance from parents or guardians due to threats to their privacy.
  • Even after being counseled on risk-reduction strategies, young women often face difficulties in attempts to implement them.

Given these challenges, the nurses made the following recommendations:

  •  Increase advocacy about YFS and awareness within the community about the existence and location of YFS.
  •  Place a greater priority for YFS in the provision of clinical and drug supplies, paying special attention to the logistical challenges young people face during stock-outs.
  •  Create private spaces for YFS within facilities.
  • Augment clinic-based health education with interventions to address broader relationship and community-level factors that affect adolescent and young women’s ability to take measures to prevent unplanned pregnancies and STIs, including HIV.
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