What Works for Women and Girls

7. Intensified efforts are needed to increase condom use and reduce multiple partnershipsby people who know their HIV-positive status or who are on ARV treatment, includingyoung people. [See Chapter 3. Prevention for Women and Chapter 7C. Treatment: ReducingTransmission]5B. Prevention for Young People:Increasing Access to ServicesWhile the literature on access to HIV services by adolescents is limited, the literature onaccess to sexual and reproductive health services more broadly demonstrates that youthfriendlyapproaches can increase use of reproductive health care services by female adolescents(Neukom and Ashford, 2003). Young people’s service needs are frequently overlooked inHIV programming that is not specifically for young people. Numerous studies in developingcountries show that adolescents under the age of 15 are sexually active. For example, in sub-Saharan Africa, adolescent girls under age 15 are 50% more likely than boys to be sexuallyactive (UNAIDS, 2008). A nationally representative sample of youth in South Africa foundthat 18% of young men and 8% of young women said they had had sex for the first time at age14 or younger (Pettifor et al., 2009). As a result of a 2002 study of Zambian secondary schoolstudents, Warenius et al. (2007) noted that although “government policy in Zambia states thatall sexually active men and women should have access to reproductive healthcare and information…inpractice, young people have limited access to such services” (p. 534). Increasingservices for adolescents need not reinvent the wheel, however; “strengthening the health caresystem to better serve adolescents requires taking a strategic look at ways to build capacitywithin the existing system, rather than creating a parallel structure focused only on adolescents”(Boonstra, 2007). [See also Chapter 13. Structuring Health Services to Meet Women’s Needs]Policy and Legal Barriers to Access Must Be OvercomePolicy and legal barriers often prevent young people from accessing services. Many healthservices will not provide sexual and reproductive health services to unmarried women. In mostcountries, young people under the age of 18 need parental consent to obtain medical care,including VCT, despite the fact that counseling and testing can lead young people to changetheir behavior and many youth are sexually active before age 18. Laws that require providersto seek parental consent before testing minors or to provide test results to parents may makeadolescents reluctant to seek services. Adolescents must feel comfortable accessing necessaryservices in order to protect themselves from HIV. Surveys of nearly 20,000 adolescents inBurkina Faso, Ghana, Malawi and Uganda found that adolescents prefer services from clinicsand hospitals rather than traditional healers and pharmacies but are often embarrassed or tooshy to seek them out (Biddlecom et al., 2007).WHAT WORKS FOR WOMEN AND GIRLS137