The burden of unintended pregnancy coupled with lack of information about the risks of abortion is putting the lives of young women living with HIV in danger.
Two years ago Mulunesh, a 25-year-old sex worker from Ethiopia, had an abortion, she said: "I almost died from blood loss."
"I couldn't get the [abortion] service at the same place I had my [HIV] blood test and I didn't want to share my status with others," she said. As a result she chose to go to a hidden place where a non-professional gave her some medicine to initiate the abortion. This decision almost cost Mulunesh her life.
Roadblocks for accessing services
Globally five million people aged 15-24 are living with HIV. Yet those people who are most affected by HIV typically fail to access comprehensive reproductive health and HIV services.
The conventional approach of providing separate services for reproductive health and HIV makes it hard for young people to reveal their HIV status every time they go to a clinic.
Stigma and taboos are critical factors which decrease the motivation of young people to seek or keep using a service. Discrimination based on age, gender, HIV status and sexual orientation, as well as attitudes and norms towards "appropriate" sexual behaviour further marginalise young people most affected by HIV.
If Mulunesh had been able to access sexual health services, including abortion, at the same clinic where she received HIV treatment it could have been a different story. But because of the shame she felt from the stigma of HIV she was afraid to go to a professional medical facility, instead she chose a back alley option.
Mulunesh's story is not uncommon. Sexual and reproductive health services for young people are often not friendly enough for young people to feel confident to approach and don't meet their unique sexual and reproductive health needs in a comprehensive manner. This is why integrating HIV and reproductive health services for young people is so important.
Integration to solve the limitation
Public health institutions, non-governmental organisations and the public sector are widely engaged in providing sexual and reproductive health and HIV services, but they lack integration. Efforts towards tackling the issue would be more effective if the services could be linked together.
Link Up is a project led by the International HIV/AIDS Alliance with a consortium of partners, which is improving the sexual and reproductive health and rights of young people most affected by HIV.
The three-year project started in January 2013 and will reach one million young people in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda.
The work focuses on young men who have sex with men, sex workers, people who use drugs, transgender people and young women and men living with HIV.
The integration of youth-friendly clinics focusing on sexual and reproductive health with HIV prevention, treatment, care and support will help increase young people's access to these services.
It means others like Mulunesh won't have to suffer just because they are embarrassed to speak out about their HIV status every time they seek a different health services.
The Link up project aims to reach its goals by December 2015, watch this space to see just how successful it is at promoting and protecting the rights of young people affected by HIV.