In Uganda, many young people lack access to quality information on sexual and reproductive health, but a project called Link Up is helping to change this.
Many young girls work in a risky environment like bars, kiosks, or lodges at a tender age in order to earn a living. Lydia* is a 17-year-old adolescent girl working in one of the top bars in Mukono, Uganda. She said: "I have to work to get what I eat and mostly in the night in order to get more money."
At times, adolescents can take risks in their behavior, which can lead to sexual and reproductive health problems. Young people need information about sexual and reproductive health and rights to help them deal with the changes they are going through, at this critical stage of their lives - but this can often be difficult for them to access.
Access to sexual and reproductive health services
HIV is a particular sexual health issue for young people - as they account for 40 per cent of all new HIV infections. AIDS is also the leading cause of death for adolescents in Africa, and the second leading cause among adolescents globally (UNAIDS).
Tabitha is a young mother living with HIV and one of the young people who accesses services from Namutumba health center 111, supported through the Link Up project. She said: "We have a youth-friendly corner at the facility where we access services like family planning, and HIV counselling and testing. This has reduced stigma and discrimination among people."
The Link Up project is being led by a consortium of partners, including the International HIV/AIDS Alliance, and works with young people who are often marginalised and struggle to access HIV services. CYSRA-Uganda is one of the implementing partners of Link Up and raising awareness and ensuring the health of adolescents and young people is at the heart of what they do. They conduct community dialogues with service providers and pass on technical skills about how to handle clients and how to create a good environment with easy access to services.
Harriet Anyango, a service provider in Busia Health center, said: "Sexually active adolescents are not well trained to seek health care. We receive adolescents here for health care after getting pregnant but it's rare to work on one who is not pregnant." This shows that access to sexual and reproductive health information is still low in Busia district.
Barriers to adolescent health care
Existing sexual and reproductive health services are often not accessible, acceptable and appropriate for adolescents due to issues like lack of knowledge and information, fear of stigma and discrimination, and poor or expensive transport to facilities.
Many people confirm this. Ssemakula is a man who has sex with men, and is a peer educator working with the Most at Risk Population Initiative (MARPI) in Kampala. He says: "Men who have sex with men are vulnerable to violence, exploitation by police and less able to access health care preventative services. There are few care centers where we can access services without harassments."
Dr Benna, assistant district health educator in Busia district, said: "The most significant barrier to health care among adolescents is low levels of education and knowledge. Young people have less formal education and less sex education. They experience internalised stigma and more social isolation and are less able to ask adults for support in decision-making."
Some young people lack support from their parents to seek health services, for example when they need their parents' consent to test for HIV. It is also a big challenge for young people whose parents have died, and also those who are students from foreign countries as they lack adult support.
Despite these challenges, some existing projects in Uganda like Link Up, VIJANA, THE PACT, and ACT! 2015 are making things easier for young people to access services and get information free from coercion or threat of violence. This has been done through involving them in decisions and planning about service provision. Some of them have also been trained as sexual and reproductive health and rights ambassadors. There is a long way to go before all young people can access the information and services they need for sexual and reproductive health, but small steps are making all the difference.
*Name changed to protect identity