Exploring the role of adolescent youth-friendly services (AYFS) in primary health care clinics that offer HIV and sexual reproductive health (SRH) services for adolescent girls and young women in Vulindlela, KwaZulu-Natal, South Africa.

Abstract

In sub-Sahara Africa, adolescent girls and young women (AGYW) bear a disproportionate burden of sexual and reproductive health (SRH) risks, where HIV infection and adolescent fertility are a major concern. Specifically, in South Africa, it is estimated that nearly 2 000 AGYW between the ages of 15 to 24 years are infected with HIV every week. Furthermore, it is estimated that by 2019, 15,6% of females between the ages of 15 and 19 years in South Africa had begun childbearing. Consequently, systemizing and expanding the reach of quality AGYW health service provision is part of the South African National Adolescent and Youth Health Policy. To promote accessibility, efficiency, quality, and sustainability of adolescent youth-friendly health services (AYFS) in primary health care clinics, national response to the HIV and SRH needs of AGYW need to be prioritized. It is for this reason that AGYW is a key focus in this study. This study was conducted in Vulindlela, in the uMgungundlovu district in KwaZulu-Natal. This area reports high levels of HIV infection, with notable high fertility rates among AGYW. The study was conducted in 3 primary health care clinics that have initiated the AYFS programme, providing HIV and SRH care to AGYW. This study has three aims: (1) to investigate whether primary health care clinics offer youth-friendly HIV and SRH services to AGYW (2) to assess the current strategies employed in primary health care clinics to make HIV and SRH services adolescent youth-friendly and (3) to explore the potential of adolescent youth-friendly services in influencing HIV and SRH care among AGYW. This study is framed by the culture-centered approach (CCA) in understanding AGYW’s experiences when accessing HIV and SRH services in primary health care clinics. CCA is founded on the principles of listening to the voices of the margins that have hitherto been unheard in policy and programming circles. Purnell’s cultural competency model (CC) of health care nurses is also crucial for AYFS to effective among AGYW. This model encourages health care nurses to understand the heritage and culture in which their patients come from in order to provide acceptable and suitable HIV and SRH services. A participatory action research design was adopted, where data collection was threefold: a PhotoVoice workshop, focus group discussion and individual interviews. Key findings from this study highlighted that lack of congruent care, administration, time management, shortage of infrastructure and health care nurses negative attitudes were identified as the main deficits to AGYW SRH care clinic. However, AYFS in primary health care clinics could encourage HIV and SRH care among AGYW. Having younger health care nurses at the clinic was one strategy that AGYW alluded to in this study. AGYW also mentioned that having a separate building for AYFS would improve their adherence to HIV and SRH services like HIV testing, family planning and antenatal care. This study highlighted the need for greater understanding of the socio-cultural perceptions of health care workers’ perceptions of adolescent sexual and reproductive health, and the provision of HIV and SRH services. This study found that HIV and SRH services are currently not youth-friendly for AGYW across all three clinics in which the study was conducted. AGYW described that the clinic structure does not have enough space to, and therefore hinders their privacy at the clinic. Health care nurses attitudes and the lack of communication between AGYW and nurses at the clinic were some of the key findings in this study. On the contrary, health care nurses find it challenging to focus one patient at the clinic because of shortage of clinical staff and administrative staff.