Efforts to increase contraceptive use in Uganda have long been part and parcel of family planning campaigns, but adolescents are rarely included.
Last month, 193 governments (including Uganda) gathered at the United Nations’ General Assembly in New York to adopt new global sustainable development goals. Goal three is to ensure healthy lives and promote wellbeing for all at all ages. In Uganda, and many other countries around the world, this will require greater understanding of young people and their sexual and reproductive health and rights (SRHR), including both family planning and HIV services.
Increasing efforts to tackle adolescent AIDS is particularly urgent considering that HIV has become the second leading cause of adolescent deaths globally and the number one in Africa (UNAIDS). And the fact that AIDS-related deaths are declining in all age groups apart from 10-19 year olds, shows just how underserved adolescents are when it comes to accessing HIV information, and prevention and treatment services.
Peer-led adolescent services
Adolescents undergo rapid physical, intellectual and emotional development, and have unique needs when it comes to accessing sexual and reproductive health services.
In Uganda a consortium* of partners are running a three-year programme called Link Up, which takes a peer-led approach. The programme provides free youth-friendly HIV and sexual and reproductive health services, such as male and female condoms, STI screening, HIV counselling and testing and family planning services.
By March 2015, Link Up had reached more than 171,000 young people aged 10-24. It also trained 4,233 young people as peer educators who became role models in protecting and promoting the sexual and reproductive health and rights of young people living with HIV.
With Link Up young people are playing a significant role in relaying services to their peers, particularly those who are most at risk of HIV, such as sex workers, men who have sex with men, young boda bodas (motorbike taxi drivers), and people from fishing communities. Peer educators organise outreach activities, condom distribution and demonstration, referral for counselling and follow up for those on treatment.
Mark’s power of determination
Mark Tuhaise, 23, is a single father living with HIV and in January 2014 he underwent training with Mildmay Uganda to counsel fellow young people and was then recruited as a peer educator. Mildmay is the biggest HIV care and treatment provider in central Uganda and one of the local organisations implementing the Link Up programme.
Mark says: “I use the power of determination to address issues that benefit young people and being HIV positive I have helped change the lives of many adolescents who are single and have children.”
Link Up creates opportunities for young people by empowering them to work as peer educators responsible for leading on service delivery of integrated HIV and sexual and reproductive health services. This includes information sharing, referring people to available services, and data collection. It also helps build their skills and provides opportunity for career development.
Mark says: “After training I was given an opportunity to work as a data entrant for the project through which I was equipped with hands-on skills in data entry and management. Three months later, I was assigned the role of coordinating and supervising my fellow peers attached to Mildmay Uganda through which I have gained new skills of leadership and coordination. It is also character building, especially with handling the dynamics of leading fellow peers.”
Behaviour change communication for adolescents
John Kizito**, 21, is another young single father living with HIV who has developed skills in counselling and guidance with support from Kisakye Youth Centre, where Link Up activities are carried out.
The centre provides young people living with HIV with: antiretroviral medication; counselling services; skills building in safer sex negotiation and disclosure of HIV status to partners and family; life-skills building, such as weaving, and career guidance; music and drama activities.
John says: “Peer education is an everyday thing we do. We support each other because most youth lack information and we confide in each other better than parents. Being a peer educator is not easy, and having knowledge about health topics is only one part of it. I learnt how to teach about condoms, but the key thing is communication with the partner before sexual intercourse. If you don’t communicate properly you end up having unprotected sex which is risky to our lives.
“Counselling adolescents is like a hobby, I feel comfort when they confide in me. It is effective because they can understand and make a lasting improvement in their lives and that’s what I want the world to remember of me, changing lives of HIV positive people,” he says laughing.
Uganda and the global goals
At the end of this year the millennium development goals expire and Uganda is unlikely to have met the targets to reduce the maternal mortality ratio by three quarters or to halt and reverse the spread of HIV (UNDP).
But with the adoption of the new sustainable development goals it’s an opportunity to start afresh with new momentum. Young people were not given much opportunity to play a role in the last set of global goals, if they are given a chance this time maybe Uganda, and the rest of the world, can hope for greater success.
* Link Up consortium partners: Community Health Alliance Uganda, Marie Stopes International Uganda, Population Council, International Community of Women Living with HIV East Africa, Uganda Youth Coalition on Adolescent Sexual Reproductive Health and HIV/AIDS and the Ugandan Network of Young People Living with HIV