Integrating Youth Reproductive Health and Family Planning into HIV/AIDS Education

This issue of International Youth Foundation (IYF)'s FieldNotes (Vol. 3, No. 17) presents IYF's experiences and lessons learned in Tanzania, where the Planning for Life project integrated youth reproductive health (YRH) education and family planning (FP) services into its HIV prevention activities and trained local youth service providers to offer youth-friendly RH services. The programme emphasised dual protection from HIV transmission and unintended pregnancy through promotion of education in abstinence and condom use. IYF claims that, "By taking part in both HIV and pregnancy prevention education, youth have benefited from a comprehensive understanding of the risks of unprotected sex and early sexual debut, and are better able to take the proper steps to protect themselves."

Since 2005, IYF has partnered with the Tanzania Red Cross Society (TRCS) to reach youth with HIV referral services and prevention messages through the Empowering Africa's Young People Initiative (EAYPI). This 5-year programme engages youth in HIV prevention through life skills-based peer education, parent-to-child communication, and community mobilisation efforts. As of April 2009, EAYPI partner organisations in Tanzania reached 805,609 individuals and trained 12,980 peer educators and parent-to-child (PTC) facilitators.

Specifically, Planning for Life used a multi-pronged, multi-stakeholder approach to integrate FP into HIV/AIDS activities. For example, sensitisation meetings with local communities were held. Teachers already engaged through the EAYPI project were trained on how to provide age-appropriate RH and FP lessons (as "add-ons" to those already being taught on HIV prevention) twice a week to in-school and out-of-school youth, covering such topics as abstinence, consequences of early pregnancy, and various contraceptive methods. In addition, health professionals visited schools to raise awareness about the availability of youth-friendly FP and counselling and testing (CT) services at clinics and hospitals. Furthermore, TRCS selected 30 peer educators, who had previously been trained in HIV prevention through the EAYPI project, and trained them to promote RH and FP education using the Ministry of Health's curriculum. From June to August 2009, these peer educators reached 255 youth ages 15 to 24 with messages relating to RH, FP, life skills, and HIV prevention. "There is some evidence that this outreach has led to greater knowledge about dual prevention, including where to access services, as well as higher uptake of family planning methods, particularly condoms, injectables, and implants."

In order to ensure that youth feel welcome at clinics and hospitals, TRCS has provided youth-friendly training for service providers. Health professionals have also used school visits as an opportunity to provide basic medical services, such as taking blood pressure and cleaning minor cuts and scrapes, thus demonstrating their "youth-friendliness" and encouraging in-school youth to access additional services. Providers focus on engaging youth in interactive discussions about RH issues - stimulating questions - rather than providing information in a didactic manner. Teachers and peer educators involved in the project now refer youth to these youth-friendly service providers for FP commodities and CT.

Organisers have learned that receiving HIV/AIDS, FP, and RH education from multiple sources is an important component in increasing knowledge and changing attitudes and behaviours among young people. Other lessons for youth-serving organisations seeking to integrate FP into HIV/AIDS programmes:

• Involve parents and the larger community; gaining the support of influential leaders in the community helps providers reach youth and helps parents support each other and their children to prevent HIV and pregnancies.
• Encourage referrals to well-equipped health facilities; provide information to peer educators, teachers, and community members so that they can link young people with the appropriate local health facilities.
• Focus a substantial part of provider training on strategies to help adults interact with youth in a respectful and non-judgmental manner.
• Tailor programmes to fit the country-specific context: Whereas countries with generalised HIV epidemics can promote integration across a range of interventions for youth, in countries where both HIV prevalence and contraceptive prevalence are low, integrating these programmes may not work as effectively.
• Abstinence, being faithful, and/or using a condom (ABC) consistently and correctly are relevant to preventing both HIV and unintended pregnancies.
• FP services or referrals should be included with CT services; during CT, all risks of unprotected sex (including pregnancy) should be discussed.
• Life-skills-based education, with a focus on improved negotiation and decision-making skills, should be the common ground for HIV and youth RH programmes.