 Youth Consultation: HIV and Sexual and Reproductive Health and Rights

Aim  The consultation aimed at learning directly from young people living with and affected by HIV about their lived experiences of accessing HIV and SRH services, including family planning; participating in decision making as young people most affected by HIV; and, their vision for realising their sexual and reproductive rights.

The consultation  Global online survey: almost 800 participants from every region; 5 languages  Focus group discussions and community dialogues: 363+ participants

Participants  Online survey:  20% lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI)  8.7% people living with HIV  6.8% men who have sex with men .5% young people who engage in sex work .1% young people who use drugs  FGDs/community dialogues, of participants who identified (and recognizing that people have multiple, overlapping identities):  62.5% were young people living with HIV  14.2% LGBTQI  11.3% young people who engage in sex work  5% MSM  7.1% young people who use drugs  33.9% of focus group participants did not identify as one group, but likely associate with at least one of these populations.

The key priorities  Human rights, including sexual and reproductive rights and policy and legal reforms.  Comprehensive sexuality education  Access to safe, comprehensive services and knowledgeable, ethical, supportive, and qualified health service providers  Meaningful youth participation in all aspects of decision-making  Addressing gender-based violence

Country focus: Bangladesh  Key issues:  Lack of comprehensive sexuality education(including SRR); cultural unacceptability of discussing SRH; gender inequality in SRH/family planning decision- making; lack of access to safe abortion; fear of sharing sexual orientation and gender identity; gender inequality in condom negotiation (MSM, SW); lack of mental health services; lack of LGBTQI-friendly VCT and treatment

Country focus: Bangladesh  Most of the time I cannot [decide whether, when, and where to have sex], due to societal power structure. Most of my partners are older and urban; they are not interested in arguing on sexual issues. –Young man who has sex with men and does sex work, Bangladesh

Country focus: Burundi  Key issues:  Lack of youth-friendly centres (closed down); lack of access to information on SRH; harassment and discrimination at health posts (transgender and PLWHA); inability to negotiate condom use (SW); lack of condom use with primary partners (SW); cultural/social lack of acceptance of sexuality of young PLWHA; little to no access to condoms; lack of safe abortion services

Country focus: Burundi  People already believe that it is forbidden for us to have sexual relationship, imagine yourself the discrimination that you can suffer because if you are pregnant, it is already an indicator that you slept with someone without a condom.  I have no problem with regard to my sexual orientation or my gender identity, only people do not admit that we have sex, sexual intercourse among young people living with HIV are considered an act of propagation of HIV. -Young people living with HIV, Burundi

Country focus: Ethiopia  Key issues: inaccessible and expensive safe abortion services; abortion “brokers;” knowledge around availability/legality of abortion sparse; sexuality not perceived as a right for young people (especiallyfrom key affected populations); extensive sexual violence against young women; RH and HIV services more easily accessible than SRHR education

Country focus: Ethiopia  When asked to define “sex” and “sexuality,” young women who do sex work perceived them as “business,” “job,” “means of income,” “what we do only for reproduction, to give birth...” and “a painful experience to a girl.” Similar sentiment was observed as sex was seen as negatively connoted to issues like HIV, unwanted pregnancy, etc.  I use pills, secretly, because he [my husband] doesn’t want me to use any methods, he want more child to have. I can’t say “no.” Sometimes I forget to take a pill before he arrives at home, in such moment, I take double. I know this can’t help me, but I don’t know what [else] I can do. –Young married woman

Country focus: Myanmar  Key issues: young women living with HIV afraid to have children; testing without knowledge at traditional health centers; lack of access to hospital- provided and regulated abortion services; decisions about where, when and how to have sex, including use of condoms or other forms of contraception, mainly made by male partners; HIV services lacking in rural areas; blame, stigma and discrimination present as barriers to service access and disclosure.  Peer support cited as crucial to information and access to services. “We need to be healthy so that we can help our sisters who are HIV positive and we do not need to be depressed at all”

Country focus: Myanmar

Country focus: Uganda  Key issues: lack of trust in services, including HIV testing; myths and misinformation about SRH and HIV rife; high levels of violence reported among male and female sex workers, sexual minority groups and women living with HIV; lack of youth-friendly SRHR services and information; lack of tailored sexual health services and commodities for men who have sex with men; low and inconsistent uptake of family planning; access to safe abortion limited and expensive

Country focus: Uganda  “I have always wanted to have a test but I feared to go to the hospitals because I imagined the long queues, the rude nurses, whom to specifically approach, and the possibility of not accessing the services even after I have waited for long. I kept wishing to get mobile doctors to help me find out my status, until I saw a counselor who was testing people from door to door. I didn’t even hesitate to find out whether she was qualified to do this work. All I wanted was to know my status. But now, am again confused. I don’t know whether the test she made was real or she lied to me!”

Visions for Positive Change  There should be an early engagement into sex education for young people. In my country, it is still taboo to talk about sex and sexuality with young people. They end up resorting to media to learn, when parents and extended family should be assuming this role. –20-24 year old young woman, East or Southern Africa  We as women and men have the right to decide if we want to use a family planning method, if we have access to information, knowledge on safe affordable and effective service and full realization will be able to decide over these things and have access to them year old woman activist, Caribbean

Visions for Positive Change  More funds [are needed] for HIV/AIDS, adolescent sexual and reproductive health, and policy influence. These funds should have limited or no restrictions that make youth led organizations able to access it. In Uganda, the youth fund was established but then the majority of the youth were kicked out because of the requirements like the level of education, running enterprise, etc. –Young man activist, Uganda  I wish there was a law to protect the human and sexual rights of sex workers, and a law that encouraged sex workers to report any sexual abuse or sexual violence whenever it happens. –Young woman sex worker, Ethiopia  All parties in a relationship having equal say in when or how to plan to have children or not year old lesbian woman, Uganda

Thank you.