Workshop Analyzing and challenging conflicting legal frameworks for adolescent HIV and sexual and reproductive health services XXI International AIDS Conference 21 July 2016

TODAY Input: Conflicting laws on ASRH in Southern and East Africa Fishbowl discussion 1: Conflicting laws and LGBTI adolescents Fishbowl discussion 2: Conflicting laws and adolescent access to abortion Group work: What are key law and policy issues in your context? Summary and conclusion

What’s special about 12-18 year olds? Key HIV and SRH needs, yet their sexuality is regulated by complex legal and moral frameworks. Adolescent sexuality is contested: moral and legal restrictions on age of sexual debut, need to balance protective with emancipatory approaches Evidence shows that adolescents are sexually active and need SRH services: Young people (aged 15-24) account for 39% of all HIV infections globally High rates of pregnancy and sexual violence among adolescent girls No harmony between policies: Dr Alex Muller, 2016

What governs ASRH? Age of majority law Sexual offences law Marriage law Children’s law Termination of pregnancy law Other criminal law (penal codes) Provisions for access to specific health services No harmony between policies: Dr Alex Muller, 2016

The ‘Contested Terrain’ study We analysed the legal frameworks around adolescent HIV/SRH service provision in Malawi, Mozambique, Namibia, Zambia and Zimbabwe. Literature review and desktop-based analysis of laws and policies 50 in-depth interviews with representatives of adolescent organisations and policy makers Thematic data analysis Comparisons across countries and specific ASRH issues *Which inconsistencies exist? *What do service providers know? *What information is available to adolescents? No harmony between policies: Dr Alex Muller, 2016

Inconsistencies in law and policy Laws regulating adolescent HIV & SRH services and sexual activity are inconsistent within and across the five countries. Age of consent lower for HCT than other SRH services Age of consent to sex higher than age of consent to HCT – adolescents asking for HCT in effect disclose illegal sexual activity Contradictions between laws and policies ‘Mature minor’ policy: age of consent for SRH lower than by law ‘Key population’ policy: targets individuals engaged in same-sex sexual behaviour, criminalised by law Child marriage: age of consent to marriage different in Marriage Act and constitution No harmony between policies: Dr Alex Muller, 2016

Contradictory provider knowledge Laws regulating adolescent HIV & SRH services and sexual activity are understood differently within and across the five countries. Participants had good knowledge about criminalised behaviour/ activities (same-sex activity, abortion) Good general knowledge about recent laws, but not their specific provisions Poor knowledge about ages of consent to medical services and sex (answers ranged from 12 – 18) Participants overestimated their obligations to report No harmony between policies: Dr Alex Muller, 2016

Zimbabwe: Age of consent to sex No harmony between policies: Dr Alex Muller, 2016

Zimbabwe: Age of consent to sex Most participants knew about the minimum age of consent to sex, but fewer were clear about the provisions affecting 12-16 year olds. Strong impact of personal moral/ religious beliefs on the interpretation of legal provisions “The law is trying to create that society that you know, delays sexual debut. The law actually even prefers a situation whereby adolescents can only indulge in sex when they get married. We are a generally Christian country and the religious moral will say no sex before marriage. Sex is only something which can be enjoyed after marriage. So there’s no way the law can provide for minors having sex with minors”. No harmony between policies: Dr Alex Muller, 2016

Zimbabwe: Access to services No harmony between policies: Dr Alex Muller, 2016

Zimbabwe: Access to services Providers thought minimum age was 16 or 18 Many providers admitted that they were unsure, and others cited the law, even if what they said was not in the law Lack of clarity likely stems from the inconsistencies and variety of age groups referred to in HIV and SRH policies, which range from 10 to 24 in the definition of adolescent No harmony between policies: Dr Alex Muller, 2016

Case study: same-sex activity Laws that criminalise same-sex activity (Malawi, Zambia and Zimbabwe) jeopardise ASRH services for lesbian, gay, bisexual and transgender adolescents. Inconsistent law and policy: Penal Code criminalises (male) same-sex activity, Ministry of Health policy specifies MSM as ‘key populations’ Inconsistent provider knowledge: No distinction between identity and behaviour, nor between MSM and WSW, wrong assumptions of duty to report LGBT adolescents fall through the cracks: Penal code and its interpretation as justification for not providing education/ services for LGBT adolescents No harmony between policies: Dr Alex Muller, 2016

Summary Laws and policies on adolescent HIV & SRH conflicting and inconsistent. Providers working with adolescent have ‘newspaper’ knowledge about ASRH laws and policies – focus on the sensational or current. Greater focus on what teenagers shouldn’t do than on what they are entitled to No harmony between policies: Dr Alex Muller, 2016

Conclusion The combination of legal inconsistencies and provider lack of knowledge Encourages discretionary, moral-based decision-making by service providers Jeopardises confidentiality of services Decreases reliable information sources for adolescents Increases barriers for adolescents’ access to HIV and SRH services No harmony between policies: Dr Alex Muller, 2016

Way forward Harmonisation of laws and policies Education of providers Not just healthcare providers but everyone working with adolescents Encourage exploring of legal and moral complexity Values clarification Mandatory reporting duties Include adolescents – adolescent agency, rights-based approach No harmony between policies: Dr Alex Muller, 2016

Thank you! Pick up a research brief on Malawi or Zimbabwe. Please feel free to contact us! Call: +27 (0) 21 406 6021 or email: alexandra.muller@uct.ac.za This research was funded by