Source: African Seer
The first time Alfred went to an HIV voluntary testing center, the healthcare provider did not treat him well. As a gay man, his story is not so rare.
"He [healthcare worker] asked me are you a man or a woman? I answered I am a man. Then he asked me about my parents," said Alfred, who lives on the Caribbean island of Saint Lucia.
"He just looked at me and treated me as if I was a disgrace to my parents. I decided not to go to the health center after that. Because I do not want to go to a place where I am judged based on my sexual orientation. I am gay and I have sex. So what? "
Challenges for youth to accessing sexual and reproductive health
Key populations in the HIV epidemic, such as men who have sex with men, sex workers and transgender people, have the same sexual and reproductive health rights as anyone else - the right to have sexual relations free from coercion, to have children and to protect themselves from infection.
Last week's International AIDS Conference in Melbourne, Australia was an opportunity for young people, especially youth from key populations, including young people living with HIV, to discuss the barriers and challenges they face in accessing sexual and reproductive health services.
During a session moderated by the Athena Network and the International HIV/AIDS Alliance, one young panelist Violet Lindiwe, 23, from Malawi, said: "In my community, when you attend HIV testing and family planning, healthcare professionals are likely to judge you because they think you misbehaved and that's why you are there."
Myo Minn Htet, a young man from Indonesia, added: "Culture and religious beliefs make it very difficult to talk about sex and to go to sexual and reproductive health services. Moreover discrimination against young key populations make their access to these services more difficult."
The legal age to attend health centers is also one of the barriers identified by young people. Annie Zamina from Malawi said: "In my country though the legal age to have sex is sixteen, you cannot go a clinic and ask for contraceptive pills without your parents' approval. It seems that while the law says you're old enough to have sex, you are still too young to use contraception or to protect yourself from HIV."
Young people vulnerable to HIV infection and unwanted pregnancies
According to the UN, globally young people account for 40 per cent of all new HIV infections. Each day, more than 2,400 young people become infected with HIV, and some five million young people aged 15-24 live with HIV.
Apart from HIV infection, poor access to sexual and reproductive health and sex education opens the door to many other consequences, such as unintended pregnancies and dropping out of school.
Violet said: "When you listen to me, you may think I have a PhD but in fact, I stopped school when I became pregnant. I have to care for me and my son now. And this is what happens to young women in my community when they get pregnant when still students."
Integrated services
According to the World Health Organization, linking sexual and reproductive health with HIV services is an approach that has the potential to increase universal access to prevention, treatment and care services.
This is what Link Up - a programme to improve the sexual and reproductive health and rights of young people - is trying to achieve. The project works with young people living with and affected by HIV in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda and is implemented by a consortium of organizations, including the International HIV/Aids Alliance, Global Youth Coalition against Aids and the Athena Network.
Sexual and reproductive health rights
Reproductive rights only become tangible when reproductive health services that offer a high quality of care are made widely available. Availability includes both affordability and easy access, which also implies a range of services under one roof.
Like Alfred, Rebeccah, a young woman living with HIV from Zimbabwe, was also treated badly the first time she went to a clinic to receive counselling about contraception. She said: "The nurse said she was surprised I was still having sex considering my 'condition'. And she told me I should abstain from sex since I am HIV positive. I cried a lot in her office and decided not to go to that clinic anymore."
But Rebeccah, like many other young people, is now getting to grips with her rights. "As a young woman living with HIV, I am sexually active and I have the right to go a clinic for family planning services," she said.
"My status should not be an argument to be denied this service. And I really hope people should not use our status, our sexual orientation or sex work as argument to deny access to healthcare because we need, no, we demand access to comprehensive sexual and reproductive health services."