Insights from Juliana Odindo on #Voices

  Q1. What barriers do young women living with HIV face in accessing Contraception?

Young women living with HIV don’t have many contraceptive options. This is due to the fact that they are forced to contend with reducing  the pill burden  given that some of the Anti-retrovirals interact with some of the available contraceptive options. There are also challenges with service providers giving incorrect and coercive information (in some cases the women are illiterate, in some cases the language used is confusing or presents a different meaning to the woman i.e. if a nurse says “your tubes will be tied” the woman accepts the option knowing and assuming that her tubes can be untied at some point). Young women especially, given the lack of comprehensive sexuality education during adolescence do not have the confidence to probe for more information and in some instances there is just no time to ask more questions. The barriers are further amplified by the lack of variety in contraceptive options in  which case local facilities offer only what they have. This creates a situation where there is no consistency in local and small facilities where most young women access contraceptives and pose a big challenge for those not on long term methods.

Q2. What impact does this have on their sexual and reproductive health?

Sometimes, young women living with HIV  lose faith in service provision and the health systems failure that they are forced to deal and contend with. This means that access for them is precarious, depriving them of their voice, choice, agency and control over their reproductive destinies, rights and autonomy. This spirals into young women living with HIV ending up with children beyond their economic means, further amplifies the risk of infection for their children if not infected already including preventable infant mortality. In overall this has a negative effect on the health and well being of young women living including their sexual and reproductive health. This is not to mention the stigma that hinders them from even accessing other sexual and reproductive health and rights services and information!

Q3. What Policy and programs can address the barriers

 We need to avail resources for research  so that all the methods and options that are showing promising results are finalized and released to into the market. This will enable  facilitate diversified access to contraception for young women living with HIV. It will also enable us to embody the leave no one behind principle as per the  Sustainable Development Goals (SDGs) framework.  Available SRHR programs have documented challenges and recommendations that should be taken into account. We should leverage on the lessons learnt to design responsive, inclusive, integrated and comprehensive programs for enabling access to contraception for young women living with HIV.  Active participation of beneficiaries( in this case young women living with HIV)  is key and central as most  programs such as   http://www.pepfar.gov/documents/organization/247602.pdf  have documented and emphasized on the need for the meaningful engagement and participation of adolescent girls and young women. Integration is  key to success, if the health system can be structured  in such a way that service providers have access to patients history without disjointment, this would facilitate access to holistic and comprehensive sexual and reproductive health services for young women living with HIV and power health data management.

Q4. As a young woman leader, what has worked in shaping the leadership and meaningful engagement of young women in HIV response. Why?

 Mentorship has worked, this is because experience matters but with recognition that it should be directed and shaped to fit the lived realities and experiences of young women including those living with HIV. When shaping the leadership amongst young women living with HIV impact is demonstrated and linkages between contextual grassroots work and national, regional and global policy fostered. The overall funding decline for gender equality and women’s empowerment has affected the work of women rights organizations who interface with young living with HIV in communities. We therefore need access to  opportunities availed  young women living with HIV  to enable them learn from the best leaders through exchanges and travel opportunities. Funding  is also required to amplify and promote social and technological innovation that facilitates young women living with HIV access to SRHR including access to contraception. This should extend to funding their contribution to planning, policy and programming

 Q5. Moving forward Kindly outline what young women need and what is the role of various actors in making this happen?

In my opinion meaningful involvement of young women is not a reality yet because we still have very few young women in important spaces where decisions regarding our lives are made. Whenever efforts  are made for us to be present, the end results has proven that it was the engagement was tokenistic since in most case, nothing about our contribution features anywhere in the final policy  and program documents. The few young women who are skilled and end up in the leadership positions are overwhelmed to the extent that they lose touch with the reality on the ground or are forced to transition from grassroots activism to policy advocacy at some point. I strongly feel that our communities does  not yet benefit from our representation; there should be a channels that facilitated a monitored bottom up approach and vice versa. Stronger communication and also access to more opportunities for young women living with HIV to influence processes is required!!

 Q6. What is your parting shot?

 Even among young women living with HIV there is diversity that no magic bullet can address. This is how our contraception needs presents as well, especially interfaced with the special needs that comes with various ART regimens. If I were in a position to do anything, I would look into the gaps and challenges that face the current systems and address them before I invest on any new method. Sometimes we don’t need new we just need improvements of the current.

 Read more about Juliana Odindo’s work and personal story  published on the International Aids Society  website where Juliana is a member -Growing up HIV; From Diagnosis To Activism