HIV/AIDS prevention among young people: Confidentiality guaranteed by Ruth Ayisi Nicoadala, Zambézia province - There were no “Youth friendly Health Services” (YFHS) in Nicoadala when fourteen-year-old Lídia Diere got pregnant. She was in the third grade at school. “My boyfriend left me. All my friends were at school and I wanted to continue studying,” says Diere. “I planned to get hold of some liquid to drink to abort my baby. I didn’t know what to do.” Diere says she wished there had been a YFHS at that time, where she could have been counselled by a peer her own age and visited a doctor who is trained to understand young people and not to be judgemental. Fortunately Diere’s parents were supportive and persuaded her not to opt for a dangerous backstreet abortion. “My parents said I could not do this because there was a live person inside me.” So Diere did not risk her life. She had her baby, and now Jone is a healthy seven-year-old boy. Diere, at 21 years old, is pregnant again and is attending the YFHS. “I like the service here as I am young and with other young people.” Diere says she finds it easier talking to the doctor at this clinic than at the District Hospital. However, she is concerned about her six-month pregnancy. “I’m feeling a lot of pain.” As she waits to be attended in the crowded room, Diere has a range of pamphlets and leaflets available to her, and she can watch videos on subjects such as family planning and HIV/AIDS. The aim of the YFHS initiative, supported by UNICEF, is to provide health services for young people, which are affordable, accessible, confidential and neutral. In those youth friendly health services, it is mainly peer educators who discuss with the other young people how to prevent unwanted pregnancies, and sexually transmitted infections including HIV/AIDS. The services also provide HIV testing and counselling. So far, there is no national policy on free treatment of sexually transmitted infections (STIs) for adolescents, but some YFHS already provide treatment. Any young person from the ages between 10 years to 24 years is entitled to these services. There is a strong emphasis on prevention, as the peer counsellors also go into school and into the communities providing information on health for young people and life skills. It is a key initiative considering that in Mozambique, young people between the ages of 15 and 24 account for 26 per cent of all people living with HIV/AIDS. Young women of that age group even make up 37 per cent of all cases. The age group 10 to 14 by contrast shows the lowest prevalence rate of all with 0.03 per cent. Children of that age are included in the programme, because they represent the window of hope. Their sexual behaviour will determine the further development of the epidemic. Like most of the 32 YFHS around the country, which are supported by UNICEF (end 2004), the one that Diere attends is on the grounds of the District Hospital. About 1,000 young people are registered in the YFHS in Nicoadala, in the northern province of Zambézia. On the whole, 50,000 young people were reached in 2004, more than 60 per cent of them girls and young women. “The young people prefer to come here where confidentiality is guaranteed, and they are not going to come across their uncle or another member of their family”, says Clemente Eusebe, a medical technician who works at the YFHS. He says that he has encouraged his 17-year-old daughter to attend the YFHS, but he will keep a back seat with her. “She has no problems as far as I’m aware, but I want her to be sensitized to the various things she will be up against.” He encourages her to talk with the peer educators, who are usually still at school and have reached at least grade six. “The peer educators do good work, but the problem is when they graduate from school, they leave the area and can no longer work with us.” Some 20 peer educators had undergone the two-week training supported by UNICEF, but half of them have recently left Nicoadala as they have gone on to further education. “This is one of our major challenges.” Another challenge comes from one of the peer educators, 21-year-old Lene Joaquim, who complains that it can be difficult to mobilise the youth. “There are some that are difficult. I find the boys easier to talk to. They come forward and want to hear more. The girls, well, they often just smile.” However, Joaquim says that he will not drop out as he values the work he is able to do at the YFHS, in the schools and in the community, especially the street theatre in which she participates. Despite Joaquim’s comment about the girls, they are the majority in the waiting room that day. Many of them are pregnant like Diere. Diere, who lost her second baby, is anxious that this one survives. “My second child died June 30th when he was two years and five months,” she says, without pausing to remember. The boy died after suffering one month of chronic diarrhoea. As well as receiving high quality health care, Diere says she now has a supportive husband, and she is studying at night school and has reached grade six.
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