Sexual and Reproductive Health
Young people in Malawi are at risk from a broad range of health problems. Sexual and reproductive health behaviors are among the main causes of death, disability and disease among young people. They are at particular risk for unwanted pregnancy and pregnancy related complications, STIs and HIV/AIDS. Other significant problems include: physical and psychological trauma resulting from sexual abuse, gender-based violence and other forms of physical violence and accidents. The youth are vulnerable to these problems because they often venture into sex unprepared; have sex with multiple partners; engage in alcohol and drug abuse that impairs judgment; have limited awareness of STI prevention; lack skills to negotiate safer sex; and have poor health-seeking behavior.
In Malawi, only 50% of youth aged 15-24 years know their HIV status. Of those who are living with HIV, 82.5% are on antiretroviral therapy and 78.8% are virally suppressed – lower rates than for adults in the country. The number of adolescents living with HIV is also growing due to increasing numbers of new infections among youth, as well as perinatally-infected children surviving into adolescence and adulthood as a result of improved antiretroviral drug regimens. Despite this around 60% of young people do not have sufficient knowledge of how to prevent HIV.
Youths – including adolescents living with HIV – are less likely to access services for multiple reasons, including service provider attitudes towards youth, transport costs, inconvenient clinic hours, long waiting times, lack of privacy, and fear of stigma and disclosure.
In response, Wandikweza implements a Community Health Worker (CHW) Youth Supporter program to improve SRH service provision to youths in Dowa. Youth Supporters assist adolescents in accessing SRH services, such as HIV testing and family planning. They link newly-diagnosed adolescents to HIV care and support adolescents living with HIV with disclosure and adherence, ensuring they receive viral load testing, their results, and appropriate follow-up. The Youth Supporters also connect young people to community support groups and psychosocial counselling when needed.
The CHW Youth Supporters are equipped with basic psychosocial counseling skills and advanced training on relevant health topics, including SRH, mental health, treatment adherence, stigma, and disclosure.
Wandikweza minimum package of youth-friendly SRH services include:
• Information and counseling on safe sex and reproductive health;
• Contraception and protective method provision (with an emphasis on dual protection);
• STI diagnosis and management;
• HIV counseling (and referral for testing and care);
• Pregnancy testing and antenatal and postnatal care;
• Counseling on sexual violence and abuse (and referral for needed services);
• Post-abortion care counseling and contraception (with referral when necessary).