An assessment of youth centres in South Africa

Within South Africa there is much interest in expanding youth center programs, particularly in the nongovernmental sector, in part because of recognition that the HIV/AIDS crisis is disproportionately affecting young South Africans. This study was designed to give implementing agencies and donors a broad view of how the youth centers function, who they reach, and the quality of information and services. The assessment underscored the importance of monitoring the performance of programs and understanding who is being reached with what interventions. Youth centers that focus on providing recreational facilities attract a large number of clients, often boys who are repeat visitors, however, linkages between providing recreation and positive health outcomes are not clearcut. Centers should not lose sight of their health objectives and should recognize that a significant proportion of young people are in need of quality reproductive health (RH) information and services. The report further recommends that attention be paid to the specific needs and circumstances of boys and girls in designing programs that satisfy their distinct RH needs

Implementing and scaling-up Stepping Stones in KwaZulu-Natal, South Africa: Lessons from working in informal settlements

KwaZulu-Natal (KZN), a major epicenter of the South African HIV epidemic, has large informal settlements where thousands of people live. The settlements are often underserved by municipal services and lack accessible health care. Given high rates of HIV, there is a critical need to assess the successes and challenges of implementing HIV prevention and treatment in this context. Stepping Stones is a widely used life-skills training intervention focused on curbing gender-based violence and reducing HIV risk. The program addresses issues such as communication about HIV, relationship skills, and assertiveness. The manual-based curriculum encourages participants to engage in critical reflection through role-playing and group dialogue. Previous evaluations of Stepping Stones in South Africa found significant reductions in intimate partner violence and herpes simplex virus-2, and improvements in couple communication and negotiation. Under Project SOAR, the Population Council and the MatCH Research Unit of the University of the Witwatersrand conducted program evaluations in 18 selected informal settlements in KZN. This brief focuses on the experiences, challenges, successes, and perceived effects of implementing (and scaling up) Stepping Stones in the informal settlement setting

Dual protection in sexually active women.

OBJECTIVE: To determine the prevalence and co-factors associated with the practice of dual protection against sexually transmitted infections (STIs) and unwanted pregnancy in a cross-sectional sample of South African women. DESIGN: Secondary analysis of cross-sectional household survey data. METHODS: Statistical analysis of responses by sexually active women to the question, 'Was a condom used on the last occasion you had sex?' were obtained from the women's questionnaire of the South African Demographic and Health Survey in relation to a number of other variables. RESULTS: (i) 10.5% of all sexually active women aged 15-49 years used a condom at last sex and 6.3% used a condom as well as another contraceptive method; (ii) condom use is more likely among younger, more educated, more affluent, and urban women, and among women who change partners more frequently; (iii) reasons for not using condoms are more likely to be associated with the personal attitudes of women or their partners than with poor knowledge of or lack of access to condoms; (iv) women who have no need or desire to prevent pregnancy are less likely to use condoms; and (v) there is a minority of sexually active women, characterised by social disadvantage, who have difficulty obtaining condoms. CONCLUSIONS: There is an urgent need for targeted programmes that increase dual protection with condoms

Women’s contraceptive choice following the use of Implanon NXT: Findings from a study in Durban, South Africa

Implanon NXT was introduced in South Africa (SA) in 2014 to expand the contraceptive method mix. While studies have explored patterns of implant use, data on contraceptive choice following implant removal is limited. Here, we describe contraceptive choice among 120 women requesting Implanon NXT removal, between 2017 and 2018, at an urban reproductive health clinic in Durban, SA. Among women who used the implant for three years (n=91), >50% chose to reinsert Implanon NXT. Reasons for choosing to reinsert included satisfaction with the implant, the desire for a long-acting method and having had no side effects. A third of women chose not to reinsert Implanon NXT after three years due to side effects such as problematic bleeding. Most women requesting early removal of the implant switched to male condoms, injectables or oral contraceptives. Contraceptive services should provide women with contraceptive options and allow women to make informed decisions regarding contraceptive choice, in addition to providing support and managing side effects among Implanon NXT users. Implanon NXT a été introduit en Afrique du Sud (SA) en 2014 pour élargir la gamme de méthodes contraceptives. Alors que les études ont exploré les modèles d'utilisation des implants, les données sur le choix de la contraception après le retrait de l'implant sont limitées. Ici, nous décrivons le choix de la contraception parmi 120 femmes demandant le retrait d'Implanon NXT, entre 2017 et 2018, dans une clinique de santé reproductive urbaine à Durban, SA. Parmi les femmes ayant utilisé l'implant pendant trois ans (n = 91),> 50% ont choisi de réinsérer Implanon NXT. Les raisons du choix de la réinsertion comprenaient la satisfaction à l'égard de l'implant, le désir d'une méthode à action prolongée et l'absence d'effets secondaires. Un tiers des femmes ont choisi de ne pas réinsérer Implanon NXT après trois ans en raison d'effets secondaires tels que des saignements problématiques. La plupart des femmes demandant le retrait précoce de l'implant sont passées aux préservatifs masculins, aux injectables ou aux contraceptifs oraux. Les services de contraception devraient offrir aux femmes des options contraceptives et leur permettre de prendre des décisions éclairées concernant le choix de la contraception, en plus de fournir un soutien et de gérer les effets secondaires parmi les utilisatrices d'Implanon NXT

Better menstrual management options for adolescents needed in South Africa: What about the menstrual cup?

Providing forms of menstrual management to women and girls in need has been on the South African government’s agenda for the past 4 years.

Are HIV and reproductive health services adapted to the needs of female sex workers? : results of a policy and situational analysis in Tete, Mozambique

Background: In the context of an implementation research project aiming at improving use of HIV and sexual and reproductive health (SRH) services for female sex workers (FSWs), a broad situational analysis was conducted in Tete, Mozambique, assessing if services are adapted to the needs of FSWs. Methods: Methods comprised (1) a policy analysis including a review of national guidelines and interviews with policy makers, and (2) health facility assessments at 6 public and 1 private health facilities, and 1 clinic specifically targeting FSWs, consisting of an audit checklist, interviews with 18 HIV/SRH care providers and interviews of 99 HIV/SRH care users. Results: There exist national guidelines for most HIV/SRH care services, but none provides guidance for care adapted to the needs of high-risk women such as FSWs. The Ministry of Health recently initiated the process of establishing guidelines for attendance of key populations, including FSWs, at public health facilities. Policy makers have different views on the best approach for providing services to FSWs-integrated in the general health services or through parallel services for key populations - and there exists no national strategy. The most important provider of HIV/SRH services in the study area is the government. Most basic services are widely available, with the exception of certain family planning methods, cervical cancer screening, services for victims of sexual and gender-based violence, and termination of pregnancy (TOP). The public facilities face serious limitations in term of space, staff, equipment, regular supplies and adequate provider practices. A stand-alone clinic targeting key populations offers a limited range of services to the FSW population in part of the area. Private clinics offer only a few services, at commercial prices. Conclusion: There is a need to improve the availability of quality HIV/SRH services in general and to FSWs specifically, and to develop guidelines for care adapted to the needs of FSWs. Access for FSWs can be improved by either expanding the range of services and the coverage of the targeted clinic and/or by improving access to adapted care at the public health services and ensure a minimum standard of quality

Feasibility of introducing a comprehensive package of antenatal care services in rural public clinics in South Africa

The Maternal, Child and Women’s Health Unit, in collaboration with the Population Council’s FRONTIERS in Reproductive Health (FRONTIERS) program, the Reproductive Health Research Unit of the University of Witwatersrand, and the Department of Medical Microbiology and Infectious Diseases of the Nelson Mandela School of Medicine, University of Natal, developed and then pilot-tested this revised model in KwaZulu-Natal, South Africa. The project’s objective was to develop and test an improved and integrated antenatal care program for public-sector clinics that would increase the range and quality of services received by pregnant women and improve their reproductive health behavior and status. Various problems, such as trainer and staff turnover, were encountered during and immediately after introduction that influenced the clinics’ capacity to implement and sustain the reorganized services. This implies that efforts to scale-up or replicate this model must consider such resource issues, and that other support systems, such as staff supervision and educational materials, also need attention. It is possible to conclude, however, that interventions such as this, that rely heavily on training staff in new ways of organizing and providing services, must develop and use training and supervisory strategies or systems that are explicitly designed to incorporate relatively rapid rates of staff turnover. This study also highlights the importance of paying attention to health systems when introducing revised or new services, especially HIV-related services

Barriers to HIV and sexual and reproductive health care for female sex workers in Tete, Mozambique : results from a cross-sectional survey and focus group discussions

Background: In the context of an operational research project in Tete, Mozambique, use of, and barriers to, HIV and sexual and reproductive health (HIV/SRH) commodities and services for female sex workers (FSWs) were assessed as part of a baseline situational analysis. Methods: In a cross-sectional survey 311 FSWs were recruited using respondent driven sampling and interviewed face-to-face, and three focus group discussions were held with respectively 6 full-time Mozambican, 7 occasional Mozambican and 9 full-time Zimbabwean FSWs, to investigate use of, and barriers to, HIV/SRH care. Results: The cross-sectional survey showed that 71 % of FSWs used non-barrier contraception, 78 % sought care for their last sexually transmitted infection episode, 51 % of HIV-negative FSWs was tested for HIV in the last 6 months, 83 % of HIV-positive FSWs were in HIV care, 55 % sought help at a health facility for their last unwanted pregnancy and 48 % after sexual assault, and none was ever screened for cervical cancer. Local public health facilities were by far the most common place where care was sought, followed by an NGO-operated clinic targeting FSWs, and places outside the Tete area. In the focus group discussions, FSWs expressed dissatisfaction with the public health services, as a result of being asked for bribes, being badly attended by some care providers, stigmatisation and breaches of confidentiality. The service most lacking was said to be termination of unwanted pregnancies. Conclusions: The use of most HIV and SRH services is insufficient in this FSW population. The public health sector is the main provider, but access is hampered by several barriers. The reach of a FSW-specific NGO clinic is limited. Access to, and use of, HIV and SRH services should be improved by reducing barriers at public health facilities, broadening the range of services and expanding the reach of the targeted NGO clinic