- With a young man saying kissing is one of the ways through which HIV is transmitted, the counsellor, Ashraf Kaboda, has a hard time convincing them that discordant couples actually exist
- Youth corners are a new innovation in health facilities to help youth attain services to improve their sexuality choices away from the prying eyes of adults
At 21, Brian Tenywa is still a virgin. Sitting on the sidelines of a Table Talk (a forum for young people) at Busowobi Health Centre III, Iganga District, the young man, who is hoping to join Senior Five soon, has come take an HIV test, and hopefully, learn how to use a condom.
“This is my second time here. On my first visit, I was given many condoms but I just kept them in a box. I do not know how to use them to protect my life. I hope the counsellors teach us more about condom use because many of my friends have died HIV (related complications).”
At the Table Talk, about 40 youth, most of them adolescents between 12 and 19 years of age, are having an open dialogue and the topic of contention is discordancy.
With a young man saying kissing is one of the ways through which HIV is transmitted, the counsellor, Ashraf Kaboda, has a hard time convincing them that discordant couples actually exist.
“If you have sex without a condom with an HIV positive woman, who is diligently taking antiretroviral treatment, you may not get the virus,” Kaboda tells the boys, continuing, “However, do not make a habit of having unprotected sex because the next time you may not be so lucky.”
Like typical teenagers, the young people are giggly and laugh out loud whenever Kaboda mentions the names of the sex organs.
Youth corners are a new innovation in health facilities to help youth attain services to improve their sexuality choices away from the prying eyes of adults.
Typically, every health centre should have youth corners, but in reality very few do. Even Busowobi does not have one; the Table Talk is hosted by Reproductive Health Uganda (RHU) clinic in Iganga.
Navigating the ban on sexuality education
In October 2016, the Ministry of Gender, Labour, and Social Development banned comprehensive sexuality education in schools until a policy to regulate sexuality education is formulated. While issuing the ban, Gender minister Janat Mukwaya, said sexuality education was leading to a decline in national values. Parliament also banned all forms of sexuality education.
In the absence of a new policy from the Ministry of Education and Sports (MoES), and in the face of sexuality challenges faced by adolescents and youth, health organisations have had to be innovative.
The RHU clinic uses the Presidential Initiative on AIDS Strategy for Communication to Youth (PIASCY) – a handbook for teachers approved by MoEs – to educate the youth.
Dominic Mulesa, project officer, RHU clinic Iganga, says: “We are repackaging sexuality education through PIASCY. In schools we use teachers, especially senior woman teachers, but in the community we use the peer to peer model. The messages in PIASCY were approved by MoES.”
In an area such as Iganga where the incidences of teenage pregnancy are high, sexuality education cannot be left to chance.
At the Table Talk, peer educators, also have on offer both male and female condoms. The older girls, who are already having sex, are advised to use short to mid-term contraceptive methods.
Such is the quality of the information given to the youths that two hours into the talk, Rabiya Nakaziba makes a spur-of-the-moment decision to have an implants inserted. The 20-year-old was seduced by a married man when she was 17 and impregnated.
“I came here longing to hear about sexually transmitted diseases. I have decided on an implant that last five years because I do not want to have another baby anytime soon. The father of my child does not give me any assistance,” she says.
The few girls who come to ask for family planning only want contraceptive pills, which makes Nakaziba unique in her decision. Iganga is a predominantly conservative Muslim society. Not many parents approve of the work of the youth counsellors and peer educators.
“Many adults in this area think contraception is bad, and since most of the young people are still living in their parent’s homes, we always get few teenagers at the Table Talks,” Kaboda says, adding that most parents think if their children begin using contraceptives early, they will become barren or get cancer.
Salima Nakiyemba, a mother of seven, waiting in line to see a doctor for a solution to her back ailment, looks disdainfully at the youths.
“How will the girls’ bodies develop if they are using contraceptives? Family planning spoils girls. How can a 12-year-old be taught how to use a condom?” she asks.
Nakiyemba says she would rather see her teenage daughters pregnant than allowing them to use contraceptives.
“If they use family planning now, in the future, they will want to give birth but their eggs would have been spoilt by then,” she says.
This is a problem Mulesa encounters every time he has an outreach.
“The fact that this is a Muslim area, affects the uptake of family planning services. One time, two girls of about 18 years asked for implants. The next day, though, they came back to tell us their parents had instructed them to remove the implants.
Apparently, a neighbour had seen them talking to us and had reported them,” she says.
She adds that the girls were counselled and they decided not to remove the implants. To deal with such issues, Mulesa holds community dialogues with the parents and local leaders to allay their fears.
Dr Alvaro Bermejo, the newly appointed director general of International Planned Parenthood Federation (IPPF), who visited Busowobi Health Centre III as part of a three-day tour of Uganda, says no country can progress without investing in its young people.
IPPF is supplying family planning products and services to Uganda through its partner RHU. However, the government needs to have the political will to open up youth corners in every health facility and stock up on contraceptives to give to youths who cannot abstain.
Using games to attract youth
At 6pm, Iganga Youth Centre still has a number of boys, some as young as 9 years, playing games such as volley ball, Ludo, and pool. According to Mulesa, only a small number of girls turns up because they are shy to talk about sex. Those who visit the youth corner usually request for contraceptive pills or injections (Depo Provera).
Seated in the corner of the compound are four men. One of them is a peer educator who is teaching the three (aged 18, 19, and 24) about ovulation and pregnancy. Soon, the conversations shifts to how to use a condom. The 24-year-old asks how it is possible that a condom can prevent an HIV infection. He also disputes the fact that discordancy exists.
“All the girls I get don’t want to use condoms. They either tell me condoms make their backs hurt, or they that condoms cause cancer,” he says, adding that he has never used a condom.
Dr Bermejo insists young people are sexual beings who have to develop their sexuality.
“It is about providing them with the methods to exercise the responsibility to develop themselves. Our role is to make sure that sexual reproductive health and rights of young people are respected and protected. This view that in Uganda we should pretend about how high teenage pregnancy rates are, and ignore sexuality education does not take us anywhere,” she says.
Tackling sexuality education head on
Recently, Muhammad Kasule, the technical advisor of HIV/Aids in MoES, revealed that the ministry had approved a national sexuality education framework. If put into action, this framework will be a timely intervention by government in areas where heath centres are not youth friendly.
With sexuality education back in schools, adolescents will be able to learn about their sexuality in a conducive environment with their peers, instead of having to share the same space with disapproving adults.
What experts say
Every health centre in Kampala, such as Kisenyi, Kawaala, Komamboga, Kisugu, and China Uganda Friendship Hospital, has a youth corner.
These youth corners were designed in such a way that young people aged 10 – 24 years can freely access services without fear of being intimidated by, or associating with, their parents, teachers, and other adults.
It was a deliberate effort to promote access to adolescent sexual reproductive health services is sure that he or she is going to interact with their peers and be attended to by youth-friendly service providers.
They know they are going to get services that satisfy their needs so that they can refer their peers. Young people have specific needs and challenges which need to be addressed differently; some of them may not be addressed very well in the mainstream health setting.
The services provided in the youth corners include screening for and management of sexually transmitted disease; family planning; antenatal, postnatal, post abortion care; HIV testing and counseling, and HIV care support services. Young people also get counseling on adolescent sexual reproductive health issues by trained counsellors.
In addition, youth corners are like information bureaus. They provide information, which is key to behaviour change. We want to empower youth with age-appropriate information, through health talks, educative films, and printed materials, so that they can make informed decisions.
During the health talks, the adolescents are free to give their opinions and ideas on different issues, because although the information provided is age-appropriate, some youth may be knowing a lot more than we expect.
That is why in our interactions we create and enabling environment for them to ask questions, which the counsellors respond to.
All the youth corners in Kampala have televisions where the adolescents watch movies to enjoy and to learn. Also, youth corners are filled with posters which have educative messages.
Henry Ntale, Behaviour Change and Communications Manager
- Naguru Teenage Centre