Reaching youth with out-of-facility HIV and reproductive health services: a systematic review

PURPOSE

Many young people, particularly those who are marginalized and most at risk for HIV and reproductive health-related problems, cannot or will not seek traditional facility-based health services. Policies and programs are being implemented to provide them with these health services in the community. We sought to review the effectiveness of such approaches in increasing HIV and reproductive health service use.

METHODS

A systematic literature review was undertaken to identify policies promoting or programs delivering HIV or reproductive health services in the community. We reviewed studies that evaluated uptake of services or commodities. Data from studies meeting inclusion criteria were qualitatively analyzed.

RESULTS

Twenty studies met inclusion criteria, including 10 containing comparative data (e.g., before and after study or control study design). The studies generally demonstrated positive impact, although results varied across settings and approaches. The most successful approaches included mail-based chlamydia screening in the Netherlands, condom distribution via street outreach in Louisiana, home-based HIV counseling and testing in Malawi, and promotion of over-the-counter access to emergency contraception in various countries.

CONCLUSION

Overall, this review suggests that out-of-facility approaches can be important avenues to reach youth. Continued evaluation is necessary to better understand specific approaches that can successfully deliver health services.

Tailoring clinical management practices to meet the special needs of adolescents: sexually transmitted infections

Sexually transmitted infections are a major health risk to all sexually active adolescents and improving clinical management for this age group is of major importance. Currently, adolescents are managed in the same way as adults. This paper summarizes recommendations by the World Health Organization that services be more responsive to adolescent concerns about confidentiality, risk assessment be more attuned to their sexual behavioral patterns, and services be tailored to give more time for counseling, assessment of stage of maturity and continuity of reproductive health care.

Contraception for adolescents: social, clinical and service-delivery considerations

A large proportion of the millions of adolescents worldwide who are sexually active have sex without using modern contraceptives or protection against sexually transmitted infections (STI). In many cases, this results in too-early (and often unwanted) pregnancies and STI, with negative consequences at different levels. Adolescents in general--and unmarried adolescents in particular--often find it difficult to obtain the contraceptives they need. Health workers are often unaware of the special needs of adolescents, and contraceptive services are only rarely provided in a manner that is accessible to adolescents. The World Health Organization stresses that age alone does not constitute a medical reason for denying any available contraceptive method to adolescents. However, it recommends that it is important for health workers to be well aware of the biomedical, psychological and social issues that affect how they can assist adolescents in making well-informed choices of contraceptive methods that suit their special needs, and in using the contraceptives, they choose in an effective manner.