NACOSA is proud to have co-authored a research paper with South African Medical Research Council, the University of Cape Town and the Sheffield Institute for International Development looking at feasibility and acceptability of Safe Spaces as part of HIV prevention interventions with adolescent girls and young women. The research paper was recently published in the BMC Public Health journal.
Safe Spaces are a feature of HIV prevention interventions for adolescent girls and young women that NACOSA implements with funding from the Global Fund, together with two other principal recipient organisations. As part of an evaluation of this programme, researchers investigated whether young women at risk for adverse sexual and reproductive health outcomes accessed these Safe Spaces, and also looked at their feasibility and acceptability.
BARRIERS TO SERVICES
Adolescents and young people often experience services in health facilities as unfriendly and unresponsive to their needs, particularly for sexual and reproductive health (SRH) care. While marginalized youth are at higher risk of SRH problems, they experience greater obstacles in accessing care. Young people need spaces where they feel accepted, free from stigma, maltreatment and violence – where they can access youth-friendly health services. In recent years, Safe Spaces have become a feature of women-centred HIV, SRH and trauma-sensitive care service models globally and are regarded as a good way to overcome some of these barriers to care.
The Global Fund Adolescent Girls and Young Women programme (called My Journey) aims to decrease HIV incidence, teenage pregnancy and gender-based violence, and increase retention in school and economic opportunities. Dedicated Safe Spaces in communities were an important feature of the approach, providing a space for SRH services to be delivered. Researchers investigated whether at-risk adolescent girls and young women beneficiaries of the programme accessed the Safe Spaces and explored the factors that attract young women to Safe Spaces, the acceptability of these spaces to young women and implementers.
Researchers randomly sampled 2,160 programme beneficiaries across the districts where the programme operates. Some interesting information about them included:
The young women shared positive views of Safe Spaces, describing benefits such as access to computers and the internet, support with homework and job and education applications, and a space in which to connect with peers. They are attracted to Safe Spaces by educational and economic empowerment interventions and recreational activities, and many will take up the offer of SRH services while they are there.
Nearly a quarter of participants reported spending time at a Safe Space. However, beneficiaries who were in the lower socio-economic status category were significantly less likely to have accessed and spent time at a Safe Space, compared with those with relatively higher socio-economic status.
The young women reported participating in the following services or activities at the Safe Space:
The vast majority (89%) reported that the Safe Space was a comfortable space to be in for young women like them.
“If you are in school and you do not have internet at home… even if they are crowded at home, these young girls can come to the Safe Space and do their homework and things like that. So, this girl has a safety net… she knows ‘I have people that can assist me’.” Implementer
CHALLENGES AND BENEFITS
Programme implementers reported that the appropriate positioning of Safe Spaces, in locations that were easily accessible, convenient and safe, was a key factor in their successful use. They also highlighted that young women’s concerns over the confidentiality of Safe Spaces was a critical issue.
The key perceived benefits of Safe Spaces included access to computers, a safe and quiet environment conducive to studying, access to homework support. Young women highly valued Safe Spaces as a place to interact with other young women and get peer support.
“I just go there and talk about what affect us as women at this age… we find solutions.” Mpumalanga, 15-19 years
Even though young women might not initially be attracted to Safe Spaces based on the availability of SRH services, if they visit a Safe Space, a large proportion are likely to take up the services on offer. The incorporation of play, rest and recreation within Safe Spaces should be viewed as critical enablers of improved health and wellbeing, recognising young people’s holistic journey to adulthood. The popularity of Safe Spaces offering such resources can be harnessed as an entry point for engaging young people in HIV prevention or treatment services and SRH care.
Unemployment, poverty and low educational attainment are structural drivers of HIV, and Safe Spaces that provide socio-economic interventions focusing on social protection can mitigate young women’s HIV risk and vulnerability as well as improving their well-being and development. The research findings highlight the importance of the provision of socio-economic interventions in Safe Spaces: the spaces can build social capital and have been shown to increase agency among adolescent girls and young women.
As Safe Space interventions are rolled out, it is important to monitor disparities in access to them and investigate the potential value of school-based Safe Spaces to improve access among the poorest girls. Other approaches might include mobile safe spaces to improve access in remote areas.