Lessons from Link Up! What's So Different About Adolescents? - Unique Challenges and Opportunities in Engaging 10-19 Year Olds in Integrated HIV and SRHR Services

“Adolescents are unique in their development, their health and their social needs; therefore, their service requirements are different.”

This brief explores some of the key lessons learned from the Link Up programme related to engaging and providing services to adolescents. Link Up was launched in 2013 by a consortium of partners led by the International HIV/AIDS Alliance, and sought to improve the sexual and reproductive health and rights (SRHR) of 10-24 year olds most affected by HIV through the delivery of integrated HIV and SRHR programmes. Over the course of three-and-a-half years, Link Up helped reach almost 1 million young people in five countries across Africa and Asia: Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda.

Specifically, this brief aims to: a) gain a better understanding of how adolescents were reached and engaged; b) outline the key challenges encountered as well as critical success factors (from providers’, programmers’, and adolescents’ perspectives) in relation to reaching adolescents with services; and c) identify gaps and make recommendations for future adolescent programming. The brief is based on data from the Link Up monitoring system, findings from research studies, and outcomes of community dialogues, which were all examined for adolescent aspects. In order to complement these data, interviews with implementing partners and consortium members explored the perspectives of those involved in managing and providing services.

The brief discusses the unique opportunities and challenges related to adolescents that emerged from the Link Up experience. To mention just a few findings: The programme showed that adolescents often do not seek out SRH services for a variety of reasons, such not being aware of their need for services and how to access them, and stigma and taboo around adolescent sexuality, which discourages them from seeking services. Link Up also found that adolescents are open to new experiences and show a willingness to learn. They are also particularly receptive to peer influence. Adolescents were also found to have limited knowledge of SRHR due to poor access to information. In addition, many service providers and family members lack the skills and experience necessary for effectively communicating with adolescents.

The brief goes on to describe some of the effective strategies and approaches that Link Up used. The following are a few examples:

• Peer-based interventions were central to the success of Link Up and in facilitating access to SRH services: Adolescents were more likely to engage in activities that included their peers and were more likely to attend a service if supported/accompanied by a peer.
• Interactive, fun activities such drama, music, sports events, and tea ceremonies were central to capturing the attention of adolescents: Interactive activities were not only successful in engaging adolescents, but they conveyed key messages and information.
• In providing a range of integrated interventions, Link Up services were able to be flexible and respond to individual needs, delivering responsive packages of care: Experience gained from Link Up highlighted that adolescents’ needs are diverse and constantly evolving, and the requirements for services, interventions, and support differ across age groups and key population groups.
• Engaging with key gatekeepers, such as parents, helped to facilitate open discussions around the SRHR of adolescents and challenge cultural barriers to access: For example, community dialogues with key gatekeepers facilitated open discussion and were seen as a step towards addressing cultural norms that hinder access.

The brief ends with a list of recommendation for future adolescent programming. The following are just a selection, which are described in more detail in the report:

• Continue to take services and information to adolescents - this should include: outreach to adolescent key populations; the use of innovative ways to connect and engage with them through music, sports, and games; and an increase of communication platforms to include media that is accessible to adolescents.
• Strengthen the quality of services by, for example, investing in youth-friendly spaces/corners, drop-in centres, and waiting areas that ensure continued engagement of adolescents at health facilities.
• Provide ongoing training and mentorship to service providers on adolescent development, assisting providers to improve their communication and respond to adolescent needs.
• Ensure a greater focus on empowerment by, for example, supporting adolescents from key populations to recognise and stand up for their rights.
• Ensure adolescents, not just young people, are involved and given roles of responsibility.
• Provide adolescent-specific materials and tools to deliver services differently by improving the ‘how to’ content focused on communication and counseling, especially regarding consent.
• Place a greater emphasis on addressing stigma around sex, contraception, safe abortion, HIV, and key populations through broader community intervention by, for example, exploring community interventions to increase awareness about adolescent health needs and that create a supportive environment for adolescent health-seeking behaviours.
• Ensure provision of SRHR and HIV information from a younger age.
• Address gender, sexuality, and violence by, for example, including adolescents in gender programmes to promote equitable gender roles and responsibilities.