First-hand: the privileged position of health providers in young people’s lives

It’s the million-dollar question: Why do young people not want to access HIV services? There's often a lot of stigma in going to a clinic. The health provider can be unfriendly, is felt to be scolding, judgemental, offering instruction without hearing or understanding the reality of the young person. Too often, the health facility doesn't present itself in a young person's life as a safe, welcoming, kind and gentle place.  

We are really trying to shift the relationship between young people and service providers. This relationship is so important and fundamental in terms of access to services. It's a critical entry point, and unless that relationship is one that is viewed as trusting, respectful and person-centred it will always remain a barrier, where young people prefer not to access services that should be available to them.  

Trusting young people 

At PATA we want a young person’s sexual and reproductive health to be something that's positive, not something surrounded with negativity and shame. But often in our communities there’s still an issue with young people being respected and trusted to make choices in relation to their own sexual and reproductive health. 

I'm a social worker by training and I've worked in many health facilities. From what I’ve seen, there is a need to create a different environment. An environment that enables young people to feel safe and supported to ask the questions they need to ask, and to have their questions answered in a way that is factual. Not layered with personal value judgements, beliefs and opinions.  

The most marginalised young people 

The highest HIV incidence right now is among key populations (putting young women and girls aside). So the evidence is clear: we're not doing what it takes to reach these groups and engage them with services.  

In far too many spaces we are still punishing key populations and criminalising human beings. Many countries still have punitive laws that mean certain services just aren’t available for key populations. Even in South Africa where I live, where we have legislation that protects people, that legislation still doesn't change attitudes.  

I've worked in health facilities where young people on a journey with their sexuality will just be told to give it some time and it will ‘come right’. I’ve seen misgendering, a total lack of understanding, and an unwillingness to self-reflect, challenge and shift one’s personal perspective.  

Sadly, I’ve seen health providers making fun of young people from key populations, laughing, calling names, shaming and being derogatory, or threatening to withhold certain services. This serves to break down the spirit of a young person who is likely feeling quite isolated already and has come for support and advice. For me, such examples are tantamount to human rights abuses.  

Changing attitudes  

For many health providers, working with young key populations might be uncomfortable or quite new. It’s on us as health providers to go out of our way to learn. To go on value clarification training courses, to educate ourselves, and to live to our code of ethics that embraces respect for life, human dignity and the rights of other persons. Often being more conscious of our language, the words we use, and always asking questions in a respectful way. Prioritising the needs of the young person should be first and foremost and providing a comprehensive package of services, so that we can offer the best care possible.  

We need to learn from young people from key populations by asking them to come to clinics to talk about their experiences of service delivery. It has often been the critical feedback that has been most useful in breaking down barriers. A young person saying ‘I didn't understand this, or this felt like you didn't hear me’ can really help you appreciate their perspective.  

None of us are ever too old to learn. A lot of that learning journey is about building relationships, building bridges of understanding, and being willing to be vulnerable and face our own blind spots. Unless we can build trusting and respectful relationships with young people, we're not going to be of much benefit. 

Celebrating the health providers getting it right   

Every year, through the PATA Summit, we bring frontline health providers together with policymakers and young people.  

We bring health providers to this space so they can share what is working. Because as much as we can talk about what health providers are doing wrong, there are many instances where health providers are getting it right. The focus should be on this: let's celebrate positive examples! Health providers that are going the distance, providing friendly, stigma-free services in a way that's intentional, sensitive and person-centred. Health providers see themselves as champions for children, adolescents and young people and a critical partner in promoting sexual and reproductive health, and ending AIDS.  

Huge opportunities, huge responsibilities 

I believe it is critical for health providers to be aware of the real responsibility they hold. Health providers have the power to shape the lifelong relationship a young person has with healthcare. This is a huge opportunity and privilege, and we need to make sure we do it right.  

All it takes is that little bit of extra time, a commitment to upskilling ourselves so that we can improve our knowledge on the specific needs of young key populations, specific age related risk behaviours, and greater understanding regarding the stigma and discrimination they may face, and ensuring that we become a champion for delivering services that are needed, in the right way, with the right attitude.  

Fundamentally, it’s about making sure we treat everyone with respect and understanding. Making sure we use every interaction with a young person as an opportunity to assist them to feel empowered, to make better choices for themselves, and to feel heard and understood.