Smith P, Marcus R, Bennie T, Nkala B, Nchabeleng M, Latka M H, Gray G, Wallace M, Bekker L-G
Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2018 Jul 25;108(8):677-681. doi: 10.7196/SAMJ.2018.v108i8.13013.
Young people in sub-Saharan Africa (SSA) are disproportionately affected by HIV, sexually transmitted infections and unplanned pregnancies. The provision of accessible sexual and reproductive health services (SRHS) for young people in SSA is vital to reduce this burden.
To examine the needs of South African (SA) adolescents with regard to differentiated, accessible and adolescent-responsive SRHS.
Data were drawn from a larger project examining the feasibility of conducting HIV vaccine trials in adolescents. Fifteen focus group discussions were conducted across five research sites in four SA provinces with 120 male and female adolescent human papillomavirus vaccine trial participants aged 12 - 19 years from low-income areas with a high incidence of HIV. Transcribed data were double-coded using framework analysis.
Three main themes emerged on how best to improve SRHS for adolescents in resource-limited settings: adolescent-friendly services, availability of developmentally appropriate and tailored information, and improved relationships between healthcare workers and clinic attendees. Participants wanted more flexible opening hours at SRHS to account for travel time to clinics from school and home. They suggested that services include contraception, counselling, educational materials, links to adoption services, emergency vehicles, pre- and postnatal care, and improved service quality from clinic staff.
While dedicated adolescent SRHS might best meet the needs of young people in SA, the study suggests that failing this, existing SRHS should be more responsive to adolescent use. Innovations such as mobile outreach services, self-testing and flexible hours will help SRHS respond to adolescents' needs.
撒哈拉以南非洲地区（SSA）的年轻人受艾滋病毒、性传播感染和意外怀孕的影响尤为严重。为SSA地区的年轻人提供可及的性与生殖健康服务（SRHS）对于减轻这一负担至关重要。
研究南非（SA）青少年对差异化、可及且适合青少年的SRHS的需求。
数据来自一个更大的项目，该项目旨在研究在青少年中开展艾滋病毒疫苗试验的可行性。在SA四个省份的五个研究地点进行了15次焦点小组讨论，参与者为120名年龄在12至19岁之间、来自艾滋病毒高发病率低收入地区的男性和女性青少年人乳头瘤病毒疫苗试验参与者。转录的数据使用框架分析法进行双重编码。
就如何在资源有限的环境中最好地改善青少年的SRHS出现了三个主要主题：对青少年友好的服务、提供适合其发育阶段且量身定制的信息，以及改善医护人员与就诊者之间的关系。参与者希望SRHS的开放时间更灵活，以考虑从学校和家中前往诊所的时间。他们建议服务应包括避孕、咨询、教育材料、收养服务链接、应急车辆、产前和产后护理，以及提高诊所工作人员的服务质量。
虽然专门的青少年SRHS可能最能满足SA年轻人的需求，但该研究表明，如果无法做到这一点，现有的SRHS应更能满足青少年的使用需求。诸如移动外展服务、自我检测和灵活工作时间等创新将有助于SRHS满足青少年的需求。
