Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
BMC Public Health. 2022 May 21;22(1):1026. doi: 10.1186/s12889-022-13445-w.
Safe Spaces are a feature of combination HIV prevention interventions for adolescent girls and young women (AGYW) in South Africa. We investigated whether AGYW at risk for adverse sexual and reproductive health (SRH) outcomes accessed Safe Spaces that were part of an intervention, as well as their feasibility and acceptability.
In December 2020 to February 2021, as part of a process evaluation of a combination HIV prevention intervention, we randomly sampled 2160 AGYW intervention beneficiaries aged 15-24 years from 6 of the 12 intervention districts. We invited them to participate in a phone survey, with questions about their vulnerability to adverse SRH outcomes, and participation in intervention components including Safe Spaces. We examined factors associated with use of Safe Spaces using bivariate analyses and Pearson's chi squared tests. We also conducted in-depth interviews with 50 AGYW beneficiaries, 27 intervention implementers, 4 health workers, 7 social workers, and 12 community stakeholders, to explore perceptions and experiences of the intervention. Thematic analysis of the qualitative data was performed.
At least 30 Safe Spaces were established across 6 districts. Five hundred fifteen of two thousand one hundred sixty sampled AGYW participated in the survey of whom 22.6% visited a Safe Space, accessing HIV testing (52.2%), mobile health services (21.2%) and counselling for distress (24.8%) while there. Beneficiaries of lower socioeconomic status (SES) were less likely to have visited a Safe Space, compared with those of higher SES (13.6% versus 25.3%; p < 0.01). Implementers described political, structural and financial challenges in identifying and setting up Safe Spaces that were safe, accessible and adequately-resourced, and challenges with AGYW not utilising them as expected. AGYW 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.
AGYW are attracted to Safe Spaces by educational and employment promoting interventions and recreational activities, and many will take up the offer of SRH services while there. The poorest AGYW are more likely to be excluded, therefore, an understanding of the obstacles to, and enablers of their inclusion should inform Safe Space intervention design.
安全空间是南非针对少女和年轻妇女（AGYW）实施的艾滋病毒综合预防干预措施的一个特色。我们调查了处于不良性健康和生殖健康（SRH）结局风险中的 AGYW 是否使用了作为干预措施一部分的安全空间，并评估了其可行性和可接受性。
在 2020 年 12 月至 2021 年 2 月期间，作为艾滋病毒综合预防干预措施的过程评估的一部分，我们从 12 个干预区中的 6 个区中随机抽取了 2160 名年龄在 15-24 岁之间的干预受益的 AGYW。我们邀请他们参加一项电话调查，询问他们对不良性健康和生殖健康结局的脆弱性，以及对包括安全空间在内的干预措施的参与情况。我们使用双变量分析和 Pearson's chi 平方检验来检查与安全空间使用相关的因素。我们还对 50 名 AGYW 受益人的 27 名干预执行者、4 名卫生工作者、7 名社会工作者和 12 名社区利益攸关方进行了深入访谈，以探讨他们对干预措施的看法和经验。对定性数据进行了主题分析。
在 6 个区共设立了至少 30 个安全空间。在 2160 名被抽样的 AGYW 中，有 515 名参加了调查，其中 22.6%的人访问了安全空间，在那里接受了艾滋病毒检测（52.2%）、移动卫生服务（21.2%）和痛苦咨询（24.8%）。与社会经济地位较高的人相比，社会经济地位较低的人访问安全空间的可能性较小（13.6%对 25.3%；p<0.01）。执行者描述了在确定和设立安全空间方面的政治、结构和财政挑战，这些安全空间是安全、可及和资源充足的，但 AGYW 并没有像预期的那样利用它们。AGYW 对安全空间有积极的看法，描述了安全空间带来的好处，例如获得电脑和互联网、支持家庭作业和求职以及教育申请，以及与同龄人联系的空间。
AGYW 被促进教育和就业的干预措施和娱乐活动所吸引，并利用安全空间提供的性健康和生殖健康服务。最贫困的 AGYW 更有可能被排斥在外，因此，了解他们被包括或不被包括的障碍和促进因素，应该为安全空间干预措施的设计提供信息。
