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Laws, flaws and the way forward for sexual and reproductive health among Asia-Pacific's young

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02.10.2013

At a recent forum examining young people’s access to sexual and reproductive health (SRH) and HIV services in the Asia-Pacific region the most powerful statements on the obstacles remaining came from the affected youth themselves.

Pakistani youth activist Faiza Aziz read the account of a young teenager in an unnamed country in the region who went to the doctor complaining of widespread blisters and bouts of diarrhea.

The doctor determined that the patient was a drug addict and made an on the spot diagnosis of HIV infection. No tests were performed to verify that guess and the medical diagnosis was shared with his relatives.

“Some of my family felt deeply sorry and were crying,” Ms Aziz quoted the teen as saying. “And then they asked to transfer me to the specialist AIDS treatment centre. There the doctors saw me and asked for the blood test result. I answered ‘not yet’.”

The physician at the treatment centre sent the teenager away with instructions to come back only after a positive test result.

Ms Aziz challenged the audience, comprising regional policy-makers and representatives from relevant UN agencies and NGOs: "Now consider yourself in the place of this young person. What would you do? What would you do? How would you go about accessing the services you need?"

This teen’s story came from one of dozens of focus group discussions included in “Young people and the law in Asia and the Pacific: A review of laws and policies affecting young people’s access to sexual and reproductive health and HIV services”, a report spearheaded by UNESCO in partnership with UNFPA, UNDP, UNAIDS, and Youth LEAD, the Asia-Pacific network of Young Key Populations, and authored by HIV and development consultant John Godwin.

The report found that young people in the region are faced with many legal and policy barriers, including obstacles in accessing information, condoms and contraceptives as well as treatment and care services for SRH/HIV. Where laws and policies are in place implementation remains an issue and where none exist the options open to youth remain grim.

“What’s the Law Got to do With it?”, a side event on 18 September at the Sixth Asian and Pacific Population Conference (APPC), marked the first public discussion of this groundbreaking systematic review of how laws and policies shape young people’s access to SRH and HIV services in the region.

At the side event, which was co-organized by ESCAP, UNESCO and UNFPA, Ms Aziz joined fellow youth health activists Rachel Arinii from Indonesia and Filipino Jeffrey Acaba as well as Mr Godwin for a dynamic panel discussion on these issues moderated by Anzaira Roxas, a youth health and rights advocate from the Philippines. Over 150 government representatives, civil society organizations, and development partners attended the event.

Kate Gilmore, Deputy Executive Director of UNFPA, remarked that it was incongruous for issues affecting the more than 1.2 billion people aged between 10 and 24 in the Asia-Pacific to be the focus of a side event rather than a primary focus.

“The world is not waking up to the demographic shift that's taking place, the largest population of young people ever seen in the history of humankind,” Ms Gilmore said. “This is not a marginal population issue.”

The numbers of those suffering as a result of inadequate access to SRH and HIV services and information add weight to the immensity of the problem: annually over 5.5 million adolescent girls in the region give birth every year; there are 3.6 million unsafe abortions among girls aged 15-24 and more than 690,000 young people are living with HIV.

On the preventative side, less than 20% of sexually active girls aged 15-19 and less than half of adolescent boys of the same age in the Pacific report having ever used a modern method of contraception. In South Asia and Southeast Asia, adolescents aged 15-19 who want to avoid pregnancy are more than twice as likely as women aged 20-49 to have an unmet need for modern contraception.

The often harrowing accounts taken from the focus group discussions and read by panelists during the forum put a human face to these numbers. This and the lively interactive approach taken by organizers served to draw delegates into the discussion and provoke them into thinking deeply about the issues raised.

Delegates were given polling devices to respond to questions – multiple choice or simple yes or no questions – posed by Ms Roxas, who used them to frame discussions around key aspects of Mr Godwin’s report.

Prior to a discussion on access to HIV testing, for example, delegates were asked: "Do you think a young person who is worried about their HIV status should ever be refused an HIV test.” Fourteen percent selected “Yes”, while 86% voted “No”.

In the discussion that followed, Mr Godwin highlighted the life-saving importance of readily accessible HIV testing for youngsters.

The panel also discussed laws relating to the legal age of sexual consent and how these laws, while necessary to protect children from predatory adults, can be damaging in other contexts.

Sexually active young people under the age of legal majority in their countries may be hesitant to pursue SRH and HIV services for fear of criminal repercussions.

Access to testing and information services is often restricted to those over 18, a ceiling Mr Godwin pointed out was arbitrary given the fact that the age of criminally liability is often much lower in these same countries.

Moreover, with colonial-era laws still on the books, homosexual acts in many countries remain illegal, regardless of age. Mr Acaba said this feeds into stigmatization and discrimination.

”We have to open our books again and start rethinking and reviewing how [our societies] put up barriers to the point of criminalizing young people and preventing them from accessing the services they need,” he said.

Mr Acaba called on the delegates at the forum to agree to pursue measures that would “eliminate … all forms of stigma discrimination against young people based on sexual orientation and gender identity."

Despite such challenges, Mr Godwin said that his report is not the dire indictment many might expect and many positive policy developments are covered.

In the Philippines, for example, a reproductive health bill was recently passed and while the Supreme Court has put its implementation on hold pending adjudication of complaints, the fact that such legislation made it to such an advanced point marks a major achievement.. “You've got [a greater number of] organized progressive voices, these young people, who are bringing the argument back to the evidence,” he said.

Heeding this groundswell of young voices is essential to substantive change taking root, Ms Gilmore said.

“Somehow we forget that we too were young, that we too explored our sexuality, that we too needed and grappled for access to information,” she said. “Come on oldies, get out of the way! Hand it over and invite your young people into the centre of decision-making.”

At the close of the forum, the three young panelists and moderator stood at the center of the hall and took turns, each of them issuing calls for “change today”.

 “Can you listen and take action with us?” Mr Acaba asked.

This query, however, wasn’t for the polling devices.

"We won't give you an option for that question,” Ms Roxas said. “Yes is the only possibility."

 

For more on the Sixth Asian and Pacific Population Conference visit the official website

The Report of the Sixth Asian and Pacific Population Conference, 26 - 20 September 2013

The official youth statement read at the conference

For further coverage of the conference visit: icpdbeyond2014.org/whats-new/view/id/74/can-we-say-yes-to-sexual-and-reproductive-health-and-rights.

 

 

Written by Noel Boivin, n.boivin@unesco.org