Barriers to accessing sexual and reproductive health services among adolescent girls and young women living with HIV in Nzega district, Tabora

Abstract

ABSTRACT Background In most of the Sub-Saharan African countries including Tanzania young people face restricted access to accurate information, appropriate guidance, or comprehensive reproductive health services and they are likely to experience significant unmet needs as they initiate sexual relationships. Previous studies in Tanzania have mainly focused their attention on the general population of Adolescent Girls and Young Women (AGYW). Little research has been conducted on the barriers to accessing sexual and reproductive health (SRH) services targeting AGYW living with HIV who are more vulnerable to contextual impediments. Objective The main objective of the study was to assess the barriers to accessing SRH services among HIV-positive adolescent girls and young women (aged 15-24 years) in Nzega District. Methodology This study employed purposive sampling approach, which utilized Focus Group Discussions (FGDs) and in-depth interviews to collect data. Expedient samples of 24 AGYW from 3 selected health facilities were purposively recruited. Modified and adapted socio-ecological model was used to explore the factors influencing access to SRH services. Data collected were analyzed using the six-phase thematic analysis approach by Braun & Clarke (1). Findings The findings of the study indicate that HIV positive AGYW in Nzega DC have limited access to and utilization of SRH services. Informants reported that, individual level factors like fear, lack of confidence, and limited awareness on SRH services among AGYWs negatively influenced their access to and utilization. Moreover, inter-personal level barriers included unfriendly language by the service providers and denial of permission to seek care by the male partner and parent(s). Furthermore, organizational barriers included: unstable availability of SRH medications, lack of comfort space at the clinic set up, and long waiting hours.

Conclusion and recommendations The study has revealed that AGYW living with HIV are exposed to range of barriers to accessing SRH services across the four levels (individual, interpersonal, community and organizational) listed in the social ecological model. This study has demonstrated that limited awareness on SRH services, limited availability of SRH services, denial to seek ASRH services by male partners or parents, financial constraints and lack of comfortable space in health facility settings creates barriers to accessing adolescent SRHS and rights. Overall, this study has provided useful information for health care workers and other stakeholders working with adolescents and young people in SRH services to addressing barriers as indicated in this study. HIV Positive AGYW should be fully engaged in programming interventions tailored to addressing their own SRH service needs.