AIDS Programme for Youth (Lovelife)

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Health

19 February 2001
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HEALTH PORTFOLIO COMMITTEE

HEALTH PORTFOLIO COMMITTEE
20 February 2001
AIDS PROGRAMME FOR THE YOUTH: BRIEFING BY LOVELIFE

Chairperson: Dr S Nkomo

Documents handed out:
The National Adolescent Friendly Clinic Initiative (NAFCI)
Love Them Enough to Talk about Sex;
And other Lovelife Documents: See
The Lovelife Website

SUMMARY
Lovelife is a unique AIDS organisation in that it focusses on youth between the ages of twelve and fifteen. The programme is brand-driven and based on popular youth culture. The National Adolescent-Friendly Clinic Initiative will give a new approach to clinics with the focus on quality care. Clinics will be more accessible for the youth for treatment as well as advice. The organisation promotes open communication about sex encouraging the involvement of parents.

Members expressed concern that Lovelife's approach has a definite urban bias and more attention should be paid to youth in the rural areas. They also criticised the organisation for being insensitive to cultural considerations.

MINUTES
Lovelife Presentation
Ms Judy Nwokedi stated that Lovelife is different to any other organisation, which has dealt with AIDS in the past as its focus is entirely on the youth. HIV/AIDS has reached epidemic proportions in South Africa. The average age for the onset of sexual activity is fifteen. A recent national youth survey has revealed that four out of ten children are becoming sexually active at the age of twelve

In order to prevent a cataclysm, Lovelife envisions a dramatically different approach to prevention. Thus, based on information gleaned from countries such as Uganda and Zambia, there are three tenets on which Lovelife is based:
- Open communication about sex.
- This is backed up with sex education
- The realisation that there is no quick fix. Instead sustained and intensive effort over a period of many years is necessary.

The National Advisory Board of Lovelife
Mr Mandla Sibeko spoke about the fact that he is a twenty year old member of the National Advisory Board of Lovelife. He had, prior to his appointment to the organisation, served on many Youth Development Programmes. He represents a segment of the youth of South Africa. His role in the organisation is to showcase the life of the youth in this country.

His recruitment was necessary in order to ensure that young people were represented at an executive level and were involved in the decision-making process. Youth work side by side with adults serving to highlight the realities facing the youth.. The involvement of youth in the programme is necessary as it is evident that HIV has hit this group the hardest.

Lovelife has formed partnerships with organisations such as the Planned Parenthood of South Africa Association, the Health Systems Trust and the Advocacy Initiatives. They are being funded by the Henry J Kaiser Trust, UNICEF and Old Mutual.

The National Adolescent-Friendly Clinic Initiative
Dr Kim Dixson-Tetteh introduced the National Adolescent-Friendly Clinic Initiative (NAFCI). This initiative was launched in response to the inaccessibility of clinics to the youth. Clinics were inaccessible by virtue of the fact that clinic staff were often judgmental of the youth who sought help. The focus of NAFCI is to improve the quality of care received at clinics, which will not just serve to provide treatment but also information. This is important as although the youth start having sex at an early age, they lack the knowledge about their bodily functions.

Objectives of NAFCI:
-To make the Health Services more accessible to the youth.
-Develop NAFCI standards and criteria throughout the country. There are already clinics throughout the country, which aim to follow this approach. NAFCI however aims to standardise the way in which clinics operate in all areas.
-To motivate health care providers to provide these services.

Working with the public sector clinics is at the heart of this initiative. The components of NAFCI are based on certain guiding principles:
- Firstly, it is necessary to follow a holistic approach. For example, if a young person suffers from gonorrhea, the clinic should do more than just treat the disease. Instead they should examine the reasons for the person having contracted the disease, such as the possibility of child abuse.
- Secondly, basic adolescent rights should be taken into account. Although reproductive rights are recognised, it is important to realise that young people also have these rights.

NAFCI standards
-Management systems to facilitate service.
- Recognition of adolescent rights such as confidentiality
-Accessibility of services to the young.
-Enhancing the physical environment
-Drug supply and service, including contraceptives
-Staff training and technical support
-Provision of information, educational materials and counselling
-Continuity of care. If a clinic is unable to deal with a case, there should be a referral system in place.
-Standardising basic services.
-Accurate psychological and physical assessment
-Provision of individualised care based on service delivery guidelines. The provision of emergency contraception, HIV testing, treatment and counselling should be provided.

The accreditation programme for service providers

This is based on the principle of quality care. The process consists of several stages:
-Self-appraisal, in terms of which the providers assess their own quality of care. A manual will help them to assess their performances.
-Quality Improvement Phase, which includes the use of resources such as a Directory of Reproductive Health. By using this directory one can access other organisations, information and educational materials. In addition, facilitators will be trained to provide the technical support needed.
-Clinics can request external assessment. The clinic will then be accredited by receiving a bronze, silver or gold medal (depending on their performance). This has already been implemented in clinics in the Western Cape and Mpumalanga.

There are enormous gaps in training programme especially in terms of emergency contraception, AIDS and counselling. They are attempting to implement the programme nationally and hope to reach at least one clinic per district.

Planned Parenting Association
Mr Joe Kelly, stated that his organisation no longer dealt only with family planning, as they are now more holistic in their approach. They have worked with the youth for more than twenty years. In 1992 they shifted their focus to youth between twelve and seventeen as this group seemed to be experiencing the impact of AIDS most severely. In addition, although 24 and 25 year olds are the most sexually active, it is important to target the lower age group as it is here that the impact of their work will be most effective.

The Planned Parenting Association are working together with Lovelife for the following reasons:
-The strong media attention received by the organisation
-To minimise the competition between NGOs
-To encourage the merging of skills

Judy Nwokedi stated that Lovelife differs from other AIDS groups as they:
-Target the age group between twelve and seventeen
-Are brand driven as they are based on the popular youth culture.
-Comprise multi-faceted and integrated organisations
-Focus on a sustained programme which will take place over a period of five to ten years.
-Are implemented by a consortium of the top NGOs working together with government and civil society structures.

The presenter focussed on the fact that sport and the development of skills will be used in order to attract youth to the programmes planned by the organisation. Innovation is needed in South Africa regarding work with AIDS. There has been an increase in the number of AIDS cases despite work being done in this area for the last fifteen years.

Lovelife has done the first baseline research of the new millenium. Previous research has been based on statistics involving the youth of the 1960s and 1970s. The terrain has changed completely in South Africa. In addition, past efforts have failed because the disease was discussed devoid of its sexual context.

The innovation involves encouraging the young to achieve their aspirations and dreams. In addition, it gives them the opportunity to embrace their differences. The work that will be done will be sustained and therefore able to have an impact. They will aim to promote abstinence amongst the target group by promoting a lifestyle of delayed sexual activity.

The presenter then focused on advertising campaigns in which Lovelife had been involved. This included advertisements on SABC One and E-TV, the publication of a magazine called S'camto and three new public service announcements. They also included advertising on billboards and taxis. The Committee watched a videotape of three advertisements that will be flighted in the near future. On the provocative nature of the advertisements, she stated that the majority of parents interviewed had admitted to being uncomfortable about their approach but said that they would support it if it was successful. The youth feel that their needs are finally being taken into account.

Discussion
Ms M Malumise (ANC) asked whether the award achievement would take into account the different conditions of different clinics. She stated that it would be necessary to do so in order to ensure equity.

Dr Dixson-Tetteh responded that the focus of the programme is on quality care by providing training and technical support and not anything beyond this such as infrastructure.

Ms Malumise asked what allowances are made if the clinic is understaffed and therefore not in the position to provide the same kind of service as another clinic.

Dr Dixson-Tetteh replied that although the Western Cape is perceived to be relatively affluent in relation to other provinces, there are also very poor clinics in this region, for example in Hout Bay. She stated that their pilot projects were taking place in the under-resourced areas.

Ms S Mnumzana (ANC) referred to the tour of the Love Train which had taken place through the provinces. She asked what was being done to reach the youth in the rural areas.

Ms J Nwokedi replied that youth centres have been established in the rural areas. Some of these have been established with the support and partnership of the Provincial and Local Government structures.

Ms Mnumzana wanted to know to what extent cultural beliefs are being taken into account. The Chair also requested clarity as to how culture has been taken into account.

Ms Nwokedi replied that in dealing with sensitive issues, cultural diversity and conservative community values are indeed taken into account without losing focus of the message. The issue of culture is hotly contested and the work done with parents is a very important component of the functioning of Lovelife. This is evident in their television advertisement which appealed to parents to "Love them enough to talk about sex". She stated that sex is a taboo topic in Black cultures as well as Afrikaner, Indian and other cultures.

Ms Mnumzana asked what relevance the messages and advertising of Lovelife had to the youth in the rural areas. Dr S Cwele also agreed that the message of Lovelife seems to have an urban bias and stated that youth in the rural areas were quite different to youth in the urban areas.

Ms Nwokedi replied that it is important to move away from the perception that the youth in the various cultures are so different. In fact, with regard to an issue such as sex, there are probably many more similarities than differences. She stated that many of the Board members of Lovelife have their roots in the rural communities, but had to come to the cities in search of better career prospects and education. Lovelife targets aspirations of all youth. Treating the youth in the rural areas differently implies that they are destined to remain in the past without much of a future. Instead, the message that Lovelife has to youth everywhere is that they should follow their dreams and realise their aspirations.

Dr B Mbulawa (ANC) asked if the programme will operate solely on a national level. She suggested that Provincial and Local Government get involved as well.

Dr Dixson-Tetteh responded that when work is done in districts, management teams work with the community structures. Clinics must identify other organisations doing the same work, as they cannot function in isolation.

Ms Nwokedi described the way in which radio is being used in order to access different cultural groups in different provinces. They feature on various African language and community radio stations.

Ms M Njobe (ANC) stated that she was still not satisfied as to the role of parents in the process and asked the presenters to expand on the campaign involving parents.

Ms C September(ANC) responded in her capacity as a member of the executive of the organisation. She referred to the "Talk about it" campaign in which parents were encouraged to talk openly about issues relating to sex and the issue of morality. It also has to be borne in mind that many of the Board members are parents themselves.

Ms Njobe was also not satisfied that cultural issues were being dealt with effectively. She believed that culture serves as a means of educating children so as to enable them to face challenges in the future. She asked whether the new approach to sexuality is aimed at doing away with cultural teachings and only accepting what is modern.

Ms September stated that the debate on this issue had not been concluded in the last board meeting. Members are thus able to contribute to the discussion. In addition it is important to mention that board members include members of churches as well as King Goodwill Zwelethini. The latter's involvement was perceived to be a special achievement as he has done so much in KwaZulu Natal since being on board.

Dr Jassat (ANC) commented that it is necessary to research why youth are reaching their sexual peak so early. He noted that the issue can be likened to that of smoking or alcohol abuse where the persons indulging are very much aware of the dangers but still choose to indulge.

Ms Nwokedi stated that as the target group is between twelve and seventeen, a person's abstinence by the age of seventeen (as a result of the programme) would have been a major accomplishment of the part of Lovelife.

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