Promoting Young People’s Sexual and Reproductive Health: Stigma, Discrimination and Human Rights

This report was developed as part of the 'Safe Passages to Adulthood,' a five-year Department for International Development (DfID) funded programme of research into young people’s sexual and reproductive health in economically poorer country settings. The report presents the discussions and experiences shared during an international knowledge synthesis meeting that took place in June 2003, bringing together programme leaders from a variety of countries to discuss stigma, discrimination and human rights in relation to young people’s sexual and reproductive health. The goal was to identify instances of innovative and effective practice with the intention of drawing out some principles that might inform future work. Major themes in the presentations included working positively with sexual diversity, promoting young people’s sexual and reproductive rights, working in the health and education sectors, ensuring young people’s participation in programmes, working with the media, and challenging stigma and discrimination in relation to young people and HIV/AIDS.

The report explains how stigma, discrimination and human rights are connected. Young people may experience stigma and discrimination in multiple ways, and in a range of settings and circumstances. Such stigma and discrimination may be based on cultural or gender norms. These norms relating to sexuality can create barriers to health promoting messages and resources. Stigma and discrimination undermine prevention efforts by making people afraid to find out whether or not
they are infected, or even to seek out information about how to reduce their risk. Stigma and discrimination also impact on the care and support of people living with HIV/AIDS, undermining capacity to provide support and reassurance to those infected and affected, in the community, in workplaces and in health care settings. Stigmatisation of those affected, but not infected, by HIV/AIDS, such as family care-givers and relatives, can affect the quality of care given to infected people and may deter professional and volunteer care-workers from providing and participating in care.

The report shares information about the projects discussed at the meeting and presents case studies showing how stigma, discrimination and the violation of human rights have been challenged in the course of their work. Based on these experiences and discussions, an number of lessons learned are synthesised, as identified from the participants:

• Changing social norms - in relation to HIV/AIDS, sexual diversity and gender is a culturally informed approach to addressing the stigma and discrimination that is experienced by many young people in relation to their sexual and reproductive health. In recognising the social nature of stigma and discrimination, this approach moves away from a paradigm of individual attitude change towards the goal of creating a social environment characterised by tolerance and respect for young people’s sexual and reproductive rights.
• Youth participation in programmes - involving young people centrally and respectfully in the design, implementation and evaluation of programmes designed for them helps to ensure that their needs are addressed and that programmes are appropriate.
• Coalitions of marginalised groups - can be developed and young people encouraged to share their experiences and discuss sensitive issues with others who find themselves in similar positions. This can lead to enhanced solidarity among these groups and the development of new forms of peer relatedness.
• Challenging the language - of stigma and discrimination by promoting positive rights-based language relating to sexuality and HIV/AIDS is crucial.
• Research - is needed to understand the contexts of stigma and discrimination,
  and understand the sexual cultures of marginalised and stigmatised groups in order to understand their
  experiences of stigmatisation, identify their health needs and begin to promote tolerance.
• Human rights framework - promoting rights-based perspectives in relation to HIV/AIDS, sexual diversity and access to information and health services is a powerful strategy to emphasise the validity of young people’s claims to the knowledge and resources they need. Promoting rights is a critical way of moving towards the creation of enabling and supportive environments for young people in which they will be able to practise their sexuality freely and in an informed manner, and access the services, support and resources they need to do this.
• Innovative methods - such as theatre, film,
  painting and writing, many of which require the
  participation of young people, can inform young people
  in an entertaining way, and help to tackle sensitive
  sexuality-related matters in a broad and non-threatening manner.
• Working with key adults - in particular their parents, teachers and health service staff, is
  necessary in order to sensitise and train them to respond to young people’s needs and rights in relation to their sexual and reproductive health, build their confidence in doing so, and enhance their communication skills.
• Recognise the diversity - Young people’s sexuality is not divorced from their wider lives. In many contexts, the stigma and discrimination experienced by young people in relation to their sexuality and sexual and reproductive health intersect with, and are compounded by, those derived from a variety of existing social and economic inequalities.
• Mass media - can be non-threatening and entertaining means of promoting messages about sexual health and rights, and discussing sensitive subjects relating to young
  people’s sexuality.