Malawi has several policy frameworks that champion the provision of services for the advancement of youth rights. But in reality, as YOHANE SYMON highlights in this FRIDAY SHAKER, a lot of young people fail to access sexual and reproductive health services. Even after contracting sexually transmitted infections, the struggle to access treatment leaves them terribly frustrated and bruised.
At the age of 17, Amina from Luwesa Village, Traditional Authority Makanjira in Mangochi District, was diagnosed with Sexually Transmitted Infections (STIs) four times in a space of eight months.
On the first two occasions, Amina could not seek medical help at Mpiripiri Health center, the only available health facility in her area.
She did not have the courage to go and approach medical personnel at the facility. She was afraid that her parents would become aware that she had contracted STIs.
Apart from that, Amina was not ready to bear the shame of being mocked by her peers that she had STIs, which she says indicates that one is promiscuous.
But after weeks of living with the infection, Amina could no longer hide it. She started producing a bad smell.
“My friend who is older than me started noticing the bad smell. She asked me about it, but I could not tell her. It was not easy to tell anyone. Everywhere I went, people were noticing the smell,” she says.
After some days, Amina says, she was noticed by an older woman when she went to buy some groceries at the market.
“The woman precisely mentioned to me that I had an STI. She correctly gave the symptoms which was what I was going through. It was not surprising to me because I had a boyfriend by then. This woman then directed me to go and get traditional medicine from her friend,” Amina recalls.
Within seven days of treatment, Amina was well again. Her life with her boyfriend continued as normal. She did not mention to the boyfriend about her infection for fear of being dumped.
After a couple of months, the STI resurfaced.
“I went again to the same woman and told her that the disease had resurfaced. This time, she advised me to seek medication from the same traditional healer together with my partner. We went and we were assisted,” she says.
But Amina was yet to win the battle against STIs as after few months, she was found in a similar situation, for the fourth time. This fourth time ended her relationship after the boyfriend accused her of infecting him.
“It was very difficult for me to understand what was happening because I thought I had been healed. Besides, I only had one sexual partner by that time. I wanted to go and visit the hospital but I was afraid that they would rebuke me. However, I gathered courage and visit a certain nurse at her home at night,” Amina says.
She says the nurse took her to the facility where she was helped. In addition, Amina was given referral notes to give to people she had slept with within the past three months from that day.
However, she decided not to use the referral notes for fear of being discriminated against.
Amina kept on seeking medical advice from the nurse who later encouraged her to join a youth club where she could be getting information on how to prevent contracting STIs.
“This was a turning point for me. It was difficult for us to buy condoms in shops but I am able to get them for free through the youth club. Now I am one of the youths in Mangochi who are helping my fellow youths to stay safe,” she says.
Among others, Amina says the club gets support like trainings from some organisations including Youth Net and Counseling.
Amina is now back at school in Form Three at Mpiripiri Community Day Secondary School after previously dropping out in Form One. She is also a member of a village savings and loans group for the youths which is helping her to get money for school fees through small-scale businesses.
Her story mirrors those of several other girls in Makanjira and other parts of the country where young people struggle to access sexual and reproductive health services including treatment for STIs.
According to the latest Population and Housing Census, Malawi has a sub-population which hugely comprises the youth between the ages of 10 and 35 years.
Mangochi alone has close to 400,000 people aged between 10 and 24 years, which is a third of the total population estimate of 1.2 million people.
Studies have revealed that most youths in the country are exposed to a wide range of sexual and reproductive health challenges which expose them to unintended pregnancies, STIs and HIV and Aids.
To address these challenges, the government, through the Ministry of Health, introduced Youth Friendly Health Programmes in 2007 to make services easily accessible by the youths.
However, access to the services in most hospitals remains a challenge.
Omar Katiwi, 23, is one the Community-Based Youth Distribution Agents in Makanjira and he admits that the prevalence of STIs as well as access to treatment for STIs remain a challenge.
Katiwi, who once suffered from syphilis, singled out lack of youth corners in most hospitals has one of the issues affecting the youths when they want to access STI treatment.
He says between 2018 and the end of 2019, he used to refer to the health centers an average of 20 youths per month to be treated for various STIs.
“But most of these youths were returning without being assisted. Some of them are ashamed to queue for the treatment while others were being told that drugs for their infections were not available,” he says.
Katiwi says initiation ceremonies and mobile markets are some events contributing to an increase in young people contracting STIs.
On the other hand, Katiwi says the situation has started to improve although there are still many challenges which are limiting access to health services among the youth especially those in need of STI treatment.
He blames lack of designated places for treating STIs as some of the factors holding the youths back from visiting health centers.
“In most cases, people with STIs have to be on the same queue with others who have other illnesses. This alone is bad because it is easy for people to notice that one is suffering from an STI. In addition, most youths are discouraged from visiting the health facilities due to shortage of drugs there,” Katiwi says.
Youth Friendly Health Services Coordinator at Mangochi District Health Office, Peter Malipa, admits that unavailability of STI drugs in most public hospitals negatively impacts of lives of young people.
“We have noted that it becomes a big problem for the youths to buy drugs in pharmacies if the drugs are not available in government health facilities. The best way is to make sure the hospitals are fully stocked, which does not always happen,” Malipa says.
On the other hand, he states that his office is doing enough to make sure that all public health facilities have youth corners where young people can be assisted in private.
“We also have coordinators at each health facility apart from some few health centres. We are doing everything possible to ensure that youths are being assisted in places where there is ultimate privacy,” he says.
Malipa adds that due to the Covid-19 pandemic, cases of STIs among the youths have dropped by 10 percent in the district due to the ban of public gatherings.
On his part, Executive Director of Action Hope, Summy Aaron, believes that more needs to be done to empower young people to win the fight against STIs.
Aaron urges society, especially parents, to accept that their children even as young as 11 years old are engaging in sexual activities which can lead them to contract STIs.
“We need to find ways of talking with the children to encourage them to practice safe sex,” he says.
Aaron further challenges government to seriously capacitate health centers and designate special places for treating STIs just like it is with HIV and Aids.
“The issue of shortage of drugs in public hospitals needs to also be addressed so that people with STIs can easily be assisted. Otherwise, people will continue seeking medication from traditional healers who do not really cure the STIs,” Aaron says.