O2.6 - Community-based integrated HIV and sexual and reproductive health services: why did we miss young men and what is it going to take to reach them?
Background: Youth, particularly young men, are under-served by and reticent to engage with sexual and reproductive healthcare (SRH) services. We conducted a cluster randomized trial of community-based integrated HIV and SRH services (CHIEDZA) for young people (16-24 years) in Zimbabwe. We explored the intervention attendance and acceptance among young men.
Methods: The CHIEDZA intervention was co-designed with youth to maximize its acceptability. Youth-centred services were developed to be convenient, accessible, and trustworthy by offering reliable, free, and integrated services and commodities by friendly non-judgmental providers. To engender trust, peer to peer mobilization was used to introduce the service to youth. We collected qualitative data, including extensive observations and interviews with clients, providers, and communities. Analyses were triangulated and informed intervention adaptations.
Results: Overall, 9266 male and 27725 female attended CHIEDZA services over the 30-month intervention period. To encourage male attendance transport to CHIEDZA, vouchers for haircuts and quality underwear were offered. Reduced waiting times were also introduced. However, all had limited impact. Overall, social activities made CHIEDZA more attractive and provided an alternative reason for attendance. Social activities were popular with young men, and we anticipated that repeated incidental exposure would encourage service uptake. The onset of COVID-19 curtailed these activities before this hypothesis could be adequately tested.
Men highlighted that in the absence of acute debilitating symptoms, they did not prioritize their health. To reflect their contextual priorities, they wanted services that offered opportunities for income generation and training, alongside social activities.
Conclusion: Despite inclusion of commodities and activities to engage men, CHIEDZA had limited appeal. This was shaped by broader contextual instability, but also potentially by the narrow “health-focused” lens framing SRH interventions for young men. We propose the adoption of a layered multisectoral approach to SRH delivery to appeal to young men. This should focus on social asset building as a mechanism essential both for engagement and well-being. Wrapping preventive health services in social and economic incentives, offers opportunities to build sustained engagement of young men whilst concomitantly addressing upstream, structural drivers of vulnerability.
