Abstract
BackgroundAdolescents have significant sexual and reproductive health needs. However, complex legal frameworks, and social attitudes about adolescent sexuality, including the values of healthcare providers, govern adolescent access to sexual and reproductive health services. These laws and social attitudes are often antipathetic to sexual and gender minorities. Existing literature assumes that adolescents identify as heterosexual, and exclusively engage in (heteronormative) sexual activity with partners of the opposite sex/gender, so little is known about if and how the needs of sexual and gender minority adolescents are met.MethodsIn this article, we have analysed data from fifty in-depth qualitative interviews with representatives of organisations working with adolescents, sexual and gender minorities, and/or sexual and reproductive health and rights in Malawi, Mozambique, Namibia, Zambia and Zimbabwe.ResultsSexual and gender minority adolescents in these countries experience double-marginalisation in pursuit of sexual and reproductive health services: as adolescents, they experience barriers to accessing LGBT organisations, who fear being painted as “homosexuality recruiters,” whilst they are simultaneously excluded from heteronormative adolescent sexual and reproductive health services. Such barriers to services are equally attributable to the real and perceived criminalisation of consensual sexual behaviours between partners of the same sex/gender, regardless of their age.Discussion/ conclusionThe combination of laws which criminalise consensual same sex/gender activity and the social stigma towards sexual and gender minorities work to negate legal sexual and reproductive health services that may be provided. This is further compounded by age-related stigma regarding sexual activity amongst adolescents, effectively leaving sexual and gender minority adolescents without access to necessary information about their sexuality and sexual and reproductive health, and sexual and reproductive health services.
Highlights
Adolescents have significant sexual and reproductive health needs
We argue that sexual and gender minority adolescents in these countries experience double-marginalisation due to their age and sexual and/or gender minority identity, and that they are routinely excluded from existing sexual and reproductive health (SRH) services
Attitudes towards sexual and gender minority adolescents Participants from (A)SRH organisations were heterogeneous in their attitudes towards sexual and gender minority adolescents
Summary
Adolescents have significant sexual and reproductive health needs. Complex legal frameworks, and social attitudes about adolescent sexuality, including the values of healthcare providers, govern adolescent access to sexual and reproductive health services. These laws and social attitudes are often antipathetic to sexual and gender minorities. Adolescents have significant needs related to HIV and sexual and reproductive health (SRH). HIV/AIDS is recognised as the primary reproductive health concern for teenagers, with young women (15 to 24 years of age) accounting for 26% of all new infections in the Eastern and Southern African region in 2016 [3, 4]. Adolescents living with HIV have health needs particular to their age demographic and context, and behavioural, medical, and social interventions and services must be varied and specialised [3]
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