Safe spaces for beneficiaries of a combination HIV prevention intervention for adolescent girls and young women in South Africa: access, feasibility, and acceptability

Abstract

Background Safe Spaces are a feature of combination HIV prevention interventions for adolescent girls and young women (AGYW) in South Africa. We investigated whether AGYW at risk for adverse sexual and reproductive health (SRH) outcomes accessed Safe Spaces that were part of an intervention, as well as their feasibility and acceptability. Methods In December 2020 to February 2021, as part of a process evaluation of a combination HIV prevention intervention, we randomly sampled 2160 AGYW intervention beneficiaries aged 15–24 years from 6 of the 12 intervention districts. We invited them to participate in a phone survey, with questions about their vulnerability to adverse SRH outcomes, and participation in intervention components including Safe Spaces. We examined factors associated with use of Safe Spaces using bivariate analyses and Pearson’s chi squared tests. We also conducted in-depth interviews with 50 AGYW beneficiaries, 27 intervention implementers, 4 health workers, 7 social workers, and 12 community stakeholders, to explore perceptions and experiences of the intervention. Thematic analysis of the qualitative data was performed. Results At least 30 Safe Spaces were established across 6 districts. Five hundred fifteen of two thousand one hundred sixty sampled AGYW participated in the survey of whom 22.6% visited a Safe Space, accessing HIV testing (52.2%), mobile health services (21.2%) and counselling for distress (24.8%) while there. Beneficiaries of lower socioeconomic status (SES) were less likely to have visited a Safe Space, compared with those of higher SES (13.6% versus 25.3%; p < 0.01). Implementers described political, structural and financial challenges in identifying and setting up Safe Spaces that were safe, accessible and adequately-resourced, and challenges with AGYW not utilising them as expected. AGYW shared positive views of Safe Spaces, describing benefits such as access to computers and the internet, support with homework and job and education applications, and a space in which to connect with peers. Conclusion AGYW are attracted to Safe Spaces by educational and employment promoting interventions and recreational activities, and many will take up the offer of SRH services while there. The poorest AGYW are more likely to be excluded, therefore, an understanding of the obstacles to, and enablers of their inclusion should inform Safe Space intervention design.

Impact of a capacity-building intervention on views and perceptions of healthcare providers towards the provision of adolescent sexual and reproductive health services in southeast Nigeria: a cross-sectional qualitative study

“…Interestingly, the informal healthcare providers believed that their capacity to deliver more adolescent-friendly SRH services following the capacity-building intervention enabled increased patronage by adolescent clients. For the formal providers, an inference was that the introduction of safe spaces, extracurricular activities and games following the SRH training of health providers improved SRH service utilisation among adolescent clients, which was similar to findings from a study in South Africa, where 89.4% of adolescent girls and young women reported that the safe spaces for delivering adolescents’ SRH services offer a safe, quiet and comfortable environment when accessing the SRH services 38. This shows that the creation of safe spaces could reduce the unmet SRH needs of adolescents 38…”

“It gives you a road map of what to do to solve your problems”: acceptability of a combination HIV prevention intervention among adolescent girls in Uganda

“…On the other side, not everybody was able to adjust. Adolescent participants mentioned family commitments and chores as a barrier to program participation, as also identified in other studies [ 53 , 54 ]. Another facilitator to program attendance was the provision of incentives in the form of transport refunds and lunch/snacks.…”

“…Another facilitator to program attendance was the provision of incentives in the form of transport refunds and lunch/snacks. Transportation costs are widely discussed as a barrier to program participation [ 53 , 55 ] as they can be prohibitive for already resource-limited families. In fact, some participants mentioned struggling with transportation costs despite the refund as they had to pay for transport upfront.…”

“…Interestingly, transportation cost was still discussed as a barrier as well given that participants had to pay for transportation upfront before being reimbursed by the program. The provision of food was also raised as a factor that motivated the adolescent girls to come to the sessions, possibly pointing out its even more critical importance in low-resource settings [ 53 ]. While both these incentives have budgetary implications for program implementation, they should be considered for interventions in limited-resource settings.…”

Factors Associated with COVID-19 Vaccine Uptake among Schoolgoing Adolescent Girls and Young Women in South Africa

“…Binary and categorical variables relating to socio-demographics, COVID-19 testing and outcomes, as well as potential barriers to, and facilitators of COVID-19 vaccination were created from survey questions and are described in Table 1. A cluster variable with two categories (relatively low and relatively high) was created for socio-economic status (SES) using 13 SES-related variables included in the survey [30]:…”