Youth Participation in HIV and Sexual and Reproductive Health Decision-Making, Policies, Programmes: Perspectives from the Field

This study presents and analyses the experiences of youth who are participating in HIV and sexual and reproductive health (SRH) decision-making, policies, and programmes. By combining a literature review of evaluation evidence with in-depth interviews and a global survey of young people, the study explores how young people view efforts to include them in decision-making, policies, and programmes and recommends strategies to better support meaningful youth participation globally. Overall, evidence indicates a need for further investments in capacity building, training, inclusive participation spaces, and research on meaningful youth participation.

Joint United Nations Programme on HIV/AIDS (UNAIDS) Regional Youth Officers interviewed 51 respondents between the ages of 18 and 29 who currently participate or have participated in HIV and SRH-related decision-making bodies at national level for at least one year. In addition, 615 respondents, predominately young people or youth advocates, completed a global online survey to assess: knowledge of and access to decision-making bodies and processes at the local, national, regional, and global levels; the current perceived representation of young people and, specifically, young members of key affected populations (KAPs) in decision-making bodies and processes; and young people's perception of the quality and impact of their participation in decision-making bodies and processes at all levels.

Findings from both the interviews and the survey confirmed common assumptions about participation in decision-making spaces related to HIV and sexual and reproductive health and rights (SRHR): Young men have more opportunity than young women, spaces for participation are more accessible to young people in their mid- to late-twenties than younger advocates, and participation spaces are more accessible for young people living with HIV (YPLWH) and young gay men or men who have sex with men (MSM) in some contexts (which is reflective of the HIV field as a whole). Respondents who were currently or had previously participated in a decision-making body or process were more inclined to positively rate both the quality and the impact of their own participation. (Survey respondents as a whole were more pessimistic about the quality of these spaces, regardless of whether or not they have participated.) About 89% of interviewees believe their leadership has had a lasting impact (three or more years). Furthermore, the great majority of respondents (98%) believe that youth engagement empowers young people within their own communities. In addition, young people have expressed that it allows them to have a voice in matters that affect their lives; therefore, issues that affect young people are more represented and expressed genuinely by young people themselves.

Young people who have participated in decision-making reflected on improvements in outreach and representation of young members of KAPs, but also expressed concerns about tokenism, age-based hierarchies, and access for younger adolescents, women, and marginalised groups. For example, one respondent said, "While there is evidence of effort to allow young people space to actively participate and get involved in the HIV response, in some cases we are invited partially or at the end of a process that has already been carried out for example to validate a plan which is not likely going to be changed even after young people make their contribution and this becomes empty participation." Many respondents mentioned that, while spaces for participation were opening up and that governments and organisations were putting more effort into engaging young people, those spaces were only open to young people from privileged socioeconomic status, or who already have more access to education and other opportunities. Others said they were only informed or consulted and not actually allowed to make decisions, or that the young people who were participating weren't heard or given any authority.

When asked for ways to increase meaningful youth participation, interviewees mentioned more spaces for young people to engage (31%), more consultation (23%), and more support and training (15% each). About 35% of survey respondents called for more economic/financial support, 26% wanted help in opening new and more spaces for youth participation, 17% sought peer mentorship, and 11% requested more training/information before engaging with a decision-making body or process. Interviewees also suggested creating quotas or a mandate for youth participation. Some proposed increasing the level of influence young people have by enlisting leadership of decision-making bodies to make changes to overcome age-biased internal decision-making mechanisms, or to promote the need to create neutral spaces for youth participation.

The report calls for:

• Stronger investment in monitoring and evaluation (M&E) of existing programmes and efforts as well as new research by and with young people themselves to establish best practices;
• Increased attention to both the sustainability of spaces for youth participation in policy, programmes, and decision-making, and increased training and capacity building not only for young people but also for adult members of policy and decision-making bodies;
• More work on cross-generational dialogues and approaches to meaningful participation, both to improve the spaces available to young people in policy and decision-making and to ensure that participation mechanisms are better able to take on young people's contributions and benefit from their expertise;
• Further support for young people who participate in decision-making bodies and processes to better network with and engage other young people in their communities, to improve communications mechanisms for increased representation, and to report back and facilitate ongoing consultations; and
• Sustained and scaled-up investments in outreach to young members of KAPs to ensure access for all young people, including the most marginalised, at all levels of decision-making.