Sexual behaviour of immigrant youth and their access to reproductive health services in Hillbrow, South Africa

Abstract

High risk sexual behaviours and lack of access to Sexual and Reproductive Health (SRH) services among youth have remained a public health challenge globally. The situation is worsened among immigrant youth due to feelings of invincibility and lack of access to services as a result of their migration status. South Africa is home to immigrants from Southern Africa, with the majority being youth aged 18-34 years. Accordingly, studies on the sexual behavior and access to services for immigrant youth have been missing, especially in immigrant dense areas, like Hillbrow, Johannesburg, South Africa. Exclusion of immigrant youth from accessing SRH services will prevent the Department of Health from meeting the SRH indicators, especially the SDG 3.7. Since the immigrant youth and native-born citizens live together in the same social space, sexual relationships between these do not respect the exclusionary borders of immigrant youth from accessing SRH services, leading to high levels of STIs and re-infections, as well as new HIV infections among the native-born South African youth. A cross-sectional study using a convergent mixed methods design was used to collect quantitative and qualitative data from male and female immigrant youth in Hillbrow in December 2019. The quantitative study showed the determinants of multiple sex partnerships 12 months prior to the survey and inconsistency of condom use, using negative binomial regression and logistic regression techniques respectively. It further showed the factors associated with access to government health facility for SRH services. The qualitative study used Focus Group Discussions (FGDs) to explore the perceptions and experiences on access to government health facilities for SRH services in Hillbrow. The study found socio-demographic and migration factors as determinants of multiple sex partnerships among sexually active respondents. The sociodemographic determinants of engaging in multiple sex partnerships are gender, age, wealth index, marital status and sharing room with other households outside that of the respondent. Gender differences exist in the risk of engaging in multiple sex partnerships, with the males having a higher risk. Migration status and duration of residence in the study area were determinants of engaging in multiple sex partnerships. The study found high levels of inconsistency of condom use among the respondents generally, almost three-quarters of the females were found to use condoms inconsistently. Gender, age, marital status, duration of residence in Hillbrow and social support were the determinants of inconsistent condom use among the study sample. Socio-demographic, migration, community social processes, knowledge and information on SRH were established as the determinants of access to government health facilities for SRH services. The themes that emerged as reasons for lack of access to SRH services were bad treatment and negative attitude towards foreigners by clinic staff, discrimination against foreigners, documentation and judgmental attitudes. The convergent mixed methods provided a deeper insight into the barriers to accessing SRH services, than would the quantitative or the qualitative results separately.

The study made contributions to policy, programme and methodological formulations. It thus recommends that policies and guidelines on access to health care facilities by immigrants should be made succinct and clear to the health care facility workers and not left to the subjective interpretations. Programmes on SRH in Hillbrow should also be strengthened to target the immigrants who have been denied access to SRH information and services by government health facilities.