Table 1_Uptake and acceptability of health services for adolescent girls and young women provided through Safe Spaces in South Africa.docx

Background and ObjectivesSafe Spaces are community-based settings where adolescent girls and young women (AGYW) are offered biomedical, behavioral, and structural services without discrimination. We investigated the uptake and acceptability of sexual and reproductive health (SRH) and related services provided to AGYW through Safe Spaces as part of the My Journey Programme, a large-scale combination human immunodeficiency virus (HIV) prevention program implemented in South Africa.
MethodsWe used data from the HERStory3 study—mixed methods impact evaluation of the My Journey Programme. The quantitative component comprised a household survey of AGYW aged 15–24 years in which participants completed a self-administered electronic questionnaire, and dried blood spot specimens were used to test for HIV. We analyzed survey data from 2,608 AGYW living in the 12 subdistricts in which the intervention was implemented. A multilevel model was used to determine the association between spending time at a Safe Space in the past year and uptake of SRH services, educational enrolment, and wellbeing. A subsample of 68 survey participants took part in qualitative in-depth interviews, which were audio-recorded, transcribed, translated into English, and analyzed using thematic analysis.
ResultsAmong participants who spent time at a Safe Space in the past year (n = 1,201), HIV testing (51.2%) and homework support (24.4%) were the most common services received by participants, and 81.3% were satisfied or very satisfied with the services they received, as reiterated in participants’ narratives. Participants who spent time at a Safe Space in the past year were 33% more likely to have had an HIV test in the past 6 months (95% CI: 1.06–1.67; p = 0.014), 69% more likely to be enrolled in an educational institution (95% CI: 1.32–2.16; p = 0.001), and 40% (95% CI: 1.14–1.71; p = 0.001) more likely to be flourishing. Interview participants also expressed appreciation for the welcoming staff at the Safe Spaces, who provided them with valuable information that increased their knowledge and uptake of SRH services.
ConclusionGiven the high levels of acceptability for Safe Spaces and positive health and health-related outcomes, Safe Spaces should be included as an important component of youth-friendly SRH programs.