New teen health policy seeks to end cycle of drugs, sex

Rasheed Mutaha just turned 18. By all standards he is young, but his teenage face and thick spectacles neatly cover a four-year battle with drug addiction. In his less than two decades on earth, he has abused drugs, lived on the wild side of life, and got expelled from at least two high schools.

Rasheed has smoked bhang, used cocaine, and popped ecstasy, all sourced by and shared with some of his friends. For four cold years he did more drugs than he will ever remember. The fleeting high was too sweet, too enticing to live without; and that momentary feeling of being on top of the world made him believe he was indomitable, some sort of god at whose feet all, especially his small harem of girls, worshipped.

“I tasted my first alcohol when I was 13,” he says. A friend convinced him that he was old enough to partake of the “drink of adults”, and soon that friend brought him bhang, then cocaine, then ecstasy, and then the women. At home he was the model child, but immediately he stepped out he shed off his cloak of innocence and transformed into this attention-hogging, drug-popping maniac.

“It was as crazy as it was fun, or so I thought. In the hazy cloud of illicit romance I did not care whether or not I was using protection. I was neck-deep in the mess,” says the first-year university student.

“Whenever I was high on drugs, I was the coolest bloke among my friends. The only approval I wanted was from my peers. They were my advisers and source of information. However, we all relied on the Internet as the truth.”

However, Rasheed discovered that the Internet was not all that it promised to be. It knew a lot, but not everything. And the answers were templated into a fit-all instruction manual than could not address his most private and pressing needs.

“I would google what is sex only to end up on porn sites. I could not ask my teachers, and I just could not bring myself to talk about these issues with my parents,” he says.

His turning point was when, after a few years of casual, unprotected sex, he developed the signs of a sexually transmitted infection. “I remember my friends asking if I had slept with a certain girl who was popular in the neighbourhood. I couldn’t remember whether I had or had not, and that scared the bats out of me. And then, at about the same time, my father started dropping hints about HIV/Aids and how it was ‘a real killer’. That messed me up emotionally.”

MISPLACED ENERGY

A friend noticed that he was not himself and asked him what was happening. Rasheed confessed that he was not himself, that there was something eating him up from inside, and that he needed help. His friend, a Muslim, told him he could help, and from then on they became the closest buddies as Rasheed slowly weaned himself off drugs.

Eventually, the boy who had been born David Ndun’gu Mutaha became Rasheed Mutaha, converted to Islam by his friend’s dedicated care and concern over his welfare.

That young boy, too, is just one of the many other adolescents in the country who are struggling with one form of drug addiction or another. Just this August, for instance, a group of high school students hired a bus on closing day and proceeded to binge-drink, lap-dance and cavort as they “toured” Kiambu County before the bus was stopped by traffic police over the loud music.

When the police climbed into the bus to see what was going on, they came face to face with the emblem of misplaced teen energy and arrant mischief. The students were all sloshed and in various degrees of undress.

“We are only talking about it because they were caught,” says Rasheed, hinting that this was not an isolated incident. “To the adolescents, such boundless ‘fun’ is normal on school closing day.”

Drug abuse, early sexual debut, lack of contraceptives, HIV/Aids and STIs, sexual abuse and violence are burdens that the average Kenyan adolescent confronts today, and some carry these nagging loads into their youth. If not dealt with early and adequately enough, the results of such misadventures scar them for the rest of their lives.

It is as a result of this that the Ministry of Health, alongside other partners, has drawn up the National Adolescent Sexual and Reproductive Health Policy, set to be launched today in Nairobi. The policy intends to bring adolescent sexual and reproductive health rights into the mainstream sphere of health and development.

It describes reproductive health as a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, in all matters relating to the reproductive system, its functions and processes.

In his foreword to the document, the Cabinet Secretary for Health, James Macharia, says the revision of the Adolescent and Reproductive Health and Development Policy developed in 2003 is necessitated by the fact that “a lot of things have changed at the national and international levels that needed to be taken into account”.

Adolescents, described as any person between the age of 10 and 19 years, comprise nearly 9.6 million of Kenya’s 40 million population. According to the Ministry of Health, this population has implications on the country’s health and development agenda “as it is likely to put increasing demands on provision of services”.

Rasheed knows it. He has been there, done that. Luckily, he survived to tell the story, but many more others never get the second chance, the rebirth, he got.

SECOND ACT: The strategy also addresses the needs of the following

At-risk youth groups

Adolescents living in informal settlements: Young people in slums are exposed to early sexual debut, low contraceptive use, transactional sex, sexual abuse, high burden of unintended pregnancies, and drug and alcohol abuse. In Nairobi slums, about 11 per cent of males and nine per cent of females initiate sexual activity before the age of 15, according to the Status Report on the Sexual and Reproductive Health of Adolescents Living in Urban Slums in Kenya. 

Adolescents in the labour market:

According to the Kenya Integrated Household and Budget Survey 2005/6, approximately one million children aged between five and 17 years were working, yet the law recognises the age of employment as 16 years and above. Due to low educational attainment, child labour is associated with limited access to reproductive health information and services, as well as opportunities for self-advancement. 

Adolescents with disabilities:

People with disabilities cannot easily access health services, and this has implications on their sexual and reproductive health. The prevalence of disability among adolescents in Kenya is estimated at about four per cent, with one out of six reporting their first pregnancy by age 20. Of these, about 87 per cent are married or in a relationship, but only 12 per cent are using a modern contraceptive method. 

Adolescents living with HIV:

Adolescents living with HIV face unique challenges as they transition to adulthood because they are less likely to be in school, likely to be orphaned, lack appropriate services and are often unable to negotiate contraceptive use or even access contraceptive methods. Of the approximately 1.6 million Kenyans living with HIV in 2013, about 16 per cent were children and adolescents (0-19 years). 

Married adolescents:

Married adolescents, as expected, experience sexual intercourse more frequently compared with those who are not married, with very limited condom use despite a higher risk of HIV. 

Orphaned adolescents:

According to the 2012 Kenya Aids Indicators Survey, there are about 1.8 million orphans aged zero to 17 years in Kenya. Nearly half of the estimated number of orphans in Kenya is as a result of the HIV/Aids epidemic, which has also contributed to the increased number of adolescents heading or living in child-headed households, a particularly vulnerable group of orphaned adolescents. Orphans tend to lack guidance and support which is associated with increased vulnerability to risky behaviours among children. 

Adolescents in emergency situations:

Displaced women face particularly high levels of maternal mortality, unmet need for family planning, complications following unsafe abortion and increased gender-based violence as well as sexually transmitted infections, including HIV. In addition, there are usually no services designed to meet the sexual reproductive health needs of adolescents in these populations.

FIVE BATTLES

EARLY SEXUAL DEBUT and CONTRACEPTION USE

Although the average age of first sexual intercourse has been increasing, from 16 years in 1993 to 18 in 2008/9, according to the Kenya Demographic Health Survey, about 12 per cent of girls and 22 per cent of boys reported to have had sex by the age of 15. Similarly, 37 per cent of girls and 44 per cent of boys aged 15 to 19 years have had sex. In Rasheed’s case, sexual debut was at 13 years. Coincidentally, one in three adolescent married girls have an unmet need for family planning. As a result, approximately 18 per cent of adolescents between 15 to 19 years have begun child-bearing.

Evidence from KDHS 2008-2009 shows that among adolescent girls who started child-bearing by age 18, 98 per cent were out of school, indicating that early pregnancy means the end of education for almost all girls. The UNFPA Country Representative Siddharth Chatterjee says “unintended pregnancies cause several thousands of girls — about 13,000 — to drop out of school in Kenya”.

Poverty, lack of education and limited economic opportunities among girls may also contribute to adolescent pregnancy rates. Mr Chatterjee adds: “Teen pregnancy is self-perpetuating because children of teens often become teen parents themselves.

Everyone must respond to the duty to help our children make good choices and to make the most of their own lives.” In the event of pregnancies, adolescents may not maintain a healthy pregnancy due to poor health education, inadequate access to antenatal care and skilled birth attendance among other healthcare services, or the inability to afford costs of pregnancy and childbirth. 

Solution:

The policy proposes age-appropriate sex education on sexuality and relationships by providing scientifically accurate, realistic and non-judgmental information, as well as enhancing provision of “high quality post-abortion care services to adolescents”.

HIV/AIDS and STIs

HIV prevalence has decreased significantly among young people aged 15 to 19 years, declining from about 3.0 per cent in 2003 to 1.1 per cent in 2012. Overall, adolescents between the ages of 10 and 19 years represent about nine per cent of persons living with HIV and 13 per cent of all HIV-related deaths in Kenya. The HIV prevalence rate for adolescents living in urban areas has higher HIV prevalence rates (2.2 per cent) compared to their rural counterparts (0.5 per cent). For those who report first sex before 15 years, HIV prevalence is 5.3 per cent among young women and 0.3 per cent among young men. About 53 per cent of female adolescents and 34 per cent of their male counterparts aged 15 to 24 years who had their first sexual encounter before the age of 15 years report condom use during their sexual debut, compared to 70 per cent of females and 65 per cent of males aged 15 to 24 years who used condoms during their sexual debut at 15 years and above. 

Solution:

The new policy suggests the supporting of provision of accurate information on HIV/Aids and other STIs to adolescents for risk reduction and ART adherence. It also proposes the promotion of screening and treatment of reproductive tract infections, including STIs. Another solution is through the global launch of the All In Campaign in Kenya in February this year, which seeks to prevent adolescent HIV/Aids infections as well as work with affected youth to better manage infections.

SEXUAL ABUSE and VIOLENCE

According to a 2012 national study by the United Nations Children’s Fund (Unicef) on violence against children in Kenya, adolescent girls aged 13 to 17 were more likely to have experienced sexual violence in the previous 12 months (10.7 per cent) compared with a similar age group of boys (4.2 per cent). Adolescents who suffer sexual abuse are more likely to be exposed to unintended pregnancy, unsafe abortions and STIs, including HIV. 

Solution

The policy proposes to strengthen the provision of medical, legal and psycho-social support for teen survivors of sexual and gender-based violence; and to enhance the capacity of law enforcers and health care teams on response to and mitigation of such violence.

DRUG and SUBSTANCE ABUSE

According to a 2012 rapid assessment of drugs and substance use in Kenya by the National Authority for Campaign against Alcohol and Drug Abuse (Nacada), about 18 per cent of adolescents aged 15 to 17 reported ever using any drug or substance, including tobacco, khat (miraa), narcotics, and inhalants. Specifically, about two per cent of females and four per cent of males aged 10 to 14, and about 11 per cent of 15-to-17-year-olds reported ever using alcohol. The United Nations Office on Drugs and Crime estimates ecstasy users to number approximately nine million worldwide, the vast majority of whom are teenagers and young adults. The use of alcohol and drugs is used as a strategy for most young people to cope with problems such as unemployment, neglect, violence, sexual abuse and poor academic performance. Despite the need for services to address substance abuse, very few drug rehabilitation programmes and counselling centres are available for adolescents in Kenya, and these tend to be urban-based. For adolescents, substance use and abuse is associated with increased risk for early sexual debut, multiple sexual partners and early child-bearing. 

Solution

The policy proposes the support of provision of medical, legal and psychological services at all levels, including rehabilitation for adolescents exposed to drug and substance abuse; as well as support of the enforcement of relevant legislation on drug, alcohol and other substance abuse among adolescents.

FGM and EARLY MARRIAGES

Female Genital Mutilation (FGM) is a deeply rooted cultural practice that remains prevalent in Kenya despite being outlawed in 2001 by the Children’s Act and Prohibition of FGM Act 2011, and being a violation of rights. According to the National Council for Population and Development, Kenya Population Situation Analysis, among young girls aged 15 to 19, FGM declined from 26 per cent in 1998 to 15 per cent in 2008, then to 11 per cent in 2014. Girls who have undergone FGM as a rite of passage are likely to drop out of school, experience child marriage and early child bearing. Also, according to KDHS 2008-2009, six per cent of females were married by age 15 and 26 per cent by age 18. Child marriage is associated with dropping out of school, increased risk of HIV infection, heightened risk of gender-based violence, early child-bearing as well as high fertility rates. There is also a risk of high infant mortality as well as maternal morbidity and mortality. 

Solution

Support the education of communities on existing legislation and policies that protect adolescents from harmful traditional practices; as well as support sensitisation programmes that advocate the reintegration to school of adolescents in early marriage and FGM situations.