Some of the young people who seek help at the Youth Information and Orientation Centre for Reproductive Health (CIOJ) in N'Djamena, capital of Chad, do not understand how they became pregnant or contracted a sexually transmitted infection (STI). Workers at the centre blame the high levels of ignorance on the failure of parents to talk to their children about sex.

CIOJ was set up by a local non-governmental family welfare organisation, the Chadian Association for Family Well-Being (ASTBEF), to provide young people with a user-friendly family planning, STI and HIV service. The centre is supported by several international partners, including United Nations agencies and the International Planned Parenthood Federation (IPPF), of which it is a member.

Although principally aimed at youth between the ages of 15 and 24, boys and girls as young as 10 come to the centre in search of information and treatment. "At nine or 10 some young people have already had sexual relations, girls in particular," said Hassane Haoua, a project coordinator at ASTBEF.

"Pregnancies at this age are rare but there are young mums in the 14-to-15 age group." In the first half of 2007, the centre, located in a working-class area of N'Djamena, saw more than 3,000 young clients, most of them girls.

Young Chadians tend to have a very poor knowledge of sexual matters. "They often know how to protect themselves against HIV, and what puts them at risk of contracting it, but some of them have never heard of contraception," said Dada Nandeh, the centre's social worker. "They don't know how to recognise the symptoms of STIs, and the girls don't know how to manage their menstrual cycles."

Although abortion is illegal in Chad, and people caught performing it can face up to five years in prison, this does not prevent young girls who become pregnant from sometimes taking desperate measures to hide their condition from their parents. "The girls go and get illegal abortions and end up dying of a haemorrhage," said the centre's midwife, Célestine Dagaïe.

A taboo subject

The subject of sexuality is so taboo in Chad that often even the most basic reproductive health and hygiene issues are not discussed in the family home.
"It was even hard to tell my mum that I'd had my first period," said Ndari Gebbe, 22, who began visiting the centre in 2003 and is now a peer educator and president of the IPPF's Youth Action Movement (MAJ). "When I first had it, I knew what it was because I'd read about it in a women's magazine, but I didn't manage to tell my mum for two years."

By contrast, young people feel comfortable talking about such issues at CIOJ, said Gebbe. "I came here because I was isolated; I didn't know anything about STIs or HIV, and I didn't talk to anyone about it, even at school. Here even the youngest ones talk about it - they're not scared."

What the centre's young female clients tell her is sometimes difficult to hear. "I've listened to girls who are traumatised; girls who had sex at the age of nine - often cases of rape," she told IRIN/PlusNews. "The girls tell us their secrets, but if it's too much for us, we take them to the centre's social worker."

Gebbe believes the lack of parent-child dialogue is at least partly to blame for incidents of sexual abuse. "If parents don't tell their children what to be careful of, they are [in danger]," she said. "Since the centre exists, [parents] may at least point their children towards it if they don't want to talk to them [about sexuality]."

In reality, said ASTBEF's Haoua, "some parents forbid their children from coming."

Before the CIOJ youth clinic opened in 2006, young people needing treatment were referred to the main ASTBEF clinic, in another district of N'Djamena, but many did not go.
"The young people were scared of bumping into their parents, especially when there were long waiting times at the clinic," said Nandeh, the social worker. "They were also scared of people being hostile, especially the girls, because boys can talk more freely. Here they can come at quieter times, between [school] classes, and they often come with friends."

Young people who come to the centre for treatment of STIs are offered an HIV test; if it is positive, they are taken to the ASTBEF clinic for psychological support and treatment of opportunistic infections, and then referred to an antiretroviral (ARV) treatment centre. In the first six months of 2007, 136 young people were tested for HIV at the centre, with 39 having a positive result.

Aside from HIV, one of the biggest worries at the centre is the resurgence of certain STIs. "We are finding STIs that had disappeared [in N'Djamena] have come back in young people", said Nandeh.

Despite these concerns, the number of visitors to the centre is growing. Some of CIOJ's young clients have even formed their own anti-AIDS organisations and are educating other young people about HIV, sexuality and reproductive health. "If they practice what they preach, we will have won the fight," said Nandeh.