HIV Voluntary Counseling and Testing Among Youth Ages 14 to 21

Executive Summary

Voluntary counseling and testing (VCT) programs have increased the adoption of safe sexual behavior and the use of care and support services among adults (Coates et al. 1998). Are VCT programs appropriate for young people, who account for the majority of all new HIV infections in East and southern Africa? To find out, researchers conducted exploratory research to identify opportunities for and barriers to providing VCT for youth. The first phase of the study, completed in May 2000, indicates that youth would like access to HIV testing and counseling services if the services are confidential and inexpensive and if the results are reported honestly.

Methods

In Nairobi, Kenya, and Kampala and Masaka, Uganda, researchers conducted focus group discussions and in-depth interviews with youth, parents, service providers, and community members and administered a survey among a convenience sample of young people ages 14-21. In Uganda, the survey sample consisted of 135 youth who had taken an HIV test and 210 untested youth; in Kenya, researchers interviewed 105 tested and 122 untested youth. Although convenience samples can not be used to generalize to larger populations, the respondents provided valuable comments and suggestions for improving services to young people.

During a second phase, we will test different service delivery and promotional strategies identified in the exploratory phase to determine whether they increase the use of and satisfaction with VCT among young women and men.

Key Findings

Most tested youth intend to practice safer sex.

Among young people who had taken an HIV test, most said they would adopt safer behaviors, such as abstaining from sexual intercourse, practicing monogamy, using condoms, or reducing the number of sexual partners. Males and females reported similar intentions, except in Uganda, where the proportion of females who intend to practice monogamy is significantly greater than that of males.

Counseling is a valued part of HIV testing.

When asked to name the satisfactory aspects of their testing experience, clients mentioned the counseling more than any other component. This happened even though the quality of counseling varied from service to service. One 21-year-old Kenyan woman commented positively on her experience:

"[The counselors who] gave me courage to go for the test were so friendly. They encouraged me that whatever the results I should not give up. I liked the fact that they told me to go back to them after the test."

Yet some youth were disappointed with their testing experience, primarily because they did not receive counseling with the test. This occurred less often in Uganda than in Kenya, where few testing facilities provide truly voluntary services and good counseling. Notably, one in four tested youth in the Nairobi group did not talk with a service provider before the HIV test. The same proportion of youth did not receive posttest counseling, and instead go their test results either as a written report or from a third person such as a parent. A 21-year-old-Kenyan woman who found out she is HIV-positive expressed disappointment with the way she was dismissed after her test:

"They should have sat me down and explained my status and counseled me on how I should take care of myself instead of treating me as if I were the first one to be diagnosed HIV-positive. They made me feel as if I would die tomorrow.",br>

Most youth disclose their HIV test results.

Only two young people in Uganda and ten in Kenya who got tested told no one about their serostatus. The most frequent response to the question "With whom did you share your test results?" was partners/spouses and peers. Fewer than one-fourth told parents about their test results. Some said that they did not want their parents to know that they are sexually active. Others feared that their parents, especially their mothers, would worry if they knew about the testing.

The majority of untested youth would take an HIV test.

Seventy-seven percent of untested respondents in Kenya and more than 90% in Uganda said they would like to be tested for HIV at some point in the future. Young people said they would be attracted to VCT if the services are confidential and inexpensive and if the results are reported to them honestly.

Service providers are not equipped to respond to youth issues.

Service providers interviewed in Kenya and Uganda reported that counseling young people requires special training and improved, youth-oriented referral services. Because many youth do not easily open up when asked to explain their problems or answer sensitive questions, providers require training to develop the skills needed to work with these clients. However, some youth tell them so much about their personal lives that it is often difficult for counselors to respond. Counselors reported frustration when youth do not return for follow-up or ignore such advice as discontinuing unprotected sex.

More support services are needed for counseled youth in Uganda.

Ugandan providers said they want to be able to refer youth who have been raped, threaten suicide, plan to leave home or school, or plan to harm their partners, but few youth-appropriate services or support groups exist. Providers in one clinic formed posttest clubs for youth to help them maintain safe behavior.

Building on Research

In Uganda, service delivery organizations have used the data from the formative research to design VCT programs that are youth-friendly and provide high-quality voluntary counseling and testing. The program improvements include:

• Increased training of service providers in counseling skills for youth about HIV.
• Use of a separate room and alternative locations so that youth do not have to risk seeing familiar adults or family members when seeking VCT.
• Reduced price of testing service.
• Establishment of a referral system for young clients that providers can use at all locations.
• Improved outreach to schools and youth groups.
• Introduction of VCT at a youth reproductive health center.
• A multimedia campaign to inform youth about VCT

In Kenya, project partners are planning to develop and implement special services for youth, including:

• Opening an adolescent counseling and recreational center where youth have access to free VCT, among other services.
• Introducing youth-friendly VCT services at existing facilities, such as fast-tracking youth seeking VCT.