A peer counselor with a female client at the Naguru Teenage Information and Health Center in Kampala, Uganda. Photo credit: Louis Apicella

Voluntary counseling and testing (VCT) programs stand out among HIV/AIDS interventions because of their dual role: Not only do they help clients adopt HIV-preventive behaviors, but they also identify people that need HIV care. Given that many of those newly infected with HIV are young people, VCT program managers and policymakers are increasingly recognizing the importance of encouraging youth to seek HIV counseling and testing and of modifying their services to meet youth’s particular needs.

A Horizons study conducted in Uganda from 2001 to 2003 tested new strategies to increase VCT utilization and satisfaction among young people. The intervention study builds on earlier research conducted in Kenya and Uganda, which revealed that youth want information about HIV and AIDS, low-cost HIV testing, and friendly, confidential, and professional counseling¹. Two facilities in Kampala, Uganda, the AIDS Information Center (AIC) and Naguru Teenage Information and Health Center (NTIHC), responded to these requests by reorienting their services to better serve youth.

AIC has provided stand-alone VCT services since 1990. Although AIC had served youth as well as adults, it did not target youth specifically. In 2001, AIC established a youth corner with a separate gate behind the regular adult clinic so youth could enter in privacy. AIC also reduced the HIV testing fee for youth.

Open since 1995, NTIHC is a drop-in center for youth that offers free reproductive health services, including family planning, pregnancy testing and counseling, and antenatal and postnatal care. In 2002, NTIHC began offering VCT two days per week and expanded its facility to provide waiting and counseling space for youth seeking VCT.

AIC developed a three-day training course for counselors at both sites on how to counsel youth seeking VCT. Specific issues addressed by the training included mental and emotional development in adolescence, how to discuss puberty with youth, and pressures in the environment that affect youth decision-making.

AIC and NTIHC informed young people about the new services by discussing VCT and the test locations on a popular radio call-in show, placing information in a well-established youth magazine, and distributing materials.

To evaluate these efforts, researchers from Makerere University and the Horizons Program conducted exit interviews with youth 14 to 21 years old who had sought services at AIC and NTIHC, in-depth interviews with some of these clients, and focus groups with tested and untested youth.

The study found that youth were highly satisfied with the new youth-oriented services. While overall satisfaction with VCT services at AIC was generally high before the intervention (79 percent), it increased after provider training and implementation of the youth corner (95 percent). There were also increases in the proportion of youth clients at AIC who indicated that the counselor took important steps as part of the VCT process such as praising the client for having the courage to come for services, clarifying information, correcting misconceptions, repeating important information, and responding to their concerns and worries.

Among NTIHC clients, satisfaction with services was also very high (93 percent) after VCT had been introduced.

When asked to name the three things they liked best about the services, the greatest number at both sites mentioned “friendly provider.” A large majority also mentioned warm reception and provider professionalism.

“I was so worried because I had lost a lot of weight but I stopped worrying when I came to this place. The reception was so good. It was like life goes on and these people are very caring,” said a male youth at AIC.

Almost all of the youth clients interviewed indicated that their counselor exhibited good counseling skills. This finding is particularly important given that NTIHC used peer counselors (AIC used professional adult counselors). In addition, all of the youth interviewed from both clinics reported that the professional and peer counselors were nonjudgmental, listened attentively, and encouraged the client to speak. Steps that counselors at both sites did not take as consistently with youth clients were making referrals for treatment, further counseling, or care services.

But, peer counselors faced particular challenges in their counseling roles. For example, some reported that clients occasionally questioned their authority and expertise. In addition, young counselors were more likely to feel isolated and less likely to feel confident about their skills.

More females than males have used the newly structured VCT services at both sites. Interestingly, AIC is attracting more young women who pay for the service themselves rather than rely on a partner to pay for VCT. This change may be due to the reduction in HIV testing fees, enabling more females to pay for VCT themselves.

The new services received positive reviews, but unfortunately both AIC and NTIHC could not handle all the young clients who came in response to the promotional activities and word of mouth.

“The response to the new services has been overwhelming,” says Ann McCauley, formerly of Horizons/International Center for Research on Women, one of the study’s principal investigators. “Young people were eager to talk to a health counselor about HIV, and the counselors were gratified because some youth sent thank you notes and referred their friends to the counselors by name.”

To avoid disappointing youth, AIC booked only the number of youth they could handle each day and scheduled future appointments for the rest. At NTIHC, the trained peer counselors determined that they could only counsel 20 young people each day, and so they accepted only the first 20 that came for VCT services each morning. Since then, however, they have added more counselors and now provide VCT to more youth.

Eventually the outreach activities had to be discontinued to reduce the demand created by their promotional messages—a finding that highlights an important conclusion of the study: There is immense unmet demand for VCT among youth, and VCT centers that set out to attract youth need to plan accordingly, which includes having adequate space and trained counselors. The study also shows that special training of providers, improved services, lowered fees, and additional testing sites attract more youth to testing.

For more information, contact Milka Juma at (mjuma@pcnairobi.org) or go to the summary of this research.

¹Horizons Program, Kenya Project Partners, and Uganda Project Partners. 2001. “HIV voluntary counseling and testing among youth: Results from an exploratory study in Nairobi, Kenya, and Kampala and Masaka, Uganda,” Horizons Baseline Report. Washington, DC: Population Council. (PDF)

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