December 2006

Studies in Brief
Family Matters: Zambia study highlights role of families in youths' testing decisions

Youths' attitudes toward HIV testing and counseling are often shaped by family members. Photo credit: Julie Denison/Johns Hopkins University

My lifestyle was crowded with a lot of things like going out with girls. Not just playing but having sex with them.
—HIV-negative male, age 17

The words of this young man in Zambia highlight that youth are often at risk of HIV and therefore need to know their status to take advantage of treatment and support services and to prevent further transmission of the virus. But to attract youth to voluntary counseling and testing (VCT) services, program managers must have an understanding of what factors influence youths’ HIV testing behaviors.

Research conducted in 2001 by Horizons and partners in Kenya and Uganda suggested that social relationships, including family interactions, influence young people’s decisions regarding HIV testing. To build on these findings and to further explore the role that families can play in youths’ decision-making around HIV testing, Horizons conducted additional research in Ndola, Zambia.

Known as the Young Voices of Hope study, it was conducted in two phases from June 2003 to February 2004 in collaboration with the Hope Centre, a Development Aid from People to People Project, and Johns Hopkins University. The first phase involved qualitative in-depth interviews with 40 adolescents ages 16–19 who had tested for HIV and their family members, to examine their attitudes toward and decision-making surrounding VCT. The second phase was a household survey of 550 adolescents ages 16–19.

Qualitative data showed that adolescents often wanted information and guidance from their parents on whether or not to seek VCT. In addition many turned to family members to discuss their options both before and after seeking the service:

In the first place I never wanted to go there [for an HIV test], but I consulted my sister. She said no and I also said no. But afterwards I asked my brother who said...you should go for VCT, so that is when I went.
—HIV-negative male, age 19

However, some youth did not engage family members in discussions about VCT because they feared having their families question them about their sexual behavior and relationships:

I was scared that my parents would scold me for sleeping with men.
—HIV-negative female, age 18

In-depth interviews with family members of HIV-tested adolescents revealed that parents feel a growing responsibility to educate their children about HIV and VCT:

In olden days I cannot tell you such things [about HIV], but now there is nothing to hide. . . . We have to talk as parents for our children to know.
—Mother, age 36

Quantitative findings from the household survey showed that families play an important role in shaping youths’ attitudes toward VCT. Respondents’ perceptions of their families’ reactions to an HIV test were associated with their future testing plans. Those who believed their families would not be upset with them were more likely to plan to take an HIV test, while perceived negative reactions of family prevented youth from planning to seek VCT.

Adolescents who talked to a family member about HIV testing were four times more likely to have been tested.

Family discussions were also related to youths’ actual test-taking behaviors. Adolescents who reported talking to a family member about HIV testing were four times more likely to have been tested for HIV than their peers who had not had such family interactions. In addition, the odds of actually having taken an HIV test was 5.5 times greater among youth who felt their families would not be upset if they tested than among those youth who felt the opposite.

The data illustrate the importance of examining family relationships in order to better understand adolescents’ VCT decisions. Based on study findings, the researchers recommended that when promoting VCT, program managers should include messages that foster communication about VCT within families. Such messages should encourage early involvement of family members in adolescents’ decision-making about VCT and subsequent VCT experiences.

For more information about this study, contact Julie Denison at jdenison@fhi.org.

—Alison Lee

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© 2006 The Population Council, Inc.

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See Also

• FRONTIERS

• Population Council – Infants and Children

• Population Council – Journals and Newsletters

• Population Council – Prevention

• Population Council – Youth

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This page updated 11 January 2007

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