January 2001

Voluntary counseling and testing (VCT) programs have increased the adoption of safe sexual behavior and use of care and support services among adults (Weinhardt et al. 1999). Are VCT programs appropriate for young people, a group that accounts for the majority of all new HIV infections in east and southern Africa? A study in Kenya and Uganda indicates that youth would like access to HIV testing and counseling services if the services are confidential, honest, and inexpensive.

Research Phases

Because little is known about whether VCT is appropriate for youth, the study began with a first phase of exploratory research to identify opportunities for and limitations of providing VCT for youth. In each country, researchers conducted focus groups, in-depth interviews, and a survey with a convenience sample of youth, ages 14-21, and parents, service providers, community members, and policymakers. In Uganda, the survey sample consisted of 135 tested and 210 untested youth; in Kenya, researchers interviewed 105 tested and 122 untested youth. Although convenience samples cannot be used to generalize to larger populations, the respondents provided valuable comments and suggestions for improving services for young people. Phase one was completed in May 2000.

During phase two, different service delivery and promotional strategies identified in phase one will be tested 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 will 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 was statistically greater than for males. (Figure 1)

Counseling is a valued part of HIV testing. When asked to name the satisfactory aspects of their testing experience, more clients mentioned the counseling than any other component. 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 fewer testing facilities provide truly voluntary services and good counseling. Notably, one out of four tested youth surveyed in Nairobi did not talk with a service provider before the HIV test. The same proportion of youth did not receive post-test counseling but instead got 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 in 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.

Most youth disclose their HIV test results. Only two young people in Uganda and 10 in Kenya who got tested told no one about their serostatus. When asked with whom they shared their test results, the most frequent responses were partners/spouses and peers. Less than a quarter told a parent 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. (Figure 2)

The vast majority of untested youth would take an HIV test. Seventy-seven percent of untested respondents in Kenya and more than 90 percent in Uganda said they would like to be tested for HIV at some point in the future. Youth would be attracted to VCT if the services are confidential, honest, and inexpensive. VCT service providers are not fully 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 necessary to work with these clients. Counselors reported frustration when youth don't return for follow-up or ignore such advice as discontinuing unprotected sex.

Ugandan providers also mentioned needing more support services for counseled youth. Some youth tell them so much about their personal lives that it is often difficult to respond. Providers 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. To provide the kind of support young people need to maintain safe behavior, one clinic formed post-test clubs.

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 need not meet adult 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 and through the media.

In Kenya the development and implementation of special services for youth is being planned.

References

Weinhardt, Lance S. et al. 1999. "Effects of HIV counseling and testing on sexual risk behavior: A meta-analytic review of published research, 1985–1997," American Journal of Public Health 89(9): 1397–1405.

Many organizations participated in this research including, in Kenya, the Adolescent Counseling Clinic in Kenyatta National Hospital, Kenya Association of Professional Counselors, Kibera Community Self-Help Programme, Riruta City Council Clinic, St. John's Community Center, University of Nairobi, and Wazu Dance Troupe; in Uganda, AIDS Information Center, Buganda Kingdom Youth Project Center, Kitovu Hospital Mobile Home Care Programme, Makerere University, Naguru Teenage Information and Health Center, and The AIDS Support Organization.

For more information on this study, contact Milka Juma, Horizons (mjuma@popcouncil.or.ke).

About Horizons

Horizons conducts global operations research to improve prevention, care, and support program. Horizons is implemented by the Population Council under a cooperative agreement with the U.S. Agency for International Development. Horizons is implemented by the Population Council in partnership with the International Center for Research on Women (ICRW), the Program for Appropriate Technology in Health (PATH), the International HIV/AIDS Alliance, Tulane University, and the University of Alabama at Birmingham.

Copyright © 2001 The Population Council

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