June 2004

Attracting Youth to Voluntary Counseling and Testing Services in Uganda

Key Findings (continued)

Youth were highly satisfied with the new youth-oriented services.

Exit interview data from AIC indicate that overall satisfaction with VCT services was generally high before the intervention (79 percent), yet 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 (Table 2).

Ninety-three percent of NTIHC clients participating in exit interviews after the introduction of youth VCT said they were satisfied with the services they had received. Moreover, almost all of the youth clients indicated that their counselor exhibited good counseling skills as part of the counseling process (Table 2). Steps that counselors did not take as consistently with youth clients at both sites were making referrals for treatment, further counseling, or care services.

Youth were asked to name three things they liked best about the services, and post-introduction of youth VCT services, the greatest number at both sites mentioned "friendly provider." A large majority also mentioned warm reception and provider professionalism. Although less than a third of respondents at both sites mentioned confidentiality, this figure had actually doubled at AIC from pre- to post-introduction of youth VCT (15 to 30 percent). Major improvements at AIC were also detected with regard to warm reception, provider professionalism, and information given on HIV/STIs (Table 3).

"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."
Male youth at AIC

Clinics could not handle all the young clients who came.

After counselors from both facilities received training in youth-friendly services, the youth corner at AIC began operation and NTIHC started offering VCT as a new type of service. To serve more youth, NTIHC placed several large tents in the garden behind the clinic to allow for more waiting and counseling space. Media promotion of VCT services by Straight Talk and a local FM station, Radio Simba, followed. These activities led to an influx of young people seeking VCT services at the two facilities.

A counseling room at the AIDS Information Center Youth Corner in Kampala. In 2001, AIC established a youth corner behind the regular adult clinic with a separate gate so youth could enter in privacy. Photo credit: Louis Apicella Horizons/Population Council

While the counselors reported that the training was beneficial to their efforts to advise young clients, they could not cope with the large numbers of young people who came to the clinics seeking services. To avoid disappointing youth, AIC booked only the number of youth they could handle each day and scheduled future appointments for the remaining youth. At NTIHC, the trained peer counselors determined that they could only counsel 20 young people each day and so they served only the first 20 to come for VCT services each morning. To reduce counselor stress, NTIHC offered services only two days a week. Eventually, the media outreach activities had to be discontinued to reduce the demand created by their promotional messages.

Key Findings (continued) >

Risk exposure was the main reason clients got tested.

In the exit interviews and focus groups with tested youth, participants gave a number of reasons why they decided to come for VCT. One was that testing is part of preparation for marriage; another was to protect a relationship in which a partner asked them to test. According to a male focus group participant who got tested at AIC, "You may propose to a girl and she gives a condition that for any relationship you have to take an HIV test first." A few felt that they needed to know their HIV status in order to plan their future or because their job, education, or insurance required that they be tested.

However, after the promotion and introduction of youth VCT services, the vast majority of exit interview respondents at AIC (81 percent) and NTIHC (86 percent) got tested because they believed they had been exposed to HIV. Specific reasons for getting tested mentioned in focus groups included having unprotected sex, having worrisome symptoms, caring for someone with an open wound, and having parents who were sick or dead due to HIV infection. For AIC, this represents a huge change in their client profile, because only 7 percent of respondents prior to the introduction of youth VCT services mentioned risk exposure as the main reason for testing.

More females than males used the VCT services at AIC and NTIHC.

At AIC, females younger than 21 years old constituted 20 percent of total clients compared to 10 percent for males (January 2001 to April 2003 service statistics). NTIHC saw equal numbers of males and females during the first two months of VCT services. However, this pattern changed from the third month onward, with increasingly more female than male youth seeking VCT at the facility.

In focus groups, youth gave various reasons for the gender disparity. Some thought that females would be more motivated to get tested because they are more vulnerable to HIV infection due to rape or intercourse with older men, or because they are enticed or forced into sex at younger ages than males. Others thought that in general, females are more likely to have a single partner and therefore a good chance of testing negative. In contrast, most young men have multiple partners and have a good reason to fear testing because of the likelihood of a positive result.

In general, both male and female youth felt that females are more concerned about their lives and future and therefore, they are more likely to seek and respond to health information than males. Respondents also noted that more females than males are getting married in their late teens and early twenties and thus are likely to seek VCT before marriage. Almost all believed that it would be the female who would want the HIV test before marriage and that she would have to persuade or even push the man to get tested.

After the intervention, AIC attracted more young women who paid for the service themselves rather than relying on a partner to pay for VCT.

Youth at AIC were asked where they got the money for the HIV test. Personal savings was the main source for males prior to the introduction of the youth corner (80 percent) and post-introduction (88 percent). However, for females who tested at AIC prior to the introduction of the youth services, most (65 percent) had partners who paid for the test. At the post-introduction measure, the proportion of females whose partners paid for the HIV test dropped to 33 percent, and the percentage who paid for their own test increased from 15 to 48 percent (Figure 1). This may be attributed to the reduction in HIV testing fees. Thus many more females could afford to pay for VCT themselves. Only 3 percent of females at post-introduction felt the HIV test fee was high, compared to 20 percent at pre-introduction.

The intervention at AIC increased the proportion of young women who came to test unaccompanied.

AIC females were twice as likely as their male counterparts to be accompanied for testing prior to the promotion and introduction of the youth corner (69 vs. 35 percent). Although females were more likely than males to be accompanied by someone at post-introduction, the proportion dropped substantially for females (49 percent), while that of males changed little (34 percent). The lowered cost of testing might have enabled more females to test independently of partners.

Accompanied youth said that they had someone with them because they wanted emotional and financial support, advice, and someone with whom they could share the experience. To explore whether accompanied youth had been pressured to come for testing, researchers interviewed 67 people who accompanied youth clients at AIC and NTIHC after the introduction of youth VCT services. Seventy-one percent of the people interviewed reported that they had been tested, and most of them had encouraged the young person they had accompanied to come for testing. More than a fourth of respondents (27 percent) said they had accompanied a partner, and these were all males. From these interviews and focus groups with youth, there seemed to be little outside pressure to test.

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This page updated
03 Jan 2009