A qualitative analysis of the barriers and facilitators of HIV counselling and testing perceived by adolescents in South Africa

Abstract

BackgroundYouth in South Africa have been identified as a high-risk group for contracting HIV. In response, the South African Integrated School Health Policy (ISHP) has been developed with the aim of guiding the provision of comprehensive healthcare services within South African schools. Accordingly, the scale-up of HIV counselling and testing (HCT) in high schools is a priority. This study examines the factors affecting the utilisation of HCT services amongst learners in high schools in the KwaZulu-Natal province of South Africa.MethodsFocus group discussions were conducted in 12 rural schools in the Vulindlela sub-district of uMgungundlovu in KwaZulu-Natal. A total of 158 randomly selected learners took part, aged 16 years and older from grades 10, 11 and 12. Qualitative analysis was conducted using the framework approach, providing a systematic structure allowing for a priori and emergent codes, with social cognitive theory as a theoretical framework.ResultsThe stigma and discrimination attached to testing, along with the inherent fear of a positive result were the biggest barriers to HCT uptake. Fear and the subsequent negative beliefs around HCT were borne out of insufficient knowledge. These fears were exacerbated by the perceived or real attitudes of peers, partners and family towards HIV. The prospect of a positive result and the possible resultant societal backlash hinders high and regular uptake of HCT. Stigma and discrimination remain the foremost barriers to HIV testing despite the presence of localised and convenient testing. Interventions aimed at addressing these challenges could increase the demand for HIV testing amongst adolescents.ConclusionsIncreasing education about the importance of HCT and creating awareness about available HCT services will not be enough to increase uptake in schools in South Africa. Efforts to decrease stigma around HIV and HCT by integrating testing into general and sexual reproductive health services offered to youth, and normalising the epidemic within the community could go some way to allaying the fears shrouding testing, if such services are designed with the specific needs of youth in mind. This paper adds to the body of literature informing the design of policy in South Africa aimed at integrating HCT into school health services.

AIDS and jail: social representations of women in freedom deprivation situations

“…This study highlights that, by gathering main consensual elements that integrate the AIDS SR -a frightening disease that causes suffering and fear when one thinks about HIV contamination, and is associated with socially reproachable behaviors (sex and drugs) -it is possible to understand the reasons that support the stereotype that forms the AIDS stigma, which consequently reproduces and stresses prejudices that favor marginalization and its social consequences (7,(24)(25) .…”

Uptake and yield of HIV testing and counselling among children and adolescents in sub‐Saharan Africa: a systematic review

“…Furthermore, qualitative studies establishing the barriers to testing for this age group should be encouraged. Those barriers are likely to be specific to both the testing strategy and the setting [20, 44]. …”

“The right place and the right time”: A qualitative study of the decision‐making process of self‐initiated HIV testing among young adults

“…Our research uniquely identified participants' self‐convincing process as they initiated the decision to seek testing. The participants who identified this prompt were relatively younger and may experience mental testing barriers like stigma and fear that remain deterrents of HIV testing (Phillips, Ybarra, Prescott, Parsons, & Mustanski, 2015; Schnall et al, 2015; Strauss, Rhodes, & George, 2015). Hence, the ability to assuage feelings of concern with the knowledge of HIV testing benefits through self‐convincing was essential for young adults to initiate testing decisions.…”