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BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

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

Authors: Michael Strauss, Bruce Rhodes, Gavin George

Published in: BMC Health Services Research | Issue 1/2015

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Abstract

Background

Youth 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.

Methods

Focus 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.

Results

The 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.

Conclusions

Increasing 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.
Footnotes
1
In this discussion we use this age group as a definition for “youth” in line with much of the literature cited in this paper [39, 41]. Although our research looks only at a sub-population within this group, we discuss the context and literature relating to groups referred to as “youth”, “young people” and “adolescents” and the various ways in which other authors have defined these groups.
 
2
These additional FGDs were used to augment data for this study and for a concurrent study assessing barriers to and facilitators of VMMC [43]. Since HCT is a prerequisite for VMMC, the FGDs were wholly compatible.
 
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Metadata
Title
A qualitative analysis of the barriers and facilitators of HIV counselling and testing perceived by adolescents in South Africa
Authors
Michael Strauss
Bruce Rhodes
Gavin George
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0922-0

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