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.
Highlights
Youth in South Africa have been identified as a high-risk group for contracting HIV
The qualitative work we present here assessed the success of the HIV counselling and testing (HCT) programmes, the impact, threats and opportunities that exist in scaling up the provision of sexual healthcare among high school learners in rural areas, as well as the importance of services integrated into school health programmes
The lack of it, was the dominant theme emerging from the data. This fear of testing or the confidence to test is realised through the interaction between the self and the environment, with behaviour relating to sexual risk, and experience of HCT having an impact on personal beliefs and the decision to test and repeat test
Summary
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. This study examines the factors affecting the utilisation of HCT services amongst learners in high schools in the KwaZulu-Natal province of South Africa. Youth (15–24 age group1) in South Africa have been identified as a high-risk group with HIV prevalence rates estimated at 7,1 % [1]. The KwaZulu-Natal (KZN) province has the second largest population (10,8 million people) and the biggest burden of HIV in the country, both in terms of prevalence (24.7 %) and incidence rates (2.3 %) [2]. The Vulindlela sub-district in Umgungundlovu, KZN, has one of the highest HIV prevalence rates (45.7 %) in South Africa, with a population of approximately 90,000 [4], and is a critical district in terms of HCT service delivery.
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