Abstract
BackgroundHIV prevalence is increasing among South African youth, but HIV counselling and testing (HCT) remains low. Adolescent pregnancy rates are also high.ObjectivesInnovative strategies are needed to increase HIV and pregnancy screening and prevention among youth.MethodThe Desmond Tutu HIV Foundation Youth Centre (DTHF-YC) offers integrated, incentivised sexual and reproductive health (SRH), educational and recreational programmes. We compared HCT and contraception rates between the DTHF-YC and a public clinic (PC) in Cape Town to estimate the impact of DTHF-YC on youth contraception and HCT utilisation.ResultsIn 2015, females < 18 years had 3.74 times (confidence interval [CI]: 3.37–4.15) more contraception visits at DTHF-YC versus PC. There were no differences in the contraception and adherence was suboptimal. DTHF-YC youth (aged 15–24 years) were 1.85 times (CI: 1.69–2.01) more likely to undergo HCT versus PC, while male youth were 3.83 times (CI: 3.04–4.81) more likely to test at DTHF-YC. Youth were a third less likely to test HIV-positive at DTHF-YC versus PC. Female sex, older age, clinic attendance for contraception and sexually transmitted infections (STIs), redeeming incentives and high DTHF-YC attendance were all independent factors associated with increased HCT.ConclusionYouth were significantly more likely to access SRH services at DTHF-YC compared with the PC. The differences were greatest in contraception use by female adolescents < 18 years and HCT by male youth. Increased HCT did not increase youth HIV case detection. Data from DTHF-YC suggest that youth-friendly healthcare providers integrated into community youth spaces may increase youth HCT and contraception rates.
Highlights
South Africa has the highest prevalence of HIV infections among adolescents worldwide, accounting for nearly 18% of global HIV infections among 15- to 24-year-old youth in 2016.1 HIV incidence is decreasing, South Africa still had 9.9 new infections per 1000 adults in 2016, with approximately 37% of those new infections in young people aged 15–24 years (22% in young women).[1]
Survey data from four of nine South African provinces revealed that 19.2% of female adolescents (12–19 years) had been pregnant at least once[5]; the 2008 Youth Risk Behaviour Survey showed that 24% of female students (11–20 years) reported at least one pregnancy.[6]
A survey of 15- to 24-year-olds in KwaZuluNatal found that only 29% of youth reported previous HIV counselling and testing (HCT),[7] while a population-based survey conducted in four South African provinces documented that less than half of 18- to 24-year-old women used hormonal contraception.[8]
Summary
South Africa has the highest prevalence of HIV infections among adolescents worldwide, accounting for nearly 18% of global HIV infections among 15- to 24-year-old youth in 2016.1 HIV incidence is decreasing, South Africa still had 9.9 new infections per 1000 adults in 2016, with approximately 37% of those new infections in young people aged 15–24 years (22% in young women).[1]. Despite the high prevalence of STIs and pregnancy, HIV testing, condom use and contraception coverage in South African youth remains suboptimal. A survey of 15- to 24-year-olds in KwaZuluNatal found that only 29% of youth reported previous HIV counselling and testing (HCT),[7] while a population-based survey conducted in four South African provinces documented that less than half of 18- to 24-year-old women used hormonal contraception.[8] The same 2008 youth survey found that 30.7% of high school learners reported consistent condom use, while only 55% of students with STI symptoms had received treatment.[5] Nationally, only 45.8% of the 15- to 24-yearhttp://www.sajhivmed.org.za. HIV prevalence is increasing among South African youth, but HIV counselling and testing (HCT) remains low.
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