Abstract

BackgroundHIV testing among adolescents is significantly lower than among adults and many adolescents living with HIV do not know their status. Adolescent perceptions of HIV testing are poorly understood and may negatively affect testing uptake. Using a qualitative design, this study sought to explore perceptions about HIV testing and treatment among adolescents living with HIV and adolescents of unknown HIV status in Lusaka, Zambia and Kenya.MethodsStudy participants were adolescents aged 15–19 years old. The adolescents living with HIV were recruited from HIV support groups at health facilities. Adolescents of unknown HIV status were recruited from existing adolescent groups within the community. In both Zambia and Kenya, four focus group discussions (FGDs) were conducted with adolescents living with HIV and four FGDs were conducted with adolescents whose HIV status was unknown, for a total of 16 FDGs. FGDs consisted of 6–12 participants, a moderator, and a note-taker. FGDs were audio-recorded, transcribed, and translated into transcripts. Transcripts were coded in the qualitative analysis software program MAXQDA v. 12. Data reduction and summary tables were generated to help identify themes across the two study population groups. Data were interpreted within the health belief model.ResultsAdolescents discussed the challenges of facing a positive HIV test result, including fear of a positive result and need to change their lifestyle, fear of social isolation, and perception of the lost opportunity to achieve future dreams. Most adolescents of unknown status were not as aware of the benefits of learning their HIV status, nor were they aware of the ability to live a long and healthy life on ART. HIV-positive adolescents reported that the messages targeted towards adolescents focus on the need to remain HIV-negative, as opposed to the benefits of knowing one’s status. Adolescents described age and requirements for parental permission as a significant limitation in their ability to access HIV testing.ConclusionsAdolescents require more information about the benefits of testing early and the ability to live a long and healthy life on ART. Educating adolescents that HIV testing is a normative behavior among their peers could strengthen HIV testing among adolescents.

Highlights

  • Human immunodeficiency virus (HIV) testing among adolescents is significantly lower than among adults and many adolescents living with HIV do not know their status

  • Educating adolescents that HIV testing is a normative behavior among their peers could strengthen HIV testing among adolescents

  • This paper explores the perspective of adolescents who have tested HIV-positive and those who have not tested for HIV

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Summary

Introduction

HIV testing among adolescents is significantly lower than among adults and many adolescents living with HIV do not know their status. Adolescent perceptions of HIV testing are poorly understood and may negatively affect testing uptake. This study sought to explore perceptions about HIV testing and treatment among adolescents living with HIV and adolescents of unknown HIV status in Lusaka, Zambia and Kenya. Adolescents and youth make up an increasing portion of people living with HIV (PLHIV). Adolescent girls and young women (AGYW) remain disproportionally vulnerable and affected by HIV, accounting for 71% of new infections in young people in sub-Saharan Africa in 2018 [2]. Adolescents face unique barriers along the HIV cascade of testing, care, and treatment. Adolescents have lower rates of HIV testing, poorer ART access and coverage, higher loss to follow-up, poorer adherence, and lower rates of viral suppression [3, 4]. AIDS is the leading cause of death among adolescents in Africa and the second leading cause globally [5]

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