Although there have been some researches on the assessment of challenges and obstacles on the reproductive health of youth, it is difficult to get research that focuses on the assessment of problems in relation to access to health care and VCT of HIV for youth in developing countries, particularly in Ethiopia. This study is a cross-sectional rapid assessment of challenges and obstacles observed in accessing youth to health care and VCT of HIV services.
Purpose / Objective
The aim of this study is to assess obstacles and challenges in accessing health care and Voluntary Counseling and Testing (VCT) of HIV/AIDS among the youth. This study has the following specific objectives:
- To identify key challenges and obstacles that prevent youth from using health
care and VCT services
- To investigate youth expectations with respect to the different types of health services
- To assess the level of knowledge and attitude regarding HIV/AIDS and VCT of HIV/AIDS, and to assess the practice of prevention methods
- To design possible strategies for interventions based on the findings
The study has been conducted in SNNPRG: Awassa, Yirgalem, Leku and Wolkite towns. These areas have been selected because of convenience and accessibility for the study and the possibility of getting a good mixture of suburban, urban and rural population. The selection is supposed to provide a good socio-economic mix; educational and health services are also available in the chosen towns.
A total number of 374 interviewees responded to structured questionnaire; 15 service providers attended in-depth interview; and 5 focus group discussions, which had 120 youths from different segments of young people, were conducted in each town. Selection was carried out by quota sampling. The 5 youth focus group discussions conducted in each town were comprised of: out-of-school youth, male and female; in-school youth, male and female; and commercial sex workers. Each group was composed of 6 people. In addition to this, 12 youth with known HIV status (6 positive and 6 negative) were selected purposely based on their agreement to participate in each town.
Key Findings and Conclusions
According to this study, HIV/AIDS is known by almost all young people (96.6%). This result is almost the same (97.6%) with the study conducted in SNNPRG, Awassa in 1998. Some young people 2.6% had no idea whether HIV is transmitted through sexual intercourse. These groups are street youth. A total of 59 (17.4%) of the youth didn't know whether there is any means to know about one's HIV status. A need to test for HIV still is predominantly stated for pre-marriage couples.
Most youth have heard of and have some idea about VCT service. Little knowledge prevailed about what it means, its purpose, scope, how it is delivered, by whom, where and when it is provided. Generally, young people's orientation about VCT service is poor.
Willingness to use VCT services is rated to 84.1% of participants. 94% young people confirmed the importance of the service. It should be designed and organised to meet the SRH needs of youths. As frequently mentioned by participants, the quality of health care depends on the technical competence of service providers, age difference between providers and clients, quality of diagnostic facility and environment in which the service is provided.
Most participants have mentioned that the existing health service is not youth-friendly. The environment in health facilities is not, as such, interactive and attractive. Health delivery inequality is reflected among the different socio-economic status of the communities. Staff are not welcoming. There is a long waiting time; privacy and confidentiality are not secure. In Wolkite town, there is a tendency to provide VCT service primarily for pre-marriage requests and, consequently, voluntary youth who are in need of the service were mostly ignored.
Most [health staff] informants noted that most of the clients in voluntary counselling and testing are youth. This is largely due to the anti-AIDS club's strong youth mobilisation. Once young people are informed about this service, they immediately overcrowd VCT centre for a time.
A serious problem, as stated by the [health staff] informants, is the shortage and lack of testing materials. It is a shame and contradictory to have a lot of voluntary people to test who are convinced by the different interventions and mobilisation, and facing shortage of testing materials. This is the situation, for example, in Wolkite town.
Participants in the interview noted that the shortage of service providers is not considered a problem, but the shortage of trained heath professionals in VCT is a serious problem in most of the towns. In contrast, an excess of trained counsellors have been found in Awassa VCT centre.
The issue of the affordability of health care and VCT Service was discussed. It has been identified as a hindering factor. Those who couldn't attend health service in time of need due to lack of money are 39%. A suggestive fee that could be paid for VCT service is 10 Birr; of course, almost 23% did not suggest any amount of fee to pay. Similarly, 26% suggested free service. 21.8% of youth are not willing to pay any fee for this service.
Challenges and obstacles that prevent youth from using health care and VCT service are also outlined: lack of money, geographical inaccessibility, lack of trust (confidentiality) on service providers, fear of family, lack of confidence in the quality of treatment and counselling, lack of information on location of services and lack of privacy, fear of exposure. In addition, lack of awareness, orientation and sensitisation on VCT service, service without entertainment, addiction to alcohol or chat are some of the challenges and obstacles.
The current practice in preventing HIV at first sex is very discouraging. Most youth did not use condom or other preventive action. This indicates that the level of awareness does not correspond with practice. Risk perception should be addressed correctly; even youth who have accurate knowledge about HIV often do not heed warnings to reduce risky sexual behaviours, and some youth at high risk, for example, do not adopt safer behaviours because they incorrectly perceive their risk as low. Perceived risk can also decrease as relationship matures.
Some service providers, from their experience, strictly advocate for the handling or sustainable follow up of HIV-negative status individuals. This group needs strict follow up since they usually are proud of their status, and they may dare to get involved in unsafe sex. With regard to this issue, it is suggested that VCT should not only concentrate on identifying the status but also on how to follow-up.
Integration of voluntary counselling and Testing (VCT) with other health service is not still given due attention. The culture of integration and looking at it as part of routine activities is still underdeveloped. Integration should start by allocating financial, human and all resources. The investigator has seen VCT services with no stationary and furniture whereas HIV/AIDS is increasingly becoming a social and developmental issue.
Finally, a wise decision must be made about how to allocate the very limited human and financial resources to reach all youth. Many interventions reach youth long after they need the information rather than when the information is most crucial. Practical behavioural change interventions should be emphasised.
Recommendations to improve and increase access to health care and VCT of HIV are forwarded:
- Tailoring service provision according to sex and age
- Targeting high risk groups
- Integrating VCT of HIV with entertainment and recreational facilities
- Promoting Behavioural Change Communication (BBC) initiatives
- Involving parents during awareness creation; training and bringing them into the planning, implementation and evaluation process
- Training of service providers
- Establishing pre- and post-VCT interventions
- Health promotion initiatives
- Promoting VCT service through anti-AIDS clubs and VCT promotion through governmental, social and cultural settings
PDF files require Acrobat Reader.
HIV/AIDS - Young People