HIV counseling and testing among Zambian adolescents: Families matter

Background. Young people account for an estimated 50% of new HIV infections worldwide. Yet few youth, especially adolescents, know their HIV status. The Young Voices of Hope Research Study examines how individual, relational and environmental factors relate to adolescents' utilization of, and demand for, HIV counseling and testing.; Methods. The study was conducted in Ndola, Zambia among 16 to 19 year olds. In-depth interviews were held with 40 HIV-tested adolescents, and a household survey was conducted with 550 randomly selected participants. The survey contained questions at the individual-level (e.g. HIV knowledge; risk perception); the environmental-level (e.g. counselor confidentiality; the accuracy of test results); and the relational-level (e.g. having discussed VCT with families, friends or sex partners). Backward stepwise logistic regression models were used to assess the factors associated with: (a) self-reports of having taken an HIV test; and (b) plans to take an HIV test within the year.; Results. Qualitative data revealed that adolescents involve family members and friends when making decisions to seek VCT. The majority also disclosed their HIV status to families or friends, and less frequently to sex partners. Survey data revealed that respondents who discussed VCT with family [OR=4.18; 95% CI=1.54-11.4] and believed that an HIV test would not upset their family [OR=5.58; 95% CI=1.24-25.07] were more likely to have taken an HIV test than their peers. Having ever had sex [OR=6.13; 95% CI=2.03-18.48] and being out-of-school [OR=2.82; 95% CI=1.26-6.35] were also associated with an increased likelihood of HIV testing. Similar variables were associated with respondent's plans to take an HIV test in one year. Having discussed VCT with family [OR=6.1; 95% CI=2.24-16.58], sex partners [OR=3.64; 95% CI=1.13-11.71 ] or friends [OR=2.61; 95% CI=1.34-5.08] were all significantly associated with HIV testing plans. Other factors associated with intentions to test include being sexually experienced and having a perception of personal risk for HIV.; Conclusions. Relational-level factors, particularly family-related constructs, were significantly associated with adolescents having taken an HIV test and their demand for the service. These findings highlight the need to examine relational and family-level factors when developing, implementing, and evaluating VCT strategies to reach adolescents.