Knowledge on VCT services

Generally, VCT are seen as an entry point to prevention and care services. In the global strategies conference done in Washington, VCT was seen as a tool for communication and education on the disease, as means for access to other interventions such as anti-retroviral drugs, and as a process that prevents involuntary disclosure of HIV status.(Coovadia 57-63)(Boswell D and Baggaley R) Most of the informants of this study have heard about the VCT services or aware with the location of at least one site.

Moreover, from the data of this study, it was found that young people’s knowledge on the components of the VCT services is limited to the following: HIV test, giving counseling, and providing treatment to STIs, while the VCT services are more than what is known by these young people. VCT is considered as an entry point for HIV test and services (See figure 2).(Boswell D and Baggaley R) Results of this study on the low coverage of VCT services and lack of important components services within the available VCT centers can be explained as among the reason to youth’s limited knowledge on the component of VCT services. Comments by some researchers can be related to the prevailing situation found in this study. They found that VCT in developing countries, particularly Africa, services appear to fall short in many specific features including lack of important services component like medical services, continuous support and others are absent.(Coovadia 57-63)(Horizon)

In the current study, we observed the same concerning limitation in youth understanding about the VCT services. In addition to this, apart from that knowledge youth have on VCT services, some avoid using the services because they are not aware that they can get the counseling without test. This result is supported by findings in the study conducted by Horizon and in a reviewed work by McCauley some young people hesitated to attend the VCT services because they were not aware that they can get the counseling without test. ^{(Horizon)(Horizon)} There is a possibility that due to this understanding many young people are not attending the VCT services.

Nevertheless, all this has to do with fear which is associated with HIV positive results.

In the study conducted in Tanzania, Kenya and Trinidad they came up with the results that VCT services facilitates behavioral change. (Boswell D and Baggaley R) However, the reported sexual

behavior of young people by counselors in this study perplexes the whole idea that VCT facilitates behavioral change. Repeatedly youth attending the VCT services due to worries derived from sexual experiences was reported by counselors which can be interpreted that sexual behavioral change to young people is not practical which is a challenge to the VCT services when trying to evaluate their contribution in young people’s behavioral change. Lau wrote, educational programs have helped disseminate a lot of information, but have not affected an overall behavioral change.(Lau c and Muula AS 402-16) However, we know that knowledge alone may not automatically lead to young people behavioral change; therefore, efforts of having more research should be implemented in tackling such problem and find the operational gaps. Most of the HIV/AIDS intervention programs which operates in Tanzania are run by NGOs have

reported the same as in the above quoted study that is fine but the problem lies on their sustainability because most lack an adequate monitoring system and financial stability. This gives a reason for doing evaluation on the VCT contribution to behavioral changes which for now not much has been done.

The current study shows that VCT are operating without national monitoring system which is needed in quality assurance. A good example is when young people posed their doubts about the quality of the services to some of the VCT centers. This can be associated with lack of national monitoring system to the services. Moreover, the finding on the professional invaders to the counseling reported by counselors in this study can be linked to it. It was interesting to note that

beside few reported youth who attend the VCT services, they talked about them sharing the VCT experience at least with someone, most likely of the same age group.

Several other ways had been mentioned as a source of information of the VCT services in this study however the finding on young people sharing their experiences about the services they get from VCT centers, show that young people are among the sources of information to the VCT services. Similar situation had been observed in other studies that young people are primary source of health information and identification of the VCT sites. ^{(Horizon)(Horizon)}

Figure 2

VCT AS AN ENTRY POINT FOR HIV TEST AND SERVICES

Source: UNAIDS, Report on the Global HIV/AIDS epidemic – July 2002.

5.1.5.2: Youth’s experiences to the VCT services

In the current studies various fears were experienced by respondents when they attended VCT or when they thought of attending the services. Fear of coercive testing was so great to young people in the study done in South Africa that lead into low attendance to the health centers when

Facilitates referral

they started offering procedures to all people.^(Horizon) This was among the results of the current study that, some of the young people could not access the VCT services due to such fear. Other fear was based in anxiety about the emotional of bearing HIV positive results was found in this study as just like in other studies done in Uganda and Kenya. ^(Horizon)Young people first

experience which is associated with fear had been mentioned by youth who have not been to VCT services which reflect that they have imaginary understanding to the services. The positive argument attained by young people who have been to the services proves that the VCT services are not well known to none users. Fear of the injection when the blood sample is drawn for test and fear to some of the questions asked by counselors during the counseling session were found in this study indicating that there is a need to advocate the VCT services to youth, especially for those who have not been to VCT services. Otherwise those young people who have not attended the services might have partial understanding which is not much supportive when they are thinking of attending the VCT services. Such discrepancy clearly shows the knowledge gap and lack of in depth information about the VCT services among youth. Therefore, the pronounced fear by some youth can be understood in such context.

The practical things which were found to be interesting to youth when they attend the VCT services were also found in other studies done in some of the developing countries. In other studies youth wanted to meet staff who are kind and who understand youth issues.^(Horizon) This was found in this study when young people were asked about what they liked most when they attended the VCT services. The good qualities of the VCT services and less time spent in the clinics were mentioned by young people as among other interesting things. This finding is also supported by the result from the study done in Kenya and Uganda.(Horizon) (Horizon) The reported young people’s interest of being attended quickly when they visit VCT services shows that young people are concerned with anonymity. They do not want to be identified if they had been to VCT services or their worry is to meet someone known to them while queuing. In the study done in Zimbabwe they observed the same concerning youth perception on time spent in the sites.(Fylkesnes K and Siziya S. 566-72)

However, some informants in the current study had negative experience to the VCT services and were questioning the quality to some of the VCTs. They explained how they were stopped by counselors from accessing the services due to the legal age for HIV testing and resulted to some having negative attitude with VCT services. As previously mentioned that young people are

among the source of information to the VCT services, therefore, negative attitude to the VCT services perceived by these youth might have negative influence to those who have not been to the services yet. And this was mentioned as a barrier to some youth attending the VCT services.