?I don?t want to go for an HIV test out of fear that i might be positive?: Barriers and facilitators to the uptake of HIV testing services among adolescents and young adults in Machinga district, Malawi


Joseph J. Sakala* and William Stones

Background: While studies generally indicate low utilization of HIV Testing Services (HTS) by young people in Sub-Saharan Africa, other reports also indicate a worrying HIV burden among the same group, as evidenced by recent trends in new infections. The low uptake of HTS among young people means that for many, new infections remain undiagnosed, hindering public health efforts for disease control We aimed to explore the factors that hinder as well as those that encourage HIV testing among adolescents and young adults in at individual, interpersonal, community and health system levels in a Malawi district.

Methods: 24 In Depth Interviews (IDIs) and 4 Key Informant Interviews (KIIs) were used to collect data, and purposive sampling was used to identify the respondents. IDIs targeted adolescents and young adults aged 15-24 years, whereas KIIs targeted HTS and Youth Friendly Health Service (YFHS) providers. Coding and analysis were done using a modified social-ecological framework.

Results: Fear of a positive result, poor communication in relationships and families, cultural norms as well as lack of youth friendly HIV testing services were key barriers to HIV testing. Perceived susceptibility to infection, presence of partner support, availability of community level youth clubs or support groups, and the provision of HTS through outreach clinics were key facilitators for HIV testing.

Conclusion: There is a pressing need for widespread mobile HIV testing at the community level to encourage uptake among young people who fail to visit health facilities for various reasons. Access to HIV self-testing through the distribution of kits at government health facilities is a promising strategy for young people who distrust service providers when it comes to maintaining the confidentiality of their results.

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