Understanding adolescents: A strategy to engage them in HIV prevention research  Health Improvements for Teen Ugandans ‘Hi-4-Tu’ Study in Kampala, Uganda Juliane Etima Makerere University – Johns Hopkins University Research collaboration (MU-JHU)

Presentation overview Background Objectives Methods Results conclusion

Background Adolescence is a period of increased sexual exploration, yet adolescents have poor health seeking behaviors and poor access to reproductive health (RH) services In Uganda teen motherhood is the norm with 58% of 19 year old women having one or more children or being pregnant The HI-4-TU study sought to enhance HIV/STI & pregnancy prevention among 519 adolescents (enrolled while pregnant) HI-4-TU included a formative phase to find out what adolescents believe, think, and do to prevent HIV/STIs and pregnancy as well as their own involvement in HIV prevention research.

objectives The HI-4-TU formative phase assessed health care providers’ and adolescent mothers’ knowledge, attitudes & practices regarding adolescent services in antenatal (ANC) and Postnatal services Focus Group Discussions (FGD) with pregnant and postnatal adolescent mothers Key Informant Interviews (KII) among health care providers (e.g. pediatricians, midwives, counselors)

methods 2 FGD with adolescents (n=20) were conducted at the Mulago National Referral Hospital, Kampala-Uganda. 1 with Antenatal adolescents (n=10) 1 with Postnatal adolescents (n=10) 9 KII with adolescent health care providers were conducted at Mulago National Referral Hospital and Kisenyi Health Center, Kampala-Uganda. Interview topics included: Knowledge, attitudes and practices (KAP) about adolescent RH and RH services and adolescent involvement in HIV prevention research were explored using a KAP semi- structured tool. Interviews were conducted in the local language for adolescents, transcribed and translated into English. KIIs were conducted in English. ATLAS.ti was used for coding and analyzing themes.

Adolescent RH knowledge Adolescents’ main source of RH information is friends with mixed messages being conveyed and some recalling vague information from a science class in primary school. “I learnt them from my friends. My friends where in higher school level and I was in primary five. They used to encourage me to get a boyfriend since they already had. They had a lot of money with them and when I asked them, they told me that they were given money by their boyfriends. I did not mind so much. They told me it was so interesting when it comes to having sex with a boy. That is when I picked interest. They also looked around for a boyfriend for me. And when I paid him my first visit that is when I learnt all the sexual activities”. (FGD Adolescent Participant)

Adolescent RH practice Cultural practices as barriers to access of services Fear of being identified (wrongly) as HIV infected hinders access to RH services including participation in HIV prevention research Adolescents commonly mentioned; Discriminatory health care provider attitudes, Lack of youth friendly services, Long waiting clinic hours

Adolescent RH practice

Adolescent attitudes towards RH services Adolescents’ HIV risk perception influences access of RH services including research participation with the majority more afraid of pregnancy than HIV infection.

Adolescent preference for RH service providers Adolescents preferred RH services provided by their peers, however they indicated that it is important to have a skilled trusted adult for technical issues that cannot be handled by peers.

Health Care service providers’ Knowledge, Attitudes and practices of Adolescent Reproductive Health issues Health care providers reported that they lack skills to meaningfully engage adolescents. Health care providers also perceived that adolescents do not trust them, so they do not access services. Mixed antenatal clinics including older women and adolescents affects provision of adolescent focused services

Conclusion Adolescents are able to participate in HIV prevention research and access services if service providers & researchers; understand their needs and priorities, involve them in the design & implementation, and if health workers are skilled, trusted and non-judgmental. It is also critical to strive to increase research literacy in communities from which research participants are drawn because stigmatization of HIV prevention research and cultural practices hinder participation in research especially for adolescents..

Acknowledgements HI-4-TU study participants HI-4-TU staff SAHU Funders

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