1. BUSISIWE NKALA AFRI-CAN FORUM 17 – 19 JANUARY 2013 ENTEBBE, UGANDA FACTORS ASSOCIATED WITH BEING WILLING TO HAVE AN HIV TEST AMONG ADOLESCENTS IN SOWETO, SOUTH AFRICA

2. OVERVIEW Introduction Background Methods Results Discussion Conclusion

3. Introduction The world is home to 1.2 billion adolescents. Adolescents defined by UNICEF, UNFPA, WHO, UNAIDS as persons between 10 and 19 years Adolescents is an age of opportunity for children, and crucial time to build on their development in the first decade of life, to help them go through risks and vulnerabilities, and to set them on the path to fulfilling their potential Nearly half of new HIV infections worldwide occur in the young people age 15 – 24

4. Introduction AIDS is estimated to be the –eighth leading cause of death among 15 – 19 –Sixth leading cause of death among 10 – 14 Investing in HIV prevention and treatment is critical to reversing the spread of HIV in adolescence

5. Soweto, South Africa South Africa’s largest urban population Estimated 1 - 4 million people 65% of total Johannesburg population Area 68 km 2 29 suburbs with populations between 50,000 and 350,000 people

6. Soweto

7. Background Recently the South African Government implemented a mass HIV- testing (HCT) campaign to support linkage to HIV related health care services among South African citizens an HIV endemic country 14.7 million South African have tested for HIV as part of the HCT campaign (2010 – 2012) Adolescent represent an important target population that need to be brought into discussions about HIV prevention and services for HIV testing Botsha Bophelo Project was set to measure among other things adolescents willingness to have an HIV test and associated factors

8. Methods Adolescents were recruited through Kganya Motsha Adolescent Centre (KMAC) and Perinatal HIV Research Unit (PHRU) Cross-sectional survey exploring socio-behavioural characteristics, HIV status, and sexual and reproductive health among adolescents Eligibility criteria –age 14-19 years –living in one of the 44 identified communities within Soweto. Targeted sampling used to ensure representation by age, gender and location Recruitment and data collection March, 2010 to March, 2012 Demographic and clinical variables of interest are described for adolescents willing and not willing to have an HIV test

9. Results

10. Demographics of Participants Total830 GenderFemales 475 (57%) – Males 355 (43%) Median Age17 EthnicityZulu 359 (43%) Sotho 128 (16%) Xhosa 116 (14%) Tswana 86 (10%) Other 141 (17%) Level of EducationPrimary Education up to Grade 7 120 (15%) High School 686 (83%) Tertiary (not complete) 18 (>1%) Tertiary (complete) 2 (<1%) Sexual ActiveTotal 461 (55%) Females 233 (51%) - Males 228 (49%)

11. Results 46% of the adolescents (379/830) reported ever having an HIV test Last time tested What is the main reason you get tested for HIV? 55% of the adolescents (453/830) reported being willing to have an HIV test 366 giving various reasons for willing to test PeriodNumber% < 6 months21055 6 >12 months10929 12 >24 months6016

12. Results ReasonFrequencyPercentCumulative % I wanted to know my HIV status21960 Had an unprotected sex371070 Was not feeling well21676 Circumcision16480 Boy/girlfriend wanted me to14484 Friend(s) had a test14488 Parents wanted me to11391 Condom broke5192 Was raped30.893 Other267100

13. Results Other factors that were sited as conditions that are motivators/necessary for adolescents testing for HIV –Encouragement –Accessibility of the testing centre –Quality of counseling/service provided –Incentive for testing –Education at schools re: testing –Adult involvement –Testing with friends/partners –Finding alternatives to needles

14. Results FactorAORCI Forced sex ever2.111.08 – 4.12 No high school education1.991.06 – 3.71 Ever having an HIV Test0.530.35 – 0.82 21% of the adolescents (144/830) reported being unwilling to have an HIV test in multivariable analysis, factors associated with being unwilling to test for HIV were ever being forced to have sex, having no high school education and having ever tested for HIV

15. Discussion Although most adolescents in Soweto are willing to have an HIV test, two in ten are reluctant The adolescents not willing to have an HIV test may be at higher risk for HIV infection due to social and structural mechanisms that influence gender norms including young male disenfranchisement from the education system and young females who experienced sexual violence Forced sex/sexual violence, no school and having a previous HIV test all predict not being willing to test. Younger age was inversely associated suggesting that younger adolescents who may be pre-sexually active are more likely to be willing to have an HIV test

16. Conclusion The data on adolescent HIV testing patterns in SA is not well documented despite the importance of these patterns in the prevention/treatment continuum This data suggests that important adolescent groups may not be accessing testing (including older, sexually active adolescents, those who are victims of sexual violence, out-of-school adolescents as well as those who have previously tested). It is imperative that we ensure that higher risk adolescents are willing to access HIV testing as testing is an entry point to services This data suggests that there is something about the testing process that make adolescents not want to get tested again… Adolescent friendly testing sites are important and should be supported Need to implement combined community level HIV prevention programme

17. Acknowledgements Authors: –Cari Miller –Janan Dietrich –Glenda Gray –Matamela Makongoza –Celokuhle Tshabalala –Sanele Mdanda –Angela Kaida –Robert Hogg Adolescent Centre Staff Donors