HIV/AIDS among Youth in Urban Informal (Slum) Settlements in Kenya: What Are the Correlates of and Motivations for HIV Testing?

"HIV counseling and testing (HCT) is widely considered an integral component of HIV prevention and treatment strategies. However, although recent estimates of the HIV/AIDS burden in Kenya underscore the particular vulnerability of youth to HIV, HIV testing and its determinants are largely understudied in this age group."

Focusing on Kenyan youth from the Nairobi settlements of Korogocho and Viwandan, this paper examines the correlates of HIV testing, including the motivations for getting (or not getting) an HIV test. [Footnotes are removed throughout by the editor.]

"Data from the 2007 Kenya AIDS Indicator Survey show a dramatic difference in HIV prevalence between 15-19 year olds (2.3%) and 20-24 year olds (5.2%). This difference suggests that many young people are infected during adolescence....Substantial efforts have been made by the Kenyan government and international development partners to increase access to voluntary counseling and testing (VCT) services in Kenya. Through these efforts, the number of VCT facilities, nationally, has increased significantly. For example, between 2000 and 2005, the number of testing facilities increased from 3 to over 500....The 2008-9 Kenya Demographic and Health Survey (KDHS) estimates show a substantial increase in the proportion of youth aged 15-24 years who have ever been tested for HIV and knew their HIV test results compared to 2003 KDHS estimates."

Existing studies distinguish which youth are more likely to get tested for HIV, but "few examine the context under which a person gets tested - that is whether a person is offered the test, volunteers for a test, or whether the test is mandatory; and the motivation for the test." This study explores the linkages between young people's socio-demographic characteristics, HIV-related psychosocial attributes, and HIV testing behaviour and investigates the reasons young people living in urban slum settlements in Nairobi give for testing (or not testing) for HIV. "A comprehensive interview questionnaire was administered that included questions covering sociodemographic characteristics (e.g. school and religious affiliation); key health and other concerns; and sexual behavior. The questionnaire also included a module on HIV knowledge, HIV testing experiences, and reasons for getting (or not getting) tested. The interviews were conducted in Kiswahili by male and female interviewers, many of whom had previous experience working in the two slum settlements." Youth were asked if they had been tested and, if "yes", were asked if they had requested a test, if it was offered and accepted, or if it was required. All youth were asked why they had sought testing or why they had not. Researchers visited test sites and evaluated if counselling was offered and test results given.

Survey results showed that older males, males living in Viwandani, and sexually experienced males were more likely to have ever been tested for HIV. Among females, age, religion, pregnancy, and sexual experience were associated with HIV testing at the .05 level of significance. Without the pregnancy variable, marital and schooling status became statistically significant with youth who were out of school and married females being more likely to have ever been tested.

Required or offered testing was more frequent among those with less knowledge of condom use for prevention. Older males were less likely to have been offered testing, while pregnant females were close to 36.5 times more likely to have been required to test. Females in school were more likely to have requested their most recent HIV test than to have been required to take the test, while married respondents and those who had ever had sex were more likely to have been required to take an HIV test than to have requested the test. Motivations for testing included pregnancy and knowing one's status (due to perceived risk).

"Of concern, however, is that among young people who had never been tested and were sexually experienced, close to two-fifths stated that they had not been tested because they were not at risk.... These results suggest that the educational campaign aimed at getting young people to understand that having unprotected sex is a risk factor for HIV infection, irrespective of what partners one is involved with, is not getting through to many young people." Researchers suggest that routine provider-initiated testing may be an alternative. Researchers found that Viwandani had fewer clinics with testing services but more staff available to test. Youth used health clinics more than mobile clinics for testing, possibly due to privacy of access. The study also found that the required counselling was not always available to accompany testing.

The study concludes: "The strong associations between HIV testing and pregnancy status among females and between HIV testing status and perceived risk have implications for policy and programmatic efforts aimed at increasing HIV testing among young people.... In particular, programs should help young people understand that having unprotected sex puts them at risk, irrespective of the partner they have sex with."