2014 Namibia: School Based HIV Testing and Counseling Pilot Programme Evaluation
Sustainable Development Goals: 3, 4
- SDG 3 - Good Health and Well-Being
- SDG 4 - Quality Education
The HIV prevalence rate amongst pregnant women in Namibia has gone down from 18.2 per cent in 2012 to 16.9 per cent in 2014. A significant portion of the pregnant women are adolescent mothers. HIV testing and counselling (HTC) remains a key HIV intervention as an entry point to accessing services including treatment, to remain HIV negative (including voluntary medical male circumcision VMMC) or to live positively with the virus. However, the uptake of HTC among adolescents and youths is low. According to the draft DHS 2013, only 42 per cent of women and 25 per cent of youth ages 15-19 have undertaken a test and know their results. Despite strategies by the government to increase testing, barriers to access and uptake of HTC persist among adolescents. These include the interpretation of age of consent, attitude of health staff, and distance to the health facility among several factors. There was thus a need to focus on providing HTC services among the group with the highest HIV prevalence - the adolescents and young people. In order to provide adolescents friendly services, technology for development was introduced into the programme. UNICEF procured 60 computer tablets for the programme in which Young People e-Aid on HIV (YEAH!) application was developed and installed. The application offered an interactive touch screen developed with input from adolescents themselves which takes the user through a series of screens to help them determine their risk of being HIV positive. The programme was implemented over a period of 3 months in 14 schools in 2 Regions of Oshana and Omusati. Twenty lay counsellors were trained in rapid testing and counselling to equip them with required skills for testing adolescents. The evaluation of the School Based HTC Pilot was completed and findings validated at a national stakeholders’ workshop.
The purpose of the evaluation was to assess how the implementation of the School Based HIV Testing and Counselling would lead to positive outcomes in the uptake of HIV Testing and Counselling services among young people. The specific objectives of the evaluation were two twofold:
- Assess whether provision of HIV Testing and Counselling services within the school premises would increase uptake of the services by young people.
- Assess whether using technology in form of computer tablet to conduct a ‘test for test’ would motivate young people to take up an HIV test.
The evaluation used a mix of quantitative and qualitative methods. Key informant interviews using a questionnaire were conducted with learners and stakeholders. Focus group discussions were carried out with learners and teachers. Qualitative data was synthesized from the KII, FGDs and the questionnaires. Quantitative data was available through DAPP’s monitoring system which collected information on number of learners who used the YEAH! application, number of learners who took an HIV test within school, and the number referred to the local health centre for an HIV test. However, there was no baseline at the start of the programme. To mitigate these factors, the evaluators attempted to establish a baseline through Ministry of Health and Social Services monitoring system of uptake of HTC by 15-19 year olds in Omusati and Oshana Regions. The zero draft of the evaluation report was presented to National steering Committee for feedback. The first draft report was presented at a national stakeholders’ workshop for validation.
Findings and Conclusions:
This evaluation has clearly demonstrated that having HIV Testing and Counselling (HTC) in schools is appropriate to the needs of adolescent learners, and is able to increase the uptake of HIV testing and counselling. However, there are areas that need to be improved in order to ensure all learners will participate including male learners who are more fearful of HTC and female learners in relationships with older men who feel powerless to influence safer sex with their boyfriends. The utilisation of computer tablets has also proven to be very popular and successful at motivating learners to take up HIV testing and counselling services, particularly if those services are brought within the school premises. The popularity of the computer tablet could be broadened to include other information relevant to adolescents and youth in the areas of HIV prevention, care and support as well as broader SRH. The confidential nature of the computer tablets, as well as the fact they can be used individually at the pace of the user was particularly successful at reaching out to male learners.
There is need to pay attention to the timeframe for implementing the programme in future. It should be in line with the number of learners aged 16 or over to ensure all learners have an opportunity to use YEAH! and access HTC. The Life Skills teacher within the school should be seen as a key stakeholder to encourage more vulnerable learners such as youth to come forward for YEAH! and testing and to ensure the programme is properly linked with other aspects of the Life Skills curriculum such as sex education The content of YEAH! should be broadened to include more information about HIV prevention including VMMC and correct condom use as well as issues around sex and sexuality and SRH. There is need to make condoms available and accessible for learners over 16 in schools as it used to be 2 years ago both as an HIV preventative measure and to reduce the risk of teenage pregnancies which is a major concern.
Stigma was a major concern amongst learners, particularly youths. Whilst this was greater in some schools than others, particularly schools without a strong commitment to Life Skills or without a Counsellor, boys felt very vulnerable to ridicule and discrimination which hampered them using the YEAH! application or going for HIV testing. Further investigation would be needed to identify how to address stigma within a school environment which encourages positive peer support around HIV and SRH in general, for both girls and youths. The pilot programme may not have reached learners who are more vulnerable such as learners in sexual relationships with older men. Staff in most schools expressed their concerns about female learners with older boyfriends as they see high levels of teenage pregnancy in this group. The learners also were concerned as they said it was harder for girls to negotiate safer sex with older men. More research is needed to see how to encourage this sub-group of learners to undertake an HIV test. Fewer boys than girls got tested for HIV. Boys are extremely vulnerable around HIV and SRH due to their own fears. There is an unmet need with boys which needs further investigation to resolve.