Barriers and facilitators to the uptake of HIV testing services among adolescents and young adults in Machinga district, Malawi

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While studies generally indicate a low uptake of HIV testing Services (HTS) among young people, other reports also indicate a worrying HIV burden among the same group. For example, the United Nations Children’s Fund (UNICEF) recently reported that globally, new infections have been dropping in all demographic groups except amongst young people where they have largely remained constant. The low HTS uptake among young people, therefore, mean that many of these infections remain undiagnosed, limiting the ability to control transmission.The study’s objective was to explore the factors that motivate, as well as factors that hinder, the uptake of HIV Testing Services among adolescents and young adults in Machinga District of Malawi at the individual, interpersonal, community and health service system levels. 24 In-depth interviews and 4 key-informant interviews were used to collect data, and purposive sampling was used to identify respondents. Respondents were adolescents and young adults aged 15-24 years, as well as HTS and youth-friendly health service (YFHS) providers. Data from audio recordings were transcribed in Microsoft Word and analyzed for content to generate themes. Data coding and analysis was done using Atlas 7. The study found that perceived risk of infection, perceived benefits of knowing one’s status for couples, availability of community-level youth clubs and other interaction fora, and the provision of HTS through outreach clinics were key facilitators for HIV testing. The findings also established that 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. The study establishes the critical role of mobile HIV testing through outreach clinics and other community-based avenues in encouraging access to HTS by young people. The findings also suggest that stigma and misconceptions associated with HIV/AIDS are still issues in Malawi as evidenced by the fear of a positive result also emerging as a critical barrier to HTS