Search

Pada tahun 2017 LSL merupakan kelompok risiko HIV tertinggi di Kabupaten Sukoharjo. VCT merupakan salah satu upaya pencegahan dan penanggulangan HIV/AIDS. Penelitian ini bertujuan untuk mendeskripsikan keyakinan perilaku, dan sikap pada pemanfaatan Klinik VCT pada LSL di Sukoharjo. Jenis penelitian ini merupakan penelitian kualitatif dengan pendekatan studi kasus. Teknik pengumpulan data dengan cara wawancara mendalam kepada lima LSL yang pernah melakukan VCT dan dua informan triangulasi terdiri dari satu PE (Peer Educator) dan satu KL (Koordinator Lapangan) yang diambil dengan purposive sampling. Hasil penelitian menunjukkan bahwa seluruh LSL sudah pernah melakukan VCT namun hanya 4 LSL yang melakukannya secara rutin. Faktor-faktor yang mempengaruhi LSL dalam melakukan VCT secara rutin setiap 3 bulan adalah keyakinan perilaku dan sikap. Namun faktor yang mendasari dalam melakukan VCT adalah keyakinan perilaku bahwa VCT memiliki keuntungan yang lebih banyak jika dibandingkan dengan kerugiannya. Sehingga peneliti menyarankan kepada petugas penanggulangan HIV/AIDS untuk meningkatkan jangkauan kepada LSL yang masih hidden agar VCT secara rutin setiap 3 bulan sekali.

Background: Human Immunodeficiency Virus (HIV) / Acquired Immunodeficiency Syndrome (AIDS) has been a global problem nowadays. To reduce its spread, Voluntary Counseling and Testing (VCT) and Provider-Initiated Testing and Counseling (PITC) have been provided. However, these interventions remain ineffective to discover new cases, as the stigma among health officers may exist. Objective: To compare the stigma towards people living with HIV/AIDS between VCT and PITC officers. Methods: This was a descriptive comparative conducted in Makassar City, Parepare City and Sidenreng Rappang Regency, South Sulawesi Province Indonesia. There were 139 samples were selected using convenience sampling technique, which consisted of 66 VCT counseling officers and 73 PITC officers. The questionnaire from Health Policy Project in Thailand was used to measure the HIV/AIDS related-stigma. Data were analyzed using descriptive analysis and Mann Whitney test. Results: Findings show that there was a statistically significant difference in stigma between the group of VCT and PITC on people living with HIV/AIDS (PLWHA), which the mean of stigma in the PITC group (73.07) was higher than the mean value in the VCT group (66.61). Conclusion: There is a significant difference in stigma between VCT and PITC officers towards PLWHA. It is suggested that PITC curriculum should be evaluated and supervision and monitoring in both VCT and PITC groups should be implemented regularly to reduce the stigma towards PLWHA.

Background: Despite the successes of testing campaigns in South Africa, many people still do not know their human immunodeficiency virus (HIV) status, and the number of new infections remains high. Delayed access to testing is a contributing factor in this regard. Utilising less conventional health settings to test for HIV, such as optometry practices, could help increase the opportunities to test for HIV. Aim: To investigate the potential of the optometry environment as a possible contributor to capacity building for HIV testing and counselling services. Setting: Three optometry practices in Pietermaritzburg, South Africa. Methods: A survey design approach was used with participants (n = 30) completing a researcher-designed 16-item questionnaire. Results: The results showed that the optometry environment was generally perceived as conducive for possible HIV testing, as the majority of participants felt that testing for HIV at an optometry practice would be more convenient (90%; n = 27), compared to testing at a clinic, with a clear preference for testing for HIV at an optometry practice as opposed to a clinic (93%; n = 27). Conclusion: The results of this study seem to illustrate a willingness within the optometry patient population to be receptive to the possibility of screening for HIV. However, while optometry falls within the ambit of primary health services for vision and eye health, the profession is yet to produce a guideline document detailing the exact scope of practitioners with regard to systemic health screenings. As such, HIV screening is not specified at present.

BACKGROUND: The quality of life (QoL) construct has also contributed to understanding the comprehension of factors involved in the existence of people infected by the HIV/AIDS. The objective of this study is to assess the quality of life (QoL) of people with HIV/AIDS (PLWHA) in Wonogiri District, Indonesia. METHODS: A cross-sectional study was conducted from September to November 2017. Convenience sampling method was employed to recruit 39 people living with HIV/AIDS (PLWHA) at Voluntary Counselling and Testing (VCT) of Wonogiri, Indonesia. Research data were collected using a self-administered questionnaire of WHOQOL-HIV BREF. The data were further analysed using a ttest and a Chi-square test, while linear regression was used to evaluate factors that correlate with the PLWHAs' quality of life. RESULTS: The results showed that the gross mean score of social relationships domain is 13.59; psychological domain is 13.31; environment domain is 13.28; spiritual/personal beliefs domainis 13.15; physical domain is 13.10; and level of independence domain is 13.77. The symptom of HIV is associated with quality of life (B = 7.611, β = 0.362, t = 2,046, p value = 0.049). CONCLUSION: Healthcare provider should increase providerinitiated testing and counselling (PITC) to contracting group, high risk group, susceptible group, and the community. The PLWHA are recommended to actively participate in peer support groups (PSGs) so that they can improve their quality of life. [ABSTRACT FROM AUTHOR]

The epidemic of Human Immunodeficiency Virus (HIV)/Acquired Immuno Deficiency Syndrome (AIDS) in Indonesia has entered the stage of the concentrated epidemic. We need to assess factors that are associated to the efforts to prevent transmission of HIV/AIDS from mother to baby by midwives in the public health centers and in the private practices in City of Denpasar using SWOT analysis. This research was a qualitative study by involving eight midwives coordinator and staffs in the public health center in the City of Denpasar, ten private practice midwives and two head of health care centers. Data were collected using in-depth interview guidance and observation sheets, and the study was conducted from June to September 2015. Data were analyzed using content analysis. The policy of the officer about screening and early detecting from the central level to the district was a major strength should be in point of view of midwives. The main weakness was the lack of awareness of the private practices of midwives to support the success of voluntary counseling and testing (VCT) and provider-initiated testing and counseling (PITC) programs and the cost of laboratory test before having an antiretroviral therapy was expensive. Midwives showed a big responsibility to prevent transmission of HIV to the fetus through early screening. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Mother-to-child-transmission (MTCT) of HIV still remains a significant route of new HIV infection in children in Malawi and Nigeria, despite the introduction of Prevention-of-Mother-to-Child-Transmission (PMTCT) of HIV programmes in both countries. A critical literature review, based on the findings from 12 primary research articles, explores the reasons for the inadequacy and failure of PMTCT. Findings show socioeconomic and sociocultural factors as the biggest barriers to the success of PMTCT programmes. Other factors include: limited male involvement, the organization of PMTCT and health workers' inefficiency. In conclusion, PMTCT programmes will remain inefficient unless these factors are addressed. There is an urgent need to strengthen PMTCT programmes by stakeholders through a collaborative strategic effort to ensure high PMTCT programme uptake in Malawi and Nigeria, in order to eliminate HIV/AIDS in children.

Migrants, particularly from low- and middle-income countries, are at a heightened risk of adverse HIV outcomes. HIV testing may improve these outcomes. We reviewed and synthesised studies into migrants and HIV testing (outcome variable), published between January 1997 and April 2014. Papers using quantitative, qualitative and mixed methods designs, and samples with adult (≥18 years) migrants from low- and middle-income countries in high-income countries were included in the paper. Of 3155 papers retrieved, 31 met the inclusion criteria and are included in the review. A large number of barriers and facilitators to HIV testing were identified across the individual, social and structural levels. A number of study design and methodological issues, however, inhibited a comprehensive synthesis. There is no doubt that addressing HIV testing in migrants in high-income countries is complex; however, it has important implications for individual, community and population health, and a strong, empirically based response is warranted. [ABSTRACT FROM AUTHOR]

Mother-to-child-transmission (MTCT) of HIV still remains a significant route of new HIV infection in children in Malawi and Nigeria, despite the introduction of Prevention-of-Mother-to-Child-Transmission (PMTCT) of HIV programmes in both countries. A critical literature review, based on the findings from 12 primary research articles, explores the reasons for the inadequacy and failure of PMTCT. Findings show socioeconomic and sociocultural factors as the biggest barriers to the success of PMTCT programmes. Other factors include: limited male involvement, the organization of PMTCT and health workers' inefficiency. In conclusion, PMTCT programmes will remain inefficient unless these factors are addressed. There is an urgent need to strengthen PMTCT programmes by stakeholders through a collaborative strategic effort to ensure high PMTCT programme uptake in Malawi and Nigeria, in order to eliminate HIV/AIDS in children. [ABSTRACT FROM AUTHOR]

Background: To endorse involvement in voluntary HIV counseling and testing (VCT), it is essential to recognize factors that influence people in deciding whether to access VCT services and their underlying route factors. Theory of planned behavior (TPB) constitutes a proficient framework for predicting behaviors and intentions. Objective: The aim of the study reported here was to assess the predicting ability of TPB in determining the intended use of VCT services among health professionals in Jimma, southwest Ethiopia. Methods: This was an institution-based cross-sectional quantitative study of a sample of 336 health professionals in 12 selected districts of Jimma, southwest Ethiopia between February 5 to March 28, 2012. Data were collected using structured questionnaire self-administered by the study participants. A hierarchal multivariable linear regression model was used to predict the role of TPB constructs that can influence the intention to use VCT services. Results: The constructs of TPB explained the variability in intention to use VCT by 27% (R2 adjusted = 0.27). The standardized regression coefficients showed that the strongest predictor of intention to use VCT was subjective norms (β = 0.32, P , 0.0005) followed by attitude (β = 0.21, P , 0.002). Perceived behavioral control was not a significant predictor of intention to use VCT among the study group (P = 0.12). Conclusion: The study revealed the possibility of describing the intention to use VCT among health professionals using TPB, with perceived social pressure being the leading predictor. In light of this, health intervention programs should be designed to develop health professionals' ability to resist norms that oppose the use of VCT and to change community-held norms against VCT use, provided they help individuals develop a positive attitude toward the services. [ABSTRACT FROM AUTHOR]

This qualitative study aimed to assess the work in Voluntary Counseling and Testing Services (VCT) in Porto Alegre, Brazil in the perspective of their counselors. It was conducted six focus groups with 13 counselors from the three VCT services in the city. Qualitative content analysis of the reports resulted in a central theme named Joining management and work processes in the VCT services. Counselors have emphasized that services are essential for HIV/AIDS diagnosis and prevention, and contributed significantly to effective healthcare. However, VCT services were facing a crisis regarding its role in the healthcare system since counseling and HIV testing activities were being extended as a responsibility of primary health care. These changes have brought anxiety and uncertainness among counselors, especially because the poor relationships with management levels and the lack of clear guidelines in the new policy context. Findings also pointed out counselors' concerns about the quality of counseling offered in the primary health care services, the lack of professionals to HIV/AIDS healthcare and the lack of medical specialist appointments. We endorsed that participatory management strategies could help to redirect VCT services activities, strength the matrix support testing and counseling for HIV and value these services as specialized healthcare providers and human resources reference for training in the area. [ABSTRACT FROM AUTHOR]

Background: Despite the recognition of stigma as a hindrance to public health treatment and prevention there are gaps in evidence on the relationship between HIV stigma and VCT services utilization in Nigeria. The purpose of this study was to examine a community's perceptions, feelings and attitudes towards people living with HIV/AIDS and how this is associated with access to utilization of voluntary counselling and treatment in Nigeria. Methods: A cross-sectional random study of Nigerians, using a mixed-method approach was carried out in two distinct ethnic areas of the country. Both quantitative and qualitative methods (mixed-methods) were used to collect data in Osun State (Yoruba ethnic group) in the South-West and Imo State (Igbo ethnic group) in the South East. Multivariate logistic regression was the model used to examine the association of interest. Results: It is shown that Nigerian public attitudes to HIV/AIDS and those infected with the disease are negative. The markers for stigma on the overall stigma index are significant predictors of utilization of voluntary counselling and testing. As the sum of negative feelings increases, there is less likelihood to using voluntary counselling and testing (VCT) and vice versa. Conclusions: Current national efforts at addressing the AIDS pandemic can only be successful when the issue of AIDS is de-stigmatized and is made a critical part of those efforts. One way to do this is through well-designed messages that should be posted in the media, community halls, health centers and other public places aimed at humanizing the disease and those affected and infected by it. [ABSTRACT FROM AUTHOR]

Background: Voluntary HIV Counseling and Testing (VCT) forms one of the cornerstones of HIV prevention strategies. It is imperative to understand HIV testing correlates and their theoretical underpinnings in order to promote VCT uptake. The aim of this study was to predict the intention to VCT and associated factors among health professionals in Jimma zone, Ethiopia using the theory of planned behavior. Methods: An institution based cross-sectional quantitative study among a sample of 336 health professionals in 12 selected districts of Jimma, Ethiopia was conducted in 2012. The constructs and principles of the theory of planned behavior (TPB) were measured. Data were collected using structured questionnaire on self administered basis. A multivariable linear regression model was used to predict the role of independent variables/TPB constructs on the intention to use VCT using SPSS version 16.0. Results: The components of TPB independently explained the variance in intention to VCT by 30.3%. Both components of TPB and socio-demographic characteristic in the final model explained 32.7% of variance in the intention to use VCT services. Significant proportions (33.0%) of the respondents have never been tested for HIV. The respective indirect components of the TPB predicted the direct components. The strongest predictors of intention to VCT were subjective norm (ß=0.39, p<0.001) and attitude (ß= 0.19, p<0.001) whereas, none of the socio-demographic variables were significantly predicted the intention to use VCT. Past VCT experience did not have significant statistical association with VCT use intention. Conclusions: Behavioral intention to use VCT was a function of attitude and perceived social pressure. Demographic related social determinants were not barriers for VCT use intention. Most health workers test their blood by themselves. Strategies to empower health professionals on social pressure resistance and programs targeted at changing negative attitude on VCT use can enhance intention of health professionals to use VCT. [ABSTRACT FROM AUTHOR]

In Ethiopia, most HIV-affected couples are in serodiscordant relationships and must weigh any childbearing desires against the risk of transmitting the virus to a partner or child. This analysis investigates the relationship between HIV diagnosis and fertility intentions among couple voluntary counseling and testing (VCT) clients in Ethiopia and whether this relationship differs between men and women. Data come from the Ethiopia Voluntary Counseling and Testing Integrated with Contraceptive Services (VICS) study, which collected information from men and women attending VCT at eight public sector health facilities in the Oromia region of Ethiopia. VCT clients were asked about their fertility intentions before (pre-test) and after (post-test) receiving their HIV test results. Sex-stratified logistic regression was used to find characteristics, such as the couple's HIV status, associated with ceasing to desire children between pre-test and post-test versus desiring children at both time points. Women belonging to serodiscordant couples were much more likely to cease desiring children than women in HIV-concordant couples, regardless of whether the woman (aOR=11.08, p<0.001) or her partner (aOR=9.97, p=0.001) was HIV+. Only HIV+ men in serodiscordant relationships were more likely to stop desiring children than men in HIV-concordant couples (aOR=12.10, p<0.001). Serodiscordant couples would benefit from family planning services or referrals during VCT to help meet their reproductive needs. [ABSTRACT FROM PUBLISHER]

Studies show reduced HIV risk behaviors after couple voluntary counseling and testing (VCT), either resulting from the couple counseling process or the type of people it attracts. A total of 1858 sexually active individual VCT clients in partnerships were compared to 866 sexually experienced couple VCT participants with multilevel logistic regression. Sexually experienced couple VCT clients were also compared to those couple VCT clients who never had sex. Among sexually experienced participants in partnerships, women, non-premarital testers, and those who felt at risk for HIV were less likely to attend couple VCT than individual VCT. Among couple VCT clients, sexually inexperienced individuals were more likely to be: testing for the first time, premarital testers, and more educated than those who were sexually experienced. Couple VCT's effectiveness might partly result from who it attracts. Addressing the diverse needs of a heterogeneous testing population is a programmatic challenge for couple VCT in Ethiopia. [ABSTRACT FROM AUTHOR]

Despite the availability of large funds and considerable efforts to improve access to antiretroviral therapy (ART), coverage of treatment with ART remains low in Democratic Republic of the Congo (DRC). We identified the bottlenecks for adults' access to ART in a semi-rural health zone in DRC, compared ART coverage in the urban and rural area and described the outcomes and yield of different HIV testing settings. An operational model was used to examine bottlenecks in the flow of patients. The study period covered the start of the HIV care programme in April 2006, until December 2008. An estimated 505 People Living With HIV/AIDS (PLWHA), of whom 201 were in need of ART, lived in the health zone. The proportion of PLWHA in need of ART who were actually receiving ART was estimated at 53%. About 6451 adults were tested for HIV, 266 of them were HIV-positive and 163 accessed the HIV care programme. About 106 of the 126-159 eligible patients initiated ART. The main bottleneck was situated at HIV detection. Access to the HIV care programme for the patients testing HIV-positive was identified as the second biggest bottleneck. About 41% of the PLWHA identified in urban areas accessed the HIV care programme, versus 11% of the rural PLWHA, showing a serious inequity. The tuberculosis (TB) programme detected 75% of the total estimated 92 co-infected patients of the health zone. Only 13% of women testing positive in the Prevention of Mother-To-Child Transmission programme accessed the HIV care programme, showing that this bottleneck is greatly accentuated in this specific group. By testing all pregnant women and all TB patients in the health zone, 28% of all PLWHA could potentially be detected in a period of 33 months, showing its great potential in settings with a relatively low HIV prevalence. [ABSTRACT FROM AUTHOR]

This article draws on a larger study that examined the ways in which out-of school youth responded to a context of HI V/AIDS and how they themselves can be active participants in HI V/AIDS prevention. In addition, four out-of-school youths, trained asfieldworkers, interviewed 32 other out-of-school youths in the Shongweni area of KwaZulu-Natal about their attitudes towards VCT. The out-of-school youth displayed a very positive attitude towards VCT and 91% stated their intentions of getting tested. However this attitude was contradicted by the facts that only nine (28%) had been for testing and that participants evidenced high levels of fear and stigma surrounding VCT. Of the participants, 43% stated a preference for a VCT site or hospital far from.horne, or, if they' could afford it, a private doctor, to minimise the likelihood of being seen by someone they knew. This factor made it more difficult and costlier for out of-school youth to access VCT. For some, the fear of HIV infection is caught up with their existing social exclusion. In contrast, one reason for wanting to test amongst girls was the health of future children. While out-of-school youth understood the role of VCT in maintaining a healthy lifestyle, the obstacles to acting on those intentions included the context of poverty, gender inequalities, stigma and the fear of gossip. Campaigns have succeeded in raising awareness, but translating awareness into action remains a central problem. [ABSTRACT FROM AUTHOR]

In countries with generalized HIV/AIDS epidemics, married couples have a shared risk of acquiring HIV/AIDS. Yet very little research has adopted a couple-level perspective to investigate perceived risk of HIV infection. In this paper, we used population-based data from 768 married monogamous couples in the 2004 Malawi Diffusion and Ideational Change Project (MDICP) to compare respondents’ perceptions about their spouses’ HIV status to their spouses’ actual HIV status. Using chi-squared and Kappa coefficient statistics, we evaluated how accurately respondents assess their spouse’s HIV status, and compared the assessment of their spouse’s HIV status with their assessment of their own serostatus. We found that individuals tend to overestimate their spouse’s as well as their own risk of having HIV. Husbands were generally more accurate in assessing their own risk of HIV infection than that of their wives, but wives were more accurate in assessing the HIV status of their spouses. In our multivariate logistic regression results, we found that marital infidelity is the most important correlate of overestimating individual and spousal HIV risk. [ABSTRACT FROM AUTHOR]

‘Health management’ of employees is becoming a common imperative for companies that do business in regions where there is an HIV epidemic. Private sector initiatives in South Africa have evolved considerably. However, core components of HIV/AIDS-oriented workplace programmes, voluntary counselling and testing and anti-retroviral treatment, are not as effective as expected, despite considerable investment in them. There is some evidence to suggest gradual improvement in employee participation, yet this is coupled with employees defaulting from treatment programmes. This article explores reasons for these developments, the focus being on the economic and financial challenges facing private sector workplace health programmes. Copyright © 2008 John Wiley & Sons, Ltd and ERP Environment. [ABSTRACT FROM AUTHOR]

This study examined the predictors of readiness for HIV testing among young people in northern Nigeria, paying special attention to the role of stigma. Stigma is measured at two levels: individual and community (social norm). There are commonalities and differences in the correlates of readiness among men and women. For men and women, knowledge about HIV prevention, knowledge about a source for VCT, discussion about condom use for HIV prevention and perceived risk are strong predictors. Knowledge that an apparently healthy person can be HIV-infected is only significant for women. Perceived stigma is a significant predictor for both men and women although the specific dimension of note differs between the sexes. Social norm is strongly and directly associated with readiness among men but has no apparent influence among women. For both sexes, social norm appears to have strong mediating influence on the relationship between personal perceived stigma and readiness. The results strongly suggest that to eliminate HIV-related stigma, it is not enough to target individual cognitive processes; strategic efforts should target social structures in order to change negative social norms. [ABSTRACT FROM AUTHOR]

Prevalence data Indicates that certain sectors within the private sector are particularly affected by HIV/AIDS. Companies in southern Africa began implementing treatment programmes in early 2002 as the corporate sector came to realise the financial imperative of offsetting employee morbidity and mortality. This article sets about to explain the rationale behind antiretroviral treatment (ART) programmes within the private sector while uncovering some of the obstacles businesses face when treating HIV-Infected employees. Data suggest that In many cases employees' uptake of voluntary counselling and testing (VCT) and ART are slow. At this early stage of workplace treatment provision, date indicate that employers must seek ways to Increase uptake of VCT and treatment in an attempt to make programmes more cost-effective. [ABSTRACT FROM AUTHOR]

In order for HIM voluntary counselling and testing (VCT) to be successful, the approval of and attendance at the VCT centre by the community it serves is necessary. To this end, the Township AIDS Project (TAP), which has VCT sites serving the greater Soweto area, attempts to maintain a high degree of visibility in the community through campaigning and various forms of advertising. To determine whether the social marketing strategies employed by the organisation encouraged attendance, pre-test questionnaires completed by volunteers attending the TAP VCT site located in the Meadowlands district of Soweto were retrospectively analysed. During 2003, approximately 34% of volunteers were made aware of the VCT site through marketing. However, a more important factor in volunteer awareness was word of mouth, with about 46% of volunteers informed of TAP VCT by a friend, partner or relative. This attests to the success of the marketing strategies employed by the TAP organisation in raising community awareness and attendance at the VCT site investigated in this study. In total, 1 141 volunteers completed a questionnaire and 1 054 of these consented to being tested for HIV antibodies. The level of infection among the sample of individuals tested at this clinic-based VCT programme was 29.9%. [ABSTRACT FROM AUTHOR]

National HIV prevalence rate is derived from the sentinel surveys, which are carried out once in two years and remain anonymized. Epidemiological data are largely unavailable on the pregnant HIV-positive mothers particularly at the grass root level. This information is urgently needed when developing a realistic intervention programme. Three hundred and forty-three consenting pregnant women attending a randomly selected primary health care clinic in inner city Ibadan from April to November 2001 were enrolled at booking and followed up till delivery of their babies. Sociodemographic and reproductive health data were collected by questionnaire and all mothers were screened for HIV/AIDS using an enzyme-linked immunosorbent assay based rapid test. Results showed that about one in three teenage mothers screened positive, having the highest HIV rate. HIV prevalence rate reduced, though not significantly, in mothers 20-29 years and those 30-39 years with mothers in these groups having similar rates. No mother over 39 years screened positive. Following logistic regression analysis, young age 15-19 years, was associated with a significantly increased risk for infection at the primary health care level (P =0.046). Christian religion was associated with a lower risk (P =0.038), and mothers who booked late in pregnancy (P =0.025) or had husbands in the lower socio-economic class (P =0.001) were less likely to be infected. None of the women were aware of their HIV status prior to the study. With a predominantly heterosexual mode of HIV transmission, it is necessary to identify infected pregnant women early through voluntary counselling and testing (VCT), so that they can be given the option to take preventive drugs, which would among other benefits reduce mother-to-child transmission, and help infected mothers stay healthy and productive for longer. [ABSTRACT FROM AUTHOR]

This article draws on a larger study that examined the ways in which out-of-school youth responded to a context of HIV/AIDS and how they themselves can be active participants in HIV/AIDS prevention. In addition, four out-of-school youths, trained as fieldworkers, interviewed 32 other out-of-school youths in the Shongweni area of KwaZulu-Natal about their attitudes towards VCT. The out-of-school youth displayed a very positive attitude towards VCT and 91% stated their intentions of getting tested. However this attitude was contradicted by the facts that only nine (28%) had been for testing and that participants evidenced high levels of fear and stigma surrounding VCT. Of the participants, 43% stated a preference for a VCT site or hospital far from home, or, if they could afford it, a private doctor, to minimise the likelihood of being seen by someone they knew. This factor made it more difficult and costlier for outof-school youth to access VCT. For some, the fear of HIV infection is caught up with their existing social exclusion. In contrast, one reason for wanting to test amongst girls was the health of future children. While out-of-school youth understood the role of VCT in maintaining a healthy lifestyle, the obstacles to acting on those intentions included the context of poverty, gender inequalities, stigma and the fear of gossip. Campaigns have succeeded in raising awareness, but translating awareness into action remains a central problem.