Voluntary Counseling & Testing
Fact Sheet on Youth Reproductive Health Policy
Voluntary counseling and testing (VCT) facilitates early referral for care and support of HIV-infected individuals and is an effective method of preventing infection. VCT services can result in positive behavior change including a decrease in unprotected intercourse.
Its Importance as a Youth Reproductive Health Issue
Key Areas for Policy Action
- Youth are a key target group for VCT interventions, because of the concentration of new HIV infections among young people.
- Young people are relatively more open to behavior change than older adults, thus enhancing the impact of interventions such as VCT.
- When compared with other age groups, young people often have very different motivations for seeking VCT. Similarly, what they gain from the service and their subsequent needs may be quite different.
- Traditional health services have sometimes denied youth confidential and respectful treatment during visits for reproductive health care.
- Thus, a different approach may be required to attract and adequately serve young people's VCT needs.
Because of the importance of VCT in combating HIV/AIDS, health ministries in many countries now support VCT through national policies. To address the special needs of youth, a number of key policy actions are warranted. These include the following:
The State of Policy Making
- Allow minors to consent to VCT without requiring the consent of a parent or other adult. In addition, policy should direct counselors to encourage all minors to consult parents or other trusted adults about their decision to test, where such consultation would be conducive to testing.
- Protect the confidentiality of HIV test results for minors consistent with the obligation to protect their right to privacy. As such, policy should prohibit the disclosure of information on the HIV status of minors to third parties including parents without the consent of the minor. At the same time, policy should direct counselors to encourage minors to discuss test results with their parents or guardians, in the case of those minors who have supportive relationships with parents or guardians.
- Reassure counselors and other health care workers that they can provide VCT to adolescent minors who request it, without fear of retribution.
- Modify operational guidelines. VCT policy should support adjustments to training, communications, referral, and other systems to make services more attractive to adolescents and to improve their quality and effectiveness.
- Encourage mainstreaming youth-friendly approach in all VCT centers. Young people seek VCT services regardless of where the services are provided. Thus, policies should ensure that all VCT services provide appropriate care to young clients.
- Encourage the development of VCT services for especially-vulnerable youth. Policies should make it a priority to serve vulnerable groups such as sex workers, drug users, orphans, and street children.
- Encourage the involvement of young people as VCT peer educators.
- Encourage links between VCT and other aspects of young people's lives. VCT services are an opportunity to connect young people with other health care and to services that help meet job and education needs.
- Develop stand-alone youth and VCT policy. Particularly in high HIV prevalence countries, it is important to have a stand-alone policy that addresses youth and HIV issues, as opposed to addressing youth within a larger HIV policy.
- Include VCT within national YRH policies.
- NGO policies are important too. In some countries, NGOs are the main provider of VCT care. Such NGOs should develop their own policies-ideally based on a national standard-for serving youth with VCT services.
While more and more governments have developed national VCT policies, very few of the current VCT guidelines explicitly address the needs of young people. Undoubtedly, some young people will seek VCT services regardless of whether they are designed specifically for them. Yet a more favorable policy environment is likely to induce many more youth to use VCT. The current lack of youth-specific policies is a critical gap that undermines efforts to fight HIV/AIDS.
Search for policies related to VCT in the policy database.
Research Findings to Support Policy Development
Here are some recent research efforts to support development of policies for youth-focused VCT services.
Horizons Operations Research. Studies from Kenya and Uganda (927kb; Population Council, 2001) on youth ages 14 to 21 indicates that young people would seek VCT if the services were confidential and inexpensive. A study in Zambia (416kb; Population Council, 2006) highlights the important role families can play in young people's decision to get tested.
Minors and the Right to Consent to Health Care (AGI, 2000). This study summarizes minor consent issues in the United States and how consent laws apply to YRH care.
Youth and VCT in Tanzania (91kb) (YouthNet, 2005). This study examined alternative VCT service models and actual versus perceived risk of infection among young reproductive health clients.
From Rhetoric to Reality: Implementation Tips
Balance affordability with sustainability. VCT must be accessible and affordable for those young people at highest risk of HIV infection or those suspected to have HIV-related illness. That may mean charging little or nothing for the service. Yet, well-intentioned VCT services for young people may easily struggle for lack of adequate financial sustainability. Service sustainability remains a challenge in many settings, especially non-integrated sites in which initial start-up costs are often funded by external international donors.
Watch Out for...
The lure of the quick fix. Learning by doing and expanded partnerships are needed to provide effective, innovative responses to the psychosocial needs of young people and children. To serve these needs requires investment in services besides VCT alone.
Mandatory testing. Some countries require mandatory HIV testing for military, employment, education, and travel. Mandatory HIV testing is neither effective nor ethical; it goes against individual rights and is not a good practice.
Related Links and Resources
Equitable Access to HIV Counseling and Testing for Youth in Developing Countries: A Review of Current Practice (463kb) (Population Council, 2004). Includes discussion of legal and regulatory issues such as age of consent.
Guidance on Provider-Initiated HIV Testing and Counseling (2.3MB) (UNAIDS and WHO, 2007). This latest UNAIDS guidance includes specific recommendations for providing testing and counseling for adolescents.
HIV Counseling and Testing for Youth: A Handbook for Providers (YouthNet, 2005). An easy-to-use desk guide on youth and HIV/AIDS including youth-friendly services, counseling young clients about HIV testing and follow-up issues, information on contraceptive options and other STIs, life skills issues, approaches to referrals, and resources.
UNAIDS/WHO Policy Statement on HIV Testing. This 2004 revision explicitly calls for VCT programs to address the special needs of young people.
VCT Case Studies (1.3MB). Young people are featured in HIV Voluntary Counseling and Testing: a Gateway to Prevention and Care, a collection of five case studies carried out by UNAIDS.
YouthLens on VCT and Young People (63kb). Read this fact sheet from the YouthNet project.
Q. What do International Policy Documents Say About VCT and Youth?
The major international policy documents on VCT, while applying equally to young people generally lack youth-specific provisions. One of the international agreements with most relevance to VCT and youth is the Convention on the Rights of the Child. The Convention defines a "child" as a person below the age of 18, unless the relevant laws recognize an earlier age of majority. Article 24 of the Convention affirms that children have the right to attain the highest standards of health and to health care, including family planning education and services (a right also recognized in earlier conventions and conferences). In June 2003, the UN committee that monitors the implementation of the Convention elaborated: "States Parties should provide adolescents with access to sexual and reproductive information, including on family planning and contraceptives, the dangers of early pregnancy, the prevention of HIV/AIDS and prevention and treatment of STIs. In addition, States Parties should ensure access to appropriate information regardless of marital status, and prior consent from parents or guardians."
The Convention on the Rights of the Child also acknowledges that children's ability to make important decisions, including decisions about their health, increases with age and experience. Article 5 calls on governments to respect the rights and duties of parents, legal guardians and extended families or communities (if empowered by local custom) to guide and direct children in the exercise of their rights "in a manner consistent with the evolving capacities of the child". The ICPD similarly noted the need to balance the responsibilities and rights of parents or guardians with the "evolving capacities" of "adolescents" (a term not in the Convention but used throughout the ICPD Programme of Action). (adapted from State of World Population, UNFPA, 2003)
For more on Convention on the Rights of the Child, see the POLICY Projects' Human Rights Matrix.
Q. What are examples of consent requirements in various countries?
In all 50 U.S. states, minors (usually anyone 12 or older) can give consent to test for HIV or other STIs. In Brazil, adolescents over the age of 12 have the same rights to health services as adults and do not require parental consent to access services. Recently, Mozambique has lowered the age at which adolescents can access VCT services to 16. Argentina's new national law on sexual health and responsible parenthood allows adolescents under age 18 access to sexual and reproductive health services without parental consent. VCT policy in Kenya allows those under 18 years old to be tested without the consent of their parents if the counselors determines that the young person has sufficient maturity to understand the testing procedures and results. In Zambia, young people under 18 need the consent of a guardian, except for pregnant girls and young mothers. In South Africa, it is national policy that the consent of a parent or guardian be obtained if a client is under 14. In Zimbabwe, young people under 16 legally require the consent of their parent or guardian. However, if they are living independently and already have a sexual partner or are pregnant, a HIV test can be considered. Jamaica is currently considering a change in law that would allow minors under 16 access to reproductive health care. In Malawi, children age 13 and over are allowed access to VCT without adult consent
Q. Can advocating for the enactment of minor consent policies backfire?
In some countries, health workers essentially ignore restrictive parental consent laws, and provide confidential care to minors who lack parental consent. In such an environment, some fear that bringing the consent issue into the open by advocating for the enactment of an official minor consent policy may end up tightening restrictions. Such fears--in part justified--underline the need for caution in planning an advocacy strategy.