‘If you find that I am HIV Positive, Don’t Tell me’: Exploring the barriers and recommendations for HIV Prevention services utilization among youth in rural southwestern Uganda

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Abstract Background Globally, the majority of new HIV infections are recorded in Eastern and Southern Africa, with the youth being disproportionately affected. HIV prevention is the cornerstone of controlling the spread of HIV and ending this epidemic by 2030. However, barriers to the utilization of HIV prevention services have not been extensively explored among the youth in rural settings in sub-Saharan Africa. This study explored these barriers and identified recommendations to improve the utilization of HIV prevention methods among youth in rural southwestern Uganda. Methods This was a qualitative study done in the Rubirizi district in southwestern Uganda between February and April 2022. We conducted six Focus Group Discussions (with youth [15-24 years] both in and out of school), nine in-depth interviews (with teachers, health workers, and members of the village health team), and four key informant interviews (with district officials) to collect data. Thematic analysis was done to identify the barriers to and establish recommendations for the utilization of HIV prevention services from the study participants. Both deductive and inductive approaches were used during the analysis. Results The identified barriers were categorized into individual barriers (ignorance and misconceptions about the services, fear of testing, low perceived susceptibility to HIV, and fear of breach of confidentiality), community barriers (lack of counseling services in the communities, peer influence, and stigma towards HIV), and a health system barrier (lack of youth-friendly services). Three main recommendations were established including the formation of youth peer support groups, ongoing awareness campaigns, and socio-economic empowerment. Conclusion There’s a need for national scaling of awareness campaigns and sexual and reproductive health services, such as youth peer support services to address most of the identified barriers. Additionally, economic empowerment especially among adolescent girls and young women has enormous potential to address the spread of HIV in this sub-population.

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