HIV Testing Services, ART and Voluntary Medical Male Circumcision

HIV Testing Services (HTS), Anti-Retroviral Therapy (ART) and Voluntary Medical Male Circumcision (VMMC)

HIV testing services are critical for reducing the spread of HIV. They provide an important opportunity to provide information on HIV, counsel and diagnose AGYW and their male partners, and to link them to necessary HIV prevention, treatment, adherence and care services as well as other sexual and reproductive health services. The WHO Consolidated Guidelines on HIV Testing Services provide detailed guidance on the scale-up of HIV testing services.

Important considerations for accelerated uptake of HTS for AGYW:
  • HIV testing services are an important entry point for reinforcing prevention information (such as information about sexual risk perception) and services, such as condoms.
  • HIV testing services should be integrated with sexual and reproductive health services, to increase their reach to AGYW.
  • HIV testing services linked to prevention, treatment and care should be provided to all AGYW as well as to AGYW from key populations.
  • Strategies to accelerate the uptake of HIV testing services, that reach out to men, provide further prevention benefits to AGYW
  • Early HIV testing services should be promoted for AGYW, given the high proportion of HIV incidence in the early stages of relationships.
  • Programmes to address structural barriers to access to HTS for AGYW (such as stigma and discrimination or age of consent laws that prohibit independent access to services) should be included in a national response.
  • HIV self-testing may increase uptake of HIV testing amongst populations who are difficult to reach with services and has been shown to increase the uptake of HIV testing amongst AGYW and adolescent boys and young men.

Antiretroviral therapy should be provided for all AGYW living with HIV. Strategies to support access and adherence to antiretroviral therapy (ART) are critical for AGYW as well as adolescent boys and young men, in order to treat HIV and also prevent HIV infection. These strategies should integrate efforts to overcome the various challenges faced by AGYW in accessing and adhering to treatment, such as peer pressure, inconsistent daily routines, stigma and discrimination, fear of disclosure of HIV status, limited access to youth-friendly information and counselling. Likewise, strategies to overcome barriers to increase access to adolescent boys and young men are equally critical.

Voluntary medical male circumcision (VMMC) is a highly cost-effective HIV-prevention intervention that can reduce the risk of transmission from women to men by about 60%. Reaching men with VMMC also provides an opportunity to communicate information on HIV and sexual and reproductive health and to link men to other health services. This is recommended by the VMMC 2021 strategy, which also includes a specific package of services for adolescent boys and young men as well as adult men at higher risk of HIV exposure.

Expanding programmes to offer VMMC to men helps to reduce the risk of HIV transmission for AGYW over time.

CASE STUDY: ARVs and Self-testing kits by bicycle courier in Khayelitsha, SA

Iyeza Health in South Africa delivers antiretroviral and other medications by bicycle courier to people in poorer areas of Cape Town, South Africa. The company was started by a young South African who realised that many people in his community had the same problem has his grandmother – they didn’t have the money, time, energy and transport to collect their medicines from public health facilities. Hospitals were also struggling to cope with the rapid increase in patients on chronic medication. Iyeza Health bicycle delivery service collects chronic medications from public health facilities and delivers it directly to over 1000 people’s homes in Khayelitsha. It also plans to begin internet-based sales of HIV self-testing kits to be delivered by bicycle courier to homes in Khayelitsha.

Iyeza Health
Capacity Required

The organisation has the capacity to provide information on HIV, to counsel and diagnose AGYW and their male partners, and to link them to necessary HIV prevention, treatment, adherence and care services as well as other sexual and reproductive health services.

The organisation can design and implement strategies to support access and adherence to antiretroviral therapy (ART) by AGYW with knowledge of specific challenges faced by AGYW in accessing and adhering to treatment, such as peer pressure, inconsistent daily routines, stigma and discrimination, fear of disclosure of HIV status, and limited access to youth-friendly information and counselling.

The organisation can identify activities to access men and to increase male involvement, which in turn result in positive outcomes for adolescent girls and young women

Critical Enablers