The implementation and outcomes of a voluntary counseling and testing (VCT) programme in a secondary school in Kigali, Rwanda.
Schools reach further into communities of young people than any other institutions, and therefore, they are critical for reducing the HIV and AIDS vulnerability and risk among this age group (UNESCO, 2002). Therefore, if the schools are to be used as an entry point for prevention activities, it is important to have a clear idea of the current level of knowledge, attitudes and behaviour with regard to HIV/AIDS. A quasi-experimental design was adopted for this study. Qualitative and quantitative data were collected during the period between June and October 2004 to establish baseline knowledge and behaviour. A total number of 613 respondents participated in this study. Two groups, an experimental and a control group with equal number (306) of pupils in each were established by drawing a random sample of 51 respondents per school from 12 secondary schools in Kigali. However, an extra respondent from one school was noted. A selfadministered questionnaire was used to collect quantitative data whereas qualitative data was generated by asking each respondent to write any concerns or experiences with HIV/AIDS on a piece of paper. All respondents (n= 613) expressed their thoughts anonymously and freely on these papers. Furthermore, focus groups and interviews were conducted with some key informants amongst the respondents who were especially the leaders of Anti-AIDS clubs and student managers from schools or counselling session organizers at Kacyiru Health Centre. These were particularly Anti-AIDS club leaders and/or active club members. After a baseline assessment, a phased intervention (sensitization, pre-test counselling, testing, post-test counselling and follow-up) were implemented with the experimental group. This process was described, identifying all barriers to implementation. Finally a second measurement concerning both groups took place. During the baseline measurement, respondents were more concerned about their reproductive health issues rather than HIV/AIDS as a specific topic. With regard to HIV/AIDS transmission, however, the following was found: high awareness, many misconceptions about HIV/AIDS transmission and almost half of respondents have had sexual intercourse. Unprotected sexual intercourse was also reported. A summary of reasons given for having sexual intercourse is: experience, curiosity, peer pressure, partner empathy, monetary gain, and coercion. A sensitization phase prior to the testing sessions resulted in a large number of respondents (434) attending Voluntary Counselling and Testing (VCT) services, the main intervention for this study which took place in a Health Centre. Only twelve respondents (3%) tested HIV positive while five respondents (1%) tested syphilis positive. Although the immediate coping with test results for all respondents was successfully dealt with, the findings from this study indicate some difficulties with regard to the management of individual respondents who tested positive. The strong emphasis on anonymity during the study did not allow the researcher to follow-up all respondents who tested positive. All steps were successfully implemented according to this study model. In spite of certain problems encountered in terms of access to schools, there was nothing insurmountable during the VCT implementation process. After the intervention, a large number of respondents showed a high HIV/AIDS awareness, expressed willingness to change their behaviours, and a willingness to advocate for VCT amongst their peers. The follow-up sessions and the quantitative data at the second measurement and especially statistical analysis carried out did not indicate a significant difference in the sexual behaviour of respondents. However, a significant difference was found when comparing the knowledge of the two groups on HIV/AIDS's physiological effects and transmission. Finally, recommendations and Best Practice Guidelines were established with regard to further research and the implementation of VCT in secondary schools.