Reaching disenfranchised youth and mobile populations in Ghana through voluntary counselling and testing services for HIV.

This paper documents the evaluation of a 20-month project to provide voluntary counselling and testing (VCT) to a mobile population of youth surrounding the Agbogbloshie market in Accra, Ghana. The specific objectives of the evaluation were to determine: 1) to what extent targets for providing VCT services to the specified population were reached; 2) how HIV prevalence among clients compared to that of the general population; 3) to what extent former clients self-reported behaviour change; and 4) whether useful lessons could be drawn regarding fees, hours, and location of services, as well as use of peer educators to increase use of VCT services among the target population. Various methodologies, including questionnaires, focus group discussions, a review of the service statistics and an exit poll of clients were used to evaluate the project. The service statistics demonstrated that the project exceeded the life-of-project target for number of clients by nearly 40%. Prevalence for the VCT client population (aged 15-25) was higher than for the general population (aged 15-24), although the gender differentials were similar. Focus group data suggested that clients may have adopted behaviour changes as a result of VCT. Finally, focus group discussions and VCT service trends showed that the high number of clients was largely influenced by three factors: services being free, location and hours of services being convenient to the target population, and use of peer educators to promote the services. In addition, the evaluation highlighted the importance of the counselling component of VCT, even as counselling can get short-changed at the expense of HIV testing when large numbers of clients are involved. The evaluation stressed the need to appropriately remunerate peer educators for their work whenever possible. Finally, VCT programmes continue to face challenges such as: HIV stigma as a barrier to people coming to be counselled and tested; insufficient availability of medication, support and services for HIVpositive clients; and difficulty of ensuring the sustainability of VCT programmes.