Responding to adolescents living with HIV in Zambia:a social–ecological approach

The number of adolescents living with HIV in Zambia is increasing, yet little is known about their experiences in a social context. Such knowledge could enable HIV programs to better respond to their needs. This qualitative study examined the experiences of adolescents living with HIV in Kitwe, Kalomo and Lusaka in Zambia. In- depth interviews were conducted with adolescents aged 10–19 living with HIV (n = 58) and their health care providers (n = 14). In addition, 13 focus group sessions were conducted with adolescents living with HIV (n = 53), health care providers (n = 24) and parents (n = 21). Thematic analysis was used to draw out the social–ecological determinants of adolescents' experiences. Results showed that a range of factors located at the individual, family and peer, community and structural levels determine the experiences of adolescents living with HIV. At the individual level, resilience and internalized stigma were found to shape adolescents' perception of an HIV diagnosis, and their ability to maintain a positive outlook and sustain relationships. Family and peers supported adolescents to adjust to new drug-taking routines, but these people occasionally disclosed adoles- cents' HIV status inappropriately. At the community level, stigma and discrimination in schools were found to negatively influence adolescents' experiences, suggesting that approaches to normalize HIV in schools are need- ed. The presence of non-governmental organizations provided an entry point for the provision of broad-based livelihood, nutritional and psychosocial services for adolescents living with HIV at the community level. At the structural level, poor flexibility of clinic opening hours, staff shortages and a lack of health policies related to adolescents living with HIV presented ongoing limitations to adolescents' ability to access relevant services. In conclusion, adolescents' experiences of living with HIV are influenced by factors located within and beyond adolescents themselves. Understanding these contextual factors, and adopting interventions that accentuate positive experiences while mitigating negative ones, could strengthen the provision of services tailored to the needs and circumstances of adolescents living with HIV in Zambia

Introduction: Going Public

The period in which the public history movement has developed has been one of considerable change. This has been a result of the passing of post-war generations, the effects wrought by continuing internal and external conflicts, the globalisation of economies, the emergence of new media forms and the major impact of the digital revolution. This has seen significant shifts in the transmission, reception and practice of history

Living as an adolescent with HIV in Zambia:lived experiences, sexual health and reproductive needs

HIV services in developing countries are often ill-equipped to address the specific needs of HIV-positive adolescents. Studies suggest a lack of consistent, age-appropriate support regarding sexuality, relationships and transitioning to adulthood. The aims of this study were to explore and document the informational, psychosocial, sexual and reproductive health (SRH) needs of adolescents (aged 10-19 years) living with HIV in Zambia, and identify gaps between these needs and existing services. This paper reports a qualitative explorative study. Semi-structured interviews and focus group discussions were conducted with 111 HIV-positive adolescents and 59 key informants, including health care workers (n=38) and parents/guardians (n=21). Participants were selected via a purposive sampling method. Three sites - Lusaka, Kitwe and Kalomo - were selected to ensure a broad representation of service-delivery settings in Zambia. Data were entered into NVIVO (QSR International) software, and analysed inductively to extract key themes, gather results and draw conclusions. Findings confirm that social networks have significant impact on treatment adherence and assist adolescents in coming to terms with an HIV diagnosis. The trauma of diagnosis, however, is exacerbated if poorly managed. Nevertheless, many adolescents are determined not to let HIV change their lives. They want to know SRH and HIV information, but service providers do not often adequately meet these informational needs. Where available, tailored and participatory events around HIV and SRH are greatly appreciated. Services that are welcoming, empowering and provide tailored information are highly valued. Adolescents living with HIV require effective, targeted and sustainable HIV services to navigate safely through adolescence

Rights-based services for adolescents living with HIV:adolescent self-efficacy and implications for health systems in Zambia

A rights-based approach in HIV service delivery for adults is increasingly taking root in sub-Saharan Africa in the context of greater availability of antiretroviral therapy. Yet there has been comparatively little progress in strengthening a rights-based approach to adolescent HIV services, which we learned during a qualitative study in 2010 among 111 adolescents living with HIV, 21 parents and 38 health providers in three districts in Zambia. Adolescents in the study expressed a range of information and support needs and wanted locally relevant interventions to meet those needs. They wanted greater access to HIV, sexual and reproductive health information, information on how to protect themselves, privacy and confidentiality in service sites, skills training so as to be able to earn money, and better control over disclosure of their HIV status to others. Both health workers and parents acknowledged that information and services needed to be improved to meet those needs far better. This paper provides examples of successful programmes in Zimbabwe, Uganda, Tanzania, Botswana and South Africa and calls for adolescent services to be linked to both paediatric and adult services, peer networks to be established to increase adolescents' ability to collectively voice their concerns and support each other, interventions supporting adolescents' control over self-disclosure, and lastly that adolescent health should become a training specialty in sub-Saharan Africa