Objectives: To assess the mental health of HIV positive Zambian adolescents by comparing with Zambian school sample and an age matched British normative sample.Design: This was a cross-sectional study of adolescents from school in the age range of 11-15 and HIV positive adolescents from clinics in Lusaka.Main outcomes: Mental health of HIV positive Zambian adolescents.Measures: Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ).Results: When compared to the school sample it is found that both the groups are almost similar in the SDQ scales. Although the HIV group seem to have more peer problems, the difference does not reach a level of significance. The HIV sample was also less likely to be in the abnormal range for conduct problems (OR = 1.8). But when compared to a British community sample the Zambian HIV positive adolescents had increased emotional symptoms (OR= 3.6) and peer problems (OR= 7.1).Conclusion: Zambian HIV positive adolescents had increased mental health problems compared to a British Community sample.Keywords: HIV, adolescents, mental health, SDQ, Za