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 adolescents' 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 needed. 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. (C) 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).