HIV prevention among Zambian adolescents: Developing a value utilization norm change model
ABSTRACT Peer-led interventions are effective in reducing risk for HIV among adolescents. A pre-intervention study was conducted to determine how to successfully carry out a possible future intervention to reduce HIV risk among adolescents in urban Zambia. Ethnographic and sexual data were collected on 276 males and females both attending and not attending secondary school during a 14-month period in 1992-1993. Additionally, several focus groups were conducted. This paper reviews the cultural background of Zambian adolescents and presents an overview of the study results. Among the findings, it was learned that most of the male and female adolescents (average age of 17) are sexually active, very few routinely use condoms, less than half of sexually active adolescents have ever used a condom, AIDS is omnipresent in Zambia, the threat of HIV infection is a very real concern for most of the adolescents, there is a strong desire to protect themselves from HIV infection during sex (but condoms are often seen as ineffective and other forms of safer sex are not discussed), nearly all of the sexually active females and some of the males have received money or gifts for sex, and some of the out-of-school females are engaging in very risky sex (e.g., unprotected anal intercourse, and anilingus) with adult men. The ethnographic data, including a brief trial risk reduction workshop, suggests that the core values and social norms of the adolescents may shape behavioral change. A value utilization/norm change (VUNC) model is developed, which is intended to provide a conceptual framework for understanding how to utilize selected core values of the adolescents to strengthen or alter norms within the social networks in order to elicit desired HIV risk reduction.
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ABSTRACT: 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).