‘So hurt and broken’: A qualitative study of experiences of violence and HIV outcomes among Zambian youth living with HIV

ABSTRACT

Emerging data show associations between violence victimisation and negative HIV outcomes among youth in sub-Saharan Africa. We conducted in-depth interviews with adolescents and young adults living with HIV (aged 15–24 years) in Ndola, Zambia, to better understand this relationship. We purposively selected 41 youth (24 females, 17 males) with varied experiences of violence and virologic results. Analysis used thematic coding. Two-thirds of participants said violence affected their medication adherence, clinic attendance, and/or virologic results. They focused on the negative effects of psychological abuse from family members in homes and peers at schools, which were the most salient forms of violence raised, and sexual violence against females. In contrast, they typically depicted physical violence from caregivers and teachers as a standard discipline practice, with few impacts. Youth wanted HIV clinic settings to address verbal abuse and emotional maltreatment, alongside physical and sexual violence, including through peer mentoring. Violence – especially verbal and emotional forms – must be recognised as a potential barrier to HIV self-management among youth living with HIV in the region. Further testing of clinic, home, and school-based interventions may be critical to reducing levels of violence and improving HIV outcomes in this vulnerable but resilient population.

Trial registration: ClinicalTrials.gov identifier: NCT04115813.

KEYWORDS:

• Violence
• HIV
• adolescent
• young adult
• Zambia

Acknowledgements

We would like to thank the youth participants for their openness in sharing their stories with us, the Project YES! team in Zambia for their support with data collection, and the Project YES! healthcare providers for their partnership on the safety protocol. Special thanks to Kayayi Chibesa, Able Hang’andu, and Gift Musenga for conducting the youth interviews and for providing valuable support on the interpretation of findings.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of PEPFAR, USAID, the National Institutes of Health, or the U.S. Government. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Additional information

Funding

Funding was provided by Project SOAR, a six-year cooperative agreement funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Agency for International Development (USAID) [grant number AID-OAA-A-14-00060] and the Johns Hopkins Center for AIDS Research [grant number P30AI094189]. KGM was supported by the National Institute of Mental Health of the National Institutes of Health [grant number F31MH116821-01A1].