Prevalence of physical and sexual violence and psychological abuse among adolescents and young adults living with HIV in Zambia

Merrill, Katherine G.; Campbell, Jacquelyn C.; Decker, Michele R.; McGready, John; Burke, Virginia M.; Mwansa, Jonathan K.; Miti, Sam; Frimpong, Christiana; Kennedy, Caitlin E.; Denison, Julie A.

doi:10.1371/journal.pone.0235203

Cited by 18 publications

(9 citation statements)

References 37 publications

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“…The act’s frequency in the past year was queried (never, once, a few times, many times), and 12 possible perpetrator types could be selected: romantic partner, parent/caregiver, other family member, friend/peer, stranger, school staff member, employer, health care worker, neighbor, religious leader, military/police, or someone else the youth knows. Three items assessing sexual violence were removed since they lacked clarity on whether the act was consensual [ 34 ]. Measures were translated into Bemba and the full instrument piloted among youth in Ndola for appropriateness.…”

Section: Introductionmentioning

confidence: 99%

Past-Year Violence Victimization is Associated with Viral Load Failure Among HIV-Positive Adolescents and Young Adults

et al. 2020

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We examined the relationship between past-year violence victimization and viral load (VL) failure among consecutively-sampled male and female adolescents and young adults, aged 15–24, in four HIV clinics in Ndola, Zambia. Measures of past-year physical violence, psychological abuse, and forced sex were adapted from the ICAST-C and WHO Multi-Country Study. Using logistic regression, we derived associations between VL failure (≥ 1000 copies/mL) and: any victimization; cumulative victimization; and types and perpetrators of violence. Among 272 youth (59.2% female, 72.8% perinatally infected), 73.5% (n = 200) experienced past-year violence and 36.8% (n = 100) had VL failure. Higher odds of VL failure were observed for participants who reported high frequency of any violence versus no violence victimization (adjusted OR, aOR: 3.58; 95% CI 1.14–11.27), high frequency of psychological abuse versus no psychological abuse (aOR: 3.32; 95% CI 1.26–8.70), any versus no violence from a family member other than a parent/caregiver for physical violence (aOR: 2.18, 95% CI 1.05–4.54) and psychological abuse (aOR: 2.50; 95% CI 1.37–4.54), and any versus no physical violence from a friend/peer (aOR: 2.14, 95% CI 1.05–4.36). Past-year violence victimization was associated with VL failure when considering the frequency, type, and perpetrator of violence. Programs addressing violence among youth living with HIV may be critical to improving viral suppression and preventing onward transmission.

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Section: Introductionmentioning

confidence: 99%

Past-Year Violence Victimization is Associated with Viral Load Failure Among HIV-Positive Adolescents and Young Adults

et al. 2020

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“…In prior analyses of baseline data from a randomised controlled trial (RCT) among youth living with HIV in Zambia, our team found a high prevalence of any past-year physical violence, psychological abuse, or forced sex (72% male, 75% female); over a third experienced overlapping types of violence (39% male, 37% female). Among victims, the most common perpetrators included peers (74% male, 45% female), family members other than a parent/caregiver (41% both sexes), and parents/caregivers (18% male, 32% female) (Merrill et al, 2020b). Furthermore, we identified significant associations between multiple types of past-year violence victimisation and viral load failure (Merrill et al, 2020a).…”

Section: Introductionmentioning

confidence: 83%

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

Merrill

Campbell

Kennedy

et al. 2021

Global Public Health

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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. Violenceespecially verbal and emotional formsmust be recognised as a potential barrier to HIV selfmanagement 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.

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“…guided transition process and safety protocol highly acceptable. The safety protocol provided space for HCPs to discuss issues that could impact HIV-related behaviors but are not typically addressed in HIV clinics with AYA clients, including AYAs' frequent experiences of physical, sexual, and psychological violence [26][27][28]. These interactions changed how HCPs viewed and interacted with AYAs in their clinics-meaningful shifts that reveal how the safety protocol was highly valued and acceptable for HCPs.…”

Section: Discussionmentioning

confidence: 99%

“Adolescents do not only require ARVs and adherence counseling”: A qualitative investigation of health care provider experiences with an HIV youth peer mentoring program in Ndola, Zambia

et al. 2021

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Introduction Adolescents and young adults (AYAs) living with HIV face unique challenges and have poorer health outcomes than adults with HIV. Project YES! was a youth-led initiative to promote HIV self-management and reduce stigma among AYAs in four Ndola, Zambia clinics. Clinic health care providers (HCPs) were involved in multiple intervention aspects, including serving as expert resources during AYA and caregiver group meetings, facilitating resistance test-based AYA antiretroviral drug changes, meeting with participants referred through a safety protocol, and guiding a subset of participants’ physical transition from pediatric to adult clinic settings. This study aimed to understand HCP insights on facilitators and barriers to implementing Project YES! and scaling up a clinic-based, youth-focused program. Methods A trained interviewer conducted ten in-depth interviews with participating HCPs from November–December 2018 and analyzed data, identifying key themes. These themes were examined in terms of two implementation science outcomes–acceptability and feasibility–to inform scalability. Results HCPs found peer mentoring valuable for AYAs with HIV and the bimonthly caregiver meetings beneficial to AYA caregivers. HCPs voiced a desire for more involvement in specific processes related to patient clinical care, such as drug changes. HCPs’ experiences with the study safety protocol, including referrals for youth experiences of violence, shifted their views of AYAs and informed their understanding of key issues youth face. Considering this, many HCPs requested more resources to support AYAs’ varied needs. HCPs noted limited time and clinic space as implementation barriers but felt the program was valuable overall. Conclusions HCPs concluded youth peer mentoring was highly acceptable and feasible, supporting scale-up of youth-led interventions addressing the multi-faceted needs of AYAs living with HIV. Continued provider involvement in resistance test-based antiretroviral drug changes, considered in the context of health system and clinic policy, would enhance long-term success of the program at scale.

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Prevalence of physical and sexual violence and psychological abuse among adolescents and young adults living with HIV in Zambia

Cited by 18 publications

References 37 publications

Past-Year Violence Victimization is Associated with Viral Load Failure Among HIV-Positive Adolescents and Young Adults

Past-Year Violence Victimization is Associated with Viral Load Failure Among HIV-Positive Adolescents and Young Adults

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

“Adolescents do not only require ARVs and adherence counseling”: A qualitative investigation of health care provider experiences with an HIV youth peer mentoring program in Ndola, Zambia

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