Perspectives of Adolescent Girls and Young Women on Optimizing Youth-Friendly HIV and Sexual and Reproductive Health Care in Zambia

Edwards, Patrick; Roberts, Sarah T.; Chelwa, Nachela; Phiri, Lyson; Nyblade, Laura; Mulenga, Drosin; Brander, Caila; Mbizvo, Michael T.; Subramanian, Sujha

doi:10.3389/fgwh.2021.723620

Cited by 8 publications

(9 citation statements)

References 15 publications

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“…The manifestations of AGYW stigma in the clinic described by the health workers in this study also echo the literature on the adolescent perspective, as adolescents have noted excessive questioning and scolding in health facilities as barriers to accessing care [ 10 , 31 ]. Recent literature that explored youth-friendly clinic attributes of importance to Zambian AGYW also found that assurances of confidentiality and provider friendliness were key adolescent expectations when attending the clinic [ 32 ]. In addition, health workers’ comments about shared waiting rooms contributing to confidentiality concerns build on past acknowledgement of the role of the physical layout of the clinic facility as something that can contribute to or mitigate the experience of stigma [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Health worker perceptions of stigma towards Zambian adolescent girls and young women: a qualitative study

Meek

Mulenga

Edwards

et al. 2022

BMC Health Serv Res

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Background The high prevalence of HIV among adolescent girls and young women aged 15–24 in Eastern and Southern Africa indicates a substantial need for accessible HIV prevention and treatment services in this population. Amidst this need, Zambia has yet to meet global testing and treatment targets among adolescent girls and young women living with HIV. Increasing access to timely, high-quality HIV services in this population requires addressing the intensified anticipated and experienced stigma that adolescent girls and young women often face when seeking HIV care, particularly stigma in the health facility setting. To better understand the multi-level drivers and manifestations of health facility stigma, we explored health workers’ perceptions of clinic- and community-level stigma against adolescent girls and young women seeking sexual and reproductive health, including HIV, services in Lusaka, Zambia. Methods We conducted 18 in-depth interviews in August 2020 with clinical and non-clinical health workers across six health facilities in urban and peri-urban Lusaka. Data were coded in Dedoose and thematically analyzed. Results Health workers reported observing manifestations of stigma driven by attitudes, awareness, and institutional environment. Clinic-level stigma often mirrored community-level stigma. Health workers clearly described the negative impacts of stigma for adolescent girls and young women and seemed to generally express a desire to avoid stigmatization. Despite this lack of intent to stigmatize, results suggest that community influence perpetuates a lingering presence of stigma, although often unrecognized and unintended, in health workers and clinics. Conclusions These findings demonstrate the overlap in health workers’ clinic and community roles and suggest the need for multi-level stigma-reduction approaches that address the influence of community norms on health facility stigma. Stigma-reduction interventions should aim to move beyond fostering basic knowledge about stigma to encouraging critical thinking about internal beliefs and community influence and how these may manifest, often unconsciously, in service delivery to adolescent girls and young women.

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Section: Discussionmentioning

confidence: 99%

Health worker perceptions of stigma towards Zambian adolescent girls and young women: a qualitative study

Meek

Mulenga

Edwards

et al. 2022

BMC Health Serv Res

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“…We used a three-step process to develop a tailored conceptual framework focused specifically on the integrated delivery of care to adolescents within HIV care programs. First, we identified key themes on barriers and preferences related to health care service delivery from prior work done by this team to inform this conceptual framework [ 11 ]. We had previously conducted interviews and focus groups with 109 AGYW aged 10 to 24 years in Zambia as part of formative research conducted for planning an implementation science trial [ 7 ].…”

Section: Methodsmentioning

confidence: 99%

“…We developed detailed guides and conducted systematic qualitative analysis to identify emergent themes. These details are included in a recently published manuscript [ 11 ]. Second, we created an initial framework that was presented to implementation scientists and researchers attending the Joint Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) and Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC 3 H) meeting in February 2020.…”

Section: Methodsmentioning

confidence: 99%

“…A recent study in Zambia found that AGYW expressed a preference for a one-stop-shop for both HIV and sexual and reproductive health services. Additionally, they valued having access to care around school or other commitments, assurances of confidentiality and privacy, friendly staff who respects adolescents, and knowledgeable providers that can help adolescents to improve their health outcomes [ 11 ]. Combining gender-affirming care to HIV prevention may improve HIV prevention outcomes among transgender women, especially youth [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Combining gender-affirming care to HIV prevention may improve HIV prevention outcomes among transgender women, especially youth [ 12 , 13 ]. By incorporating direct preferences from adolescents, integrated services can be better targeted with adolescent-focused characteristics to meet the complex needs of adolescents [ 11 ]. Although many of these health services are offered directly to adolescents in the clinic setting, offering support in the community setting and reinforcing beneficial strategies through public policy may help to enhance linkages to care and optimize programs for improved HIV outcomes [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Integrated Health Care Delivery for Adolescents Living with and at Risk of HIV Infection: A Review of Models and Actions for Implementation

et al. 2022

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Integrated service delivery, providing coordinated services in a convenient manner, is important in HIV prevention and treatment for adolescents as they have interconnected health care needs related to HIV care, sexual and reproductive health and disease prevention. This review aimed to (1) identify key components of adolescent-responsive integrated service delivery in low and middle-income countries, (2) describe projects that have implemented integrated models of HIV care for adolescents, and (3) develop action steps to support the implementation of sustainable integrated models. We developed an implementation science-informed conceptual framework for integrated delivery of HIV care to adolescents and applied the framework to summarize key data elements in ten studies or programs across seven countries. Key pillars of the framework included (1) the socioecological perspective, (2) community and health care system linkages, and (3) components of adolescent-focused care. The conceptual framework and action steps outlined can catalyze design, implementation, and optimization of HIV care for adolescents.

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Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women: conflicting perspectives in South Africa

et al. 2022

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Background Globally, an urgent need exists to expand access to HIV prevention among adolescent girls and young women (AGYW), but the need is particularly acute in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) offers an effective HIV prevention method. In many countries, however, accessing PrEP necessitates that AGYW visit their local health clinic, where they may face access challenges. Some countries have implemented youth-friendly services to reduce certain challenges in local health clinics, but barriers to access persist, including clinic stigma. However, evidence of clinic stigma toward AGYW, particularly with respect to PrEP service delivery, is still limited. This mixed methods study explores stigma toward AGYW seeking clinic services, in particular PrEP, from the perspective of both clinic staff (clinical and nonclinical) and AGYW who seek services at clinic sites in Tshwane province, South Africa. Methods Six focus group discussions were conducted with AGYW (43 total participants) and four with clinic staff (42 total participants) and triangulated with survey data with AGYW (n = 449) and clinic staff (n = 130). Thematic analysis was applied to the qualitative data and descriptive statistics were conducted with the survey data. Results Four common themes emerged across the qualitative and quantitative data and with both AGYW and clinic staff, although with varying degrees of resonance between these two groups. These themes included (1) clinic manifestations of stigma toward AGYW, (2) concerns about providing PrEP services for AGYW, (3) healthcare providers’ identity as mothers, and (4) privacy and breaches of confidentiality. An additional theme identified mainly in the AGYW data pertained to stigma and access to healthcare. Conclusion Evidence is needed to inform strategies for addressing clinic stigma toward AGYW, with the goal of removing barriers to PrEP services for this group. While awareness has increased and progress has been achieved around the provision of comprehensive, youth-friendly sexual and reproductive health services, these programs need to be adapted for the specific concerns of young people seeking PrEP services. Our findings point to the four key areas noted above where programs seeking to address stigma toward AGYW in clinics can tailor their programming.

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Perspectives of Adolescent Girls and Young Women on Optimizing Youth-Friendly HIV and Sexual and Reproductive Health Care in Zambia

Cited by 8 publications

References 15 publications

Health worker perceptions of stigma towards Zambian adolescent girls and young women: a qualitative study

Health worker perceptions of stigma towards Zambian adolescent girls and young women: a qualitative study

Integrated Health Care Delivery for Adolescents Living with and at Risk of HIV Infection: A Review of Models and Actions for Implementation

Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women: conflicting perspectives in South Africa

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