Abstract Intimate Partner Violence (IPV) has been shown to affect women’s access to sexual and reproductive health services, including modern contraceptives. However, there is conflicting data in the literature on how the experience of IPV among women affects modern contraceptive use, with some studies showing decreased rates of modern contraceptive use, while others have shown increased rates of modern contraceptive use among these women. This study therefore, aimed at studying the association between the experience of IPV and modern contraceptive use among women presenting for abortion care in Lusaka District, Zambia. A cross-sectional study was conducted from 1 November to 31 December 2024 at four hospitals in Lusaka District. Women seeking abortion care were enrolled via convenience sampling, and data were obtained using a pre-tested interviewer-administered questionnaire. The outcome variable was modern contraceptive use in the preceding six months; exposures included IPV within the prior six months, as well as socio-demographic and reproductive characteristics. Analyses comprised descriptive statistics, chi-square test and multiple logistic regression. A total of 372 women participated in the study and data was analysed for 367 women, with a median age of 25 years (IQR 22-30). IPV was reported by 231 participants (62.9%), most commonly emotional violence (44.7%). Modern contraceptive use within the preceding six months was reported by 150 women (40.9%). The odds of modern contraceptive use was lower amon women with IPV exposure compared with those who were not exposed (aOR 0.3; 95% CI 0.17–0.52), but higher among women seeking abortion care services from Chawama First Level Hospital compared to those seeking services from the Women and Newborn University Teaching Hospital ((aOR 4.4; 95% CI 1.68 – 11.65) and among women aged above 24 years compared to adolescent girls and young women (AGYW) aged 14-24 years (aOR 14; 95% CI, 6.40 – 30.60). More than half of the women accessing abortion care services in Lusaka district experienced intimate partner violence, and less than half had used modern contraceptives within six months before they participated in the study. Thus, policies and programmes aimed at increasing modern contraceptive use among women should pay particular attention at addressing IPV and the reproductive health needs of AGYW and women residing in peri-urban areas.

Background and aims : Substance use and the internalization of traditional gender norms,or inequitable gender beliefs, are co-occurring risk behaviors for poorer health and well-being in young people in Southern Africa. Addressing the social and structural factors that reinforce substance use and inequitable gender beliefs, including peer influence and socioeconomic adversity, such as lack of education or employment, is necessary to support sustainable change in these behaviors. However, most existing interventions focus only on changing individual behavior. This study therefore aims to address this limitation by testing the efficacy of an intervention to reduce substance use and promote equitable gender beliefs, delivered to peer groups and embedded within existing vocational training (VT) programs. Design : Two-arm cluster randomized controlled superiority trial with assessments at baseline, 12-week, and 24-week follow-up. Setting : Selected VT programs in Zambia, Zimbabwe, and South Africa. Participants: Sixty-six peer groups, comprised of 3 to 6 young people (index case plus 2 to 5 peers) aged 16-24 years old, who use substances together weekly, or binge drink at least monthly, and enrolled in eligible VT programs. Intervention and comparator: Peer groups are randomly allocated (1:1) to receive either: (i) the standard VT program plus Peer Education for Gender Inclusion and Substance Use in Southern Africa (PEGISUS), an 8-session interactive intervention delivered by VT program staff to peer groups or (ii) standard of care (SOC), which is the standard VT program and a referral for substance use services. Measurements: The primary outcome is the between-group (PEGISUS vs. SOC) mean difference in the change in the total substance use involvement score on the ASSIST (Alcohol, Smoking, and Substance Involvement Screening Test) from baseline to the 12-week follow-up. Secondary outcomes compare the between-group mean difference in (1) other substance use scales on the ASSIST and at other timepoints (i.e., 24-week follow-up); (2) change in gender equitable beliefs using the GEMS (Gender Equitable Men’s Scale) from baseline to the 12-week and 24-week follow-up; and (3) VT program attendance and completion rates, employment status, and income earned at the 24-week follow-up. Comments: This is one of the first known studies in Southern Africa to assess the efficacy of an intervention that addresses substance use and gender equity beliefs among young people and their peers delivered in VT programs. PEGISUS addresses socioeconomic adversity and offers a potential pathway to sustainable delivery by embedding the intervention within existing VT programs. If unhealthy risk behaviors are reduced, and employment opportunities are improved, this can lead to improved well-being in the life trajectories of these young people.

BACKGROUND:Sexual and reproductive health (SRH) services are widely available in Lusaka, Zambia but use among adolescent girls and young women remains low. This study investigated the perceptions and experiences of a sub-sample of female university students accessing clinic-based SRH services. METHODS:Thirty-four female students participated in focus group discussions in June-August 2022. Participants were recruited from a survey at a public university, where interested participants could opt-in to join focus groups discussing experiences and perceptions of SRH services. Focus groups were audio recorded, transcribed, and analysed using a line-by-line constant comparison approach in which a codebook based on the research questions was created a priori and revised as new codes inductively emerged. Key themes and illustrative quotes related to experiences and perceptions of SRH health care were identified. RESULTS:The most salient theme was widespread fear of seeking SRH services and interacting with healthcare providers. Three sub-themes included: (1) receiving moral judgement instead of health information; (2) negative clinic experiences; and (3) privacy concerns. As a result, a second theme revealed a reliance on less effective contraceptive methods, describing that these culminating experiences have led to decreased interest for SRH services. CONCLUSION:As one of the few qualitative studies on female university students in a high HIV-prevalence setting, we identified key barriers in the healthcare system that hindered the use of critical SRH services. This research contextualised the use of less effective contraceptive methods, low uptake of pre-exposure prophylaxis, and persistent suboptimal SRH outcomes in this sub-population of young women.

Background Substance use contributes substantially to morbidity among adolescents and young adults (AYAs) in Southern Africa, with lifelong consequences. This study aimed to characterize the substance use risk and resilience cycle among this population and identify participant-informed intervention leverage points. Methods We conducted 12 focus group discussions with 97 AYAs (16–24 years) in Zambia, Zimbabwe, and South Africa. Participants had moderate to severe substance use risk and a history of school non-completion or unemployment. We used thematic analysis informed by grounded theory to develop a model of risk and resilience. Findings Participants described a reinforcing cycle in which substance use was influenced by structural, interpersonal, and individual factors, particularly unemployment, school non-completion, poverty/financial stress, peer pressure, family conflict, mental distress, and gangsterism/crime. AYAs also described resilience pathways to reduce exposure to high-risk settings and sustain attempts to reduce or stop use. Building on these accounts, we mapped seven participant-informed resilience strategies to disrupt the cycle, including return-to-school and exam support, prosocial supports, and sports and rehabilitation. Interpretation Entry points to interrupt the cycle of substance use risk at the structural, interpersonal, and individual levels offer a practical framework to inform substance use intervention efforts for AYAs within low-resource African settings. Consistent with multisystem resilience theory, these pathways may operate through changes in resources and exposure, producing positive developmental cascades that reduce escalation and support recovery. Funding Swiss National Science Foundation (SNSF)/Swiss Agency for Development and Cooperation (SOR4D 400440_213259); SNSF (Ambizione PZ00P1_201690).

Identity formation is the core developmental task during adolescence, yet research in sub-Saharan Africa is limited. We examined identity statuses in German and Zambian adolescents (N = 941; nZambia = 395; MAge = 14.75; 47% female) using three identity dimensions: commitment, in-depth exploration, and reconsideration of commitment. We hypothesized that among both samples a) five identity statuses (achievement, early closure, moratorium, searching moratorium, and diffusion) are found and b) identity status profiles are comparable in terms of psychosocial functioning. The results largely confirmed these hypotheses, however, indicating that early closure and searching moratorium statuses seemed more adaptive for Zambian adolescents, whereas the diffusion status seemed more adaptive for German adolescents. Implications, including the need for further cross-cultural research, are discussed.

OBJECTIVE:In this cross-sectional study in Zambia, we examined factors that influence cognitive performance in adults with clade C human immunodeficiency virus-1 (HIV) infection who were on antiretroviral therapy. METHOD:We examined if detectable HIV ribonucleic acid (RNA) in blood plasma, nadir CD4+ T-cell count before antiretroviral therapy, increase in CD4+ T-cell count during antiretroviral therapy, and having pulmonary tuberculosis (TB) influenced cognitive performance. We performed a multilinear regression in which the dependent variable was the global mean cognitive T-score, an overall composite score based on 16 neuropsychological tests that were adjusted for age, sex, and education using normative data from Zambian adults without HIV infection. The 16 tests were merged into seven cognitive domains: Executive Functions, Verbal Fluency, Attention/Working Memory, Learning (immediate recall), Memory (delayed recall), Motor Control, and Speed of Information Processing. RESULTS:When on antiretroviral therapy, a greater increase in CD4+ T-cells was significantly associated with a better global mean cognitive T-score (p = .002). Pulmonary TB was independently associated with worse performance (p = .008). Neither nadir CD4+ T-cell count nor plasma HIV RNA during antiretroviral therapy was associated with cognitive performance. CONCLUSIONS:Accounting for CD4+ T-cell increase after antiretroviral therapy initiation and comorbid pulmonary TB may help explain cognitive outcomes in persons with HIV infection in endemic settings. We suggest that it is essential that those with a low CD4+ T-cell count increase the number of cells as early as possible. Our data suggest that this is important for their cognitive functioning. Future research should determine whether the deleterious effect of pulmonary TB resolves after completion of TB treatment. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Studies that have investigated client-provider interactions in HIV service delivery have focused mainly on the views of sexual and gender minorities. This study explored the views of both Healthcare Providers (HCPs) and Sexual Minority Men (SMM) in Zambia about factors that influence client-provider interactions and how this could affect HIV service delivery. We conducted in-depth interviews with 20 HCPs (>25 years old) and 20 SMM (20-34 years old) purposively recruited from Lusaka with help from local partners in 2021. Interviews lasted 30-80 min, were conducted in English, and were audio-recorded. Verbatim transcripts of audio files were iteratively coded using Nvivo. Thematic analysis was performed using the inductive approach. Study findings suggest that a lack of trust in HCPs among SMM and the religious and cultural persuasions of some HCPs negatively impact communication between SMM and HCPs. The above factors will likely make establishing a good working relationship between HCPs and SMM difficult and could negatively influence HIV service delivery. Therefore, promoting an SMM-friendly environment at health facilities and promoting HCPs' understanding of the health needs of SMM are critical to ensure the delivery of quality HIV services to SMM in Zambia.

Abstract Background Adolescent girls and young women (AGYW) in Zambia experience challenges including gender-based violence (GBV) and difficulty obtaining care for sexual and reproductive health (SRH) and treatment for HIV. Implementation strategies for delivering GBV, SRH and HIV services targeted to AGYW in community health systems (CHS) have not been fully specified. We sought to define and specify common implementation strategies being used in Zambia. Methods In a qualitative case study in 3 districts, we interviewed 29 key informants from government bodies, NGOs, and community leaders; we also conducted 23 in-depth interviews with AGYW aged between 10 and 24 years. Analysis of the data used thematic analysis based on the four CHS lenses (programmatic, relational, collective action, and critical lenses) and on the Expert Recommendations for Implementing Change (ERIC) compilation of implementation strategies. Results Implementation strategies identified under the programmatic lens were 1) changing infrastructure, which included increasing health facilities and delivering adolescent- and young people-friendly services; 2) training and educating stakeholders, which consisted of increasing capacity building, developing and using educational materials, ongoing training and educational outreach visits; and 3) adapting and tailoring services to context, which included delivering integrated services and developing by-laws. Relational lens strategies were 1) developing stakeholder interrelationships such as building a coalition of service providers; and 2) using new funding through cost-sharing among stakeholders. Under the collective action lens, implementers mainly engaged consumers, by increasing demand using community networks, using mass media to share information, and intervening with patients to enhance uptake of services. The critical lens showed that effective implementation of GBV, SRH and HIV services was affected by structural and socio- cultural factors such as social stigma and cultural norms. Conclusion This study builds on the ERIC compilation of implementation strategies by identifying and specifying implementation strategies used in the delivery of HIV, GBV and services for AGYW in community health systems. We provide additional evidence on the importance of relational and collective-action approaches in strengthening community-engaged implementation and dissemination.

The healthcare industry in the United Arab Emirates (UAE) operates in a dynamic and complex environment, necessitating effective management strategies to ensure optimal organizational performance. In recent years, knowledge management (KM) and internal marketing (IM) have emerged as crucial factors for success in the UAE's healthcare sector. While previous research has explored the influence of KM and IM on organizational performance in various industries, there is a lack of understanding regarding their specific effects within the health sector. Given the distinctive characteristics of healthcare organizations, it is imperative to investigate the relationship between these two concepts and organizational performance in order to enhance outcomes in this important industry. This paper presents a pilot study conducted in the UAE, aiming to assess the potential impact of KM and IM on organizational performance within the health sector. The study aimed to develop a conceptual model, review the survey instrument and analyze findings.

IntroductionAcross various cultural contexts, success in goal realization relates to individuals’ well-being. Moreover, commitment to and successful pursuance of goals are crucial when searching for a meaningful identity in adolescence. However, individuals’ goals differ in how much they match their implicit motive dispositions. We hypothesized that successful pursuance of affiliation goals positively relates to commitment-related dimensions of interpersonal identity development (domain: close friends) that, in turn, predict adolescents’ level of well-being. However, we further assumed that the links between goal success and identity commitment are particularly pronounced among adolescents who are characterized by a high implicit affiliation motive.MethodsTo scrutinize the generalizability of the assumed relationships, data were assessed among adolescents in individualistic (Germany) and collectivistic (Zambia) cultural contexts.ResultsRegardless of adolescents’ cultural background, we found that commitment-related dimensions of interpersonal identity development mediate the link between successful attainment of affiliation goals and well-being, particularly among adolescents with a pronounced implicit affiliation motive; that is, the strength of the implicit affiliation motive moderates the association between goal success and identity commitment.ConclusionWe discuss findings concerning universal effects of implicit motives on identity commitment and well-being.

BackgroundLimited research has been conducted on the forms, manifestations and effects of intersectional stigma among young HIV-positive men who have sex with men (MSM) and transgender women (TGW) in Zambia. In this study, we aimed to address this gap by elucidating the experiences of these in a small group of young, HIV + MSM and TGW in Zambia.MethodsWe applied a mixed-methods design. Data were collected from January 2022 to May 2022. Qualitative data were collected using in-depth interviews while quantitative data were collected using a questionnaire. Qualitative transcripts were coded using thematic analysis while paper-based questionnaire data were entered into Kobo Connect. Descriptive statistics, using chi-squared tests were calculated using Excel. In this paper, we provide a descriptive profile of the sample and then focus on the qualitative findings on intersectional stigma, depression, and contemplation of suicide.ResultsWe recruited 56 participants from three sites: Lusaka, Chipata, and Solwezi districts. Participants' mean age was 23 years. The study found that 36% of all participants had moderate to significant symptoms of depression, 7% had major depression, 30% had moderate signs of anxiety, 11% had high signs of anxiety, 4% had very high signs of anxiety and 36% had contemplated suicide at least once. A greater proportion of TGW had moderate to significant symptoms of depression (40%) or major depression (10%) compared to MSM, at 33% and 6%, respectively (X2 = 0.65; p = 0.42). Similarly, more TGW (55%) had contemplated suicide than MSM peers (36%, X2=1.87; p = 0.17). In the qualitative data, four emergent themes about the forms, manifestations, and effects of intersectional stigma were (1) HIV, sexual orientation, and gender identity disclosure; (2) Dual identity; (3) Challenges of finding and maintaining sexual partners; (4) Coping and resilience. Overall, having to hide both one's sexuality and HIV status had a compounding effect and was described as living "a private lie."ConclusionEffectively addressing stigmas and poor mental health outcomes among young HIV-positive MSM and TGW will require adopting a socio-ecological approach that focuses on structural interventions, more trauma-informed and identity-supportive care for young people with HIV, as well as strengthening of authentic community-informed public health efforts.

Sexual minority men (SMM) in Zambia face significant challenges including stigma, discrimination, and mental health issues, which further impact their HIV-related risk behaviors. This study aimed to investigate the associations between enacted stigma, substance abuse, HIV-related behaviors, and mental health (i.e., depression, anxiety, and post-traumatic stress disorder [PTSD] symptoms) among SMM in Zambia. SMM aged 18-35 years who reported having multiple and/or concurrent sexual partners or low and/or inconsistent condom use in the past three months were recruited from four districts in Zambia between February and November 2021. Participants completed an anonymous interviewer-administered survey. Key variables of interest were compared between participants with higher vs. lower levels of enacted stigma. Independent samples t-tests were used for continuous variables, and chi-squared tests were used for categorical variables. A total of 197 eligible SMM participated in the study (mean age = 24.41 years). Participants with a higher level of enacted stigma showed a higher level of anxiety symptoms (χ2 = 12.91, p ≤ .001), PTSD symptoms (χ2 = 7.13, p < .01), tobacco use (χ2 = 10.47, p < .01), cannabis use (χ2 = 5.90, p < .05), and a higher number of sexual partners (t = 1.99, p < .05) in the past three months. Stigma reduction interventions may help mitigate substance abuse, HIV-related behaviors, and adverse mental health outcomes among SMM in Zambia. Health care providers, especially psychiatric-mental health nurses, can incorporate strategies for recognizing and addressing stigma into their practice through training and integrate multiple resources to create an inclusive and non-judgmental environment for SMM to improve their well-being.

Background Online therapies have been shown to be effective in improving students’ mental health. They are cost-effective and therefore have particular advantages in low-income countries like Zambia where mental health resources are limited. This study aimed to explore the perceived impact of the COVID-19 pandemic and the feasibility of implementing an Internet-Based Cognitive Behavioural Therapy (iCBT) intervention (‘moodgym’) to improve resilience in vulnerable Zambian students. Methods The study was a qualitative interview study. Participants identifying as having symptoms of low mood and completing a baseline, online survey ( n = 620) had the option to volunteer for a semi-structured interview to explore views about their experience of the pandemic and the acceptability and perceived benefits and limitations of using moodgym. Results A total of 50 students ( n = 24 female, n = 26 male) participated in the study. One theme with 4 sub-themes, captured the severe emotional and social impact of the COVID-19 pandemic. A second, very strong theme, with 5 sub-themes, reflected the considerable negative effects of the pandemic on the students’ educational experience. This included the challenges of online learning. The third theme, with three subthemes, captured the benefits and acceptability of moodgym, particularly in terms of understanding the relationship between thoughts and feelings and improving academic performance. The fourth theme described the technical difficulties experienced by students in attempting to use moodgym. Conclusion COVID-19 caused fear and impacted wellbeing in vulnerable students and severely impaired the quality of students’ educational experience. The findings suggest that moodgym might be a valuable support to students in a low-income country.

This study investigated whether perceived HIV stigma and HIV infection concerns among healthcare providers (HCPs) mediate the association between stigmatizing clinical setting and their interaction quality with sexual minority men (SMM) patients in Zambia. In 2021, a cross-sectional survey was conducted with 91 HCPs offering HIV-related services to SMM in Zambia. Path analysis was conducted to examine the potential mediation effect of "perceived HIV stigma" and "HIV infection concern" among HCPs in the association between "stigmatizing clinical setting" and their "interaction quality with SMM". Mediators i.e., "perceived HIV stigma" and "HIV infection concern" among HCPs, were associated positively with the stigmatizing clinical setting (beta = 0.329, p < .01, beta = 0.917, p < 0.01), and negatively with physician-patient interaction quality (beta = -0.167, p = 0.051; beta = -0.126, p < 0.05). Stigmatizing clinical setting had a significant and negative indirect effect on HCPs interaction quality with SMM through increased perceived HIV stigma (z = -1.966, p < 0.05) and increased HIV infection concern (z = -1.958, p = 0.050). To improve physician-patient interaction quality, stigma reduction interventions among HCPs, who serve SMM in Zambia, should target development of development of inclusive policies and the cultivation of cultural norms that are supportive and respectful to SMM, and protection of HCPs from enacted stigma due to offering care to SMM.

Sexual minority men (SMM) face persistent stigma in Zambia. From a holistic perspective, we aim to explore its impacts within and between multiple socioecological levels, demonstrating how their interactions create a vicious cycle of barriers to the well-being of SMM. In-depth interviews were conducted with 20 purposively recruited SMM from Lusaka, Zambia. All interviews were audio-recorded, after written consent, transcribed verbatim, and iteratively coded employing inductive (i.e., data-driven) approaches for thematic analysis using NVivo. Results suggest three key themes: (1) interpersonal socially perpetuated sexual minority stigma (SMS); (2) multidirectional interactions between psychosocial well-being and risk-taking behaviors; and (3) institutionally perpetuated SMS as a barrier to seeking and receiving health care. SMS permeates across all levels of the socioecological model to negatively impact the psychosocial well-being of SMM while acting also as a barrier to accessing HIV prevention and care. Our study necessitates structural public health intervention to decrease stigma and discrimination against SMM in Zambia, in efforts to increase their psychosocial well-being as well as their access to and utilization of HIV care by breaking the vicious cycle of SMS that pervades through the intrapersonal, interpersonal, and institutional levels of the socioecological model.

Abstract Background Health protective behaviours are crucial in the prevention of the spread of COVID-19, particularly in university students who typically live and study in large groups. Depression and anxiety are common in students and can impact young people’s motivations to follow health advice. The study aims to assess the relationship between mental health and COVID-19 health-protective behaviours in Zambian university students with symptoms of low mood. Methods The study was a cross-sectional, online survey of Zambian university students. Participants were also invited to take part in a semi-structured interview to explore views about COVID-19 vaccination. Invitation emails were sent explaining the study aims and directed students who self-identified as having low mood in the past two weeks to an online survey. Measures included COVID-19 preventive behaviours, COVID-19-related self-efficacy, and Hospital and Anxiety Depression scale. Results A total of 620 students (n=308 female, n=306 male) participated in the study, with a mean participant age of 22.47±3.29 years (range 18–51). Students reported a mean protective behaviour score of 74.09/105 and 74% scored above the threshold for possible anxiety disorder. Three-way ANOVA showed lower COVID-19 protective behaviours in students with possible anxiety disorder (p=.024) and those with low self-efficacy (p<0.001). Only 168 (27%) said they would accept vaccination against COVID-19, with male students being twice as likely to be willing to accept COVID-19 vaccination (p<0.001). Of 50 students interviewed. 30 (60%) expressed fears about the vaccination and 16 (32%) were concerned about a lack of information. Only 8 (16%) participants expressed doubts about effectiveness. Conclusion Students who self-identify as having symptoms of depression have high levels of anxiety. The results suggest that interventions to reduce anxiety and promote self-efficacy might enhance students’ COVID-19 protective behaviours. Qualitative data provided insight into the high rates of vaccine hesitancy in this population.

HIV-related stigma is a major challenge to HIV prevention for sexual minority men (SMM) in Zambia, but little is known about the underlying mechanisms. This study aimed to investigate whether physician–patient interaction quality mediates the relationship between HIV-related stigma and HIV-prevention behaviors among SMM. Data were collected using a cross-sectional survey from 194 SMM (aged: mean = 24.08, SD = 4.27) across four districts in Zambia between February and November 2021. Participants were asked about their demographic characteristics, HIV-related stigma, SMM-related stigma, physician–patient interaction quality, HIV-testing intention, and use of pre-exposure prophylaxis (PrEP). Path analysis was used to test the mediation effect of physician–patient interaction quality in the associations of HIV-related stigma/SMM-related stigma with HIV-testing intention and current PrEP use. Higher self-reported physician–patient interaction quality was negatively associated with HIV-related stigma ( β = − 0.444, z = − 2.223, p < 0.05), and positively associated with HIV-testing intention ( β = 0.039, z = 5.121, p < 0.001) and current PrEP use ( β = 0.008, z = 2.723, p < 0.01). HIV-related stigma among SMM had a significant and negative indirect effect on HIV-testing intention ( β = − 0.017, z = − 2.006, p < 0.05), and current PrEP use ( β = − 0.004, z = − 2.009, p < 0.05) through physician–patient interaction quality. Contrary to our expectations, SMM-related stigma did not have a significant and negative indirect effect on HIV prevention behaviors through physician–patient interaction quality. Health interventions need to improve physician–patient interaction quality by offering healthcare provider training, targeting HIV-related stigma in healthcare settings, and devising inclusive healthcare policies to promote HIV prevention efforts.