1. Adolescent Support Services in Zambia
Dr. Lloyd Mulenga | University Teaching Hospital | Lusaka, Zambia
2016 International AIDS Society Conference | Durban, South Africa
Wednesday, 20 July | 700 hours

2. Health related problems
The main health related problems facing adolescents
Sexually Transmitted Diseases (STIs)
including HIV and AIDS
Behaviour related health problems
early and unprotected sex
sexual abuse
early marriages and pregnancies
unsafe abortions
substance and alcohol abuse

3. Burden of HIV in Adolescents
3,915,000 adolescents ( about 27% of general population)
120,000 children between the ages of 0–14 years are living with HIV
Among young women, HIV prevalence is more than twice that of men:
The HIV prevalence for 15–24 year old males is 4.2%
The HIV prevalence for 15–24 year old females is 8.9%

4. Comprehensive Knowledge of HIV among Youth by Residence
Percent of women and men age with comprehensive knowledge* of HIV
Comprehensive knowledge is an indicator that measures how much young people know about transmission and prevention of HIV. Comprehensive knowledge includes knowing that condoms and monogamy prevent HIV transmission, that a healthy looking person can have HIV infection, and rejects the two most common local misconceptions about HIV transmission.
This slide shows that young men are somewhat more informed than young women; and urban women and men are more informed than their rural counterparts.
*Comprehensive knowledge means knowing that the risk of getting HIV can be reduced by using condoms and limiting sex to one uninfected partner, knowing that a healthy looking person can have HIV, and rejecting the two most common local misconceptions about HIV prevention and transmission.

5. Knowledge of a Condom Source among Youth by Residence
Percent of women and men age who know a condom source
Young men are more likely to know where to get condoms than young women—94% of men vs. 84% of women. Urban young people are slightly more informed than rural youth.

6. Age at First Sexual Intercourse
12% of young women and 16% of young men age had sexual intercourse before age 15.
56% of young women and 50% of young men age had sexual intercourse before age 18.
Young people who start having intercourse very young are at greater risk of exposure to HIV infection. Less than 20% of young women and men age had their first sexual intercourse before age 15. More than half of women and half of men age had sex before age 18.

7. Premarital Sexual Intercourse and Condom Use among Youth
Among never-married women and men age who had sexual intercourse in past 12 months, percent who:
Percent of never-married women and men age who:
This is a complicated slide. On the left, the slide shows that 53% of young women and 41% of young men have never had sexual intercourse; 632% of women and 41% of men had intercourse in the last 12 months.
The right side of the slide shows that among the young people who had been sexually active in the previous year, 40% of women and 49% of men used a condom the last time they had sex.

8. Multiple Sexual Partners among Youth
Among women and men age who had 2+ sexual partners in past 12 months, percent who:
Percent of women and men age who had:
Young men are more likely than young women to report having multiple partners in the past 12 months. 11% men have had 2 or more partners compared to only 2% of women. Among both young men and women with multiple partners in the past year, only 34% of women and 40% of men say they used a condom at last intercourse.

9. HIV Testing among Youth
Among women and men age who had sexual intercourse in past 12 months, percent tested for HIV in past 12 months and received the results
56% of young women and 39% of young men who had sex in the past year have been tested for HIV and received the results.

10. Key Priorities for Adolescent Services
Service Delivery
Healthcare Workforce
Medical Products, Infrastructure, Equipment and Transport
Health Information
Healthcare Financing
Leadership and Governance

11. HIV testing in adolescents
Lack of standardized definition of terms
In general, adolescent is young person beginning at age 10
Legal Age for Voluntary Testing in Zambia is 16 years
Adolescents under the age of 16 may seek services voluntarily (regardless of parent consent/assent process) if they fall within one of the following categories:
Abused child
Married
Pregnant
High HIV-risk behaviors such as commercial sex work, engaging in sexual activity with multiple partners, or refusal to use condoms or other prophylaxis
Head of household

12. Resources in Zambia
Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection
Zambia National Counseling and Testing Guidelines
Zambia Adolescent Health Strategic Plan
Adolescent HIV Care and Treatment, A Training Curriculum for Health Workers – ICAP
Zambia National Guidelines for Treatment and Prevention of HIV Infection in Adolescents (anticipated 2016)
Zambian E-learning HIV Care and Treatment Training Package for Healthcare Workers
Disclosure Support Guide – EGPAF (anticipated 2016)

13. Programmatic Resources – Successes
The following programmatic resources provided are available throughout facilities in Zambia:
Youth Friendly Corners
Peer counselors and advocates
Support groups
Disclosure counseling
Separate clinic space/days (where available)
Transition Support (where available)
Examples
Livingstone COE
Lusaka COE
Materu First Level Hospital
Chongwe Rural Health Center

14. Challenges in Service Provision
Lack of standardized resources and definitions regarding adolescent care
HCW Limitations
Case finding and linkage to care
Limited space outside of COE’s and in rural settings
Age of voluntary testing
Adherence and retention in care
Stigma
Limited pediatric formulations (adolescents in lower weight bands)
Lack of adolescent specific indicators
Lack of disaggregated/stratified data