Access to sexual reproductive health services among HIV positive adolescents attending university teaching hospital (UTH) – PCOE (Pediatric Center of Excellence) Lusaka-Zambia.

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Ndongmo, Therese Ntigwa
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The University of Zambia.
An estimated 80,000 adolescents (10-19 years) are living with HIV in Zambia (UNICEF, 2011). As they mature into adulthood, adolescents encounter challenges related to sexuality and sexual reproductive health (SRH), coupled with dealing with a complex condition such as HIV infection. The current study aimed at exploring the experience, challenges and barriers encountered by adolescents in accessing reproductive health services at the Pediatric Center Of Excellence (PCOE) - University Teaching Hospital (UTH). It is hypothesized that adolescents living with HIV are also beginning to experience their sexuality, may have some challenges in accessing SRH services. The study was conducted using a mixed-method whereby adolescents aged 15-19 years were surveyed using a semi-structured questionnaire, about their needs and access to SRH. Services offered at the study setting (UTH PCOE) were also investigated through key informants’ in-depth interviews of healthcare workers. Emerging themes from open-ended questions qualitative data were explored using content analysis. The data was entered into an access database and exported to SPSS for analyses. Ethical clearance was obtained from the UNZABREC. A total of 148 adolescents aged 15-19 years were interviewed, including 63.5% females and 36.5% males. The majority (77%) had secondary education level. Those currently in school were 77.2%. About 68.9 % expressed intention to have children; 40.1 % admitted to having a boy or girl friends. Overall 15.1 % (21/139) have ever had sex. Of those sexually experienced, only 61.1 % reported consistent condom use. Two (2.1%) of the girls had been pregnant before. Ten out of 52 respondents indicated having had an STI before. Not being in school was found to be a positive predictor, not only for knowing where to go to talk about sex (OR= 2.53; 95% CI:1.10-5.82; p=0.02), but also for having ever gone to seek advice on sexual issues (OR=2.61; 95% CI:1.04-6.58; p=0.03). While SRH services are available, although not covering the full spectrum of needs at the PCOE, healthcare workers expressed challenges in terms of time and resources dedicated to these services. Overall access to SRH services (at least a counseling, FP, or STI service) was 31.5% in terms of availability and utilization combined. There was no significant factor that predicted access or not. We find evidence of reported “sexuality experience” illustrated by their expressed sexual desire and needs, presence of social friendships, and desire to have healthy children. HIV infected adolescent sexual reproductive needs were found to be similar to those of general population of the same age in terms of counseling in sexual matters, Family Planning (FP) and Sexual Transmitted Infection (STI) services. ALHIV face additional challenges within their family and social environments. This suggests that efforts should be made to provide one-stop center for all adolescent overall health care needs and to create an environment that is more aware, responsive, and tolerant of adolescent sexuality not only at tertiary but also a lower levels of healthcare settings. HCWs are available at the UTH PCOE to provide the services but still face challenges in terms of adequate training, time and recourses dedicated to these services.
Thesis of Master of Public Health (MPH).