Social Worker Perspectives on Barriers to HIV Risk-Reducing Sexual Behaviors Among the Zambian Population

Background and Purpose: Like many Sub-Saharan African countries, HIV/AIDS has been present in Zambia for several decades. However research indicates continued practices of high-risk sexual behaviors despite universal HIV/AIDS knowledge and high HIV prevalence in the region. In 2014, an estimated 1.1 million people were reported to be living with HIV/AIDS in Zambia with approximately 18,900 HIV/AIDS related deaths. Behaviors that increase risk of infection such as multiple sexual partners, extramarital relationships, low condom use, and polygyny continue to be common practices in Zambia. This article reports findings from an exploratory qualitative study that addressed the research question, “What are the attitudinal, cultural, interpersonal, and contextual barriers to safer sexual behavior change among the Zambian population?” The study sought to explore the perspectives of health professionals who provide HIV related services in the community.

Method: In-depth semi-structured interviews were conducted with eight social work professionals, men and women between the ages of 26 and 35. Participants provided HIV testing and counseling services in two Zambian cities, and had an average of 5 years experience in HIV related services. The constant comparative method was utilized to analyze the data. Data were compared across participants to identify commonalities and differences in perspectives regarding the research questions. Open coding was utilized to conceptualize, compare and categorize data. Member checks and an external reviewer were utilized to ensure the credibility of our analysis.

Results: Findings indicated barriers at individual levels, interpersonal levels and community levels. Individual level barriers included, gendered differences (such as limited sexual decision making power for females), issues related to illiteracy contributing to misinformation about HIV prevention methods, and adolescent specific barriers (such as fear of adult reprisal, and peer pressure). Lack of communication and perceived meaning of condom use emerged as factors influencing unsafe sex at partner levels. For example, the viewing of unprotected sex as a symbol of love and trust between a couple. Community level factors included high rates of poverty, increased incidence of substance abuse, availability of anti-retroviral therapy, inconsistent condom supplies, some cultural beliefs, unemployment, and limited recreational activities.

Conclusions and Implications: These findings highlight the impact of socioeconomic factors on continued HIV sexual risk behaviors in Zambia. In addition, results contribute to emerging findings in scholarly literature of the effects of anti-retroviral therapy on HIV/AIDS attitudes in Sub-Saharan Africa. Even though HIV risk in Zambia runs across socioeconomic status, women and individuals from poor households were reported to be most vulnerable to unsafe sexual practices. Efforts to promote safe sex practices and reduce HIV infection rates should go beyond HIV/AIDS education and include structural and economic interventions. Further investigation is warranted with a much larger sample that includes perspectives from community members.