A comparative analysis of social support, risk behaviors, and HIV health service use among adolescent and young males and females in Lusaka, Zambia.

Background: Human immunodeficiency virus (HIV) remains the leading cause of death in Zambia. While females are disproportionately affected by HIV, males - especially young males - are vulnerable to the disease due to a variety of risk factors. This study aimed to understand what, if any, sex-related differences exist between young females and males on social support, risk behavior, and HIV healthcare utilization issues. Methods: Baseline survey responses from an implementation trial (NCT03995953) were examined for 863 females and 302 males affected by HIV between ages 15 and 26. We created summary statistics related to peer and familial support, risk factors (i.e., physical safety, economic security, mental health, substance abuse, and sexual behavior), and HIV healthcare utilization. Summary statistics were evaluated for statistical significance through Pearson Chi-Square testing. Findings: Females and males, regardless of HIV status, have higher average confidence in familial support (67 %) than peer support (40 %). Across HIV status, females and males had similar rates of physical safety risk. Regardless of HIV status, about half the participants reported worrying about running out of food. Substance abuse risk is higher among males; 15 % of males at risk of HIV and 7 % of males living with HIV report drug usage other than alcohol or marijuana compared to just 1 % of all females. Among individuals at risk of HIV, there are differences in rates of HIV testing by sex: 27.7 % among males vs. 6.7 % among females. Interpretations: While there are some differences, the many similarities between young females and males suggest that joint interventions which incorporate familial support could be beneficial to address shared risk factors. These joint interventions can be supplemented with sex-specific interventions related to substance abuse for males and HIV testing for females. Funding: Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under Award Number UH3HD096908. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.