Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Educational Psychology, Sociology, and Special Education, School of Education, University of Zambia, Lusaka, Zambia.
Reprod Health. 2018 Mar 27;15(1):55. doi: 10.1186/s12978-018-0493-8.
BACKGROUND: Adolescents living with HIV face challenges, such as disclosure of HIV status, adherence to antiretroviral therapy, mental health, and sexual and reproductive health (SRH). These challenges affect their future quality of life. However, little evidence is available on their sexual behaviors and SRH needs in Zambia. This study aimed at assessing their sexual behaviors and SRH needs and identifying factors associated with marriage concerns and a desire to have children. METHODS: This cross-sectional study was conducted at the University Teaching Hospital from April to July 2014. We recruited 200 adolescents aged 15-19 years who were aware of their HIV-positive status. We collected data on their first and recent sexual behavior, concerns about marriage, and desire to have children. We used the Generalized Linear Model to identify factors associated with having concerns about marriage and desire to have children. We performed thematic analysis with open-ended data to determine their perceptions about marriage and having children in the future. RESULTS: Out of 175 studied adolescents, 20.6% had experienced sexual intercourse, and only 44.4% used condoms during the first intercourse. Forty-eight percent had concerns about marriage, and 87.4% desired to have children. Marriage-related concerns were high among those who desired to have children (adjusted relative risk [ARR] = 2.51, 95% CI = 1.02 to 6.14). Adolescents who had completed secondary school were more likely to desire to have children (ARR = 1.35, 95% CI = 1.07 to 1.71). Adolescents who had lost both parents were less likely to want children (ARR = 0.80, 95% CI = 0.68 to 0.95). Thematic analysis identified that major concerns about future marriage were fear of disclosing HIV status to partners and risk of infecting partners and/or children. The reasons for their willingness to have children were the desire to be a parent, having children as family assets, a human right, and a source of love and happiness. CONCLUSIONS: Zambian adolescents living with HIV are at risk of engaging in risky sexual relationships and have difficulties in meeting needs of SRH. HIV care service must respond to a wide range of needs.
背景：感染艾滋病毒的青少年面临着一些挑战，如艾滋病毒状况的披露、抗逆转录病毒治疗的依从性、心理健康以及性健康和生殖健康（SRH）。这些挑战影响他们未来的生活质量。然而，在赞比亚，关于他们的性行为和 SRH 需求的证据很少。本研究旨在评估他们的性行为和 SRH 需求，并确定与婚姻问题和生育愿望相关的因素。
方法：这是一项横断面研究，于 2014 年 4 月至 7 月在大学教学医院进行。我们招募了 200 名年龄在 15 至 19 岁之间、知晓自己 HIV 阳性状况的青少年。我们收集了他们首次和最近的性行为、对婚姻的担忧以及生育愿望的数据。我们使用广义线性模型来确定与婚姻问题和生育愿望相关的因素。我们对开放式数据进行主题分析，以确定他们对未来婚姻和生育的看法。
结果：在 175 名研究的青少年中，20.6%有过性行为，仅有 44.4%在首次性行为时使用了避孕套。48%的人对婚姻有担忧，87.4%的人希望有孩子。有生育愿望的人对婚姻问题的担忧较高（调整后的相对风险 [ARR]为 2.51，95%可信区间 [CI]为 1.02 至 6.14）。完成中学学业的青少年更有可能有生育愿望（ARR 为 1.35，95%CI 为 1.07 至 1.71）。父母双亡的青少年不太可能想要孩子（ARR 为 0.80，95%CI 为 0.68 至 0.95）。主题分析确定，对未来婚姻的主要担忧是害怕向伴侣透露 HIV 状况，以及感染伴侣和/或孩子的风险。他们愿意生育的原因是想要成为父母、将孩子视为家庭资产、一项人权，以及孩子是爱和幸福的源泉。
结论：赞比亚感染艾滋病毒的青少年有发生危险性行为的风险，并且难以满足性健康和生殖健康需求。艾滋病毒护理服务必须应对广泛的需求。
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