Development Aid from People to People in Zambia

A cross-sectional survey among 550 randomly selected 16–19-year-olds in Ndola, Zambia, assessed the influence of individual (e.g., HIV knowledge), relational (e.g., discussed HIV testing with family), and environmental factors (e.g., distance) on adolescents’ use of HIV counseling and testing. A multivariable logistic regression analysis comparing respondents who have taken an HIV test to respondents who have not found that at the relational level believing that one’s family would not be upset if the youth has taken an HIV test (adjusted odds ratio [AOR] = 5.08; 95% confidence interval [CI] = 1.16–22.35); and having discussed with a family member whether or not to take an HIV test (AOR = 3.51; 95% CI = 1.08–11.47) were significantly related to adolescent testing. At the individual-level, having ever had sex (AOR = 6.43; 95% CI = 2.14–19.30) and being out-of-school (AOR = 2.95; 95% CI = 1.32–6.59) were also strongly associated with HIV testing. Environmental measures were not found to be significantly related to HIV testing. These findings support the need to examine not only individual characteristics but also relational level factors, particularly the role of families, when implementing and evaluating adolescent HIV testing strategies. Programs to increase communication about HIV testing and counseling within families should be tested in a prospective design in order to assess the impact on young people’s decisions to learn their HIV status and subsequent health seeking and protective behaviors.