HIV risks and vulnerabilities reported among adolescent girls and young women accessing DREAMS services in three Zambian districts: Monze, Mazabuka, and Mongu, 2020–2022

TL;DR

This study examines HIV risks among adolescent girls and young women in Zambia, highlighting vulnerabilities like violence, orphanhood, and risky sexual behaviors.

Contribution

The study provides age-disaggregated data on HIV risks and vulnerabilities among AGYW in Zambia, supporting targeted prevention strategies.

Findings

Emotional or physical violence and orphanhood were most common among girls aged 10–14 years.

Older AGYW (15–24 years) reported high rates of no/irregular condom use and transactional sex.

Clinical service engagement was associated with being out of school and risky sexual behaviors.

Abstract

Adolescent girls and young women (AGYW) in sub-Saharan Africa face socio-economic and gender-related factors that heighten risk of HIV infection. We examined HIV risks and vulnerabilities among AGYW enrolled in the Determined Resilient Empowered AIDS-free Mentored and Safe (DREAMS) program in Zambia.

AGYW aged 10–24 years were screened at enrollment in DREAMS using a standardized tool assessing exposure to sexual and reproductive health risks, gender-based violence, and orphanhood. We analyzed 24 months of data (October 2020–September 2022) from six centers in Southern and Western Provinces. We characterized age-disaggregated risks and used multivariable logistic regression to examine associations with engagement in HIV-related clinical services.

Among 63,118 AGYW screened, 34.9% were aged 10–14 years, 50.7% aged 15–19 years, and 14.4% aged 20–24 years. Emotional or physical violence (78.0%) and orphanhood (22.3%) were most common among girls aged 10–14 years. Among AGYW 15–19 years, top risks included no/irregular condom use (58.1%), orphanhood (29.2%), multiple partners (23.5%), and transactional sex (20.1%). In the 20–24 years group, 83.5% reported no/irregular condom use, with 29.9% reporting multiple partners and 23.0% transactional sex. Clinical service engagement was positively associated with being out of school, sexually active, using drugs/alcohol, and reporting prior pregnancy, STIs, or multiple sexual partners.

Socio-economic vulnerabilities were common among younger AGYW in Zambia, while older AGYW reported high levels of behavioral HIV risk. DREAMS reached vulnerable and at-risk AGYW in Zambia, representing an opportunity to reduce HIV acquisition through targeted prevention services.

The online version contains supplementary material available at 10.1186/s12981-026-00848-7.

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