HIV Testing Uptake in a Sexual and Reproductive Health Service for Youth and Impact on Population-Level Prevalence of Undiagnosed HIV in Zimbabwe.
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms—particularly those related to gender, sexual behavior, and violence—operate as important community-level determinants of HIV outcomes among youth, influencing both access to testing and the likelihood of remaining undiagnosed. The discussion highlights that harmful norms, including stigma around HIV and sexual activity and norms tolerating violence against women, can discourage engagement with services even when they are accessible and youth-friendly. Importantly, norms interact with structural barriers such as service availability, mobility, and socioeconomic conditions, meaning that improving HIV outcomes requires addressing both normative and systemic constraints.
Objectives The study aimed to assess uptake of HIV testing within a community-based, integrated HIV and sexual and reproductive health (SRH) service for youth in Zimbabwe, and to evaluate its impact on the population-level prevalence of undiagnosed HIV, as well as identify individual- and community-level factors associated with undiagnosed HIV.
Methods A cluster randomized trial (CHIEDZA) was conducted across three provinces in Zimbabwe, with clusters randomized to receive integrated HIV/SRH services or standard care over 30 months, followed by a population-based survey. Quantitative analyses assessed HIV testing uptake, prevalence of undiagnosed HIV, and associated factors. Social norms were measured at the community level using scales including the Gender Equitable Men scale and measures of attitudes toward violence against women, alongside proxies such as service availability and testing behaviors.
Results HIV testing uptake within the intervention was high, with 84% of eligible youth testing at least once and most testing at their first visit. However, at the population level, HIV prevalence was 7%, and 47% of those living with HIV were undiagnosed, with no significant difference between intervention and control groups. Individual factors associated with being undiagnosed included male sex, higher education, no prior testing, and inconsistent condom use. Community-level factors—including limited availability of SRH services, fewer testing opportunities, and harmful social norms (e.g., attitudes tolerating violence)—were associated with higher levels of undiagnosed HIV.
Conclusions The study concludes that while integrated, youth-friendly HIV/SRH services can substantially increase testing uptake, they are insufficient to reduce population-level undiagnosed HIV without addressing broader social and structural barriers. Effective strategies must incorporate community engagement, address harmful social norms and stigma, and expand access to services to reach underserved youth populations and improve HIV outcomes.
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