The socio-cultural context of HIV risk and sexual behaviours among youth living with HIV in Mwanza, Malawi: A focused ethnography

Author Identifier

Maggie Zgambo

Date of Award


Document Type



Edith Cowan University

Degree Name

Doctor of Philosophy


School of Nursing and Midwifery

First Supervisor

Associate Professor Diana Arabiat

Second Supervisor

Dr Deborah Ireson


Introduction Recent empirical evidence suggests that youth living with HIV are likely to engage in sexual risk behaviours and report antiretroviral therapy non-adherence, both of which are critical in controlling the risk of HIV transmission. Malawian youth living with HIV have a role to play in controlling the transmission, however, their perceptions and comprehension of this role are not well understood. Therefore, this study explores the social-cultural contexts of HIV risk and sexual behaviours among Malawian youth living with HIV.

Methods From January to May 2019, 20 participants living with HIV, aged between 15 to 24 years and who had voluntarily given consent to participate were enrolled in this study. All were recruited through an HIV treatment program at a public referral hospital in Mwanza District, Malawi. Using focused ethnography, in-depth interviews were conducted using a developed and piloted interview guide, casual observations were recorded, and fields notes were taken. Interviews were digitally recorded and transcribed verbatim. A thematic analysis was carried out to synthesize data.

Findings From the thematic analysis, four themes emerged:

1. HIV knowledge and health risk behaviours - sources of HIV knowledge included the clinic, peers, parents, church and community leaders, however, knowledge from community sources was not always accurate. Inadequate HIV knowledge coupled with traditional initiation ceremonies, religious affairs and beliefs, facilitated sexual risk behaviours and antiretroviral non-adherence or stoppage. The interplay between both sexual risk behaviours and antiretroviral therapy non-adherence with poverty and personal characteristics of shyness and forgetfulness were prominent in this theme.

2. Perspectives of HIV status disclosure - participants struggled with HIV status disclosure to sexual partners out of fear of either stigma or discrimination based on cultural perceptions of HIV in the community and past negative experiences. Inadvertently, fear of HIV status disclosure influenced sexual risk behaviours and antiretroviral therapy nonadherence.

3. The usability of health services - contextual factors at individual and structural levels facilitated and/or impeded accessing HIV health services. Innovative health care delivery approaches, which encompassed entertainment and flexibility and welcoming behaviours of health care workers, were motivational aspects to encourage accessing health services. Conversely, ignorance of available HIV services, delays at the clinic, and an individual’s socioeconomic status, all shaped the negative health-seeking behaviours. 4. The impact of HIV infection and coping mechanisms - negative experiences encountered while living with HIV had a detrimental effect on the mental health of participants, and this also influenced HIV risk behaviours.

Conclusions Innovative health promotion and management approaches for youth living with HIV should take into consideration the dynamics of culture and an individual’s unique circumstances and preferences, and their psychological needs. Attuning the health care system to reinforce measures that promote the delivery of standard care and professional discipline could heighten the quality of care.

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