Exploring the role of social networks in shaping STI disclosure among adolescents and young people using a health behavioral model in Lusaka, Zambia.
This qualitative study in Lusaka, Zambia, utilizes the COM-B model to reveal that adolescents' and young people's decisions to disclose STI status are shaped by a complex interplay of limited knowledge, service accessibility, stigma, and social support, highlighting the need for interventions that address both individual and community-level barriers.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
Sexually transmitted infections, or STIs, are common bacterial and parasitic infections that spread through intimate contact. While many can be cured with simple medicines, they often remain hidden. This is especially true for adolescents and young people, who face a unique set of hurdles when deciding whether to tell anyone they are sick. The decision to speak up is not just a personal choice; it is shaped by what a person knows, the support they have around them, and their fear of how others might react. When young people do not disclose their status, they often delay getting treatment, which can lead to serious long-term health problems and allows the infection to spread further. Understanding why silence persists is a critical step in protecting the health of communities.
In a high-density neighborhood in Lusaka, Zambia, researchers set out to uncover the specific reasons why young people between the ages of 15 and 24 struggle to share their STI status. The team conducted a detailed study involving twenty in-depth interviews with young people who had either been diagnosed with an infection, reported symptoms, or had been treated in the past. They also held five group discussions with young people and six more with community members, including parents, local leaders, and health workers. To make sense of the complex web of reasons behind these decisions, the researchers used a framework called the COM-B model. This approach looks at behavior through three lenses: capability, which is what a person knows and can do; opportunity, which is the environment and social support available to them; and motivation, which is the internal drive or fear that pushes them to act.
The study revealed that a lack of clear knowledge is a major barrier. While many young people could name common infections like syphilis or gonorrhea, their understanding of other infections was often clouded by myths. Some believed that symptoms like genital sores or discharge were simply fungal infections caused by using shared toilets or poor hygiene, rather than signs of a sexually transmitted disease. Others thought that washing with alcohol, lemon water, or herbal roots could cure an infection. Because of these misconceptions, many young people did not realize they had an STI at all, or they assumed it was something minor that did not require telling anyone. This confusion meant they often waited until symptoms became severe before seeking help, by which time they had already missed the chance to protect their partners.
Even when a young person knew they were infected, the social environment often made it impossible to speak up. Stigma was a heavy weight; many felt that having an STI made them "dirty" or shameful. This feeling was reinforced by community attitudes, including from religious groups that sometimes viewed sexual health topics as taboo or associated them with sin. Consequently, young people feared being labeled as promiscuous, gossiped about, or even rejected by their families and friends. In many households, parents were seen as strict or unwilling to discuss sexual matters, leaving young people without a safe space to ask for advice or support. Trust played a crucial role; young people were only willing to tell someone they trusted implicitly, such as a long-term partner or a close friend, but even then, the fear of a negative reaction often kept them silent.
The nature of a relationship also dictated whether a young person would speak the truth. Those in committed, loving relationships were more likely to disclose their status, sometimes even going to the clinic together. However, in new or casual relationships, the fear of being judged or losing the partner usually won out. Some young people felt a moral duty to tell a partner, but this was often overridden by the terror of violence or abandonment, particularly for young women. The study also found that while youth-friendly health clinics existed, many young people were too afraid to use them. They worried about being judged by staff, did not know what to expect during a visit, or could not afford the costs associated with tests and medication, leading them to buy drugs from pharmacies instead.
Ultimately, the decision to disclose an STI is not a simple act of will but a result of a tangled mix of knowledge, social pressure, and fear. The researchers found that while some young people were motivated to speak up to protect their health or their partners, the overwhelming fear of rejection and the lack of a supportive environment usually stopped them. The study suggests that fixing this problem requires more than just telling young people to be honest. It demands a shift in the community itself: correcting myths about how infections spread, reducing the shame attached to them, and creating spaces where young people feel safe to ask for help without fear of judgment. Until these social and cultural barriers are addressed, the cycle of silence and untreated infection is likely to continue.
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