Barriers to safe-sex behavior change in Zambia: Perspectives from HIV/AIDS psychosocial counselors

Abstract Despite being one of the Sub-Saharan African countries most affected by HIV/AIDS, few studies address the mismatch between continued practices of high-risk sexual behaviors considering increased HIV/AIDS knowledge in Zambia. This article reports findings from an exploratory qualitative study that addressed the research question, “What are the attitudinal, cultural, interpersonal, and contextual barriers to safer sexual behavior change among the Zambian population?” The study involved semistructured interviews with eight psychosocial counselors from two Zambian cities who provide HIV testing and counseling services. Data were analyzed using the constant comparative method. Findings indicated individual level barriers including gendered differences, adolescent specific barriers, and issues related to illiteracy. Lack of communication and perceived meaning of condom use emerged as factors influencing unsafe sex at partner levels. Community level factors included high rates of poverty, substance abuse, availability of antiretroviral therapy, inconsistent condom supplies, cultural beliefs, unemployment, and limited recreational activities.