Exploring the role of social networks in shaping STI disclosure among adolescents and young people using a health behavioral model in Lusaka, Zambia

Abstract Disclosure of sexually transmitted infections (STIs) is a key strategy for STI prevention and control. However, for adolescents and young people (AYP) aged 15-24, disclosure remains a challenge, usually shaped by several dynamics that affect AYP’s choice of whether to disclose or not, and to whom. This study sought to understand what influenced AYP decisions to disclose their STI status and to whom, using the Capability, Opportunity, and Motivation-Behavior (COM-B) model, in Lusaka, Zambia. This qualitative study, conducted from April-August 2024, included twenty in-depth interviews with AYP who participated in a cross-sectional STI prevalence survey, including those diagnosed with an STI, self-reporting STI symptoms, and reported ever being treated (regardless of symptoms). Additionally, five focus group discussions (FGDs) with AYP and another six FGDs with community members were conducted. Data were then analysed thematically using the COM-B model. The capability to disclose was influenced by AYP’s limited knowledge about STIs. Physical opportunity to disclose was shaped by the availability and accessibility of youth-friendly Sexual and Reproductive Health (SRH) services, while community and self-stigma, and relationships and household dynamics also shaped AYP’s social opportunities to disclose their STI status. Motivation to disclose was influenced by concern for one’s overall health, individual values and beliefs, and the need to seek support when experiencing an STI. However, fear of negative reactions reduced AYP’s motivation and willingness to disclose their STI status. AYP’s decisions to disclose an STI diagnosis is shaped by a network of personal and social influences. Social support plays an important role in disclosure, with supportive social networks facilitating the process and thus encouraging individuals to seek treatment. STI interventions should not only focus on individuals but also on increasing STI awareness, reducing stigma, and leveraging existing social support within the broader community context.