Applying the social determinants of health lens to the situation of young key populations in Zambia: what can it tell us about what we could do
Background: According to census data, Zambia has a predominantly young population with 65% under the age of 25 years. Improving the sexual and reproductive health of young people aged 15-24 years has become a crossing-cutting priority for sustainable development for the country. Certain sub-groups within this population, namely young gay men and other men-having-sex-with-men; young sex workers; young transgender people; and young prisoners – collectively termed key populations – may have poorer sexual and reproductive health than their general population peers. The application of the social determinants of health framework offers a way to understand these inequities in order to more effectively address them.
Methods: Data and other information to support this analysis were collected using key informant interviews and desk review. Interviews were conducted with 30 individuals deemed to be knowledgeable about the situation of young key populations in Zambia. Peer-reviewed literature on these groups is very limited. As a result, non-peer-reviewed sources were also used.
Results: According to the limited information that is available, young key populations do indeed have significantly poorer sexual reproductive health, particularly elevated rates of HIV and other sexually transmitted infections. This may arise due to a range of determinants linked to a general context of marginalisation and disadvantage, as well as the more specific pathways related to the effects of punitive laws and policies; negative socio-cultural beliefs and practices; a high degree of social exclusion; and limited or no access to relevant and acceptable health services. While, in this last regard, tailored HIV-focused programming is beginning to expand for some groups, it is not yet addressing these broader forces of risk and vulnerability.
Conclusion: The growing attention to young key populations in Zambia is both appropriate and necessary. However, more research is urgently needed to guide this emphasis. The social determinants of health can provide a highly relevant organising framework for this work. Should further investigation confirm some of the conclusions of this analysis, more will be needed to achieve health equity for young key populations than tailored services alone. Enabling, inclusive, and protective legal, policy and programmatic approaches will be equally critical.
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