Mental Health Services Fall Short for Young Zambians Living with HIV, Mapping Study Finds

Adolescents and young people living with HIV in Zambia face a double burden: managing a lifelong infection while navigating the psychological and social pressures that come with it. A new mapping study published in PLOS Mental Health has now provided one of the most detailed pictures to date of where mental health and psychosocial support services actually exist in two Zambian districts, and the results reveal a striking mismatch between where services are located and where the heaviest treatment burden lies. The research, led by Carlos Muleya and colleagues, focused on Lusaka and Shibuyunji districts and examined whether the availability of youth-responsive services aligns with the distribution of adolescents and young people living with HIV who are receiving antiretroviral therapy.

The study team conducted a cross-sectional mapping survey between 10 and 21 February 2025, visiting facilities that provided any form of mental health or psychosocial service. Rather than simply counting facilities, the researchers documented the practical features that determine whether a young person can actually use a service: which treatment modalities are offered, on which days facilities operate, what eligibility and consent requirements apply, whether privacy infrastructure exists, and whether facilities are government or privately owned. This granular approach matters because the difference between a service that exists on paper and one that a teenager can realistically access on a Saturday afternoon, without a parent’s signature, and behind a closed door, can determine whether mental health care is received at all.

To assess alignment with treatment needs, the team linked mapped facilities to antiretroviral therapy sites using standardized facility names and districts, and connected them to September 2024 treatment-current data for patients aged 15 to 24. As of that month, 16,550 adolescents and young people living with HIV were on antiretroviral therapy across 87 sites, with 97.7 percent of that burden concentrated in Lusaka district. This concentration reflects the demographic reality of Zambia’s capital, where the majority of the country’s young people living with HIV receive care. Shibuyunji, a more rural district, accounted for the remaining small fraction of the treatment burden.

The mapping exercise identified 88 facilities offering mental health or psychosocial services, 73 of them in Lusaka and 15 in Shibuyunji. Ownership was dominated by the public sector, with 58.0 percent of facilities government-owned and 40.9 percent privately owned. Counseling emerged as the near-universal service modality, available at 97.7 percent of mapped facilities. This is encouraging in one sense, since talk-based support is the backbone of psychosocial care for young people coping with HIV-related stigma, disclosure challenges, and adherence difficulties. Yet the narrower service landscape beyond counseling tells a more complicated story about the depth of care on offer.

Group therapy was available at only 31.8 percent of facilities, medication at 37.5 percent, and medical supervision in the form of observed medication at 38.6 percent. Medication services were frequently referral-based, meaning that a young person screened at one facility would need to travel elsewhere to receive pharmacological treatment. For conditions such as moderate to severe depression, where counseling alone may be insufficient, this referral dependency introduces delays, transport costs, and drop-out risks that fall disproportionately on adolescents, who are already among the groups most likely to disengage from HIV care. The gap between the ubiquity of counseling and the scarcity of biomedical mental health interventions suggests that the service system is oriented toward lighter-touch support rather than comprehensive clinical care.

Access features that matter particularly to young people were also unevenly distributed. Weekend availability was reported by 60.2 percent of facilities, an important consideration given that many adolescents and young adults attend school or work on weekdays and may be reluctant to be seen at a clinic during those hours. Parental or guardian consent requirements, which can be a decisive barrier for young people who have not disclosed their HIV status to caregivers, applied at 28.4 percent of facilities. Privacy infrastructure, another prerequisite for honest engagement with mental health services, varied across the mapped sites. Each of these organizational details shapes whether a young person will initiate or continue care, and the study’s findings indicate that they are not consistently guaranteed even where services nominally exist.

Readiness of routine data also differed sharply between the two districts. In Lusaka, 93.2 percent of facilities had adequate routine data readiness, compared with 66.7 percent in Shibuyunji, a difference that was statistically significant with an odds ratio of 6.8 and a 95 percent confidence interval of 1.7 to 27.7, and a p-value of 0.011. This disparity has practical consequences: districts with weaker routine data systems are harder to plan for, harder to monitor, and more likely to have their service gaps remain invisible to national decision-makers. The finding underscores that strengthening information systems is not an administrative afterthought but a core component of equitable service delivery.

The burden-weighted coverage analysis, which linked 47 facilities to antiretroviral therapy sites serving 11,194 adolescents and young people living with HIV, quantified how much of the treatment burden is actually within reach of key services. Coverage was 40.7 percent for weekend services and 47.2 percent for referral medication. Most strikingly, only 23.0 percent of the burden was covered by a composite package combining weekend availability, on-site counseling, and referral medication. In other words, fewer than one in four young people on treatment had access to a facility that combined the three features most likely to support sustained, youth-friendly mental health care. The researchers concluded that key access features, including weekend options and privacy, along with biomedical support beyond counseling, often depend on referral pathways and are not consistently aligned with high-burden sites.

The implications of the study extend beyond the two districts surveyed. Zambia, like many countries in sub-Saharan Africa, has made substantial progress in expanding HIV treatment, but the psychosocial dimensions of care for adolescents and young people have lagged behind. Young people living with HIV face elevated risks of depression, anxiety, and treatment fatigue, and poor mental health is closely linked to reduced adherence to antiretroviral therapy, which in turn affects viral suppression and long-term health outcomes. By mapping services against treatment burden, the study provides a template for identifying precisely where investments in youth-friendly service organization, referral functionality, and routine monitoring would yield the greatest benefit. The authors suggest that strengthening these elements at high-burden sites may improve equitable access to mental health and psychosocial support for the population that needs it most.

The study also demonstrates the value of systematic service mapping as a planning tool. Because the researchers used standardized facility names and districts to link mental health services to antiretroviral therapy program data, they were able to convert two separate administrative datasets, one describing services and one describing treatment burden, into a single actionable picture of coverage. This method could be replicated in other districts and countries where mental health service information is scattered across facility records and program reports. For the 16,550 young Zambians on treatment in these two districts, the findings make clear that counseling is widely available, but the fuller package of care that supports mental wellbeing, from weekend hours to medication access, remains out of consistent reach for most, and closing that gap will require deliberate alignment of services with the sites where the treatment burden is heaviest.

Subject of Research: Availability of mental health and psychosocial support services for adolescents and young people living with HIV in Zambia

Article Title: Mapping mental health and psychosocial support service availability for adolescents and young people living with HIV in Lusaka and Shibuyunji districts, Zambia: Alignment with ART program burden (September 2024)

Article References: Muleya, C., Likwa, R. N., Chipimo, P. J., Folotiya, J. J., Mwiya, N., Mapiki, L., Sibuchi, A., Chulu, G., Baumhart, C., Claassen, C. W., Dalal, N., & Mulenga, L. B. (2026). Mapping mental health and psychosocial support service availability for adolescents and young people living with HIV in Lusaka and Shibuyunji districts, Zambia: Alignment with ART program burden (September 2024). PLOS Mental Health, 3(8), e0000610. https://doi.org/10.1371/journal.pmen.0000610

Image Credits: AI Generated

DOI: 10.1371/journal.pmen.0000610

Keywords: HIV, adolescent health, mental health services, psychosocial support, Zambia, antiretroviral therapy, service mapping, Lusaka, Shibuyunji, health systems, youth-friendly services, PLOS Mental Health