Cross-sectional study of multiple SKILLZ programs for adolescents and young adults in Zimbabwe

DETAILED SUMMARY

Importance

• Adolescents and young adults remain disproportionately affected by HIV in Zimbabwe, with limited engagement in preventive health services such as HIV testing and counselling.

Objective

• To assess HIV and reproductive health knowledge, attitudes, and behaviours among adolescents who attended Grassroot Soccer Zimbabwe programmes and to determine whether HIV knowledge levels were associated with health service utilization in Bulawayo, Zimbabwe.

Study details

• Study design: Cross-sectional study
• Data collection tools: Self-administered questionnaires; demographic and behavioural data; HIV and reproductive health knowledge test; attitudes and service-use questions
• Participants: Mixed-gender adolescents and young adults aged 13–30 years who attended at least one of three Grassroot Soccer programs
• Implementation setting: Eleven secondary schools implementing Grassroot Soccer programmes in Bulawayo, Zimbabwe (urban)
• Study period: July 2017–February 2018

Intervention

• Generation SKILLZ, SKILLZ Street, & SKILLZ Holiday: Sport-based programming integrating football drills with HIV prevention, healthy relationships, and gender norms education, delivered by trained Coaches in school settings. Generation SKILLZ promotes healthy relationships; SKILLZ Street is girls-only and focuses on standing against gender-based violence; SKILLZ Holiday is delivered over school holidays and addresses risky behaviours driving HIV transmission. Programs target adolescents aged 13–19 years and have operated since 2011.

Results

• Sample: 392 participants responding out of 450 questionnaires distributed (87.1% response rate); 76.3% female; 78.3% in the 15–19 years age group.
• Knowledge: 77.7% achieved high HIV and reproductive health knowledge, with females scoring higher (81.1%) than males (71.1%), though the association with sex was not statistically significant (p = 0.07).
• Health service use: A marginally significant association observed between higher knowledge and access of health services within 24 months (p = 0.045).
• Behaviours: 72% reported willingness to abstain from risky behaviours, such as drug use and “Vuzu” sex parties. Only 18 participants (5%) reported ever having had sexual intercourse; of these, 33.3% reported condomless sex.
• Service access: Clinics were the most frequently visited providers for Generation SKILLZ (28.5%) and SKILLZ Street (39.5%) participants, while a Grassroot Soccer Zimbabwe boot camp provided services for 48% of SKILLZ Holiday participants. Voluntary medical male circumcision and voluntary HIV counselling and testing were the services most accessed by Generation SKILLZ (26.8%) and SKILLZ Holiday (46.1%) participants; SKILLZ Street participants most often sought information on sexually transmitted infections.
• Attitudes: Positive attitudes toward condom use and rejection of multiple partners.

Conclusions and implications

• HIV and reproductive health knowledge levels were relatively high among adolescents who had attended Grassroot Soccer Zimbabwe programmes and were associated with greater health service use.
• Programs should strengthen communication between parents and youth, address gendered risk perceptions, and continue using sport-based platforms to normalize adolescent health-seeking and HIV testing.