Background: Support for Young people aged between 16-24 years living with HIV (YPLHIV) is critical but remains limited in Zambia, partly because YPLHIV are often hidden within communities, having disclosed to very limited networks.
Methods: A qualitative cohort of 8 purposively sampled YPLHIV (4 women, 4 men) in four communities in Zambia. Over a 10-month period in 2017, each participant was involved in three research activities (carried out at three-month intervals), including participant observations, individual in-depth interviews and a participatory workshop. Within these methods, visual tools included social network diagrams that explored geographical and ''close in feeling'' networks and how these linked to disclosure. Qualitative analysis carried out by a team of social scientists reviewed the data and identified disclosure, secrecy and desire to share experiences with other YPLHIV as inductive key themes.
Results: YPLHIV, like other participants, had a wide network of friends and family, but only an extremely restricted number of people (and largely close family members) knew their HIV status. Parents/guardians often actively and strongly discouraged disclosure, regulated who knew the adolescents'' HIV status and rarely spoke about HIV within their homes. “Mum said I shouldn''t tell them otherwise they will start using it against me, like they do to her”, explained one young woman living with HIV, aged 19. However, YPLHIV expressed their desire to speak with, share experiences with, and get support from others who are “in their shoes”. The weight of not telling others about their HIV status sometimes led to feelings of loneliness and fatigue, exacerbated by the continuous secrecy of taking their antiretrovirals in private. Fears about unintended disclosure (usually linked to ART), coupled with silence about HIV in their homes stifled opportunities to be connected with other YPLHIV. One participant had attended a support group and found this contact fulfilling, and supportive for adherence.
Conclusions: YPLHIV were isolated by limited disclosure and being ''hidden'' by parents/guardians. Drawing on this research and literature, interventions targeting YPLHIV should address relationships in the home and the benefits, challenges and strategies for disclosure YPLHIV to allow them to share experiences, concerns and feel less alone.

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