| Summary: | The incidence of HIV infection is increasing among Zimbabwean adolescent blood donors. Since this group contributes around 70% of total blood collections, the increase may pose future public health challenges such as lack of adequate and safe blood. Previous research on this group observed a positive association between history of sexually transmitted infections (STIs) and HIV. However, previous study designs suffered from both a dearth of data on sexual behaviour and their inability to provide a platform for adolescent blood donors to discuss the factors which may impact on their ability to protect themselves against HIV. This study sought to describe sexual behaviour and practices among adolescent blood donors as well as the contextual factors shaping such behaviour. In this qualitative study, 10 adolescent participants and four key informants were purposively selected. Semi-structured interviews were carried out in 2013 in both Harare and Masvingo, Zimbabwe. Data were categorised both manually and using the NVivo software before thematic analysis was undertaken. All except one adolescent participant were regular donors. The number of previous donations given ranged from one to nineteen. Key informants had between two and 27 years' experience of working in HIV-related clinical and counselling services. The majority (n=7) of adolescent blood donors were practising sexual abstinence. Social status of being blood donors, together with the knowledge that all donated blood is tested for HIV were protective against risky sexual behaviour. However, socio-economic and cultural factors were reported to override this protective effect. Half the number of adolescent participants reported acceptability of unprotected sex if they had sex with other blood donors, as they perceived a low risk of HIV infection in these individuals. Contextual factors; including gender and age imbalances, economic deprivation, partying, pressure for sex on female students from some male lecturers who promise them good grades, inaccessibility of condoms and lack of practical skills on condom use may put adolescent donors at risk of HIV. Socio-economic and cultural factors make it difficult for adolescent donors to make safe behaviour choices. This suggests that behavioural change models (ABC model), are unlikely to be effective in reducing HIV incidence in this group. Ensuring financial security, especially among female adolescents, acknowledging adolescents as sexually active beings and making them aware of the risk of other STIs which may be prevented by using condoms are likely to have an impact in ensuring a safe and consistent pool of adolescent blood donors in Zimbabwe.
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