"Your status cannot hinder you": the importance of resilience among adolescents engaged in HIV care in Kenya

Casey Adams; Millicent Kiruki; Robinson Karuga; Lilian Otiso; Susan M Graham; Kristin M Beima-Sofie

doi:10.1186/s12889-022-13677-w

"Your status cannot hinder you": the importance of resilience among adolescents engaged in HIV care in Kenya

BMC Public Health. 2022 Jun 30;22(1):1272. doi: 10.1186/s12889-022-13677-w.

Authors

Casey Adams^{1

2}, Millicent Kiruki³, Robinson Karuga³, Lilian Otiso³, Susan M Graham^{4

5

6}, Kristin M Beima-Sofie⁴

Affiliations

¹ Department of Global Health, University of Washington, Seattle, WA, USA. cpadams992@gmail.com.
² Department of Social Work, University of Washington, Seattle, WA, USA. cpadams992@gmail.com.
³ Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya.
⁴ Department of Global Health, University of Washington, Seattle, WA, USA.
⁵ Department of Medicine, University of Washington, Seattle, WA, USA.
⁶ Department of Epidemiology, University of Washington, Seattle, WA, USA.

Abstract

Background: Approximately 40% of the 110,000 adolescents living with HIV (ALHIV) in Kenya have not achieved viral suppression. Despite the increasing availability of adolescent-friendly services, adolescents face barriers that impact ART adherence. This study aimed to identify key stigma-related barriers to ART adherence and strategies used by adolescents in overcoming these barriers.

Methods: Data were collected by LVCT Health, a Kenyan organization with a programmatic focus on HIV testing, prevention, and care. 122 participants were recruited from 3 clinical sites affiliated with LVCT Health in Nairobi, Kisumu, and Mombasa. In-depth interviews were conducted with ALHIV (n = 12). Focus group discussions were conducted with ALHIV (n = 5), peer leaders (n = 3), and adolescents receiving HIV services in community settings (AIC) irrespective of HIV status (n = 3). Interviews and focus groups were audio recorded, translated, and transcribed. Data were analyzed thematically, with a focus on stigma and resilience.

Results: While AIC primarily focused on adherence barriers and stigma, ALHIV and, to some extent, peer leaders, also identified resilience factors that helped overcome stigma. Four major themes emerged: 1) knowledge and future-oriented goals can drive motivation for ALHIV to remain healthy; 2) disclosure to others strengthens support systems for ALHIV; 3) medication-taking strategies and strategic disclosure can overcome adherence challenges in school; and 4) a supportive clinic environment promotes continuous adolescent engagement in HIV care. These concepts were used to develop a conceptual stigma/resilience model depicting how resilience moderates negative effects of stigma among ALHIV.

Conclusions: This study demonstrates the positive effects of ALHIV resilience on ART adherence and illuminates how stigma impacts ALHIV differently depending on their resilience. Strengths-based interventions, focused on increasing resilience among ALHIV in Kenya, and more formal involvement of adolescent peers to bolster adolescent support, have the potential to improve ART adherence among ALHIV.

Keywords: AIDS; Adolescents; Adolescents living with HIV; HIV; Kenya; Resilience; Stigma.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Disclosure
HIV Infections* / drug therapy
Humans
Kenya
Medication Adherence*
Social Stigma

Abstract

Publication types

MeSH terms

Grants and funding