Department of Global Health, University of Washington, Seattle, WA, USA.
Department of Social Work, University of Washington, Seattle, WA, USA.
BMC Public Health. 2022 Jun 30;22(1):1272. doi: 10.1186/s12889-022-13677-w.
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.
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.
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.
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.
肯尼亚约有 110000 名感染艾滋病毒的青少年（ALHIV）中，有 40%未达到病毒抑制。尽管越来越多的青少年友好服务，但青少年面临着影响抗逆转录病毒治疗（ART）依从性的障碍。本研究旨在确定与 ART 依从性相关的关键耻辱障碍，并确定青少年克服这些障碍所采用的策略。
数据由肯尼亚组织 LVCT Health 收集，该组织的项目重点是艾滋病毒检测、预防和护理。在位于内罗毕、基苏木和蒙巴萨的 3 个与 LVCT Health 有关联的临床点招募了 122 名参与者。对 ALHIV（n=12）进行了深入访谈。与 ALHIV（n=5）、同伴领袖（n=3）和在社区环境中接受艾滋病毒服务的青少年（无论艾滋病毒状况如何，n=3）进行了焦点小组讨论。对访谈和焦点小组进行了录音、翻译和转录。对数据进行了主题分析，重点关注耻辱感和韧性。
虽然 AIC 主要关注依从性障碍和耻辱感，但 ALHIV 以及在某种程度上，同伴领袖，也确定了帮助克服耻辱感的恢复力因素。出现了四个主要主题：1）知识和面向未来的目标可以激励 ALHIV 保持健康；2）向他人透露可以加强 ALHIV 的支持系统；3）服药策略和策略性披露可以克服学校中的依从性挑战；4）支持性的诊所环境促进青少年持续参与艾滋病毒护理。这些概念被用来开发一个概念性的耻辱/韧性模型，描绘了韧性如何在 ALHIV 中调节耻辱感的负面影响。
本研究表明，ALHIV 的韧性对 ART 依从性有积极影响，并阐明了耻辱感如何根据 ALHIV 的韧性而对其产生不同的影响。以肯尼亚的 ALHIV 为重点，加强他们的韧性的基于优势的干预措施，以及更正式地让青少年同伴参与来支持青少年，有可能提高 ALHIV 的 ART 依从性。
