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

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          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.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12889-022-13677-w.

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          Most cited references36

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          Toward an experimental ecology of human development.

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            Adolescence: a foundation for future health

            Adolescence is a life phase in which the opportunities for health are great and future patterns of adult health are established. Health in adolescence is the result of interactions between prenatal and early childhood development and the specific biological and social-role changes that accompany puberty, shaped by social determinants and risk and protective factors that affect the uptake of health-related behaviours. The shape of adolescence is rapidly changing-the age of onset of puberty is decreasing and the age at which mature social roles are achieved is rising. New understandings of the diverse and dynamic effects on adolescent health include insights into the effects of puberty and brain development, together with social media. A focus on adolescence is central to the success of many public health agendas, including the Millennium Development Goals aiming to reduce child and maternal mortality and HIV/AIDS, and the more recent emphases on mental health, injuries, and non-communicable diseases. Greater attention to adolescence is needed within each of these public health domains if global health targets are to be met. Strategies that place the adolescent years centre stage-rather than focusing only on specific health agendas-provide important opportunities to improve health, both in adolescence and later in life. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures.

              Recent analyses suggest that lack of clarity in the conceptualization and measurement of HIV stigma at an individual level is a significant barrier to HIV prevention and treatment efforts. In order to address this concern, we articulate a new framework designed to aid in clarifying the conceptualization and measurement of HIV stigma among individuals. The HIV Stigma Framework explores how the stigma of HIV elicits a series of stigma mechanisms, which in turn lead to deleterious outcomes for HIV uninfected and infected people. We then apply this framework to review measures developed to gauge the effect of HIV stigma since the beginning of the epidemic. Finally, we emphasize the utility of using three questions to guide future HIV stigma research: who is affected by, how are they affected by, and what are the outcomes of HIV stigma?
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                Author and article information

                Contributors
                cpadams992@gmail.com
                Millicent.Kiruki@lvcthealth.org
                Robinson.Karuga@lvcthealth.org
                Lilian.Otiso@lvcthealth.org
                grahamsm@uw.edu
                beimak@uw.edu
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                30 June 2022
                30 June 2022
                2022
                : 22
                : 1272
                Affiliations
                [1 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Global Health, , University of Washington, ; Seattle, WA USA
                [2 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Social Work, , University of Washington, ; Seattle, WA USA
                [3 ]GRID grid.463443.2, ISNI 0000 0004 0372 7280, Department of Research and Strategic Information, LVCT Health, ; Nairobi, Kenya
                [4 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Medicine, , University of Washington, ; Seattle, WA USA
                [5 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Epidemiology, , University of Washington, ; Seattle, WA USA
                Article
                13677
                10.1186/s12889-022-13677-w
                9245269
                35773690
                2332fb5c-05f4-4ba6-89d8-288662564193
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 31 January 2022
                : 22 June 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100006641, UNICEF;
                Award ID: KCO/LVCT Health/HIV
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100007813, Center for AIDS Research, University of Washington;
                Award ID: AI027757
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Public health
                hiv,aids,adolescents,resilience,stigma,kenya,adolescents living with hiv
                Public health
                hiv, aids, adolescents, resilience, stigma, kenya, adolescents living with hiv

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