‘Everyone has a secret they keep close to their hearts’: challenges faced by adolescents living with HIV infection at the Kenyan coast

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Abstract

Background

The upsurge in the uptake of antiretroviral therapy (ART) has led to a significant increase in the survival of vertically acquired HIV infected children, many of whom are currently living into adolescence and early adulthood. However little if anything is known of the lived experiences and the challenges faced by HIV positive adolescents in the African context. We set out to investigate psychosocial challenges faced by HIV infected adolescents on the Kenyan coast.

Methods

A total of 44 participants (12 HIV-infected adolescents, 7 HIV uninfected adolescents, and 25 key informants) took part in this qualitative study, using individually administered in-depth interviews. A framework approach was used to analyze the data using NVIVO software.

Results

We observed that the challenges faced by adolescents in rural Kenya could be placed into six major themes: poverty, poor mental and physical health, the lack of a school system that is responsive to their needs, challenges in how to disclose to peers and family members, high levels of stigma in its various forms, and challenges of medical adherence leading to the need for close monitoring.

Conclusion

In this African community, vertically acquired HIV-infected adolescents face a complex set of social, economic and medical challenges. Our study points to the urgent need to develop multisectorial intervention support programmes to fully address these challenges.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2854-y) contains supplementary material, which is available to authorized users.

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Most cited references 13

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Social protection to support vulnerable children and families: the potential of cash transfers to protect education, health and nutrition

M. Adato, Darryl L Bassett (2009)

Investing in social protection in sub-Saharan Africa has taken on a new urgency as HIVand AIDS interact with other drivers of poverty to simultaneously destabilise livelihoods systems and family and community safety nets. Cash transfer programmes already reach millions of people in South Africa, and in other countries in southern and East Africa plans are underway to reach tens and eventually hundreds of thousands more. Cash transfers worldwide have demonstrated large impacts on the education, health and nutrition of children. While the strongest evidence is from conditional cash transfer evaluations in Latin America and Asia, important results are emerging in the newer African programmes. Cash transfers can be implemented in conjunction with other services involving education, health, nutrition, social welfare and others, including those related to HIV and AIDS. HIV/ AIDS-affected families are diverse with respect to household structure, ability to work and access to assets, arguing for a mix of approaches, including food assistance and income-generation programmes. However, cash transfers appear to offer the best strategy for scaling up to a national system of social protection, by reaching families who are the most capacity constrained, in large numbers, relatively quickly. These are important considerations for communities hard-hit by HIV and AIDS, given the extent and nature of deprivation, the long-term risk to human capital and the current political willingness to act.

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Antiretroviral Therapy Outcomes among Adolescents and Youth in Rural Zimbabwe

Helen Bygrave, Judith Mtangirwa, Kwenzakwenkosi Ncube … (2012)

Around 2 million adolescents and 3 million youth are estimated to be living with HIV worldwide. Antiretroviral outcomes for this group appear to be worse compared to adults. We report antiretroviral therapy outcomes from a rural setting in Zimbabwe among patients aged 10–30 years who were initiated on ART between 2005 and 2008. The cohort was stratified into four age groups: 10–15 (young adolescents) 15.1–19 years (adolescents), 19.1–24 years (young adults) and 24.1–29.9 years (older adults). Survival analysis was used to estimate rates of deaths and loss to follow-up stratified by age group. Endpoints were time from ART initiation to death or loss to follow-up. Follow-up of patients on continuous therapy was censored at date of transfer, or study end (31 December 2008). Sex-adjusted Cox proportional hazards models were used to estimate hazard ratios for different age groups. 898 patients were included in the analysis; median duration on ART was 468 days. The risk of death were highest in adults compared to young adolescents (aHR 2.25, 95%CI 1.17–4.35). Young adults and adolescents had a 2–3 times higher risk of loss to follow-up compared to young adolescents. When estimating the risk of attrition combining loss to follow-up and death, young adults had the highest risk (aHR 2.70, 95%CI 1.62–4.52). This study highlights the need for adapted adherence support and service delivery models for both adolescents and young adults.

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Stigma, disclosure, coping, and medication adherence among people living with HIV/AIDS in Northern Tanzania.

Marijn de Bruin, Sarah Stutterheim, H Hospers … (2014)

This study examines a proposed theoretical model examining the interrelationships between stigma, disclosure, coping, and medication adherence among 158 HIV-infected patients on antiretroviral therapy (ART) in northern Tanzania. Perceived and self-stigma, voluntary and involuntary disclosure, positive and negative coping, and demographics were assessed by trained interviewers, and self-reported adherence was collected during 5 months follow-up. Data were examined using correlation and regression analyses. The analyses showed that perceived stigma is primarily related to involuntary disclosure, whereas self-stigma is related to voluntary disclosure. Religious coping positively relates to acceptance, whereas perceived stigma explains higher levels of denial of HIV status. Lastly, adherence was negatively affected by alcohol use, self-stigma, and denial. We conclude that adherence is predominantly predicted by negative rather than positive coping mechanisms. Therefore, substituting maladaptive coping mechanisms like denial and alcohol use with a more adaptive coping style may be an important strategy to improve long-term ART adherence and well-being of patients. Moreover, this study showed that it is useful to examine both involuntary and voluntary disclosure when studying its relation with stigma.

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Author and article information

Contributors

Amina Abubakar: AAbubakar@kemri-wellcome.org

Fons J. R. Van de Vijver: Fons.vandeVijver@uvt.nl

Ronald Fischer: Ronald.fischer@vuw.ac.nz

Amin S. Hassan: Ahassan@kemri-wellcome.org

Joseph K Gona: Jgona@kemri-wellcome.org

Judith Tumaini Dzombo: Jtumaini@kemri-wellcome.org

Grace Bomu: Gbomu@kemri-wellcome.org

Khamis Katana: KKatana@kemri-wellcome.org

Charles R. Newton: Cnewton@kemri-wellcome.org

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 29 February 2016

Publication date PMC-release: 29 February 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 197

Affiliations

[ ]Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya

[ ]Tilburg University, Tilburg, Netherlands

[ ]Lancaster University, Lancaster, UK

[ ]North-West University, Potchefstroom, South Africa

[ ]University of Queensland, Brisbane, Australia

[ ]Victoria University of Wellington, Wellington, New Zealand

[ ]University of Oxford, Oxford, UK

[ ]Aarhus University, Aarhus, Denmark

Article

Publisher ID: 2854

DOI: 10.1186/s12889-016-2854-y

PMC ID: 4772469

PubMed ID: 26927422

SO-VID: 5d43ed93-176b-4341-9467-00286c235c3c

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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.

History

Date received : 4 April 2015

Date accepted : 10 February 2016

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ScienceOpen disciplines: Public health

Keywords: hiv,adolescents,in-depth interviews,kenya

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ScienceOpen disciplines: Public health

Keywords: hiv, adolescents, in-depth interviews, kenya

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‘Everyone has a secret they keep close to their hearts’: challenges faced by adolescents living with HIV infection at the Kenyan coast

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Abstract

Background

Methods

Results

Conclusion

Electronic supplementary material

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HIV Self-Testing

Most cited references 13

Social protection to support vulnerable children and families: the potential of cash transfers to protect education, health and nutrition

Antiretroviral Therapy Outcomes among Adolescents and Youth in Rural Zimbabwe

Stigma, disclosure, coping, and medication adherence among people living with HIV/AIDS in Northern Tanzania.

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Cited by 39

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