Multitype violence exposures and adolescent antiretroviral nonadherence in South Africa

Abstract

Objectives:HIV-positive adolescents have low-ART adherence, with consequent increased risks of mortality, morbidity, and viral resistance. Despite high rates of violence against children in the Africa region, no known studies have tested impacts on HIV-positive adolescents. We examine associations of ART adherence with adolescent violence victimization by caregivers, teachers, peers, community members, and healthcare providers.Design and methods:HIV-positive adolescents were interviewed (n = 1060), and clinic biomarker data collected. We sampled all 10–19-year olds ever ART-initiated within 53 clinics in 180 South African communities (90.1% reached). Analyses examined associations between nonadherence and nine violence types using sequential multivariate logistic regressions. Interactive and additive effects were tested with regression and marginal effects.Results:Past-week self-reported ART nonadherence was 36%. Nonadherence correlated strongly with virologic failure (OR 2.3, CI 1.4–3.8) and symptomatic pulmonary tuberculosis (OR 1.49, CI 1.18–2.05). Four violence types were independently associated with nonadherence: physical abuse by caregivers (OR 1.5, CI 1.1–2.1); witnessing domestic violence (OR 1.8, CI 1.22–2.66); teacher violence (OR 1.51, CI 1.16–1.96,) and verbal victimization by healthcare staff (OR 2.15, CI 1.59–2.93). Past-week nonadherence rose from 25% with no violence to 73.5% with four types of violence exposure.Conclusion:Violence exposures at home, school, and clinic are major and cumulating risks for adolescent antiretroviral nonadherence. Prevention, mitigation, and protection services may be essential for the health and survival of HIV-positive adolescents.

‘Yummy or crummy?’ The multisensory components of medicines-taking among HIV-positive youth

“…However, similarities also emerged. These resonated with findings from quantitative and qualitative datasets of the Mzantsi Wakho study, including the enduring effects of HIV-related stigma, and the impacts of various socio-structural determinants on adherence to ART (Cluver et al, 2016(Cluver et al, , 2018Toska et al, 2016;. Findings 'Yummy of Crummy?'…”

“…The disclosure of their HIV-status, by a nurse or family member, was often accompanied by new understandings about the illness and death of their parents and siblings. Within the quantitative sample, an estimated 75% of adolescents were perinatally infected, and 59% had lost one or both parents (Cluver et al, 2018).…”

“…I would think that the person was trying to kill me'. The Mzantsi Wakho study has investigated associations between high rates of violence and non-adherence among participants, finding that violence victimisation at home, school and clinic were strongly associated with non-adherence (Cluver et al, 2018).…”

Pesky metrics: the challenges of measuring ART adherence among HIV-positive adolescents in South Africa

“…For many, taking ART inconsistently was an experience that was difficult to convey, particularly since admissions of non-adherence were often followed by reproaches or reprimands by guardians and health providers, who viewed it as their duty to oversee, coax, and at times enforce adherence. Responses to caregivers' and healthcare workers' discoveries of non-adherence among adolescents ranged from verbal rebukes to physical threats and punishments, and took place both in homes and in clinics (Cluver et al, 2018).…”

Prevalence of physical and sexual violence and psychological abuse among adolescents and young adults living with HIV in Zambia

“…Some studies-for example, in Tanzania [18], South Africa [19,20], and Malawi [21]have assessed exposure to violence among HIV-positive youth as an independent or adjustment variable, reporting wide-ranging prevalence figures derived from widely varying measures and methodologies. Only one study was identified for which violence was the primary focus in a population of HIV-positive adolescents in SSA; this study by Cluver et al found that between 41% and 47% of the sample of 1,060 South African boys and girls (ages [10][11][12][13][14][15][16][17][18][19] reported exposure to past-year physical or verbal violence from teachers, peers, or community members [22] but did not measure IPV. While there is limited data on HIV-positive adolescents (up to age 19), there is virtually no information available on HIV-positive young men (aged 20-24 years) and violence victimization in SSA.…”