Stigma and mental health challenges among adolescents living with HIV in selected adolescent-specific antiretroviral therapy clinics in Zomba District, Malawi

Abstract

Background Of the 1.8 million adolescents between the ages of 10 and 19 living with HIV globally in 2020; approximately 1.5 million of these live in sub-Saharan Africa. These adolescents living with HIV (ALHIV) are at higher risk of experiencing mental health problems than those without; in Malawi, 18.9% have a depressive disorder. ALHIV can face numerous psychosocial challenges, but little is known about how ALHIV in Malawi perceive these stressors. Understanding psychosocial challenges of ALHIV is a key step in ensuring good mental health care. The aim of this study was to assess the psychosocial challenges faced by ALHIV attending adolescent-specific ART program in Zomba, Malawi. Methods Between April and May 2019, we engaged a purposive sample of ALHIV ages 12–18 (n = 80) in a series of eight focus groups drawing from four Teen Clubs linked to an adolescent-specific ART program. Data were analyzed inductively and deductively to identify themes related to ALHIV psychosocial experiences. Results Two themes that emerged from the study include: 1) stigma and discrimination within communities and families; 2) non-adherence to medications. HIV-related stigma was associated with increased psychological distress; physical and emotional/verbal abuse; low social support, isolation, and a feeling of rejection; and risky health behaviors such as medication hiding and non-adherence to ART. Discriminatory actions were manifested in a form of being given separate utensils for their meals and mistreatment at school. Furthermore, some parents did not allow their children to play with the participants out of fear that HIV transmission. Conclusions Stigma and discrimination are overlooked potential barriers to HIV treatment and care. If HIV services are to effectively meet ALHIVs' needs, mental health interventions are needed to prevent and manage depression and improve adherence to ART. These findings highlight the crucial need to develop culturally relevant mental interventions aimed at helping ALHIV to cope with these diverse challenges.

Predicting Lost to Follow-Up Status Using an Adolescent HIV Psychosocial Attrition Risk Assessment Tool: Results From a Mixed Methods Prospective Cohort Study in Uganda

“…13,[29][30][31] Although we did not develop a tool that is able to predict LTFU among adolescents within 5 months, our tool does assess a range of psychosocial issues that affect adolescents in HIV care, including stigma, mental health, and HIV disclosure among others, and highlighted concerns about issues such as food security, stigma, and distance to care that were shared across the board by participants. 32,33 Despite the APARA tool not being able to predict LTFU after 5 months, the tool was useful for identifying psychosocial issues experienced by study participants and highlighting the challenges faced by participants. Additional exploration of common issues, including missing a meal in the past 30 days, not being enrolled in school, feeling a need to hide ARVs for fear of disclosing, and missing a dose of ARVs in the past 30 days, is warranted, along with considerations for HIV programs to address these challenges as part of comprehensive HIV care for adolescents.…”

“…13,29–31 Although we did not develop a tool that is able to predict LTFU among adolescents within 5 months, our tool does assess a range of psychosocial issues that affect adolescents in HIV care, including stigma, mental health, and HIV disclosure among others, and highlighted concerns about issues such as food security, stigma, and distance to care that were shared across the board by participants. 32,33…”

“…Furthermore, feelings of isolation or a lack of social support can affect nonadherence to ART including hiding medications for fear of disclosure, which was experienced by many in the study. 33 If adolescents are not comfortable openly taking their ARVs, they may also be unlikely to attend their appointments, thus putting them at risk of nonadherence and becoming LTFU.…”

Hotspots and determinants of women’s discriminatory attitude towards people living with HIV; evidence from ethiopian demographic and health survey data

“…Stigma and discrimination within communities and families has adverse consequences including non-adherence to medications, increased psychological distress; physical and emotional/verbal abuse; low social support, isolation; and risky health behaviors such as medication hiding [ 11 ]. Moreover, stigma and discrimination is incriminated as a major barrier for the success of HIV prevention and care programs [ 6 ].…”