“We need our own clinics”: Adolescents’ living with HIV recommendations for a responsive health system

Woollett, Nataly; Pahad, Shenaaz; Black, Vivian

doi:10.1371/journal.pone.0253984

Cited by 18 publications

(20 citation statements)

References 64 publications

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“…Experiences of stigma, and acts of discrimination, exist within life contexts, as well as a larger web of socio-cultural experiences and inequities. For example, a recent systematic review found that poor health outcomes of adolescents living with HIV were related to anticipated stigma, internalized stigma and stigma experienced when accessing healthcare [16]. Similarly, a more comprehensive view of gender identities has increased, and studies have highlighted stigma experienced by cis-and transgender people [17,18].…”

mentioning

confidence: 99%

Addressing stigma and discrimination at scale: uniting for a common vision while acknowledging local realities

Stackpool-Moore

Nkosi²,

Zulu³

et al. 2022

J Int AIDS Soc.

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mentioning

confidence: 99%

Addressing stigma and discrimination at scale: uniting for a common vision while acknowledging local realities

Stackpool-Moore

Nkosi²,

Zulu³

et al. 2022

J Int AIDS Soc.

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“…The perception and internalization of HIV-related stigma, coupled with the lack of supportive social relationships from HCPs, can lead to increased substance use, decreased general psychological health, and decreased engagement in healthcare. ALHIV tend to have mental health challenges that impact negatively on adherence and retention in care and health systems that appreciate this reality may be more responsive to it [ 49 , 58 ]. ALHIV need more reliable care and HCPs have a unique opportunity to provide supportive, comprehensive care, and try to understand their patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…Healthcare providers were open about their lack of capacity to provide adolescent‐friendly services, which were either non‐existent or poorly implemented in HIV treatment facilities, as well as the non‐complementarity between school programs and adolescent HIV treatment programs. Lack of skilled staff to manage ALHIV and weak implementation of adolescent‐friendly services is a leading challenge in structural efforts to improve holistic adolescent HIV care services in LMICs [ 68 , 69 ]. The need to integrate the school needs of ALHIV into their treatment programs cannot be overemphasized.…”

Section: Resultsmentioning

confidence: 99%

“…The need to integrate the school needs of ALHIV into their treatment programs cannot be overemphasized. It is important to promote differentiated service delivery care for ALHIV with multi‐month prescription of ART for treatment stable ALHIV, individualized treatment plans for unstable patients, taking into consideration their school schedules [ 68 , 69 ]. Some countries in SSA lack national guidelines on treatment and care for ALHIV.…”

Section: Resultsmentioning

confidence: 99%

Health‐related needs reported by adolescents living with HIV and receiving antiretroviral therapy in sub‐Saharan Africa: a systematic literature review

et al. 2022

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Introduction Adolescents living with HIV (ALHIV) on antiretroviral therapy (ART) have specific health needs that can be challenging to deliver. Sub‐Saharan Africa (SSA) is home to 84% of the global population of ALHIV, of whom about 59% receive ART. Several studies in SSA have demonstrated health service gaps due to lack of synchronized healthcare for ALHIV receiving ART. We conducted a systematic review of health‐related needs among ALHIV on ART in SSA to inform decisions and policies on care. Methods We searched MEDLINE, Web of Science, EMBASE, PsycINFO, Cochrane library and grey literature for studies reporting health‐related needs among ALHIV receiving ART in SSA, between January 2003 and May 2020. Results and discussion Of the 2333 potentially eligible articles identified, 32 were eligible. Eligible studies were published between 2008 and 2019, in 11 countries: Zambia (7), Uganda (6), Tanzania (4), South Africa (4), Kenya (3), Ghana (2), Zimbabwe (2), Rwanda (1), Malawi (1), Botswana (1) and Democratic Republic of Congo (1). Seven categories of health needs among ALHIV were identified. In descending order of occurrence, these were: psychosocial needs (stigma reduction, disclosure and privacy support, and difficulty accepting diagnosis); dependency of care (need for family and provider support, and desire for autonomy); self‐management needs (desire for better coping strategies, medication adherence support and reduced ART side effects); non‐responsive health services (non‐adolescent friendly facility services and non‐compatible school system); need for food, financial and material support; inadequate information about HIV (desire for more knowledge to fight misinformation and misconception); and developmental and growth needs (desire to experience sex, parenthood and love). Ecological analysis identified different priority needs between ALHIV, their caregivers and healthcare providers, including psychosocial needs, financial challenges and non‐responsive health services, respectively. Conclusions To respond effectively to the health needs of ALHIV and improve ART adherence, interventions should focus on stigma reduction, disclosure challenges and innovative coping mechanisms for ART. Interventions that address the health needs of ALHIV from the perspective of carers and providers, such as financial support schemes and adolescent‐friendly healthcare strategies, should supplement efforts to improve adolescent ART adherence outcomes.

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“We need our own clinics”: Adolescents’ living with HIV recommendations for a responsive health system

Cited by 18 publications

References 64 publications

Addressing stigma and discrimination at scale: uniting for a common vision while acknowledging local realities

Addressing stigma and discrimination at scale: uniting for a common vision while acknowledging local realities

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

Health‐related needs reported by adolescents living with HIV and receiving antiretroviral therapy in sub‐Saharan Africa: a systematic literature review

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