“Your status cannot hinder you”: The importance of resilience among adolescents living with HIV in Kenya

Thesis (Master's)--University of Washington, 2021Background: There are approximately 110,000 adolescents living with HIV (ALHIV) in Kenya, of whom 40% have not achieved viral suppression. Despite the increasing availability of adolescent-friendly services, adolescents face barriers, such as widespread stigma, that impact adherence to ART. 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 from the Adolescents Living with HIV Research Project conducted by LVCT Health, a Kenyan organization with a programmatic focus on HIV testing, prevention, and care, and gender-based violence. A total of 122 participants were recruited from 3 clinical sites affiliated with LVCT Health in Nairobi, Kisumu, and Mombasa. In-depth interviews (IDIs) were conducted with ALHIV (n = 12). Focus group discussions (FGDs) were conducted with ALHIV (n = 5), peer leaders (n = 3), and adolescents in the community (AIC) irrespective of HIV status (n = 3). IDIs and FGDs were audio recorded, translated, and transcribed. Data were analyzed thematically, with a focus on stigma and resilience. Results: While AIC and peer leaders focused heavily on adherence barriers and stigma, ALHIV moved beyond stigma to identify resilience factors that enabled them to 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 the 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 level of resilience. Strengths-based interventions, focused on increasing resilience among ALHIV in Kenya, as well as more formal involvement of adolescent peers to bolster adolescent support, have the potential to improve ART adherence among ALHIV