Page 184 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 7 Original Research

Challenges to HIV treatment adherence amongst

adolescents in a low socio-economic setting

in Cape Town

Authors: Background: Despite the successful rollout of anti-retroviral therapy (ART) and steep declines
Brian E. van Wyk 1 in HIV incidence in South Africa, this has not been the case for adolescents (10–19 years).
Lee-Ann C. Davids 1
Adolescents on HIV treatment have lower rates of viral load suppression and adherence
Affiliations: compared to adults and children.
1 School of Public Health,
Faculty of Community and Objectives: This article reports on the adherence challenges faced by adolescents
Health Sciences, University receiving ART in a primary health care clinic in a low socio-economic urban setting in
of the Western Cape, Cape Town.
Cape Town, South Africa
Method: An exploratory qualitative design was employed where data were collected
Corresponding author:
Brian van Wyk, through four focus group discussions with adolescents (n = 15) who received ART at a
[email protected] primary health care clinic in a low socio-economic urban setting in Cape Town and followed
up with eight individual, semi-structured interviews with two adolescents from each focus
Dates: group. Two key informant interviews were conducted with health workers at the clinic.
Received: 26 June 2019
Accepted: 24 July 2019 Audio data were digitally recorded and transcribed verbatim. Data were analysed using
Published: 28 Oct. 2019 content analysis.
How to cite this article: Results: School commitments, strained teacher–learner relationships, negative household
Van Wyk BE, Davids L-AC. dynamics and ill treatment by non-biological caregivers were reported as major barriers to
Challenges to HIV treatment adherence. In addition, poor service delivery, missing or misplaced files and long waiting
adherence amongst
adolescents in a low times came under major criticism. Fear of unintended disclosure of HIV status, stigma and
socio-economic setting in discrimination, treatment fatigue and having unstructured lives negatively influenced
Cape Town. S Afr J HIV Med. adherence. Having a strong social support system and having life goals and ambitions were
2019;20(1), a1002. https:// motivators to remain adherent.
doi.org/10.4102/sajhivmed.
v20i1.1002 Conclusion: This study highlighted the complexity of ART adherence in the midst of juggling
Copyright: school, home life and personal life goals and aspirations. Interventions to improve adherence
© 2019. The Authors. should address psychosocial factors such as treatment fatigue, disclosure and family and
Licensee: AOSIS. This work household dynamics, in addition to streamlining service delivery between the school and
is licensed under the clinic.
Creative Commons
Attribution License. Keywords: HIV; AIDS; adolescents; youth; adherence.

Introduction

Background
Globally, there are 2.1 million adolescents (10–19 years) estimated to be living with HIV in 2016,
which accounts for 6% of all people living with HIV. The successful scale-up of antiretroviral
1
therapy (ART) and Prevention of Mother To Child Transmission (PMTCT) programmes has led to
the improved survival of perinatally infected children – who are now the ‘first generation’ of
2
children with HIV entering adolescence. Despite improved access to ART and steep declines in
HIV incidence and HIV-related mortality globally, HIV-related mortality amongst adolescents
(15–19 years) has increased by about 50% between 2005 and 2012. 3,4

In 2015, HIV was the second leading cause of mortality amongst adolescents globally and the
5
Read online: leading cause of mortality in sub-Saharan Africa. The World Health Organization (WHO)
Scan this QR argues that the reason for this statistic is partly because of insufficient prioritisation of
code with your adolescent health in national health programmes, poor provision of appropriate HIV testing
smart phone or
mobile device and counselling (HCT) services and substandard follow-up care for adolescents who test
to read online.
HIV positive and who require ART. Further, it is widely reported that even when adolescents
4
http://www.sajhivmed.org.za 177 Open Access