Page 188 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 5 of 7 Original Research

disclose their HIV status or that they are on treatment to I am tired of taking it they encourage me to continue. They
friends, even when they sleep over: always check if I take my treatment and they will notice that I
am not taking it. We are such a close family but I am closer with
‘I don’t want to disclose my [HIV] status to my neighbour or to my mother.’ (Group 4, male, 16)
my friends. I want to disclose my status only to my family.’
(Group 3, female, 17) ‘Yah because I feel like I am free, even when he [my friend] visits
my place or I visit his place I feel free to take my medication.
Furthermore, some of the younger participants did not When I am sleeping over at his place, when I say I am going to
disclose their status because their parents forbade them to do take my pills he understands and even remind me some days.’
so. This may be because if an adolescent discloses their HIV (Group 4, male, 18)
status they may also indirectly be disclosing their parent’s Discussion
HIV status:
‘Because my mother told me that I must not tell anyone [about my The findings of our study indicate three extended themes,
HIV status].’ (Group 1, female, 10) namely the conflict between the school and clinic, the need
for HIV-competent households and adolescent-friendly HIV
‘They [my parents] prohibit us from talking about it [our HIV status].’
(Group 2, male, 14) services.

Many participants felt that no harm would come to them if Conflict between school and clinic
they miss taking their medication on occasions. They would The importance of keeping adolescents living with HIV in
rather have fun with friends and have unplanned sleepovers school has been expressed by researchers and social
following parties than come home to take their medication. activists, because education reduces the vulnerability of
The participants reported that they do not make provision girls and instils hopefulness for the future in all
to take their medication with them in the event of social adolescents. 14,15,16 It is thus concerning that this study reports
functions:
conflicted commitments to school attendance and making
‘There are times when there is a party somewhere and my clinic appointments. In addition, the need to communicate
friends will be attending and I also have to go with them. In attending regular clinic visits to teachers posed a significant
those instances we come home the following day, and I will barrier to attending regular clinic follow-ups as they feared
miss my pills. Those gatherings are fun, I can’t leave fun mos.’
(Group 4, male, 18) unintended disclosure which may potentially lead to stigma
and discrimination. The findings of the study are in keeping
‘Sometimes, like holiday like December like its few party. And with the literature which suggests that mainstream schooling
so like if I was at a party with friends, like maybe I am whatever may not necessarily always have a positive impact on
place with my friends but my friends did not know I was
HIV positive. So when it was 9 o’clock it was difficult to just adherence. In this study, the routine of schooling also made
leave. So I would just think argh, so what if I don’t take them, clinic visits difficult and some participants felt that their
nothing will change I will just take them on another day.’ frequent absences may lead to unintended disclosure of their
(Group 3, female, 15) HIV status. It is well documented that if adolescents disclose
their status to a trustworthy person or people, they are more
Some participants reported feelings of being alone and not likely to receive help in the form of knowledge and resources
normal or dirty because they were HIV positive and have to to help them cope with a HIV diagnosis and to access and
4,5
take medication: remain in HIV care. We recommend that educators should
‘To be like a normal person, when I am taking these ARVs I don’t be sensitised – HIV competent – to handle HIV disclosure of
feel like a normal person because everybody does not drink learners with sensitivity and understanding.
these pills. I feel like I am the only one here that drinks these
pills.’ (14-year-old male) HIV-competent households
‘… It is me alone at my home that is drinking the medication and A lack of financial support and negative household dynamics
that it makes me … it makes me feel very lonely.’ (14-year-old male)
were found to have a negative impact on ART adherence.
‘Not now like last year a lot because I feel bored and I feel no The findings of the study are thus in keeping with the
future. I am dirty I feel like I take the pills to the toilet and flush literature on the positive effects of financial support and/or
[the pills].’ (Group 3, female, 15)
income security of households on adherence amongst
adolescents. 4,15 In our enquiry, negative household dynamics
Facilitators of adherence had a detrimental effect on reported ART adherence. Some

Receiving social support from family members, particularly participants reported feeling like outcasts in their family as a
siblings, and friends encouraged participants to remain result of being the only family member who was HIV
adherent to their ART: positive and on treatment. This was also the reason they
gave for sometimes feeling like ending their lives by not
‘Okay we are four, it’s me, my mom, and my two sisters. But
I am close to my mom. Me and my big sister we quarrel a lot, taking their medication. The findings are in keeping with the
even out of nothing. She knows about my treatment but when literature that identifies parenting and family dynamics as
we have fights she doesn’t say anything about it, even when playing a pivotal role in facilitating adherence to ART. 4,17,18

http://www.sajhivmed.org.za 181 Open Access