Williams, S., Renjy, J., Ghilardi, L., and Wringe, A. Journal of the International AIDS Society (September 2017), 20:21922, doi: 10.7448./IAS.21.1.21922.
This meta-analysis of 24 qualitative studies examined prominent issues that affect initiation and retention in care for adolescents living with HIV (ALHIV) in sub-Saharan Africa. All studies identified anticipated, internal, and external stigma as having significant negative impacts on receiving test results, treatment initiation and retention, and adherence. Diminished self-efficacy interfered with HIV testing and self-care behaviors, including adherence. Insufficient family support led to lack of full disclosure to ALHIV, lack of consent for ALHIV to access health services, and neglect or abuse. When available, community-based social support positively influenced engagement in the care cascade. Services that cater to ALHIV’s needs and increase retention in the care cascade include youth-friendly hours, trained health care workers, and integrated sexual and reproductive health services. Past experiences with illness also served as a reminder for ALHIV to remain adherent and engaged. Financial instability reduced ALHIV’s ability to pay for transport and food. The authors noted that mass media were effective in reaching ALHIV, but did not always translate to changed behaviors. The authors said that while there are multiple barriers for ALHIV, stigma is the most pervasive, affecting engagement in each step of the care cascade. They urged prioritizing psychosocial interventions to increase ALHIV’s engagement in care.