'They Can Stigmatize You': A Qualitative Assessment of the Influence of School Factors on Engagement in Care and Medication Adherence among Adolescents with HIV in Western Kenya

School-related factors may influence retention in care and adherence to antiretroviral therapy (ART) among adolescents with human immunodeficiency virus (HIV). We analyzed data from in-depth interviews with 40 adolescents with HIV (aged 14-19 years), 40 caregivers of adolescents with HIV, and 4 focu...

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Published in:Health education research 2022-09, Vol.37 (5), p.355-363
Main Authors: Wiggins, Lisa, O'Malley, Gabrielle, Wagner, Anjuli D, Mutisya, Immaculate, Wilson, Kate S, Lawrence, Sarah, Moraa, Hellen, Kinuthia, John, Itindi, Janet, Muhenje, Odylia, Chen, Tai-Ho, Singa, Benson, Mcgrath, Christine J, Ngugi, Evelyn, Katana, Abraham, Ng'ang'a, Lucy, John-Stewart, Grace, Kholer, Pamela, Beima-Sofie, Kristin
Format: Article
Language:English
Subjects:
Acquired Immunodeficiency Syndrome (AIDS)
Adolescents
Caregivers
Clinics
Compliance (Psychology)
Drug Therapy
Educational Environment
Foreign Countries
Health Services
Original
Patients
Peer Influence
Peer Relationship
Social Discrimination
Teacher Attitudes
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Summary:School-related factors may influence retention in care and adherence to antiretroviral therapy (ART) among adolescents with human immunodeficiency virus (HIV). We analyzed data from in-depth interviews with 40 adolescents with HIV (aged 14-19 years), 40 caregivers of adolescents with HIV, and 4 focus group discussions with healthcare workers to evaluate contextual factors affecting adherence to ART and clinic attendance among adolescents, with a focus on the school environment. Informed by Anderson's Model of Health Services Utilization, transcripts were systematically coded and synthesized to identify school-related themes. All groups identified the school environment as a critical barrier to engagement in HIV care and medication adherence for adolescents with HIV. Adolescent participants reported inflexible school schedules and disclosure to school staff as the biggest challenges adhering to clinic appointments and ART. Adolescents described experiencing stigma and discrimination by peers and school staff and would adjust when, where and how often they took ART to avoid inadvertent disclosure. Boarding school students faced challenges because they had limited private space or time. Caregivers were often instrumental in navigating school permissions, including identifying a treatment supporter among school staff. Additional research engaging school staff may guide interventions for schools to reduce stigma and improve adherence and retention.
ISSN:0268-1153
1465-3648
1465-3648
DOI:10.1093/her/cyac018