Adolescents and young adults living with HIV (AYLHIV) in sub-Saharan Africa experience poorer health outcomes than adults. This study evaluates a structured support group intervention, Vhutshilo 3, to improve adherence to ART and sexual health behaviors of AYLHIV in South Africa. Self-reported pre- and post-intervention survey data was collected from a cohort of 548 participants 7.5 months apart. Results indicated short-term improvement in key outcomes including ART adherence, contraceptive use, HIV treatment knowledge, self-rated health, and school attendance. However, effects were small and many significant care and treatment gaps remained. Greater emphasis on addressing barriers to adherence and self-management of HIV may yield more clinically significant outcomes.

A high number of young people in South Africa are living with HIV, and many engage in unprotected sex, increasing their risk of acquiring other sexually transmitted infections and transmitting HIV. This study aimed to identify factors associated with condom use among sexually active adolescents and young adults living with HIV (AYLHIV) in South Africa. Important factors identified as unique to AYLHIV include: disclosure, HIV-related mistreatment and ART adherence. Disclosure to their sexual partner was associated with higher odds of condom use, whereas recent HIV-related mistreatment was associated with lower odds. Careful consideration of disclosure is needed as it may not always mitigate sexual risk-taking and could introduce other harms, including HIV-related mistreatment. Importantly, condom use was lower among those who were not ART adherent, increasing the possibility of onward transmission. The study highlights the critical implications for both individual health and epidemic control of comprehensive sexual and reproductive health interventions tailored for AYLHIV.

The acute and unique pressures of the pandemic offer an opportunity to understand how family dynamics affect the mental health and adherence of adolescents and young adults living with HIV (AYLHIV). Pathways analyses demonstrated a direct path from experiencing life stressors to increased verbal aggression from caregivers, which led to anxiety and ultimately, poorer ART adherence. Key implications of this study are the importance of support services addressing family strengthening measures, mental health, ART adherence, parenting skills, and economic needs of HIV-affected households. Family strengthening interventions that provide parenting skills and mental health support could be crucial to improving AYLHIV adherence.

Adolescents and young adults living with HIV (AYLHIV) in South Africa often have lower adherence to ART compared to other age groups, which often hinders the self-management of HIV for this population. This study aimed to identify patterns associated with ART adherence below a 90% threshold. Using latent class analysis, a sample of 857 HIV-positive youth on ART were placed into subgroups based upon self-reported reasons for missed ART doses. The subgroup reporting multiple barriers like forgetting, feeling sick, worrying about side effects, or doubting effectiveness of ART had three-times lower odds of reporting good ART adherence than subgroups with only one or more barriers . Barriers such as concerns about side effects and lack of belief in ART efficacy were unique to this group. Simple tools could be used to identify both AYLHIV with co-occurring barriers to ART adherence and individuals who may benefit from targeted interventions. Results also suggest adult accompaniment to clinics, use of youth friendly services and contextual factors would also support AYLHIV adherence.

Adolescence is characterized by rapid expansion of social networks, lending to heightened considerations for HIV status disclosure among adolescents and young adults living with HIV (AYLHIV). This is of particular concern in South Africa where HIV stigma is prevalent. Using survey data from 1,186 AYLHIV in South Africa, this study investigates HIV disclosure and stigma among AYLHIV in South Africa. Knowledge of HIV status from peers, teachers and/or sexual partners was associated with double the odds of a recent HIV-related mistreatment. Findings support concerns regarding status disclosure among peer networks and school environments. AYLHIV need counseling to decide when, how, and whom to disclose to, coupled with coping skills to handle stigma and other adverse reactions. They can also benefit from support managing their physical health to prevent inadvertent disclosure and discrimination.