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.

Background: Child and youth care workers (CYCWs) are a crucial and growing component of South Africa’s national response to HIV and AIDS and other issues affecting children and families. CYCWs use the community-centred Isibindi model of care to reach the most vulnerable with key services including psychosocial, health, economic and education support. Like others in similar professions, they may be at risk for occupational challenges affecting retention.

Let’s Talk is a structured, family-centered adolescent HIV prevention program developed for use in South Africa using key components adapted from programs successfully implemented in the US and South Africa. It is designed to address individual HIV transmission risk factors common among orphaned and vulnerable adolescents, including elevated risk for poor psychological health and sexual risk behavior. These efforts are accentuated through parallel programing to support caregivers’ mental health and parenting skills.

Many children in South Africa live outside of parental care due to orphanhood, parental labour migration, unemployment and unstable formal partnerships. Few studies have examined risk factors for parent-to-child physical aggression (PCPA), a term encompassing varying severities of physically aggressive acts, among children residing outside of parental care. In this context prior custody preparation is uncommon, and alternative caregivers have been found to experience high levels of psychological distress and burden. This study examined these risk factors using secondary analysis of baseline cross-sectional survey data drawn from a bereavement support group evaluation.

Preventing HIV among young people is critical to achieving and sustaining global epidemic control. Evidence from Western settings suggests that family-centred prevention interventions may be associated with greater reductions in risk behaviour than standard adolescent-only models. Despite this, family-centred models for adolescent HIV prevention are nearly non-existent in South Africa − home to more people living with HIV than any other country. This paper describes the development and formative evaluation of one such intervention: an evidence-informed, locally relevant, adolescent prevention intervention engaging caregivers as co-participants.

To our knowledge, this is the first study to document correlates of complicated grief among bereaved adolescents in sub-Saharan Africa. Participants included 339 female adolescents in South Africa who experienced the loss of a loved one at least six months prior to the survey; their primary caregivers were also surveyed. One-fifth of adolescents were classified as having complicated grief using the Inventory of Complicated Grief Revised for Children in conjunction with grief-induced functional impairment.

Background: Bereavement increases children’s risk for psychological disorders, highlighting the need for effective interventions, especially in areas where orphanhood is common. We aimed to assess the effects of an eight-session support group intervention on the psychological health of bereaved female adolescents in South Africa.

Community-based care and support programmes for orphaned and vulnerable children and their families are a critical component of HIV prevention and treatment efforts worldwide. The challenges of evaluating community-based programmes for HIV-affected families limit the evidence base for effective social work programming. Addressing these challenges can improve the validity of evaluations to provide better direction for the programme under study as well as promote best practices generally.

Children and adolescents affected by HIV are at elevated risk of depression, yet research on related interventions in this population is scarce in sub-Saharan Africa. This study sought to examine the effects of interpersonal psychotherapy for groups (IPTG) on depressive symptomology among orphaned and vulnerable adolescents in South Africa. A cluster randomized controlled trial wherein adolescents ages 14–17 enrolled in community-based programming for HIV-affected and vulnerable families were randomly assigned by geographic cluster to participate in a 16-session IPTG intervention or the standard of care (n = 489).

The objective of this study was to assess standard grief measures through cognitive interviews with bereaved adolescents in Free State, South Africa, and make recommendations designed to improve the measurement of grief in this and similar populations. Twenty-one parentally bereaved adolescents participated in semi-structured cognitive interviews about the Core Bereavement Items (CBI) questionnaire, Grief Cognitions Questionnaire for Children (GCQ-C), or Intrusive Griefs Thoughts Scale (IGTS).

HIV counseling and testing (HCT) is critical for children in generalized epidemic settings, but significant shortfalls in coverage persist, notably among orphans and others at disproportionate risk of infection. This study investigates the impact of a home visiting program in South Africa on orphaned and vulnerable children’s uptake of HCT. Using propensity score matching, survey data for children receiving home visits from trained community-based care workers were compared to data from children living in similar households that had not yet received home visits (n = 1324).

Evidence-based approaches are needed to address the high levels of sexual risk behavior and associated HIV infection among orphaned and vulnerable adolescents. This study recruited adolescents from a support program for HIV-affected families and randomly assigned them by cluster to receive one of the following: (1) a structured group-based behavioral health intervention; (2) interpersonal psychotherapy group sessions; (3) both interventions; or (4) no new interventions.