Abstract
BackgroundAdolescents living with HIV (ALHIV) in Malawi experience multiple challenges associated with their illness and various social, environmental, economic and cultural factors. In exploring their various medical concerns and social vulnerabilities, we consider the role of multiple services in creating a pathway for resilience.MethodsMultiple methods and case studies allowed for triangulation of evidence and provided a holistic understanding of resilience among adolescents with complex needs. The research methods included: (1) a survey to identify examples of young people with complex needs, (2) qualitative interviews and field notes to further explore these needs, (3) patient files and health passports to identify clinical challenges, and (4) ecomapping exercises to personalize cases and identify resilience-enabling resources and supports. We present four case studies to highlight the complex experiences and access to services of ALHIV, and to illustrate their growing power and decision-making capacity over time.ResultsAdversity experienced by ALHIV varied by gender, family situation, years of schooling, and use of teen-clubs for support. The two female adolescents emphasised their need to be accepted and how this impacted sexuality and reproduction. The two males illustrated how ideas of masculinity influenced their sexual practice and involvement with health services and the correctional justice system. Multiple risks (alcohol use, sexual activities) and complex needs (belonging, having a purpose in life/productive activities, autonomy, desire for offspring) influence pathways to resilience. ALHIV were able to strengthen their own wellbeing by resisting negative behaviours and peer pressure and caregiver interactions through ‘strategic silence’.ConclusionALHIV experienced self-transformation as a result of taking ART, with fewer severe episodes of illness and distressing skin conditions. Continuous engagement at the teen-club clinic transformed both productive activities and social relationships among ALHIV as they set life goals, gained a sense of empowerment, requested SRH services, and formed intimate relationships. These transformative opportunities allowed them to learn ways of minimizing risk of reinfection and violence, and of navigating health worker–caregiver–adolescent interactions.
Highlights
Many adolescents, globally, experience poverty, abuse, learning difficulties, family breakdown, stigma and discrimination [1,2,3]
Data collection included the administration of the Child Youth Resilience Measure-28 (CYRM-28) to identify adolescents’ complex needs and service usage, recorded qualitative in-depth interviews, and field notes
These four Adolescents living with HIV (ALHIV) all attended at least some teen-club clinic meetings, utilised alternative health facility services, and reported that they were doing well [36, 48]
Summary
Experience poverty, abuse, learning difficulties, family breakdown, stigma and discrimination [1,2,3]. Compared with peers of the same age without a chronic illness, ALHIV have difficulties economically, socially and psychologically. This leads to Kaunda‐Khangamwa et al AIDS Res Ther (2020) 17:35 low aspirations, poor goals and a sense of failure [4,5,6]. Adolescents living with HIV (ALHIV) in Malawi experience multiple challenges associated with their ill‐ ness and various social, environmental, economic and cultural factors. In exploring their various medical concerns and social vulnerabilities, we consider the role of multiple services in creating a pathway for resilience
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