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Introduction: Efficacious antiretroviral treatment (ART) enables people to live long and healthy lives with HIV but young people are dying from AIDS-related causes more than ever before. Qualitative evidence suggest that various forms of HIV-related discrimination and resulting shame act as profound barriers to young people's engagement with HIV services. However, the impact of these risks on adolescent retention in HIV care has not been quantified. This study has two aims: (1) to examine whether and how different types of discrimination compromise retention in care among adolescents living with HIV in South Africa; and (2) to test whether internalized stigma mediates these relationships. Methods: Between 2014 and 2017, adolescents living with HIV (aged 10 to 19) from 53 health facilities in the Eastern Cape, South Africa, were interviewed at baseline (n = 1059) and 18-month follow-up (n = 979, 92.4%), with responses linked to medical records. Data were analysed through multiple regression and mediation models. Results: About 37.9% of adolescents reported full retention in care over the 2-year period, which was associated with reduced odds of viral failure (OR: 0.371; 95% CI: .224, .614). At baseline, 6.9% of adolescents reported discrimination due to their HIV status; 14.9% reported discrimination due to HIV in their families and 19.1% reported discrimination in healthcare settings. Healthcare discrimination was associated with reduced retention in care both directly (effect: -0.120; CI: -0.190, -0.049) and indirectly through heightened internalized stigma (effect: 0.329; 95% CI: 0.129, 0.531). Discrimination due to family HIV was associated with reduced retention in care both directly (effect: -0.074, CI: -0.146, -0.002) and indirectly through heightened internalized stigma (effect: 0.816, CI: 0.494, 1.140). Discrimination due to adolescent HIV was associated with reduced retention in care only indirectly, through increased internalized stigma (effect: 0.408; CI: 0.102, 0.715). Conclusions: Less than half of adolescents reported 2-year retention in HIV care. Multiple forms of discrimination and the resultant internalized stigma contributed to this problem. More intervention research is urgently needed to design and test adolescent-centred interventions so that young people living with HIV can live long and healthy lives in the era of efficacious anti-retroviral treatment. Keywords: HIV; stigma; discrimination; adolescent; retention; adherence, 1 | INTRODUCTION There are 1.8 million adolescents living with HIV globally, of whom 1.5 million (85%) are in Sub-Saharan Africa [1]. At a time when efficacious antiretroviral treatment (ART) [...]

Introduction: There are two million HIV-positive adolescents in southern Africa, and this group has low retention in care and high mortality. There is almost no evidence to identify which healthcare factors can improve adolescent self-reported retention. This study examines factors associated with retention amongst antiretroviral therapy (ART)-initiated adolescents in South Africa. Methods: We collected clinical records and detailed standardized interviews (n = 1059) with all 10- to 19 year-olds ever initiated on ART in all 53 government clinics of a health subdistrict, and community traced to include lost-to-follow-up (90.1% of eligible adolescents interviewed). Associations between full self-reported retention in care (no past-year missed appointments and 85% past-week adherence) and health service factors were tested simultaneously in sequential multivariate regression and marginal effects modelling, controlling for covariates of age, gender, urban/rural location, formal/informal housing, maternal and paternal orphanhood, vertical/horizontal HIV infection, overall health, length of time on ART and type of healthcare facility. Results: About 56% of adolescents had self-reported retention in care, validated against lower detectable viral load (AOR: 0.63, CI: 0.45 to 0.87, p = 0.005). Independent of covariates, five factors (STACK) were associated with improved retention: clinics Stocked with medication (OR: 3.0, CI: 1.6 to 5.5); staff with Time for adolescents (OR: 2.7, CI: 1.8 to 4.1); adolescents Accompanied to the clinic (OR: 2.3, CI: 1.5 to 3.6); enough Cash to get to clinic safely (OR: 1.4, CI: 1.1 to 1.9); and staff who are Kind (OR: 2.6, CI: 1.8 to 3.6). With none of these factors, 3.3% of adolescents reported retention. With all five factors, 69.5% reported retention. Conclusions: This study identifies key intervention points for adolescent retention in HIV care. A basic package of clinic and community services has the potential to STACK the odds for health and survival for HIV-positive adolescents. Keywords: adolescent; HIV; delivery of healthcare; medication therapy management; adolescent health services; viral load, 1 | INTRODUCTION Two million HIV-positive adolescents (aged 10 to 19) live in Sub-Saharan Africa, both horizontally and vertically infected. This age group has the lowest rates of retention in [...]

Drawing upon a sample of 1,599 adults caring for children in HIV-endemic Umlazi Township in South Africa, this cross-sectional survey investigated whether perceived social support varied among caregivers of AIDS-orphaned children (n = 359) as compared with caregivers of children orphaned by other causes (n = 171) and caregivers of nonorphaned children (n = 1,069). Results of multivariate linear regressions indicate that caregivers of AIDS-orphaned children reported significantly lower levels of social support compared with caregivers of other-orphaned children and nonorphaned children independent of socio-demographic covariates. Caregivers of other-orphaned and nonorphaned children reported similar levels of social support. In terms of sources of support, all caregivers were more likely to draw support from family and significant others rather than friends. These findings indicate a need to develop interventions that can increase levels of social support for caregivers of AIDS-orphaned children, particularly networks that include friends and significant others. (Contains 3 tables.)

In the midst of a generalised HIV and AIDS epidemic in southern Africa, the argument for more coordinated and comprehensive youth sexual health interventions is intensifying. Yet the crucial question of "how best" to provide young people with these skills and knowledge remains a key challenge for policy-makers, researchers and practitioners in our region. Moreover, amongst the available literature on sex education in southern Africa, few authors have taken an applied perspective, to look at fresh approaches and tools with the potential to be implemented more broadly. This paper argues for a greater focus on concepts of masculinity and sexuality in the development of sexual health efforts in southern Africa. It aims to bridge theory and practice by advancing six promising approaches with the potential to create a suitable space and environment for participants to engage with these issues. Approaches include methods and tools currently being implemented in existing programmes, as well as ideas emerging from recent literature. Our paper is ultimately a call for further "out-of-the-box" thinking to find more effective and creative practical ways of providing the sexual health education our region's youth urgently needs. It is also a call for more applied research, to better inform future sex education programmes in southern Africa. (Contains 1 table.)

Author(s): Marisa Casale [sup.1] [sup.2] , Lauren Wild [sup.2] , Lucie Cluver [sup.3] [sup.4] , Caroline Kuo [sup.4] [sup.5 ] [sup.6] Author Affiliations: (1) grid.16463.36, 0000000107234123, Health Economics and HIV [...]

Community violence is a prevalent form of interpersonal violence in South Africa for children living in low-income areas. Trauma arising from violence exposure is of concern in contexts where access to treatment is often unattainable. As simultaneous multisectoral strategies show higher potential to counter interpersonal violence than single interventions, the World Health Organization with partners created INSPIRE. INSPIRE takes an integrated approach coordinated across formal and informal settings of civil and private society. Responding to research paucity on methods that counter community violence in LMIC settings, this study employed a cross-sectional correlational design consisting of a sample of 2,477 children aged 10 to 17 years from the Young Carers 2009–2010 study conducted in a low-income, HIV-endemic province of South Africa highly affected by community violence. Multiple logistic regressions assessed individual and dose associations between four INSPIRE-based violence prevention strategies—positive parenting, basic necessities, formal social support, and school structural support—and direct and indirect community violence outcomes. Three strategies had significant associations with community violence outcomes: necessities (direct p <.001; adjusted odds ratio [AOR] =.57; indirect p <.01; AOR =.62), formal support (direct p <.05; AOR =.83; indirect p <.05; AOR =.73), and school support (direct p <.001; AOR =.53; indirect p <.001; AOR =.49). Combined interventions in direct and indirect community violence analyses demonstrated that children reporting a higher number of strategies were less likely to have experienced community violence. This outcome extends the results of longitudinal studies in South Africa highlighting social protection with care as a means to overcome structural deprivation strains, thereby reducing the likelihood of children's exposure to community violence. Moreover, these findings uphold the INSPIRE model as an effective cross-sectoral approach to prevent and reduce the community violence that children experience. [ABSTRACT FROM AUTHOR]

Despite ample evidence of the protective role of social support for mental and physical health, key gaps remain in our understanding of the pathways and mediating processes explaining these relationships in specific vulnerable populations. The author applies a theoretical framework developed by House et al. to qualitative data, collected with 24 caregivers of children living in HIV-endemic South African communities, to explore potential effects and processes linking social support to health. The data used for this analysis were part of a sequential mixed-methods research study with caregivers of children; previous survey findings (n = 2,477) showed significant associations between more social support and better mental health and self-reported physical health. Results point to multiple pathways and biopsychosocial mediating processes possibly explaining the support–health relationship. The author develops an exploratory model to illustrate these findings, based on the House et al. framework, and discusses implications for research, interventions, and theory. [ABSTRACT FROM AUTHOR]

Although declining in all other age groups, AIDS-related deaths among adolescents are increasing. In the context of HIV, mental health problems are associated with negative health outcomes, including non-adherence to life-saving ART. For effective programming it is essential to identify factors associated with psychological outcomes in this population. Adopting a socioecological perspective, we aimed to identify correlates of internalising and externalising symptoms in a large, representative sample of South African adolescents living with HIV. HIV-positive adolescents (n = 1060), who received care in public health facilities in South Africa's Eastern Cape, completed measures of internalising and externalising symptoms. Hypothesised correlates included HIV and health-related factors (physical health, mode of infection, medication sideeffects, disclosure, stigma), health-service related factors (negative interactions with clinic staff, clinic support group), interpersonal factors (abuse, bullying victimisation, social support), parenting-related factors (orphanhood, positive parenting, parental monitoring, parent communication), as well as individual and demographic-related factors (self-efficacy, age, gender, urban/rural location, poverty). Correlates operating across a variety of contexts were identified. Bullying victimisation, self-efficacy, and positive parenting may be particularly salient intervention targets as they were associated with better outcomes on most or all mental health measures, can be addressed without directly targeting adolescents living with HIV (reducing the chances of accidental exposure and stigma), and are associated with better adolescent mental health in South Africa more generally. [ABSTRACT FROM AUTHOR]