Portraits of HIV: a pilot photovoice study of adolescent experiences with HIV treatment in South Africa

Abstract

# Background Adolescents are one of the fastest growing groups of people living with HIV (PLWH) in South Africa. They are also more likely than PLWH in other age groups to report poor adherence to antiretroviral therapy (ART). This trend is likely due to a confluence of factors including life stage and transition from child to adult care. Solutions are urgently needed to support adolescent adherence, since ART can improve the lives of PLWH and limit HIV transmission. We explored adolescents’ facilitators and barriers to ART adherence via photovoice, to pilot the method with South African youth and gain information to inform future interventions. # Methods The pilot study included three Photovoice groups, with 10 adolescents, who were enrolled in ART at two urban public primary health care centres in the Western Cape province of South Africa. Groups were organized by age and sex (group 1: 10-14 years, girls; group 2: 15-19 years, girls; group 3: 15-19 years, boys). Participants were given cell phones with cameras, and instructed to take pictures representing their experiences with HIV and treatment. # Results Youth’s pictures and discussions focused on four key themes related to treatment and ART adherence. These themes included motivations for taking medicine, forming an identity with HIV, managing disclosure and treatment, and relationships between living conditions and HIV treatment. Treatment motivation was informed by familial support. Themes shed light on participants’ challenges and resilience in the face of HIV. # Conclusion Adolescents found expressing their views through photos ‘exciting’ and were encouraged to share personal meanings in discussion with peers and researchers. Older adolescents needed less direction and encouragement than younger adolescents, to fully participate in photo-taking and discussions. Findings pave the way for future, larger Photovoice studies. Themes reiterate the importance of personal motivation including aspects of positive identity with HIV in helping youth adhere to medicine, as well as the need to address relational (e.g. family, disclosure) and structural (e.g. living conditions) factors in adherence interventions for this age group. Despite challenges, youth also have strengths (e.g. desire to commit to treatment) that interventionists can capitalize on to support adolescent treatment outcomes.