Participant characteristics
In the present study, analysis involved a total of 22 transcripts. Table 1 summarizes the basic demographic characteristics of the study participants.
Table 1: Participant demographic characteristics
Characteristic
|
Frequency (%)
|
Sex
|
|
|
Male
|
10 (45%)
|
|
Female
|
12 (55%)
|
Age
|
|
|
Range
|
18 – 24 years
|
|
Mean
|
20.7 years
|
Education level
|
|
|
None
|
1 (4%)
|
|
Primary
|
7 (32%)
|
|
Secondary
|
11 (50%)
|
|
Tertiary
|
3 (14%)
|
Religion
|
|
|
Christian
|
18 (82%)
|
|
Muslim
|
4 (18%)
|
Residence in Kilifi County
|
|
|
Peri-urban areas
|
11 (50%)
|
|
Rural areas
|
11 (50%)
|
|
|
|
|
|
Challenges faced by Young people Living with HIV
Several themes emerged in our discussions with young adults living with HIV about the challenges they face in their day to day life at different levels of the socio-ecological system. Figure 1 provides a summary of these emergent challenges as themes. Below, we present each of the reported challenges in two ways. First, we present challenges reported from a specific level of the adapted socio-ecological system i.e. individual level challenges, challenges at the family level and community level (namely the general community, school, workplace and the HIV facility). Second, we present inter-level challenges (those cutting across two or more levels). Illustrative quotes from each theme were selected for presentation through researcher consensus.
Individual level challenges
Acceptance of HIV positive status. We asked the participants whether acceptance of HIV positive status was a challenge among young adults living with HIV. Many respondents discussed how it is difficult for some young people to come into terms with an HIV positive identity with some not wanting to be told they have HIV. Notably, none of the respondents directly reported this as being a challenge to self, instead talked about it as a challenge to ‘other’ YLWH. Nonacceptance of HIV positive status contributed to non-adherence to antiretroviral medication.
There are some who will not accept and will say ‘I am this way now [living with HIV], it is better not to take those medications [antiretrovirals] and just wait to die’.
(Participant 12, Female, 18 years old).
S/he does not accept [HIV positive status] and does not want to be told they have HIV, now you get s/he no longer takes their medication [antiretrovirals].
(Participant 20, Female, 19 years old).
A few participants however reported acceptance of HIV positive identity not being a challenge from the onset. To them, acceptance was like an eye-opener helping them to think of better ways of improving their life and health. It was easy to accept being HIV positive because of reasons such as being clearly informed of how one got the virus in the first place.
For example within the community you come out and accept [being HIV positive], definitely you will have disclosed that status to several people and that also gives you the strength, you will say ‘now that I have accepted what next?’ Also, it gives your brain an allowance to think more, what can I do so that according to the state that I am in, yes, I have accepted, what will I do to sustain or improve my life, my health?
(Participant 7, Male, 19 years old)
Disclosure of HIV positive status: Many of the participants discussed how disclosure was a challenge because of trust issues, fear of being asked too many questions (e.g. where they got the infection), being discriminated against, or the information spreading beyond those to whom they confide. Disclosing to people outside immediate caregiving family such as friends, relatives, romantic partners, or teachers (for those in school), was particularly difficult.
That is a challenge that we also go through [disclosing HIV positive status], because it is my secret and I do not want you to know, eeeh that is my secret. Now you find if I tell this one, s/he will go tell others, when they speak out now others will start talking badly about me, and I will feel bad…and there are some who will even start discriminating [against] you.
(Participant 5, Female, 24 years old)
Disclosure was mainly a challenge if one had not accepted her/his HIV positive identity.
P: Haah! It is not a challenge [disclosing HIV positive status], once they have accepted their situation, things are easy.
I: What if they have not accepted?
P: Now there, s/he will face a great challenge.
(Participant 13, Female, 19 years old)
Adherence to antiretroviral medication: This was a frequent challenge and was brought up by many of the interviewed young adults living with HIV from our setting. According to sentiments of one participant, which other participants also mentioned, young people in general have numerous activities of interest such as partying and travelling. In the process, those living with HIV may end up prioritizing such activities over the need to consistently take their antiretroviral medication.
Young people particularly have a great challenge in adherence to drugs [antiretrovirals], eeeh they have a great challenge because they have a lot of activities, unlike children and the elderly. Young people have a lot [of activities], there is lots of travelling, there is what they call partying etc, so taking medication can be a challenge because let us say on Friday, weekends most people like partying, you know? One [a YLWH] has a set time for taking her/his medication, like 8 or 9pm, then her/his friends come around 7pm and tell her/him ‘aaah, there is a party somewhere and we have fare, let’s go!’ That one will forget taking her/his medication because s/he has heard there is a party and s/he will not carry medication to take while at the party, so that is also a challenge.
(Participant 19, Female, 22 years old)
Non-adherence to ART seemed to be a challenge particularly among young adults who had not accepted their HIV positive status. Other reasons that made it a challenge for young adults living with HIV to adhere to their medications included the size of the pills (being too big) and medication side effects such as dizziness.
“It is really a challenge [antiretroviral adherence] for those who have not accepted living with HIV because someone will for sure refill their antiretroviral medication [at the HIV clinic]. Every time, they do not miss refilling, but now when it comes to taking the medication while at home, they don’t, you see?
(Participant 7, Male, 19 years old)
Now, others say the [antiretroviral] pill is big, it is difficult to swallow. Others say after taking the pills, they feel dizzy. Others say after taking the pills, they often feel hungry. These are some of the reasons why it becomes difficult for some to adhere.
(Participant 10, Female, 22 years old)
With antiretroviral medication, adherence is not only about taking the pills regularly, but also ensuring that the time between dosages is regular. Some of the young adults described how it was difficult maintaining regular routine time of taking their antiretroviral medications because of reasons such as visitation by friends whom they have not disclosed to or conflicting school schedule.
Now, maybe you are required to take [antiretroviral medication] at 8 o’clock, you are supposed to swallow them at 8 o’clock, that time you find maybe you are required to be in a certain place and you must be there at that time and you cannot carry your medication and have them with you in class.
(Participant 1, Female, 21 years old)
From the in-depth discussion around medication adherence with the participants, aspects of ‘getting tired’ and ‘giving up’ on daily antiretroviral dosage emerged. One of the participants was keen to point out that most young people living with HIV would have preferred other modes of administration of antiretroviral drugs such as monthly injections (if made available) compared to use of daily oral pills.
You know most young people [living with HIV] say at least there should have been antiretroviral drug injections that one can use for a month after which they go back for another injection, at least that would have been better.
(Participant 9, Female, 24 years old)
Intimate relationship challenges: Several participants discussed about the challenges of starting or sustaining an intimate relationship as a young adult living with HIV. From the discussions, it emerged that having a boy/girlfriend when in this age bracket is expected. However, many of the young adults do not disclose their HIV positive status to their relationship partners because of fear that such a relationship may end, and they will be heartbroken. For those whose status was known, or willingly disclosed their HIV positive status to a potential relationship partner, being rejected was not uncommon as explained in the following excerpt:
You find that in the community I have friends, both male and female friends. Before I came to know about my [HIV positive] status, I had not started dating girls. Afterwards, I came to know about my status, and as I continued taking these drugs [antiretrovirals] and my viral load improved, I now wanted to be in a relationship with a girl. So, the very first time, the girl I talked to rejected me because I told her my [HIV positive] status, as I did not want to hide it from her. I told her the truth about being HIV positive and that I did not want to have a relationship with her so that I infect her, no, it was simply starting a close relationship, so we live happily in the community.
(Participant 14, Male, 19 years old)
For some who were thinking about marriage, finding someone to start a lifelong relationship seemed a challenge, especially if that other person was HIV-uninfected. Others were uncertain about marriage life altogether, worrying for instance about how they will get married when they have HIV.
Now, when you are in a relationship and you are this way [HIV positive], you question yourself a lot. The aim of starting a relationship is getting to know each other very well, because this often leads to marriage, and remember when you enter marriage life there is a time you will want to have children. So, a young person will question herself a lot, saying “this state of mine [being HIV positive], how will I get married? Will I give birth to children? Maybe the children will also be HIV positive. You understand?
(Participant 19, Female, 22 years old)
Meeting costs of care: Many young adults talked of how meeting the costs of seeking HIV-related care was a personal challenge, especially the regular transportation costs to and from the HIV clinics for antiretroviral medication refill. At worst, some have to go without taking their medication until when they can find the fare.
I: The costs associated with seeking HIV care, in your opinion, do you think this is a challenge to young adults living with HIV?
P: Eeeh, there is a challenge in this way, you live with HIV and now you do not have fare. Like me, I come from XXXX, you cannot walk from XXXX to Kilifi, it is far (I: I agree, it is far). So, you are forced to take a motorbike to the bus stop, at the bus stop you take a public service vehicle to here [Kilifi]. Now when you do not have fare, you are forced to stay at home even when your [antiretroviral] medication is finished, until when you get fare.
(Participant 20, Female, 19 years old)
Mental health challenges: Common mental health problems such as depression and anxiety emerged as another challenge that young adults living with HIV face because of reasons such as losing parent(s) through HIV/AIDS, stigma and discrimination (explained in detail under the subsection on inter-level challenges), and external pressure to marry/get married when they perceived that their HIV situation may be a hindrance. These mental health problems were expressed by many of the participants we talked to often using idioms like “feeling sad”, “thinking too much”, and “worrying a lot” which are equivalent to local conceptualization of common mental health problems.
Myself, I have a lot of sadness, I see others having their parents and I don’t, my parent died because of this HIV, so I am… [shaking head] until sometimes, it gets to a point, I cry.
(Participant 22, Male, 19 years old)
The way people say, aah! Young man, you need to marry. Now, because people do not know that I have this illness [HIV], I just keep quiet, then I go sit down and think too much, I have lots of thoughts, I say, aah! These people are telling me to marry and the way I am this way [living with HIV]?
(Participant 4, Male, 24 years old)
Psychological distress can negatively impact the life of a young adult with HIV in that some may stop taking their antiretroviral medication, loose concentration in school (hence poor school performance) or think about committing suicide.
When you are stressed up, you cannot even concentrate on other things. Maybe you are in class and stressed, you cannot keep up with studies. Also, if one [a YLWH] is stressed up, s/he cannot even do some things, s/he will think about many things, maybe regretting why it had to be like this [living with HIV] and what will happen in the long run. Now, such a situation can even discourage you, you decide even to stop taking the medication you were taking, you wait to die.
(Participant 11, Female, 20 years old)
When you are stressed or worrying a lot, there is another thing, you will say, ‘aah! Now why am I like this [living with HIV]? It is better I commit suicide, or I die through drug overdose.
(Participant 18, Female, 22 years old)
According to one participant, many affected young adults living with HIV end up abusing drugs as a coping strategy to avoid stressful thinking.
Many end up using drugs of abuse, because of thinking a lot. They want to do away with such stressful thoughts, so they begin abusing drugs.
(Participant 3, Female, 21 years old)
Family level challenges
Parental loss: Most participants mentioned how loss of parent(s) can be challenging for a young adult living with HIV. A few participants specifically mentioned that they had lost one or both of their parents. Such parent(s) were a source of happiness to these young adults and played a key caretaking role including providing food. Parental loss greatly impacted on their lives. One participant mentioned getting stressed, losing weight and being unable to control their viral load (related to medication adherence problems) following parental death.
The challenge that I have personally faced is when I lost my mother. Yeah, that affected me a lot, it was a great loss that I have never experienced in my life before (I: sorry for your loss), because she was my greatest source of support, she provided food, she stood by me, she was my happiness, but when she passed on, is when I started getting stressed until I lost weight, viral load went up to an extent I could not bring it down.
(Participant 2, Male, 22 years)
Poverty: Poverty related issues including lack of food and financial problems within the family were described by many young adults living with HIV. Lack of food, for instance, made some young adults avoid taking their antiretroviral drugs (often strong and required to be taken after eating) while some reported taking their medication on an empty stomach. Financial challenges in the household made it difficult for a young adult living with HIV to have regular balanced diet and those depending on family support for transport/fare faced difficulty at the time they needed to go and refill their medication at the HIV clinic.
Like me, I may sometimes not have money, no food, so you take medication [antiretrovirals] but you are hungry, you just take the medication like that [without eating].
(Participant 10, Female, 22 years old)
There is a challenge there, financial problems [in the family] contributes to a YLWH not having a balanced diet.
(Participant 6, Male, 22 years old)
Interpersonal relationship difficulty within the family: A few participants mentioned instances where themselves (or a young person they know living with HIV) were unaccepted, disliked or despised by immediate family members. In some cases, this was because other siblings thought that they received ‘special treatment’ in the family.
P: There is another challenge we go through. For a young person, but even any other person who lives with HIV, this virus does not go hand in hand with stress. So when your parent gets to know that you have this illness [HIV], and other siblings are well, there is a way they try beyond their means to cater for your needs first then those of other siblings, so that you do not become stressed and they ensure your health is good. These others [siblings] will begin saying you are being favoured.
I: Ehe, so when they say you are being favoured, in what way is that a challenge?
P: It can be a challenge because now all your siblings will be against you and they will not like you.
(Participant 19, Female, 22 years old)
Community level challenges
General community challenges
Socializing with fellow peers: Under this topic of discussion, young adults living with HIV were of divided opinion. Several of them talked about the difficulty in socializing with other peers within the community set-up because they feared that others will gossip about them, when or if they knew about their HIV positive status. This resulted in such young adults avoiding socializing with peers and living a solitary life.
P: It is a challenge [peer-to-peer socialization] because you will see that when you are around your friends, you feel that they are talking badly about you, you feel uncomfortable.
I: Ehe, and how does that affect this young person?
P: Makes her/him not to socialize, s/he becomes lonely, always alone.
(Participant 16, Female, 24 years old)
Other young adults living with HIV felt that socializing with peers was not a challenge if one had not disclosed their HIV status:
Myself, I do not see any challenge, because you will not have told them that you have HIV or what, no. You will just be chatting with them and no one will be knowing. That will just remain your secret.
(Participant 10, Female, 22 years old)
Challenges within the school environment
Making close friendships: Only one participant raised this as a challenge. He described how difficult it was for a young person living with HIV to make close friendships within the school environment because of a fear of being suspected or asked detailed questions by such friends when seen taking medication routinely.
You find that sometimes you fear making close friendships because you can…I mean when you get used to people, others can scrutinize you, for example at school, when you are taking medication, I mean those we are given [at the HIV clinic], on a daily basis, so they begin suspecting you and in that they can ask you a lot of questions, so this makes you fear a little bit. So…I mean such friendship becomes a problem sometimes.
(Participant 22, Male, 19 years old)
Forced to be out of school: This was another challenge within the school environment as reported by one participant. In the wake of death of biological parents, relatives often take up caregiving roles but such care, as reported by the participant, may not compare to that from parents. A young adult living with HIV with a younger HIV-infected sibling may be forced to be out of school (sometimes for a very long time) to care for such a sibling when her/his condition deteriorates.
For me, my parents passed away when I was very young. So, we were raised by our aunt, but the aunt was not raising us the way other children are raised. So, I could not go to school because I had my younger sibling whom this illness [HIV] was worsening. So, I had to stop schooling and studying completely and wait for my sibling to recover first before I continued.
(Participant 21, Male, 19 years old)
Challenges at work
Non-supportive work environment: According to one participant, some employers may not be understanding and supportive when it comes to the employee’s HIV-related health issues (in this case a young adult living with HIV) such as being allowed to go for the regular clinic appointments. This is despite the employer being aware of the HIV positive status of the employee. All they prioritize is their work being done.
P: Another challenge is if one is employed, there is a way the boss may fail to understand. You will try explaining to her/him, but s/he will not want to understand. What s/he wants is for you to do her/his work but matters of your health is none of her/his concern.
I: Okay, is that after you have already told her/him about your HIV status, or you simply told her/him that you would like to go to the hospital?
P: Yeah, after you have already told her/him your HIV status.
(Participant 1, Female, 21 years old)
Challenges at the HIV facility
Long waiting time: The HIV clinic where we recruited the study participants is a high-volume facility attending to about 60 to 100 patients per day. A few participants raised long waiting time at the facility as a challenge mainly stemming from few health care providers who are available to offer services. Total time spent at the HIV clinic could be up to half a day.
The service here needs to be improved a bit but also this [antiretroviral] medication need to be added [quantity] because for some of us who come from far, we come here [at the HIV clinic] we wait until 1pm is when we get our medication then we leave, now we suffer from hunger, we left home early morning only to come and wait here, the doctor is only one so we are told wait…and wait.
(Participant 15, Male, 18 years old)
This service would have been better because we can come here, here at the [HIV] clinic, you get few doctors, either one or two, so the services are very slow but when doctors are many, if we come here, we will be served quickly, one who needs to return to school goes, one who needs to go back to work goes.
(Participant 20, Female, 19 years old)
Inter-level challenges
Discrimination against young adults living with HIV and an experience of different forms of HIV-related stigma (internalized, perceived, enacted and associative) were mentioned by different study participants at multiple levels of the socio-ecological system. HIV-related discrimination was specifically mentioned at the family and community levels (general community, at school and when seeking employment). HIV-related stigma was experienced at an individual, family, and community level (general community, at school and at the HIV clinic). Table 2 presents the different forms of HIV-related discrimination and stigma experienced by these young adults. Select supporting quotes are also provided.
Table 2: Forms of HIV-related stigma and discrimination experienced by young adults living with HIV from coastal Kenya, according to the different levels of the socio-ecological system
Level of social ecosystem
|
Forms of HIV discrimination
|
Data sources
|
Select supportive quote(s)
|
Forms of HIV-related stigma
|
Data sources
|
Select supportive quote(s)
|
Individual level
|
-
|
-
|
-
|
|
4 young adults living with HIV
|
Like me, when I come this side [Kilifi], I usually come to my sister, so I cannot take my medication [antiretrovirals] in front of her workers or other people at home, I usually hide so that I can take the medication.
(Participant 21, Female, 24 years old)
|
Family level a
|
- Separate plate or cup to use
- § Their education being stopped or changed to e.g. doing short courses
- § Considered to be of no value
- § Overwhelmed with chores unlike the rest of the children
|
13 young adults living with HIV
|
Like me, I have a big problem. At home there is discrimination, I am given my own plate and told to sit aside alone, I am told ‘sit there you are worthless’. So, I am very sad at home, I am there but not happy. It is just that I don’t have an option but to stay, you wish to move out and go stay with your dad, but again it is very far.
(Participant 15, Male, 18 years old)
A person like me, when they tell me to wait, all of us have performed well, but my sibling has been taken to [secondary] school, not me. When they tell me to wait, I will start having a lot of thoughts. I will think maybe they are thinking when they educate me or when they pay my fees it is like wasting their money because it is like I will die any time.
(Participant 19, Female, 22 years old)
|
|
3 young adults living with HIV
|
…they can say this person is HIV-infected, now when s/he mingles with my children, will s/he infect them? You realize in this they lack an understanding.
(Participant 1, Female, 21 years old)
Most will often be afraid sitting next to you or even sharing a bed with you, some house chores that need sharing like washing utensils, cooking, they will not want you to cook for them.
(Participant 4, Male, 24 years old)
Now I was not born with HIV, I got it after being born. Now I come to tell my parents, I am this way [living with HIV], it will take a lot of time for them to understand me. Now they can even chase me, telling me ‘go and stay on your own, fend for yourself because that [acquiring HIV] was your making’.
(Participant 5, Female, 24 years old)
|
Community level
|
|
- Being sidelined in community activities
- Friends keeping away once their HIV status is known
|
4 young adults living with HIV
|
Now there is a way if one is living with this virus [HIV], now in the community there is this spreading of rumours, and then some people really lack knowledge about this virus. They think that when one gets the virus then they are not of any value to the community. You find maybe there is an activity that needs all young people to be involved maybe it is of benefit to them, but now that people in the community know that you are HIV positive, they sideline you.
(Participant 19, Female, 22 years old)
For young people like us [living with HIV], our life is usually very difficult. Even your friends can distance because XXXX now has HIV, you see?
(Participant 9, Female, 24 years old)
|
|
5 young adults living with HIV
|
P: For me, one of the challenges I face, you may be going somewhere, and people there know that you have HIV, now when you pass, they begin saying ‘you see that lady, that lady has HIV. Now when it gets to that level, you begin thinking and questioning whether you have any value.
I: Eee, what thoughts now?
P: You can even think of committing suicide.
I: Eee, have you ever planned to do so?
P: Haah! Not yet, but such thoughts come and go
(Participant 13, Female, 19 years old)
Like me, I face a big challenge. I was very close with some friends in the community but then they were told, ‘aah! That boy, do not associate with him, when you greet him, he will infect you with HIV.’
(Participant 15, Male, 18 years old)
|
|
- A teacher being reluctant to mark work by a young person living with HIV
- Other students reluctant to play games with a young person living with HIV
- § Other students reluctant to share anything with a young person living with HIV
|
3 young adults living with HIV
|
You become discriminated in school, you are at school, maybe when you let the teacher know that on a certain day you will go to the clinic to refill medication, now s/he begins asking what the drugs are for, you are left with no option but to explain. Now when you tell her/him, s/he begins to discriminate you. Things to do with your books, s/he will…that is s/he will mark with caution or sometimes will never mark, that teacher will never mark that book. S/he will tell fellow students, the students also will discriminate you, they will not want to play [games] with you or share anything with you.
(Participant 20, Female, 19 years old)
|
|
2 young adults living with HIV
|
At school there is also a challenge because from 18 to 24 years, most are in school, and students at times have problems, they are stubborn and intolerant. Now there [at school], when you are known to have HIV, first your desk-mate can run away when told ‘you are sitting next to an HIV-infected person, heeh! At your own risk, I cannot sit next to an HIV-infected person.’ Sometimes during breaktime, you may have bought foodstuff to share with friends. When others are given by their friends, they take, but when you want to share, they refuse ‘she has HIV, do not take her food, do not eat’, now those are the challenges.
(Participant 19, Female, 22 years old)
Another thing, maybe when other young people know that you have HIV, they will discriminate you or will not talk well about you. friends will run away because they do not want to be in contact with you, maybe you can infect them.
(Participant 11, Female, 20 years old)
|
- iii. At workplace (when seeking employment)
|
- Not considered for a job after health check
- Not considered for a job after disclosing HIV positive status
|
3 young adults living with HIV
|
There are certain jobs where health tests are a must, and when one gets tested and is found to be HIV positive, s/he will not get the job
(Participant 11, Female, 20 years old)
Young people living with HIV, especially those who have completed secondary education or university or college, it is not easy for them to get a job so that they can sustain themselves. Wherever they go, when they decide to disclose that they are living with HIV, mostly, such young people are never considered and remain jobless.
(Participant 21, Female, 24 years old)
|
-
|
-
|
-
|
iv. At the HIV clinic d
|
-
|
-
|
-
|
|
5 young adults living with HIV
|
There is a big challenge here [HIV clinic], for example when a young adult like me coming from place XXXX, I am still in some form of denial, now you will say, ‘I do not want to go there [HIV clinic] and find so and so who will see me’, you see? Now you will have the fear that when you come here [HIV clinic] you will find the mother of so and so, ‘aah! So even the mother of so and so is here, she will go and tell other people’, you see? Now you give up [coming to the clinic]. Others will come in uniform [to be prioritized first], cover their faces with headscarf so that they are not recognized, others act as if they are staff at the clinic when they notice someone familiar, but actually they have come to refill their medication, you see?
(Participant 3, Female, 21 years old)
|
Notes.
- None mentioned
a at the family level, discrimination was more profound where a young person lived with a stepparent or other relatives following the death or separation of biological parent(s).
b psychological distress and suicidal thoughts emerged to linger on for some young people whose HIV positive status is known and have experienced a form of stigmatization
within the community.
c at the school setting, discrimination and stigma from both teachers and fellow students mainly arose from the knowledge about a young person’s HIV positive status. The
prospects of discrimination within the school environment made some young people not to disclose their HIV status.
d perceived form of HIV stigma at this setting was more pronounced where a young person was still in denial of HIV positive status
|
Support systems aiding positive coping among young adults living with HIV
We asked the participants about the pillars of support aiding their positive coping amidst the challenges of living with HIV. These young people mentioned several sources of support which we summarize in Figure 2.
According to the views of several participants, economic independence (i.e., opportunity to work in formal or self-employment) not only keeps young adults living with HIV busy (therefore distracted from stressful thinking related to having HIV) but also the earnings thereof enables one to cater for basic needs including buying food and catering for own transportation needs during clinic appointment days.
Us young people [living with HIV] do not have any other source of support other than a job. When you have a job, most of the stress is avoided because first, you will not be at home, maybe it is the home environment that is stressing. You will not be there; you will be busy involved with your development matters.
(Participant 7, Male, 19 years old)
Reliance on spirituality, including advice from spiritual leaders, gives hope to young adults living with HIV (e.g. about emergence of a cure drug in the future) and guards against sexual promiscuity (which for instance may lead to acquisition of other HIV virulent strains).
It can be a pillar because like a Christian, when you become religious, you cannot engage in some things out there, things like being promiscuous. You cannot do such things out there, if you are religious.
(Participant 4, Male, 24 years old)
The different forms of social support (from families, friends, community-based organizations, healthcare providers and peer meetings) described by the participants were, among others, a source of encouragement/moral support, financial support (mostly family and friends), advice and guidance (see Additional file 2 for more examples and illustrative quotes). As would be expected, healthcare providers play a key supportive role in terms of HIV treatment, care and follow-up.
They [doctors] are a source of support, a big pillar of support, because without them, without doctors, then it is death. Doctors are especially a strong pillar of support because when you arrive here [HIV clinic], when you explain yourself well, you get the best treatment.
(Participant 9, Female, 24 years old)