Body image and antiretroviral therapy adherence among adolescents and young people living with HIV in Durban, South Africa.

Abstract

Background: The benefits of antiretroviral therapy (ART) for treating HIV among adolescents and young people living HIV (AYPLHIV) may be undermined by non-adherence to ART. Several reasons for non-adherence to ART have been reported among young people including internalised HIV-related stigma, body image concerns, and depression. Research into how AYPLHIV experience and make sense of feared or actual body changes is limited, yet these changes have emotional and psychological implications which may curtail adherence to ART. This doctoral thesis investigated the relationship between body image and various psychosocial factors; and explored the perceptions and feelings about body appearance among AYPLHIV in Durban, South Africa. Method: A cross sectional, convergent parallel mixed method approach was adopted in which quantitative and qualitative data were concurrently collected in the same phase of the research process using non-probability sampling. For the quantitative part of the study, a total of 76 AYPLHIV (15-24 years) were conveniently sampled. Qualitative data were obtained through a series of semi-structured in-depth interviews with a sub-set of 18 AYPLHIV who were purposively and conveniently recruited from the quantitative sample. Descriptive statistics, Pearson Product Moment correlations, and mediational analyses were used to analyse the quantitative data whereas thematic analysis was used for the qualitative data analysis. Results: The converging quantitative and qualitative results from this study provide evidence that body image is a significant issue among AYPLHIV and is differentially associated with various psychosocial factors. Self-esteem and adherence to ART were indirectly associated through a two-step path of internalised HIV-related stigma and then body appreciation. Findings from the qualitative analysis showed physical and psychosocial effects of living with HIV among young people including weight loss, body dissatisfaction and social withdrawal. Coping mechanisms such as social support networks and physical exercises were highlighted as important in counteracting the physical and psychosocial effects of negative body image and living with HIV. Conclusion: The findings from this study suggest that body image concerns are central to the health and well-being of AYPLHIV as they are related to several psychosocial challenges. The findings underscore the need for development of multi-pronged interventions to boost body image.