Beyond the Numbers, Unpacking the Challenges: Adherence and Retention among Young Adults Living with HIV in Eswatini
Abstract:
This
study investigates adherence to Antiretroviral Therapy (ART) and retention in
care among HIV-positive young adults aged 18–24 years in Eswatini, a country
with one of the highest HIV prevalence rates globally. Using a mixed-methods
approach, quantitative data were collected from 161 participants and
complemented with qualitative interviews to explore personal and contextual
experiences. The quantitative findings revealed that mean adherence to ART was
96.3% (±6.1 SD), with 77.6% of participants maintaining high adherence levels
of 95–100%. Viral suppression below 50 copies/mL was achieved in 85.7% of the
study population, while retention in care was 82.6%. Although these results are
encouraging, they fall short of UNAIDS 95-95-95 targets, highlighting
persistent gaps. The qualitative findings provided deeper insights into lived
realities. Motivators of adherence included family support, encouragement from
healthcare providers, personal motivation to remain healthy, and peer
encouragement. Barriers included stigma, fear of disclosure, financial
constraints, treatment fatigue, and negative experiences with healthcare staff.
Benefits of adherence included improved health, strength to perform daily
tasks, and reduced risk of HIV transmission. Integrating the findings
underscores the multifaceted nature of ART adherence, influenced by individual,
social, economic, and systemic factors. The study concludes that addressing
adherence challenges requires youth-centered interventions, stigma reduction,
economic empowerment, and healthcare system strengthening. These results
provide evidence to guide Eswatini’s HIV response and contribute to the global
goal of achieving sustained epidemic control.
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