Stigmas intersecting with antiretroviral adherence in young key populations living with HIV in Zambia

Abstract

Introduction: Limited research has been conducted on the experiences of ART adherence among young HIV-positive men who have sex with men (MSM) and transgender women (TGW) in Zambia. This study aimed to address this evidence gap through elucidating the manifestations of stigmas intersecting with antiretroviral adherence in young key populations living with HIV in Zambia. Methods: This study used a mixed-methods design. In-depth interviews collected qualitative data, and a questionnaire collected quantitative data. We used thematic analysis for qualitative data. Qualitative data were descriptively analysed using Stata. ART adherence was defined as ever missing an ART dose (yes/no). Frequencies and percentages were generated for ART adherence by socio- demographic characteristics and stigma indicators. Results: We recruited 56 participants from three sites: Lusaka, Chipata and Solwezi districts. Participants’ mean age was 23 years. Half of the participants reported ever missing an ART dose, with equal proportions among MSM (50%) and TGW (50%). Missed doses were more frequent among participants who experienced HIV related stigma (59.4%) compared with those who did not (37.5%). Missed doses were more prevalent among those living with family (88.9%) compared to those not living with family. Stigma related to sexual orientation or gender identity (SOGI) showed mixed patterns, with no consistent differences in missed doses. Variations in adherence were observed across age, education, employment, living arrangements and care settings, however, there were no clear patterns that had emerged due to the small sample. The emergent themes were sexual orientation and gender identity–based stigma, negotiating self-identity amid uncertainty, stigma experiences in the family and ART adherence, sexual orientation, HIV ART adherence and disclosure challenges, as well as restarting ART. Conclusion: The study provides evidence of how stigmas intersect with antiretroviral therapy (ART) among young key populations. Meanwhile, most of the stigma that affected adherence to ART was related to HIV. Supporting adherence to ART among adolescents and young people, including sexual minority groups, may require tailored approaches that address their lived experiences.