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Name: Personal
Name: Personal
Name: Personal
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Note: thesis: Thesis (M. P. H.)--Brown University, 2019
Genre (aat): theses
Abstract: Introduction: South Africa has a large population of perinatally infected adolescents born to women who did not have access to HIV treatment in the early 2000s. This adolescent population faces distinct psychosocial challenges, including disclosure and the need for life-long adherence to HIV treatment. Many adolescents living with HIV have poor adherence to antiretroviral treatment, leading to low rates of viral suppression and premature death. Adolescents perinatally infected with HIV and their biological mothers experience a unique connection that impacts the mother-child relationship, including their lived experiences of HIV. This qualitative thesis seeks to understand how this connection impacts maternal and adolescent mental health and adolescent adherence behaviours. Methods: This qualitative thesis uses in-depth interviews with biological mothers of adolescents living with HIV (n = 26) to understand their perspectives on the maternal-child relationship in the context of perinatal HIV infection. Semi-structured interviews, conducted in Cape Town, South Africa, were audiotaped and transcribed verbatim. Using Nvivo12 software, a coding scheme was applied to interview transcripts. Analysis included open and axial coding of data, analytical decision-making, and code synthesis to develop major themes. Through thematic analysis four major themes related to adolescent adherence and the maternal-adolescent relationship were developed. An audit trail was maintained to ensure reproducibility. Findings: Four themes regarding the maternal-adolescent relationship and adolescent adherence emerged: (1) Mothers describe how their experiences with HIV diagnosis and treatment inform strategies to improve adolescent adherence, and discuss how parenting a child living with HIV influences their own treatment management; (2) Mothers explain how the adolescent’s perinatal HIV infection complicates the disclosure process, HIV acceptance and adolescent adherence to treatment (3) Mothers discuss how parenting an adolescent perinatally infected with HIV impacts their mental health, as feeling of guilt and self-blame undermine their ability to assist the adolescent with adherence; (4) Mothers describe how HIV is deeply integrated into family structure and household dynamics. These findings show the complex effects of perinatal HIV infection on the mental health, HIV treatment adherence and the lived experiences of mothers and adolescents living with HIV. Discussion: These findings reveal how being perinatally infected with HIV uniquely impacts the adolescent’s lived experience of HIV and adherence to treatment. This thesis highlights the significance of the disclosure process and HIV acceptance for adolescent adherence, and the importance of the mother-child relationship in full disclosure and the ability to live successfully with HIV. Furthermore, for biological mothers who could not access HIV treatment, these findings emphasize the critical importance of treatment availability, as well as psychosocial support services and interventions. While the population perinatally infected with HIV is decreasing, biological mothers and their children in South Africa continue to experience the distinct challenges associated with being perinatally infected with HIV.
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Identifier: DOI: 10.26300/fkye-0p05
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Access Condition: restriction on access: Collection is open for research.