Perceived Adherence-Related Barriers for Youth Living With HIV in the Southern United States

Objective: Youth are at high risk for HIV, accounting for 19% of new diagnoses in the United States (US) in 2021. Highly effective HIV treatment is available in the form of antiretroviral therapy (ART), which enables individuals with HIV to achieve viral suppression. However, youth living with HIV (YLHIV) have poorer ART adherence and lower rates of viral suppression than adults. This study aimed to explore the perspectives of YLHIV and their HIV care providers on barriers and facilitators to ART adherence for YLHIV in the southern US. Methods: Semi-structured qualitative interviews were conducted with YLHIV ( n = 16) and HIV care providers ( n = 15) in South Carolina. A team-based rapid qualitative analysis approach was used to analyze data, extracting themes and quotes illustrating barriers to ART adherence on intrapersonal, interpersonal, community, and structural levels. Results: YLHIV reported forgetfulness, privacy concerns, and fears about HIV disclosure as reasons for ART nonadherence. Few utilized self-management strategies, though both YLHIV and providers reported that parental support improved adherence. Providers perceived that youth had high nonadherence because they experienced minimal HIV symptoms early in the course of HIV and because of developmental challenges. Additional provider-reported barriers included living in systemically marginalized communities and low health literacy. YLHIV and providers indicated an mHealth intervention could improve adherence and would likely be acceptable and feasible. Conclusions: YLHIV in the southern US face numerous challenges to ART adherence and may benefit from interventions that feature self-management support and consistent adherence strategies.