Challenges and Enablers of Antiretroviral Therapy Adherence Among Ethiopian Adolescents: A Qualitative Study

Background: Despite global decline in acquired immunodeficiency syndrome (AIDS)-related mortality, adolescent (10–19 years) deaths are rising. Adolescents living with Human Immunodeficiency Virus (ALHIV) face unique antiretroviral therapy (ART) adherence challenges, especially in low-income settings. This study explores factors influencing ART adherence among Ethiopian adolescents. Methods: A qualitative study was conducted with 12 ALHIV from August to September 2021in Ethiopia’s Amhara Region. Semi-structured interviews were conducted, transcribed, and analyzed using deductive coding and an interpretive phenomenological approach. Results: The analysis explored three prominent themes: (1) culture and religion, (2) connection and belonging, and (3) stigma and mental health. These themes collectively provide a comprehensive understanding of the barriers and facilitators influencing adolescent adherence to ART. Cultural and religious beliefs, especially those held by parents, such as misconceptions about long-term medication use, side effects of ART, and illness as divine punishment, acted as barriers to adherence. On the other hand, connection and belonging through family, community support, and shared experiences with peers facilitated adherence. However, stigma—whether internalized, experienced, or anticipated—caused isolation and mental health challenges, creating significant barriers to treatment adherence. Conclusion: This study sheds light on the multifaceted challenges faced by adolescents in adhering to HIV treatment, including cultural misconceptions, social and familial dynamics, and mental health barriers. Addressing these issues requires culturally sensitive health education and fostering environments that promote connection and support. Community-based interventions and peer networks can play a pivotal role in strengthening adherence, while stigma-reduction efforts are essential to addressing the mental health challenges adolescent’s encounter. The findings highlight the need for a holistic approach integrating health education, stigma reduction, provider training, and mental health support to enhance adherence and outcomes for ALHIV.