“I Don’t Have Time to Exercise”: Determinants of Physical Activity and Diet Consumption Among Adolescents Living with HIV in Southern Tanzania – A Phenomenological Qualitative Study

Justina J Maganga,1,2 Andrew Katende,1,3 Ezekiel Luoga,3 Nancy Nshatsi,2,4 Jamal Siru,1,3 George Sigalla,1,3 Clara Mollay,2 Maja Weisser,1,3,5,6 Sally Mtenga7 1Interventions and Clinical Trials, Ifakara Health Institute, Morogoro, Tanzania; 2The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; 3Saint Francis Regional Referral Hospital, Morogoro, Tanzania; 4Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara, Tanzania; 5Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland; 6Swiss Tropical and Public Health Institute, Allschwil, Switzerland; 7Health System Impact Evaluation and Policy, Ifakara Health Institute, Dar-es-Salaam, TanzaniaCorrespondence: Justina J Maganga, Ifakara Health Institute, P.O. Box 53, Off Mlabani Passage, Ifakara, Morogoro, Tanzania, Tel +255 754 469 103, Email [email protected]: Low physical activity and unhealthy diets are among the key modifiable risk factors for non-communicable diseases (NCDs), often initiated in adolescence. Little is known about the underlying factors influencing these two behaviors, particularly in adolescents living with HIV (ALHIV). This study aimed at qualitatively exploring the factors perceived to influence physical activity and diet consumption in this vulnerable population.Methods: Semi-structured in-depth interviews were conducted with ALHIV aged 15 to 19 years (N=22) and their parents and caregivers (N=10) to explore the lived experiences and perceptions regarding physical activity and diet consumption. The interviews were carried out from May to July 2024 at the Chronic Diseases Clinic in Ifakara (CDCI) in Tanzania. Thematic content analysis was performed aided by NVivo software version 14. Three levels of the socio-ecological model (intrapersonal, interpersonal, and community levels) guided the theoretical categorization of findings.Results: Factors reported to influence physical activity in ALHIV were intrapersonal factors (time constraints, insufficient knowledge); interpersonal (encouragement from family members and peers); and community level aspects (gender and social norms, negative beliefs, inadequate facilities). On the other hand, intrapersonal factors (lack of autonomy, weight gain concerns, food preferences); interpersonal factors (low family income, large family size); and community level factors (increased availability of fast foods) were reported to influence diet consumption among ALHIV. The adolescents’ parents and caregivers similarly shared some of these views.Conclusion: The findings suggest that both physical activity and diet consumption in ALHIV are influenced by multiple factors in the socio-ecological system. The community, parents and caregivers need to be engaged to provide support systems to address barriers to physical activity and diet consumption in ALHIV. Physical activity and nutrition education need to be integrated into HIV care programs and guidelines to emphasize these health behaviors in this population.Keywords: ALHIV, lifestyle behaviors, non-communicable diseases, qualitative study