“It’s being uncomfortable for who you are, because I think HIV is part of me … ”: psychosocial adaptation and treatment engagement among GBMSM older and younger than 30 years engaged in a coping and disclosure skills intervention in the Eastern Cape,

Despite expanded antiretroviral therapy access since 2006 in South Africa, gay, bisexual and men who have sex with men (GBMSM) living with HIV face challenges navigating status-sharing risks with limited skills. Stigma, isolation and generational disparities further shape adherence and psychosocial needs across age groups. The Speaking Out and Allying Relationships (SOAR) intervention was designed to strengthen coping and disclosure skills with partners and family members, providing an opportunity to examine how younger and older GBMSM navigate HIV treatment, stigma and social networks. Between April and June 2024, participants completed in-depth interviews addressing intervention experiences, treatment motivators, social support and community perceptions. Guided by Social Cognitive Theory, Erikson's psychosocial development theory and the illness identity framework, systematic coding and comparative analysis explored living with HIV across two generations of GBMSM. Twenty-one participants (aged 21-42, median three years living with HIV) described ongoing stigma influencing self-acceptance and adherence decision-making, yet remained motivated by health and longevity. Older participants (>30 years) reported broader support networks and generativity, while younger GBMSM (<30 years) faced privacy and status-sharing challenges. Overall, findings highlight the importance of age-responsive interventions that address identity and health behaviors across the life course in South Africa.