Objective(s): HIV-positive adolescents have low ART-adherence, with consequent increased risks of mortality, morbidity and viral resistance. Despite high rates of violence against children in the Africa region, no known studies have tested impacts on HIV-positive adolescents. We examine associations of ART-adherence with adolescent violence victimisation by caregivers, teachers, peers, community members, and healthcare providers.
Design and methods: HIV-positive adolescents were interviewed (n = 1060), and clinic biomarker data collected. We sampled all 10–19 year olds ever ART-initiated within 53 clinics in 180 South African communities (90.1% reached). Analyses examined associations between non-adherence and 9 violencetypes using sequential multivariate logistic regressions. Interactive and additive effects were tested with regression and marginal effects.
Results: Past-week self-reported ART non-adherence was 36%. Non-adherence correlated strongly with virologic failure (OR 2.3, CI 1.4–3.8) and symptomatic pulmonary tuberculosis (OR 1.49, CI 1.18·2.05). Four violence types were independently associated with non-adherence: physical abuse by caregivers (OR 1.5, CI 1.1–2.1); witnessing domestic violence (OR 1.8, CI 1.22–2.66); teacher violence (OR 1.51, CI 1.16–1.96,) and verbal victimisation by healthcare staff (OR 2.15, CI 1.59–2.93). Past-week non-adherence rose from 25% with no violence, to 73.5% with four types of violence exposure.
Conclusions: Violence exposures at home, school and clinic are major and cumulating risks for adolescent antiretroviral non-adherence. Prevention, mitigation, and protection services may be essential for the health and survival of HIV-positive adolescents.