Intimate partner violence hinders adolescents’ ARV treatment adherence

Award-winning research into antiretroviral (ARV) treatment adherence, led by PhD student Siyanai Zhou and University of Cape Town (UCT) academic Professor Lucie Cluver, established that intimate partner violence (IPV) and other forms of violence impede adolescents and young adults living with HIV from accessing this life-saving treatment. This could derail decades of hard-won gains in the global fight against HIV and AIDS.

Zhou is a second-year PhD student in the Division of Social Behavioural Sciences in UCT’s School of Public Health and Family Medicine based in the Faculty of Health Sciences. Currently, his research study focuses on exploring and modelling long-term ARV treatment adherence patterns among adolescents and young adults in South Africa. More than 1 000 adolescents living with HIV participated in Zhou’s study, and he said many revealed that they find it challenging to consistently access their ARV treatment.

“It was important to get to the bottom of this and to find out what factors are influencing our young people from accessing this vital treatment. We know that neglecting ARV treatment is highly detrimental to the health and well-being of people living with HIV,” Zhou said.

Stumbling blocks

Together with a team of researchers, Zhou said they set out to investigate and identify the barriers that prevent adolescents and young adults from accessing their ARV treatment. From past research, he noted, it is widely known that IPV, sexual abuse and other forms of violence are key drivers in the HIV epidemic, and mainly affect young women and girls in sub-Saharan Africa. He said their findings and subsequent work to address this challenge would also help South Africa reach the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets – to diagnose 95% of people living with HIV, to treat 95% of those infected, and to attain a viral load suppression in 95% for those on treatment – to ensure a significant reduction in HIV infections worldwide by 2030.

Zhou’s research has produced some startling findings. Approximately 37% of adolescents and young adults reported a lifetime history of IPV or sexual abuse and more than half of these participants were young women and girls. Further, about 11% of participants indicated that they were subjected to violence in the last two years. Only about half of the participants (51%) reported consistent adherence to their ARV treatment. His research also indicated that adolescents who reported no history of violence were 72% likely to remain on treatment diligently.

“We need to change gear and shift to solutions-driven mode.”

“Through this work, we found that a history of IPV and sexual abuse were directly associated with poor adherence to HIV treatment among adolescents living with HIV in the country. While the study found that more girls experienced violence, the overall negative impact of violence on ARV treatment adherence affected both girls and boys,” he said. “With these findings, we need to change gear and shift to solutions-driven mode. There is dire need to find alternative ways to mitigate violence and its impact on adolescents and young adults in the country.”

Adapt violence-prevention programmes

These research findings, Zhou said, also paint an alarming picture regarding the scourge of IPV and sexual abuse in South Africa, and its effects signal a serious problem for the nationwide and continental fight against HIV and AIDS. There’s an urgent need to adapt violence-prevention programmes to aptly fit the needs of adolescents and young adults. This approach, he said, should involve promoting safety in communities and schools, as well as during community-related initiatives regularly attended by adolescents and young adults.

“This study paints a very grim picture, and the findings expose the reality that victims of violence are faced with in their day-to-day lives. Sadly, this means they fail to see the positive outcomes that come with ARV treatment,” he said. “My hope is that we can use these findings to raise awareness of the long-term impact of violence. In this case, it directly affects HIV/AIDS outcomes for those on treatment and the long-term impact also affects livelihoods.”

He urged South Africans to reflect and start developing alternative violence-prevention strategies and to take collective responsibility for a scourge that has widespread, far-reaching consequences on the health and well-being of the future generation.

“It is time for you and I to be ready to listen and to be the safe space that adolescents and young adults need and to support families and caregivers to keep our future generations safe,” he said.

Award-winning work

Zhou’s work has not gone unnoticed. At the 2022 AIDS Conference, which took place in Montréal, Canada, in July, he walked away with the AIDS 2022 Prize for Excellence in HIV research related to the needs of children and adolescents – the Biennial prize. The conference is one of the largest global health gatherings and joins experts, policymakers and activists who advocate for a world where HIV no longer presents a threat to public health.

“I am honoured to have received such a prestigious award and I am earnestly grateful for the recognition.”

“I am honored to have received such a prestigious award and I am earnestly grateful for the recognition. Winning this award would not have been possible without the encouragement and guidance of my mentors, Professor Cluver, Associate Professor Elona Toska and Associate Professor Lucia Knight. Not forgetting our team of incredibly inspiring researchers whom I have such deep respect for and who share my views and passion on creating a world where young people are committed to remaining on ARV treatment,” he said.