No retraction, correction or concern found when last checked on Oct 19, 2026.

Contemporary issues on the epidemiology and antiretroviral adherence of HIV‐infected adolescents in sub‐Saharan Africa: a narrative review

Olurotimi A Adejumo, Kathleen M Malee, Patrick Ryscavage and 2 more

Journal of the International AIDS Society · 2015 · Review · CC BY

doi:10.7448/ias.18.1.20049

Abstract

Introduction. Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour.

Methods. We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included “adherence,” “compliance,” “antiretroviral use” and “antiretroviral adherence,” in combination with “adolescents,” “youth,” “HIV,” “Africa,” “interventions” and the MeSH term “Africa South of the Sahara.” Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed.

Discussion. Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV.

Conclusions. Although higher levels of ART adherence have been reported in sub-Saharan Africa than in other well-resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population.

References 246

1.
The gap report. 2014.
Not in our library
2.
Adolescent health. 2013.
Not in our library
3.
The state of the world's children 2011: adolescence – an age of opportunity. 2011.
Not in our library
4.
Marcell AV, Kliegman RM, Behrman RE, Jenson HB, Stanton BMD, Zitelli BJ, Davies HW. Adolescence. Nelson textbook of pediatrics. 2007;Chapter 12.
Not in our library
5.
Gardner M, Steinberg L. Peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: an experimental study. Dev Psychol. 2005;41:625-35.
Not in our library10.1037/0012-1649.41.4.625
6.
Chein J, Albert D, O'Brien L, Uckert K, Steinberg L. Peers increase adolescent risk taking by enhancing activity in the brain's reward circuitry. Dev Sci. 2011;14:F1-10.
Not in our library10.1111/j.1467-7687.2010.01035.x
7.
Adolescents and youth: towards realizing the full potential of adolescents and youth [Internet]. 2014.
Not in our library
8.
Blum RW, Nelson-Mmari K. The health of young people in a global context. J Adolesc Health. 2004;35:402-18.
Not in our library10.1016/j.jadohealth.2003.10.007
9.
Romer D. Adolescent risk taking, impulsivity, and brain development: implications for prevention. Dev Psychobiol. 2010;52:263-76.
Not in our library10.1002/dev.20442
10.
Adolescent mental health: mapping actions of nongovernmental organizations and other international development organizations [Internet]. 2012.
Not in our library
11.
Adolescent friendly health services: an agenda for change [Internet]. 2003.
Not in our library
12.
Idele P, Gillespie A, Porth T, Suzuki C, Mahy M, Kasedde S, et al. Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps. J Acquir Immune Defic Syndr. 2014;66:S144-53.
Not in our library10.1097/qai.0000000000000176
13.
Parienti J-J. The case of adherence in the youth: rebel without a cause? AIDS. 2014;28:1983-5.
Not in our library10.1097/qad.0000000000000317
14.
Sawyer S, Drew S, Duncan R. Adolescents with chronic disease – the double whammy. Aust Fam Physician. 2007;36:622-7.
Not in our library
15.
Bregnballe V, Schiøtz PO, Lomborg K. Parenting adolescents with cystic fibrosis: the adolescents’ and young adults’ perspectives. Patient Prefer Adherence. 2011;5:563-70.
Not in our library10.2147/ppa.s25870
16.
The adolescent with a chronic condition. 2007.
Not in our library
17.
Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge. Lancet. 2007;369:1302-13.
Not in our library10.1016/s0140-6736(07)60368-7
18.
AIDS by the numbers [Internet]. 2013.
Not in our library
19.
Towards an AIDS-free generation – children and AIDS: sixth stocktaking report, 2013. 2013.
Not in our library
20.
All in towards ending the AIDS epidemic among adolescents [Internet]. 2014.
Not in our library
21.
Opportunity in crisis: preventing HIV from early adolescence to young adulthood. 2010.
Not in our library
22.
Regional overview: youth in Africa [Internet]. 2012.
Not in our library
23.
Progress for children: a report card on adolescents (No. 10). 2012.
Not in our library10.1016/s0140-6736(12)60531-5
24.
Zou J, Yamanaka Y, John M, Watt M, Ostermann J, Thielman N. Religion and HIV in Tanzania: influence of religious beliefs on HIV stigma, disclosure, and treatment attitudes. BMC Public Health. 2009;9:75.
Not in our library10.1186/1471-2458-9-75
25.
Balogun AS. Islamic perspectives on HIV/AIDS and antiretroviral treatment: the case of Nigeria. Afr J AIDS Res. 2010;9:459-66.
Not in our library10.2989/16085906.2010.546764
26.
Amuri M, Mitchell S, Cockcroft A, Andersson N. Socio-economic status and HIV/AIDS stigma in Tanzania. AIDS Care. 2011;23:378-82.
Not in our library10.1080/09540121.2010.507739
27.
O'Brien S, Broom A. Gender, culture and changing attitudes: experiences of HIV in Zimbabwe. Cult Health Sex. 2013;15:583-97.
Not in our library10.1080/13691058.2013.776111
28.
"Just like fever": a qualitative study on the impact of antiretroviral provision on the normalisation of HIV in rural Tanzania and its implications for prevention · 2009
Not checked
29.
The Stigma of Being HIV-Positive in Africa · 2005
No notice
30.
Barriers to accessing highly active antiretroviral therapy by HIV‐positive women attending an antenatal clinic in a regional hospital in western Uganda · 2010
No notice
31.
Addressing the fear and consequences of stigmatization - a necessary step towards making HAART accessible to women in Tanzania: a qualitative study · 2011
Not checked
32.
Akullian A, Kohler P, Kinuthia J, Laserson K, Mills LA, Okanda J, et al. Geographic distribution of HIV stigma among women of childbearing age in rural Kenya. AIDS Lond Engl. 2014;28:1665-72.
Not in our library10.1097/qad.0000000000000318
33.
A systematic review of interventions to reduce HIV‐related stigma and discrimination from 2002 to 2013: how far have we come? · 2013
No notice
34.
Kandwal R, Bahl T. Link to slower access to care: what is the stigma?: an Indian perspective. Curr HIV/AIDS Rep. 2011;8:235-40.
Not in our library10.1007/s11904-011-0096-2
35.
Williams MV, Palar K, Derose KP. Congregation-based programs to address HIV/AIDS: elements of successful implementation. J Urban Health Bull N Y Acad Med. 2011;88:517-32.
Not in our library10.1007/s11524-010-9526-5
36.
Wolf HT, Halpern-Felsher BL, Bukusi EA, Agot KE, Cohen CR, Auerswald CL. “It is all about the fear of being discriminated [against] … the person suffering from HIV will not be accepted”: a qualitative study exploring the reasons for loss to follow-up among HIV-positive youth in Kisumu, Kenya. BMC Public Health. 2014;14:1154.
Not in our library10.1186/1471-2458-14-1154
37.
Madiba S, Mokgatle M. “Students want HIV testing in schools” a formative evaluation of the acceptability of HIV testing and counselling at schools in Gauteng and North West provinces in South Africa. BMC Public Health. 2015;15:388.
Not in our library10.1186/s12889-015-1746-x
38.
Denison JA, Banda H, Dennis AC, Packer C, Nyambe N, Stalter RM, et al. “The sky is the limit”: adhering to antiretroviral therapy and HIV self-management from the perspectives of adolescents living with HIV and their adult caregivers. J Int AIDS Soc. 2015;18.
Not in our library10.7448/ias.18.1.19358
39.
Birungi H, Obare F, van der Kwaak A, Namwebya JH. Maternal health care utilization among HIV-positive female adolescents in Kenya. Int Perspect Sex Reprod Health. 2011;37:143-9.
Not in our library10.1363/3714311
40.
HIV among youth [Internet]. 2014.
Not in our library

All 246 references

Cited by papers we hold 2

Reads

Read by people on this page

None yet.

Checked or read by AI through naulon

None yet.

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.

Are you an author?

Is this your paper?

Claim it to add your note and be paid when agents cite it. Free.