Into the fourth decade of the human immunodeficiency virus (HIV)/ Acquired Immunodeficiency Syndrome (HIV/AIDS) epidemic, there are over 34 million people living with HIV in the world and about five million of them are aged between 15 and 24 years [1]. Adolescence a mental, physical and emotional stage leading into adulthood [22]. During this developmental stage individuals experience behavioral experimentation, identity formation, risk taking behaviors, challenging romantic relationships, exploring sexuality and experimenting with alcohol and recreational drugs [2–3]. Furthermore, adolescents often have poorly developed life skills, limited life experiences and often lack financial autonomy [4]. Additionally, they have limited access to healthcare facilities and are more likely to experience peer pressure and stigma [4]. Adolescents have become a heightened concern for health care professionals in this field [5], with 42% of new HIV infections occurring in this age group in 2010 [1]. Due to these factors, adolescents have been recognized as a vulnerable group to becoming infected and marginalized from mainstream healthcare services [6].
Additionally, adolescents are vulnerable to HIV in behaviorally-associated transmission of infections during the adolescence growth phase. The development during adolescence is a time for exploring and navigating peer relationships, gender norms, sexuality, and economic responsibility. However, many adolescents don’t receive adequate sexual education which can lead to higher rates of sexually transmitted diseases and unplanned pregnancies [16]. Multiple and intersecting forms of discrimination and structural inequality affect the lives of young people and increase their vulnerability to HIV [7].
Survival among perinatally infected adolescents with HIV has been greatly extended since the advent of highly effective antiretroviral therapies, while adherence to HIV medication regimens is suboptimal and decreases as children reach adolescence [8]. Health care professionals are alert on the issue of high prevalence of low adherence to adolescents [17]. Non- adherence involved more than forgetting to take medication, as in also involves a person's conduct such as—taking medication, making lifestyle changes including diet changes per recommendations of a health care provider [18]. Low adherence can lead to increase in morbidity and compound medical complications, leading to poorer quality of life as well as overuse of the health care systems [16].
There are many risk factors that impact adolescents’ development and future life success. It is imperative for healthcare professionals to understand these risk factors and implement interventions to aid in supporting clients with HIV, especially those in the high risk adolescent group. A study by Haberer JE et al., identified five groupings of factors that are associated with determining adherence to ART. The groupings are the individual (e.g. knowledge, resources, mental health); interpersonal/network relationships (e.g. social support, stigma); the community (e.g. socio-cultural norms); health system factors (e.g. service provision) and structural issues (e.g. access to services) [19].
Another study identified similar factors that influence adherence which fall into 4 main groups: (1) patient factors, for instance drug use, alcohol use, age, sex, and ethnicity; (2) medication regimen, which may include dosing complexity, number of pills, or food requirements; (3) the patient-health-care provider relationship; and (4) the system of care [20]. Other factors such as acceptance, disclosure, determination, and family support of the patient, as well as patient relationship with healthcare professionals can influence adherence [18]. These studies show the importance for health providers to understand the influencing factors affecting adherence of ART to appropriately address them and provide adequate support [9]. An adolescent needs social or emotional support from friends or family members especially after disclosing their HIV status to avoid being affected by stigma [10]. There should be adequate attention given to psychosocial health of adolescents regarding HIV adherence, as it is key to adolescents’ optimization of ART. Generally, psychosocial refers to the close relationship between the individual and the collective aspects of any social entity.
Adolescent psychosocial health includes the emotional, social, mental, and spiritual aspects The adolescent psychological aspect in this context can be defined as how adolescents think about themselves, how they deal with and express their emotions and how they navigate and manage relationships. Social factors can be defined as the adolescents’ relationships and roles, expectations, opportunities, moving towards family formation, family structures, economic security, and citizenship. There are a few aspects of adolescent development related to health behaviors that are important to name, they are autonomy, cognitive processes, and social influences. Autonomy allows adolescents to have the opportunity to engage in independent health decision-making with lifelong consequences. Just as important are the cognitive processes influencing adolescent decision making. However, decision-making and judgment skills are not fully developed in adolescents. Multiple studies argued that adolescents’ decision making is influenced by socio-emotional and self-regulatory factors, stating that slow development of impulse control and response inhibition increases the reliance on social factors and emotions to make decisions. [18, 21]. It is imperative that health behavior interventions is an important tool in decision-making among the adolescents more so in developing and/or identifying validated objective measures assessing all aspects of health literacy and integrating developmental theory[22]. Ensuring easy access to psychosocial support and care, such as counseling and support groups, together with optimal therapies is critical to reducing AIDS-related deaths among adolescents and help deliver good outcomes [11].