Journal Article

Reflections of Resilience and Vulnerability of Adolescents Living with HIV During COVID-19: A Photovoice Study in Peri-Urban Cape Town, South Africa

Mayman, Yolanda, Crowley, Talitha, Wyk, Brian van

2025

Overview

Background: Adolescents living with HIV (ALHIV) in low socio-economic contexts face challenges related to physical development and health, stigma, and economic instability. The onset of the COVID-19 pandemic exacerbated these vulnerabilities, impacting the physical, mental, and social well-being of ALHIV. ALHIV were positioned in a particularly precarious situation, requiring them to navigate the disruptions caused by the pandemic while simultaneously striving to maintain resilience and adherence to their antiretroviral treatment (ART). Objectives: To explore the resilience and vulnerability of ALHIV on ART in a peri-urban community in Cape Town, South Africa during the COVID-19 pandemic. Methodology: A participatory photovoice study was employed with 20 ALHIV aged 14 to 19 years. Participants received basic training on photography techniques and were asked to capture images representing their experiences during the COVID-19 pandemic. These photographs were shared and discussed in both individual interviews and group discussions. All interviews and discussions were audio-recorded, and the resulting transcripts were analysed using content analysis to identify key themes and insights. Results: Four key themes were identified: (1) disrupted routines and emotional strain, (2) support systems and coping mechanisms, (3) HIV treatment adherence facilitators and barriers, and (4) economic vulnerability and household stress. Despite the compounded challenges and significant hardships, ALHIV in this study demonstrated notable resilience, maintaining treatment adherence and a positive outlook despite economic struggles and social disruptions. Conclusions: This study highlights the resilience and vulnerability of ALHIV in resource-limited settings. Findings underscore the need for targeted mental health and social support interventions to address their unique vulnerabilities. Strengthening healthcare access, social support networks, and local community resources can improve the well-being and coping capacity of ALHIV in future crises. Plain Language Summary Reflections of Resilience and Vulnerability of Adolescents Living with HIV During COVID-19: A Photovoice Study in Peri-Urban Cape Town, South Africa Background: Adolescents living with HIV (ALHIV) in low socio-economic contexts face challenges related to physical development and health, stigma, and economic instability. The onset of the COVID-19 pandemic exacerbated these vulnerabilities, impacting the physical, mental, and social well-being of ALHIV. ALHIV were positioned in a particularly precarious situation, requiring them to navigate the disruptions caused by the pandemic while simultaneously striving to maintain resilience and adherence to their antiretroviral treatment (ART). Objectives: To explore the resilience and vulnerability of ALHIV on ART in a peri-urban community in Cape Town, South Africa during the COVID-19 pandemic. Methodology: A participatory photovoice methodology was employed with 20 ALHIV aged 14-19 years. Participants received basic training on photography techniques and were asked to capture images representing their experiences during the COVID-19 pandemic. These photographs were shared and discussed in both individual interviews and group discussions. All interviews and discussions were audio-recorded, and the resulting transcripts were analysed using content analysis to identify key themes and insights. Results: Five key themes emerged: (1) the social impact of COVID-19 on communities, (2) economic impact on households, (3) coping behaviours of ALHIV during lockdown, (4) mental health and well-being of ALHIV during the pandemic, and (5) maintaining adherence to HIV treatment. Despite the compounded challenges and significant hardships, ALHIV in this study demonstrated notable resilience, maintaining treatment adherence and a positive outlook despite economic struggles and social disruptions. Conclusions: This study highlights the resilience and vulnerability of ALHIV in resource-limited settings. Findings underscore the need for targeted mental health, strengthened social support interventions and community-based resilience to address their unique vulnerabilities.

• Publisher: SAGE Publications,SAGE Publishing
• Subject: Adaptation, Psychological / Adolescent / COVID-19 - epidemiology / COVID-19 - psychology / Female / HIV Infections - drug therapy / HIV Infections - epidemiology / HIV Infections - psychology / Humans / Male / Medication Adherence - psychology / Original / Pandemics / Photography / Resilience, Psychological / SARS-CoV-2 / Social Stigma / Social Support / South Africa - epidemiology / Vulnerable Populations - psychology / Young Adult