Step 2: Qualitative study
depression, HIV education, anxiety
MAY, SECONDARY
To elicit perceived barriers to treatment initiation and the acceptability of our proposed Yima Nkqo intervention, our team conducted qualitative semi-structured interviews with youth ages 18–24 from July 2018 to May 2019. These youth were ART-naïve, meaning that they reported not previously accessing ART. Details of the study design have been published [Our codebook was initially organized into two sections, treatment barriers and feedback on potential intervention strategies. We iteratively developed our codebook using an inductive analytic approach informed by grounded theory [Team-based coding and analysis of the qualitative data identified three primary categories of barriers to ART initiation among young people. The first was stigmatizing social norms. Participants described the social expectation of young people being healthy. In this context, a diagnosis of HIV feels discordant with those social norms. Thus, there is a fear of potential unwanted disclosure to peers, family members, and partners, who could be unsupportive. The secondary primary category also related to anticipated stigma, but focused especially on contextual issues in the clinic rather than anticipated stigma from staff. Young people felt that the clinic’s physical layout and procedures could lead to unwanted disclosure. For example, participants reported separate waiting areas and differently colored medical folders for persons living with HIV. The last primary category focused on challenges coping, including struggles with denial, alcohol, anxiety, depression, and suicidal ideation, making it extremely difficult for youth to accept their diagnosis, let alone start treatment. Lastly, participants identified three features of the proposed Yima Nkqo intervention as most important: 1) peer support to remind youth they are not alone; 2) facilitator support to help youth develop positive coping skills and to provide HIV education; and 3) a community space that is welcoming to youth with food and music. Participants also highlighted the importance of emphasizing confidentiality within the group to avoid unwanted public disclosure.