Social Support, HIV Care Engagement, and Intimate Partner Violence Among Adolescent Girls and Young Women Living with HIV: A Qualitative Study

Background/Purpose: Social support plays a key role in improving HIV engagement and reducing intimate partner violence (IPV) risk. Adolescent girls and young women living with HIV (AGYWLHIV) who report IPV have lower levels of social support compared to AGYWLHIV who do not report IPV. We conducted an exploratory study to understand stakeholders’ perceptions regarding the role of social support in AGYW’s HIV care engagement and IPV experience.

Methods: This is a qualitative study exploring social support among AGYWLHIV recruited for the Kisoboka Mukwano intervention, a couples-based intervention to improve HIV care engagement and reduce IPV risk. Participants were recruited through community partners and HIV clinics. The study took place in Wakiso District, Uganda.

We conducted 8 in-depth individual interviews and 2 focus groups (n=13) with the AGWYLHIV aged 15-24 years with a history of IPV; 11 in-depth interviews with service providers working with the population of focus. Data were collected using a semi-structured interview guide and audio-recorded. Interviews/focus groups were conducted in Luganda, transcribed, and translated into English. We conducted a deductive thematic analysis based on a social support model assuming social support fulfills different emotional, informational, tangible, and companionship functions.

Results: Three themes emerged in data analysis regarding social support in the form of tangible support or material aid; emotional support or positive affect, empathetic understanding, and encouragement; and informational support or advice, information, guidance or feedback. Results indicated that AGYW received or desired (1) tangible support in the form of financial assistance from male partners (e.g., money for clinic transportation and food), medication delivery from healthcare workers, and shelter from IPV nonprofit agencies. Participants also discussed (2) emotional support. For example, participants described AGYW involvement in social support groups that provide motivation to remain adherent and engaged in care and included other AGYW with similar backgrounds. Additionally, they discussed the importance of having a supportive partner who encouraged AGYWLHIV to take their medication and how AGYW received either positive or negative reactions from family members after disclosing IPV. Lastly, (3) informational support was noted as being available through various sources, including gender-based violence “health talks” at HIV clinics and community leaders, such as traditional elders (“ssenga”) who offered guidance to couples struggling with IPV.

Conclusions/Implications: Social support is imperative for AGYWLHIV with a history of IPV in Uganda, especially those facing financial barriers and not engaged in care. Male partners can help to improve AGYW’s HIV care engagement by providing both emotional and tangible support. Thus, HIV interventions involving married/cohabiting AGYWLHIV should involve male partners and aim to improve partner social support by building skills for healthy relationships. These interventions should also involve well-known and trusted community members who can offer informational and emotional support for both HIV and IPV. Lastly, because family members may provide either positive or negative emotional social support, interventions involving AGYWLHIV with a history of IPV should teach skills for distinguishing between positive and negative support persons and encourage AGYW to seek support from family members with a history of providing positive support.