Correlates between Risk Factors and School Life Satisfaction Among Adolescents Living with HIV (ALWHIV) in Low Resource Settings. the Case of the M-Suubi Study in Uganda

Background: Adolescence is a critical transitional period marked by increased vulnerability to risk factors such as peer pressure, identity exploration, and risk-taking behaviors. For adolescents living with HIV (ALWHIV), these challenges are compounded by poverty, stigma, mental health distress, and barriers to healthcare access, including antiretroviral therapy (ART) adherence. School-attending ALWHIV face additional difficulties, as they must navigate academic pressures alongside HIV management. While prior research has explored mental health and adherence in ALWHIV, less is known about how psychosocial and structural factors shape school life satisfaction—a critical determinant of academic achievement. This study examines how psychosocial and structural factors are associated with school life satisfaction among ALWHIV in Uganda.

Methods: We analyzed baseline data from the NIH-funded M-Suubi Study (N = 833 ALWHIV). Participants were eligible is they were; 1) aged 10–17 years; 2) on ART; 3) enrolled in boarding schools; and 4) living in a family settings. The primary outcome was school life satisfaction (assessed using an 8-item School Life Satisfaction Scale). Predictor variables included, poverty (assessed using asset index), food insecurity, orphanhood status, HIV-related stigma (assessed using the HIV-stigma scale), HIV-related shame (assessed using the Shame Questionnaire), caregiver type (biological or non-biological), Depression (assessed using the Child Depression Inventory [CDI], and Hopelessness (assessed using the Beck’s Hopelessness Scale [BHS]), medication barriers (transport and medications funds), and adolescent’s age. A multivariate mixed linear regression model assessed associations between these factors.

Findings: Results indicate that older age (β = 0.89, 95% CI: 0.31, 1.48), was positively associated with school life satisfaction score. Depression (b = -0.13; 95% CI: -0.23, -0.30), hopelessness (b = -0.26; 95% CI: -0.36, -0.16), and poverty (b = -0.10; 95% CI: -0.18, -0.01). were negatively associated with school life satisfaction. Finally, medication barriers specifically having no funds for medication was associated with an improvement in school life satisfaction scores (b = 0.74; 95% CI: 0.68, 1.42).

Discussion and Conclusion: Psychosocial distress and poverty negatively impacts school life satisfaction among ALWHIV. The counterintuitive findings on having no funds for medication warrants further investigation, as it may reflect unmeasured protective factors (e.g., social support) or socio-contextual dynamics where material resources do not directly enhance school-related well-being. These results highlight the need for targeted psychosocial interventions to improve educational experiences for ALWHIV.