title: 'Everyone has a secret they keep close to their hearts': challenges faced by adolescents living with HIV infection at the Kenyan coast.
abstract: BACKGROUND
  The upsurge in the uptake of antiretroviral therapy (ART) has led to a significant increase in the survival of vertically acquired HIV infected children, many of whom are currently living into adolescence and early adulthood. However little if anything is known of the lived experiences and the challenges faced by HIV positive adolescents in the African context. We set out to investigate psychosocial challenges faced by HIV infected adolescents on the Kenyan coast.
  
  
  METHODS
  A total of 44 participants (12 HIV-infected adolescents, 7 HIV uninfected adolescents, and 25 key informants) took part in this qualitative study, using individually administered in-depth interviews. A framework approach was used to analyze the data using NVIVO software.
  
  
  RESULTS
  We observed that the challenges faced by adolescents in rural Kenya could be placed into six major themes: poverty, poor mental and physical health, the lack of a school system that is responsive to their needs, challenges in how to disclose to peers and family members, high levels of stigma in its various forms, and challenges of medical adherence leading to the need for close monitoring.
  
  
  CONCLUSIONS
  In this African community, vertically acquired HIV-infected adolescents face a complex set of social, economic and medical challenges. Our study points to the urgent need to develop multisectorial intervention support programmes to fully address these challenges.
authors.affiliation: Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya. AAbubakar@kemri-wellcome.org.|Tilburg University, Tilburg, Netherlands. AAbubakar@kemri-wellcome.org.|Lancaster University, Lancaster, UK. AAbubakar@kemri-wellcome.org.
authors.forename: Amina
authors.initials: A
authors.lastname: Abubakar
authors.affiliation: Tilburg University, Tilburg, Netherlands.|North-West University, Potchefstroom, South Africa.|University of Queensland, Brisbane, Australia.
authors.forename: Fons J R
authors.initials: FJR
authors.lastname: Van de Vijver
authors.affiliation: Victoria University of Wellington, Wellington, New Zealand.|Aarhus University, Aarhus, Denmark.
authors.forename: Ronald
authors.initials: R
authors.lastname: Fischer
authors.affiliation: Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Amin S
authors.initials: AS
authors.lastname: Hassan
authors.affiliation: Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Joseph
authors.initials: J
authors.lastname: K Gona
authors.affiliation: Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Judith Tumaini
authors.initials: JT
authors.lastname: Dzombo
authors.affiliation: Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Grace
authors.initials: G
authors.lastname: Bomu
authors.affiliation: Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Khamis
authors.initials: K
authors.lastname: Katana
authors.affiliation: Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya.|University of Oxford, Oxford, UK.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Newton
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D030881:Disclosure; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006304:Health Status; D006801:Humans; D007630:Kenya; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D011203:Poverty; D036301:Qualitative Research; D012574:Schools / Q000458:organization & administration; D057545:Social Stigma