Navigating socio-ecological and institutional barriers to antiretroviral therapy adherence

Abstract

Background: The Human Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS) pandemic remains a major global health issue, with 40.8 million people affected at the end of 2024. In Sub-Saharan Africa, Antiretroviral Therapy (ART) coverage reached 74%, though adherence remained challenging, particularly among youth due to poverty, stigma, and weak health systems. Aim: This paper explored socio-ecological and institutional barriers to ART adherence among young men and women aged 18–24 living in Kibra, Nairobi’s largest informal settlement. Methods: The study utilized phenomenological research design to explore lived experiences within social contexts to uncover hidden structural barriers using qualitative methods. In-depth interviews (n = 25), key informant interviews (n = 10), participant diaries (n = 25), structured clinic and home observations (n = 25), and case narratives (n = 10). Participants were purposively selected. Data were analyzed thematically using deductive and inductive coding in NVIVO 14. Results and discussion: Barriers emerged at individual, socioeconomic, and health system levels. These included limited ART knowledge, pill burden, comorbidities, food insecurity, stigma, violence, and negative healthcare provider attitudes. Addressing these requires multi-level interventions that go beyond medical treatment to tackle structural and social determinants of health.