Relationship between substance use and socio-behavioral drivers of poor ART adherence among young people with HIV in Zambia

Bibliographic Data

ID19439007
AuthorsHappy Zulu (0009-0004-7863-6946, University of Zambia, corresponding author), Bo Wang (0000-0002-0290-2134, UMass Memorial Medical Center), Joseph Mumba Zulu (0000-0003-1480-4977, University of Zambia), J Anitha Menon (0000-0002-7388-7509, Curtin University), Ravi Paul (0000-0003-0246-7096, University of Zambia), Paul Ravi (University of Zambia), Deogwoon Kim (0000-0002-8928-6847, UMass Memorial Medical Center), Anna Bryce (0009-0004-5779-9762, UMass Memorial Medical Center), Janelle Renterghem (0009-0000-0989-5224, University of Massachusetts Chan Medical School), Janelle P Renterghem (UMass Memorial Medical Center), Karen MacDonell (0000-0001-8916-624X, Florida State University)
Year2026
Volume38
Issue3
Pages466-478
Publication date2026-03-04
Open AccessNo
TypeARTICLE
VenueAIDS Care (JOURNAL)
Journal identifiersISSN: 0954-0121 • E-ISSN: 1360-0451
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/09540121.2025.2611066
PMID41503806
OpenAlexW7118792782
LanguageEN
Citations received1
References cited27

Despite improved access to antiretroviral therapy (ART) in Zambia, adherence among young people with HIV (YPHIV) remains suboptimal, compromising treatment effectiveness. YPHIV face unique developmental and socio-behavioral challenges including HIV-related stigma, depression and substance use, which further undermine consistent ART adherence. Alcohol and drug use impair cognitive and emotional functioning, increasing the likelihood of disrupted medication routines. This study applied the Hierarchical Model of Medication Adherence (HMMA) to examine how individual, social and structural factors influence ART adherence among YPHIV in Zambia. A qualitative descriptive design was employed using six focus group discussions (FGDs) with 48 purposively selected participants aged 18-24 years, all reporting <80% adherence and recent substance use. Data were audio-recorded, transcribed verbatim and thematically analyzed. HIV-related stigma, mental health distress and negative healthcare experiences were key drivers of substance use. Substance use impaired adherence by causing forgetfulness and other factors. Depression and emotional exhaustion also emerged as major contributors to substance use and poor adherence. The study offers novel, context-specific insights into the multilevel drivers of poor adherence among Zambian youth aged 18-24. Findings highlight the need for youth-centred interventions that address stigma, mental health and substance use to improve ART adherence and health outcomes

Depression (economics) · Distress · Focus group · Human immunodeficiency virus (HIV) · Medication adherence · Mental health · Psychological intervention · Qualitative research · Substance use · HIV Research and Treatment · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions

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