{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T15:53:07Z","timestamp":1771257187973,"version":"3.50.1"},"reference-count":45,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T00:00:00Z","timestamp":1583107200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008196","name":"M\u00e9decins Sans Fronti\u00e8res","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Many adolescents living with HIV in sub\u2010Saharan Africa struggle to achieve optimal adherence to antiretroviral therapy (ART), but few studies have investigated how their treatment\u2010taking decisions are influenced by their social interactions with providers, caregivers and community leaders. This study aims to explore the narratives that define expectations of adherence to ART among adolescents living with HIV in a rural Malawian setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Overall, 45 in\u2010depth interviews were conducted in 2016 with adolescents living with HIV, caregivers, health workers and community leaders, and four group sessions using participatory tools were undertaken with adolescents. Interviews and group sessions were audio\u2010recorded, transcribed and translated into English. Data were coded inductively and analysed thematically.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Adolescents were given strict behavioural codes around optimal treatment adherence, which were often enforced through encouragement, persuasian and threats. In HIV clinics, some staff supported adolescents with broader concerns relating to living with HIV, but other measures to address sub\u2010optimal adherence in HIV clinics were perceived by patients as punitive, including pill\u2010counts and increased frequency of clinic visits. Community leaders felt responsible for young peoples' health, sometimes attempting to influence their treatment\u2010taking by threatening to withdraw services, or to publically \u201cout\u201d those deemed to be non\u2010adherent. At home, discussions with adolescents about HIV were often limited to dose reminders, and some caretakers resorted to physical punishment to ensure adherence. While some adolescents complied with strictly\u2010enforced adherence rules, others demonstrated resistance by hiding missed doses, secretly throwing away drugs, or openly refusing to take them.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The potential of young people to adhere to their ART may be undermined by restrictive messages and punitive approaches to enforce and control their engagement with treatment at home, in the clinic and in the wider community. Interventions should focus on creating safe spaces for adolescents to speak frankly about the adherence challenges that they face and support for caregivers including home\u2010based interventions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25459","type":"journal-article","created":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T05:49:55Z","timestamp":1583214595000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["\u201cWe give them threatening advice\u2026\u201d: expectations of adherence to antiretroviral therapy and their consequences among adolescents living with HIV in rural Malawi"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4135-2403","authenticated-orcid":false,"given":"Rose","family":"Burns","sequence":"first","affiliation":[{"name":"Epicentre Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denview","family":"Magalasi","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Blasco","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Szumilin","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Estelle","family":"Pasquier","sequence":"additional","affiliation":[{"name":"Epicentre Paris France"},{"name":"M\u00e9decins Sans Fronti\u00e8res Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8316-9896","authenticated-orcid":false,"given":"Birgit","family":"Schramm","sequence":"additional","affiliation":[{"name":"Epicentre Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6939-3461","authenticated-orcid":false,"given":"Alison","family":"Wringe","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,3,2]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"UNICEF.Key HIV epidemiology indicators for children and adolescents aged 0\u201019 2000\u20102018.2019.United Nations International Children's Emergency Fund (UNICEF). 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