{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T17:41:24Z","timestamp":1777052484648,"version":"3.51.4"},"reference-count":34,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000897","name":"Cystic Fibrosis Foundation","doi-asserted-by":"publisher","award":["HarrySchwachmanClinicalInvestigatorAward008743Q125"],"award-info":[{"award-number":["HarrySchwachmanClinicalInvestigatorAward008743Q125"]}],"id":[{"id":"10.13039\/100000897","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["T32HL166133"],"award-info":[{"award-number":["T32HL166133"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,28]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adolescent girls and young women (AGYW) living with HIV in Ghana face multiple intersecting forms of marginalisation. Beyond the clinical management of HIV, little is known about how they construct meaning, navigate identity and imagine their futures within structural contexts shaped by stigma, gender inequity, economic precarity and colonial legacies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore how AGYW living with HIV in Ghana understand and negotiate their social identities in work and school. We then aimed to understand how their lived experiences at school and work are shaped by broader systems of power.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This qualitative study drew on semi-structured interviews with AGYW (ages 11\u201324, n=24) receiving HIV care in Kumasi, Ghana. Data were coded both inductively and deductively. Themes were interpreted through the Ghanaian context using intersectionality, Critical Disability Studies, spoiled identity theory and African feminist decolonial theory. The analysis was conducted iteratively and reflexively, with attention to positionality, gender and structural power dynamics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven major themes were identified: (1) social support; (2) concrete plans for the future; (3) unattainability of the future; (4) coping via detachment; (5) need for privacy and confidentiality; (6) role as an arbiter of HIV information; and (7) financial stress. Across these themes, AGYW described dynamic processes of identity negotiation, moral and emotional labour and structural constraint. HIV was rarely the sole barrier. Rather, it intersected with gender norms, family dynamics, age hierarchies, economic marginalisation and misinformation to shape participants\u2019 social worlds. Some participants coped through detachment or concealment, while others reclaimed agency through caregiving roles, education or aspirational goals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AGYW living with HIV in Ghana are not only navigating a chronic illness but also resisting a layered matrix of social and structural injustice. Their stories reveal both vulnerability and strategic agency. Interventions and policy must go beyond biomedical care to address stigma, provide confidential and affirming school and work environments, and offer structural supports for emotional, educational and economic well-being.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107976","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T17:05:13Z","timestamp":1777050313000},"page":"e107976","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["The world according to girls: a qualitative study of school, work and identity among adolescent girls and young women living with HIV in Ghana"],"prefix":"10.1136","volume":"16","author":[{"given":"Veena","family":"Bhagavathi","sequence":"first","affiliation":[{"name":"Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Martyn-Dickens","sequence":"additional","affiliation":[{"name":"Komfo Anokye Teaching Hospital Directorate of Child Health, Kumasi, Ghana"},{"name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheila Agyeiwaa","family":"Owusu","sequence":"additional","affiliation":[{"name":"Komfo Anokye Teaching Hospital Directorate of Child Health, Kumasi, Ghana"},{"name":"University for Development Studies, Tamale, Ghana"},{"name":"London School of Hygiene & Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK"},{"name":"Tamale Teaching Hospital, Tamale, Northern Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustav Kumu","family":"Nettey","sequence":"additional","affiliation":[{"name":"Komfo Anokye Teaching Hospital Directorate of Child Health, Kumasi, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Bedele","sequence":"additional","affiliation":[{"name":"Goryeb Children\u2019s Hospital, Morristown, New Jersey, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ama D","family":"Sarfo","sequence":"additional","affiliation":[{"name":"Komfo Anokye Teaching Hospital Directorate of Child Health, Kumasi, Ghana"},{"name":"KNUST, Department of Health Policy, Management and Economics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Munyikwa","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheryl A","family":"Moyer","sequence":"additional","affiliation":[{"name":"University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, Michigan, USA"},{"name":"Department of Learning Health Science, University of Michigan-Ann Arbor, Ann Arbor, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony K","family":"Enimil","sequence":"additional","affiliation":[{"name":"Child Health, Kwame Nkrumah University of Science and Technology College of Health Sciences, Kumasi, Ashanti Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6326-3543","authenticated-orcid":false,"given":"Leah","family":"Ratner","sequence":"additional","affiliation":[{"name":"Division of Global Health Equity, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"2026042410050722000_16.4.e107976.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12981-024-00691-8","article-title":"95-95-95 HIV indicators among children younger than 15 years in South Africa: results from the 2017 national HIV prevalence, incidence, behaviour, and communication survey","volume":"22","author":"Magobo","year":"2025","journal-title":"AIDS Res Ther"},{"key":"2026042410050722000_16.4.e107976.2","unstructured":"HIV.gov . 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