{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:44:18Z","timestamp":1775043858249,"version":"3.50.1"},"reference-count":46,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This study explored the challenges and support needs of adolescents identified as living with perinatally acquired HIV based on clinical history and early childhood treatment records to generate evidence that can inform the development of an adolescent-centred support programme. A mixed-methods, sequential exploratory design was employed. In the qualitative phase, semi-structured interviews were conducted with 21 APHIV (mean age 15.5 years, range 12\u201319; 61.9% female) recruited from health facilities in rural Limpopo, South Africa. In the quantitative phase, a survey informed by qualitative findings was administered to 186 APHIV. Life Course Theory informed the conceptual framework of this study and guided the development of the interview guide as well as the interpretation of adolescents\u2019 lived experiences. Data saturation was reached after twenty-one in-depth interviews. The qualitative analysis generated themes related to HIV\/AIDS knowledge and support systems, which were subsequently interpreted through key Life Course Theory constructs, including time and place, agency, timing, and linked lives. The findings revealed that the life trajectories of older adolescents were more strongly shaped by the historical circumstances surrounding their HIV diagnosis and disclosure compared with those of younger adolescents. The results further highlighted gaps in treatment literacy, challenges in disclosure processes, emotional distress, and variability in family and health-care support. Most adolescents reported that their HIV-positive status was disclosed by someone other than their parents, while some discovered their status independently. The findings provide empirical evidence on informational, psychosocial, and support needs that can guide the design of adolescent-centred interventions for adolescents living with perinatally acquired HIV. This study recommends the development of context-specific, adolescent-centred support programmes that integrate psychosocial support, family engagement, and improved communication with healthcare providers to strengthen adherence and well-being among APHI.<\/jats:p>","DOI":"10.3390\/ijerph23040441","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T10:09:21Z","timestamp":1775038161000},"page":"441","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Needs Assessment to Inform a Life Course-Based Support Programme for Adolescents with Perinatally Acquired HIV in Rural Limpopo, South Africa"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9826-4767","authenticated-orcid":false,"given":"Rirhandzu Austice","family":"Mabasa","sequence":"first","affiliation":[{"name":"Department of Public Health, University of Limpopo, Sovenga St., Polokwane 0727, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3338-0962","authenticated-orcid":false,"given":"Cairo Bruce","family":"Ntimana","sequence":"additional","affiliation":[{"name":"DIMAMO Population Health Research Centre, University of Limpopo, Sovenga St., Polokwane 0727, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8577-9126","authenticated-orcid":false,"given":"Tebogo Maria","family":"Mothiba","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Executive Deans Office, University of Limpopo, Polokwane 0700, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5614-4017","authenticated-orcid":false,"given":"Linda","family":"Skaal","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Health Sciences, Sefako Makgato University, Ga-Rankuwa 0208, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/S1473-3099(13)70363-3","article-title":"Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: A review of emerging challenges","volume":"14","author":"Lowenthal","year":"2014","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1007\/s10461-022-03856-6","article-title":"Challenges and Fears of Adolescents and Young Adults Living with HIV Facing Transition to Adult HIV Care","volume":"27","author":"Ashaba","year":"2023","journal-title":"AIDS Behav."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Gona, P.N., Gona, C.M., Ballout, S., Rao, S.R., Kimokoti, R., Mapoma, C.C., and Mokdad, A.H. (2020). Burden and changes in HIV\/AIDS morbidity and mortality in Southern Africa Development Community Countries, 1990\u20132017. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-08988-9"},{"key":"ref_4","unstructured":"UNAIDS (2025). World AIDS Day Report 2025: Overcoming Disruption: Transforming the AIDS Response, Stylus Publishing, LLC. Available online: https:\/\/books.google.com\/books?hl=en&lr=&id=OkWlEQAAQBAJ&oi=fnd&pg=PT5&dq=South+Africa+continues+to+rank+high+amongst+high-burden+countries+with+HIV\/AIDS+in+African+countries.+According+to+recent+HIV+statistics,+there+was+an+estimated+40.8+million+people+living+with+HIV+by+the+end+of+2024+(WHO,+2025),+with+approximately+1.4+million+children+(aged+0%E2%80%9314+years)+and+millions+more+adolescents+living+with+the+infection+globally&ots=ny80rZcNqE&sig=rBCTnchgLPSdhjJpU_1hHSFA-Pw."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S2352-4642(18)30022-1","article-title":"The age of adolescence","volume":"2","author":"Sawyer","year":"2018","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1097\/QAD.0000000000002092","article-title":"Growing up with perinatal HIV","volume":"33","author":"Flynn","year":"2019","journal-title":"Aids"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1097\/QAD.0000000000000316","article-title":"Adherence to antiretroviral therapy in adolescents living with HIV: Systematic review and meta-analysis","volume":"28","author":"Kim","year":"2014","journal-title":"Aids"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s12978-015-0082-z","article-title":"Correlates of ever had sex among perinatally HIV-infected adolescents in Uganda","volume":"12","author":"Mbalinda","year":"2015","journal-title":"Reprod. Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"21591","DOI":"10.7448\/IAS.20.4.21591","article-title":"HIV treatment and care services for adolescents: A situational analysis of 218 facilities in 23 sub-Saharan African countries","volume":"20","author":"Mark","year":"2017","journal-title":"J. Int. AIDS Soc."},{"key":"ref_10","unstructured":"World Health Organization (2013). The Voices, Values and Preference of Adolescents on HIV Testing and Counselling: Consultation for the Development of the World Health Organization HIV Testing and Counselling Guidelines for Adolescents, World Health Organization. Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/95143\/WHO_HIV_2013.135_eng.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1089\/apc.2023.0019","article-title":"Mortality and Loss to Follow-Up Among Adolescents and Young Adults Attending HIV Care Programs in Kenya","volume":"37","author":"Mburu","year":"2023","journal-title":"AIDS Patient Care STDs"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e25176","DOI":"10.1002\/jia2.25176","article-title":"STACK ing the odds for adolescent survival: Health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa","volume":"21","author":"Cluver","year":"2018","journal-title":"J. Int. AIDS Soc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2498","DOI":"10.1007\/s10461-019-02621-6","article-title":"Barriers and Facilitators to the Successful Transition of Adolescents Living with HIV from Pediatric to Adult Care in Low and Middle-Income Countries: A Systematic Review and Policy Analysis","volume":"23","author":"Jones","year":"2019","journal-title":"AIDS Behav."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/QCO.0000000000000424","article-title":"Optimizing HIV transition services for young adults","volume":"31","author":"Foster","year":"2018","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Henderson, M., Fidler, S., and Foster, C. (2024). Adults with perinatally acquired HIV; emerging clinical outcomes and data gaps. Trop. Med. Infect. Dis., 9.","DOI":"10.3390\/tropicalmed9040074"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Toska, E., Pantelic, M., Meinck, F., Keck, K., Haghighat, R., and Cluver, L. (2017). Sex in the shadow of HIV: A systematic review of prevalence, risk factors, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0178106"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Namukisa, M., Kamacooko, O., Lunkuse, J.F., Ruzagira, E., Price, M.A., and Mayanja, Y. (2023). Incidence of unintended pregnancy and associated factors among adolescent girls and young women at risk of HIV infection in Kampala, Uganda. Front. Reprod. Health, 5.","DOI":"10.3389\/frph.2023.1089104"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"23740","DOI":"10.1038\/s41598-021-03096-z","article-title":"The prevalence of unintended pregnancy and its association with HIV status among pregnant women in South Africa, a national antenatal survey, 2019","volume":"11","author":"Woldesenbet","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Halfon, N., and Forrest, C.B. (2017). The emerging theoretical framework of life course health development. Handbook of Life Course Health Development, Springer.","DOI":"10.1007\/978-3-319-47143-3"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e25488","DOI":"10.1002\/jia2.25488","article-title":"Multiple forms of discrimination and internalized stigma compromise retention in HIV care among adolescents: Findings from a South African cohort","volume":"23","author":"Pantelic","year":"2020","journal-title":"J. Int. AIDS Soc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1080\/09540121.2015.1071775","article-title":"Sex and secrecy: How HIV-status disclosure affects safe sex among HIV-positive adolescents","volume":"27","author":"Toska","year":"2015","journal-title":"AIDS Care"},{"key":"ref_22","first-page":"21","article-title":"Revisiting mixed methods research designs twenty years later","volume":"1","author":"Creswell","year":"2023","journal-title":"Handb. Mix. Methods Res. Des."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.srhc.2018.05.002","article-title":"Perceptions of adolescents and teachers on school-based sexuality education in rural primary schools in Uganda","volume":"17","author":"Achora","year":"2018","journal-title":"Sex. Reprod. Healthc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2325958221999579","DOI":"10.1177\/2325958221999579","article-title":"HIV-Related Knowledge, Attitudes, Behaviors and Experiences of Kenyan Adolescents Living with HIV Revealed in WhatsApp Group Chats","volume":"20","author":"Chory","year":"2021","journal-title":"J. Int. Assoc. Provid. AIDS Care JIAPAC"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/JNC.0000000000000011","article-title":"Perceptions of HIV self-management roles and challenges in adolescents, caregivers, and health care providers","volume":"30","author":"Mutumba","year":"2019","journal-title":"J. Assoc. Nurses AIDS Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1080\/09540121.2016.1176681","article-title":"Equity in adherence to antiretroviral therapy among economically vulnerable adolescents living with HIV in Uganda","volume":"28","author":"Bermudez","year":"2016","journal-title":"AIDS Care"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Vreeman, R.C., Scanlon, M.L., Mwangi, A., Turissini, M., Ayaya, S.O., Tenge, C., and Nyandiko, W.M. (2014). A cross-sectional study of disclosure of HIV status to children and adolescents in western Kenya. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0086616"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"49","DOI":"10.5539\/gjhs.v5n2p49","article-title":"The impact of fear, secrecy, and stigma on parental disclosure of HIV status to children: A qualitative exploration with HIV positive parents attending an ART clinic in South Africa","volume":"5","author":"Madiba","year":"2012","journal-title":"Glob. J. Health Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S57","DOI":"10.1097\/QAD.0000000000000695","article-title":"\u2018HIV is like a tsotsi. ARVs are your guns\u2019: Associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa","volume":"29","author":"Cluver","year":"2015","journal-title":"Aids"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1007\/s10461-021-03398-3","article-title":"HIV-Related Stigma and Psychological Adjustment Among Perinatally HIV-Infected Youth in Cape Town, South Africa","volume":"26","author":"Perez","year":"2022","journal-title":"AIDS Behav."},{"key":"ref_31","unstructured":"World Health Organization (2011). Guideline on HIV Disclosure Counselling for Children up to 12 Years of Age, World Health Organization. Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/44777\/9789241502863_eng.pdf."},{"key":"ref_32","first-page":"2607249","article-title":"Perceptions and Experiences about Self-Disclosure of HIV Status among Adolescents with Perinatal Acquired HIV in Poor-Resourced Communities in South Africa","volume":"2016","author":"Madiba","year":"2016","journal-title":"AIDS Res. Treat."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1080\/09540121003623693","article-title":"Psychosocial challenges and protective influences for socio-emotional coping of HIV+ adolescents in South Africa: A qualitative investigation","volume":"22","author":"Petersen","year":"2010","journal-title":"AIDS Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s13643-019-0980-1","article-title":"Challenges and support for quality of life of youths living with HIV\/AIDS in schools and larger community in East Africa: A systematic review","volume":"8","author":"Kimera","year":"2019","journal-title":"Syst. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/S2352-4642(22)00101-8","article-title":"From surviving to thriving: Integrating mental health care into HIV, community, and family services for adolescents living with HIV","volume":"6","author":"Cluver","year":"2022","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Toska, E., Cluver, L., Orkin, M., Bains, A., Sherr, L., Berezin, M., and Gulaid, L. (2019). Screening and supporting through schools: Educational experiences and needs of adolescents living with HIV in a South African cohort. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-6580-0"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"S251","DOI":"10.1097\/QAD.0000000000000327","article-title":"Evidence of impact: Health, psychological and social effects of adult HIV on children","volume":"28","author":"Sherr","year":"2014","journal-title":"Aids"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s12187-016-9428-5","article-title":"\u2018They Say HIV is a Punishment from God or from Ancestors\u2019: Cross-Cultural Adaptation and Psychometric Assessment of an HIV Stigma Scale for South African Adolescents Living with HIV (ALHIV-SS)","volume":"11","author":"Pantelic","year":"2018","journal-title":"Child Indic. Res."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Mavhu, W., Berwick, J., Chirawu, P., Makamba, M., Copas, A., Dirawo, J., Willis, N., Araya, R., Abas, M.A., and Corbett, E.L. (2013). Enhancing psychosocial support for HIV positive adolescents in Harare, Zimbabwe. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0070254"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"International Advisory Panel on HIV Care Continuum Optimization (2015). IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents. J. Int. Assoc. Provid. AIDS Care JIAPAC, 14, S3\u2013S34.","DOI":"10.1177\/2325957415613442"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"19358","DOI":"10.7448\/IAS.18.1.19358","article-title":"\u201cThe sky is the limit\u201d: Adhering to antiretroviral therapy and HIV self-management from the perspectives of adolescents living with HIV and their adult caregivers","volume":"18","author":"Denison","year":"2015","journal-title":"J. Int. AIDS Soc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"18866","DOI":"10.7448\/IAS.17.1.18866","article-title":"Adolescent HIV disclosure in Zambia: Barriers, facilitators and outcomes","volume":"17","author":"Mburu","year":"2014","journal-title":"J. Int. AIDS Soc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4236\/wja.2015.51004","article-title":"Depression, internalized HIV stigma and HIV disclosure","volume":"5","author":"Okello","year":"2015","journal-title":"World J AIDS"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jad.2018.10.102","article-title":"Suicidal thoughts and behaviour among South African adolescents living with HIV: Can social support buffer the impact of stigma?","volume":"245","author":"Casale","year":"2019","journal-title":"J. Affect. Disord."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1097\/QAD.0000000000001795","article-title":"Multitype violence exposures and adolescent antiretroviral nonadherence in South Africa","volume":"32","author":"Cluver","year":"2018","journal-title":"Aids"},{"key":"ref_46","unstructured":"Mabasa, R.A. (2022). The Development of a User-Friendly Support Programme for Adolescents Living with Perinatally Acquired Human Immunodeficiency Virus in the Vhembe District of Limpopo Province, South Africa. [Ph.D. Thesis, University of Limpopo]."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/4\/441\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T10:12:02Z","timestamp":1775038322000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/4\/441"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":46,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["ijerph23040441"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23040441","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]}}}