Does living in a slum matter for HIV medication adherence? : examining adolescent behavior in Matero, Zambia

Abstract

Three decades into the HIV/AIDS epidemic, annual infection and mortality figures have been dropping rapidly, and there is a sense of an existential crisis averted. While the AIDS epidemic is coming under control among the broader population, it is growing among vulnerable populations, including the young. Deaths due to HIV have increased by 50% among adolescents, and HIV continues to be the number one cause of death among this cohort group in sub-Saharan Africa. Poor adherence to anti retroviral medication is to blame in large part for this situation. Paradoxically, this is happening in a public health environment where anti retroviral medication availability and distribution are increasingly unfettered, and guidelines for HIV testing and treatment are robust and comprehensive.

What causes these youngsters, who understand the importance of being adherent to missing their life-saving medication? Rapid urbanization is transforming most parts of the developing world, and over half of Africa's population now lives in cities. Almost all of this growth has been in slums. Slums in sub-Saharan Africa have a younger demographic, a higher HIV prevalence, and spatially present the most critical target for any efforts to address medication adherence among youth. Where previous studies on medication adherence among adolescents have focused on the patient, the caregivers, and medication-related barriers, this study examines if living in a slum neighborhood creates impediments to antiretroviral adherence. Through 42 semi-structured interviews conducted in a slum neighborhood in Lusaka, Zambia, this study uncovers ways in which the physical, environmental, social, and resource dimensions of the Matero compound may be impacting adolescent HIV medication adherence.

The health of slum residents is one of the primary urban challenges for the coming decades. Successful health interventions may require a deeper understanding of life in slums and adopting both a slum-centered and a disease-centered approach.