The sample comprised 76 (56.58% male) seropositive young people residing in the city of Durban, South Africa. Durban is located within the province of KwaZulu-Natal, which has the highest HIV prevalence rate in the country.37 Participants ranged from 15 to 24 years of age (Mage=19.36, s.d.=2.56) and identified racially as African (82.89%) or coloured (17.11%). A majority of the sample had fulfilled high school equivalency requirements (67.11%) or completed post-secondary education (28.95%). A small proportion of the participants had not completed any formal education (3.95%). Almost half of the sample (52.63%) indicated that they had acquired HIV after birth from a source other than their mother (i.e. horizontal infection), and the remainder (47.37%) reported that they had been infected through mother-to-child transmission (i.e. vertical infection).
Rosenberg Self-Esteem Scale
The Rosenberg Self-Esteem Scale (RSES) is a 10-item measure of self-respect and self-acceptance. Items (e.g. ‘I feel that I am a person of worth, at least on an equal plane with others’) are rated using a fourpoint response scale (1 = Strongly disagree; 4 = Strongly agree), half of which are reverse scored. In this study, responses to all items were aggregated for a total raw score (range: 10 to 40). Findings of various studies support the construct validity of the RSES.38,39 Estimated internal consistency reported for the RSES in prior research has been ≥0.80.40
Internalised AIDS-Related Stigma Scale
The Body Appreciation Scale-2 (BAS-2) contains 10 items that measure a person’s perceptions of their body (e.g. acceptance, appreciation, inner positivity) and attention towards their body’s needs through the adoption of healthy behaviours.43 Participants rate the items (e.g. ‘I feel good about my body’) using a five-point response scale (1 = Never; 5 = Always). Item responses are summed for a total score ranging from 10 to 50. Higher scores indicate greater levels of body appreciation. The BAS-2 has been cross-culturally validated in samples from diverse countries (e.g. China, England). Previous studies have reported internal consistency values of ≥0.80 for women and men44, and evidence supports the convergent, incremental, and discriminant validity of the BAS-243.
Morisky Medication Adherence Questionnaire
The Morisky Medication Adherence Questionnaire (MMAS-8) comprises eight items that assess patient adherence to medication for chronic conditions. The first seven items (e.g. ‘When you feel like your symptoms are under control, do you sometimes stop taking your medicine’) are rated using a dichotomous response format (0 = Yes; 1 = No). A five-point response format is used to rate the final item (e.g. ‘How often do you have difficulty remembering to take all your medicine’), which is transformed to a dichotomous score prior to aggregation of item responses (0 = A; 1 = B–E). In this study, participants completed the MMAS-8 by referencing their adherence to ART medication. We aggregated responses to each of the MMAS-8 items for a total score ranging from 0 to 8, with higher scores reflecting greater adherence to ART. Evidence supports the psychometric utility of the MMAS-8 as a valid and reliable measure of medication adherence46, including ART adherence47. Previous research has reported internal consistency values of ≥0.75 for the MMAS-8, and the findings of several studies support the construct validity of the measure.
Ethical approval for this study was granted by the Humanities and Social Sciences Research Ethics Committee of the University of KwaZulu-Natal (HSS/0522/018D). Written permission was acquired from a local HIV youth centre to access YPLHIV who received ART from the organisation. A purposive, convenience sampling approach was used to recruit participants. Specifically, YPLHIV who presented at the youth centre to collect their monthly medication were invited by a team of researchers to participate in this study. Interested individuals were directed to a private administrative office where they were initially given details about the study purpose, the participation procedures, and ethical considerations (e.g. anonymity, confidentiality). Those who agreed to participate were invited to provide their written informed consent. With the assistance of the nurses at the youth centre, parents and legal guardians of potential participants below 18 years were informed of the research. Written parental consent was obtained on behalf of all legal minors who indicated their interest in participating. Written assent was also obtained from legal minors. The measures were administered in English, which participants completed in an office provided by the youth centre. The research team was present and available to address any questions or issues that arose during the course of the subjects’ participation.
Article TitleSelf-esteem and antiretroviral therapy adherence among young people living with HIV: An exploratory serial mediation analysis
Capitalising further on the benefits of antiretroviral therapy (ART) for individual treatment requires an improved understanding of the psychological processes that may affect optimal ART adherence among people living with HIV. We examined internalised HIV/AIDS-related stigma and body appreciation as mediators of the association between self-esteem and ART adherence among young people living with HIV (YPLHIV). A sample of 76 YPLHIV (Mage = 19.36, s.d.age = 2.56; male 56.58%) residing in an HIV hyperendemic region of South Africa completed self-report measures of self-esteem, internalised HIV/AIDS-related stigma, body appreciation, and ART adherence. Path-analytic mediation modelling was performed to test for direct and indirect effects linking self-esteem with ART adherence. Results of serial mediation analyses indicated that self-esteem and ART adherence were indirectly associated through a two-step path of internalised HIV/AIDS-related stigma and then body appreciation, as well as a one-step path through internalised HIV/AIDS-related stigma. The results provide preliminary support for internalised HIV/AIDS-related stigma and body appreciation as mechanisms underlying the association between self-esteem and ART adherence. Implications of the findings for promoting ART adherence among YPLHIV are discussed.