Adolescents living with HIV (ALHIV) in Malawi experience multiple challenges associated with their illness\nand various social, environmental, economic and cultural factors. In exploring their various medical concerns and\nsocial vulnerabilities, we consider the role of multiple services in creating a pathway for resilience.\nMethods: Multiple methods and case studies allowed for triangulation of evidence and provided a holistic understanding\nof resilience among adolescents with complex needs. The research methods included: (1) a survey to\nidentify examples of young people with complex needs, (2) qualitative interviews and field notes to further explore\nthese needs, (3) patient files and health passports to identify clinical challenges, and (4) ecomapping exercises to\npersonalize cases and identify resilience-enabling resources and supports. We present four case studies to highlight\nthe complex experiences and access to services of ALHIV, and to illustrate their growing power and decision-making\ncapacity over time.\nResults: Adversity experienced by ALHIV varied by gender, family situation, years of schooling, and use of teen-clubs\nfor support. The two female adolescents emphasised their need to be accepted and how this impacted sexuality and\nreproduction. The two males illustrated how ideas of masculinity influenced their sexual practice and involvement\nwith health services and the correctional justice system. Multiple risks (alcohol use, sexual activities) and complex\nneeds (belonging, having a purpose in life/productive activities, autonomy, desire for offspring) influence pathways to\nresilience. ALHIV were able to strengthen their own wellbeing by resisting negative behaviours and peer pressure and\ncaregiver interactions through â??strategic silenceâ??.\nConclusion: ALHIV experienced self-transformation as a result of taking ART, with fewer severe episodes of illness\nand distressing skin conditions. Continuous engagement at the teen-club clinic transformed both productive activities\nand social relationships among ALHIV as they set life goals, gained a sense of empowerment, requested SRH services,\nand formed intimate relationships. These transformative opportunities allowed them to learn ways of minimizing\nrisk of reinfection and violence, and of navigating health workerâ??caregiverâ??adolescent interactions.
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