| dc.description.abstract | Adolescents, worldwide, account for approximately 63% of People Living with HIV (PLHIV) during 2010-2020. Similarly, while HIV-related deaths have declined across all age groups, that of adolescents rose from 18,000 deaths per annum in 2010 to 41,000 deaths in 2020, with boys constituting 69%. In Siaya, one of the HIV high prevalence counties in Kenya, an average of 257 AIDS-related deaths among young adolescents occurred (153 Males; 104 Females) compared to neighbouring counties between 2015 and 2022. Whereas poor healthcare infrastructure and costs of medication are mentioned as barriers in the HIV and AIDS treatment struggle, socially constructed norms such as masculinity have received attention, particularly among male adults and not adolescent boys on ART. The primary aim of this study was to explore masculinity factors influencing VL suppression among adolescent boys on ART in Siaya County, Kenya. Specifically, the study investigated how perceptions of masculine identity influence VL suppression, establish how masculinity conceptions of sexual behaviour influence VL suppression, and determined the influence of alternative policy interventions on VL suppression. This study was guided by Kimberlé Williams Crenshaw‘s Intersectionality theory advanced in 1989. Intersectionality recognises that people's lives are shaped by their identities, relationships and context-based social factors. The target population included 795 adolescent boys on ART, comprehensive care-in-charge charge and other experts from the County. A sample size of 265 boys was computed using Yamane‘s formula. Seven interviews were done with key informants: one County AIDS/HIV and STI Coordinator (CASCO), three Sub County AIDS Coordinators (SCACOs), and threecomprehensive care-in charge (CCC), while a semi-structured questionnaire was administered to the adolescent boys. Similarly, 12 focus group discussions were conducted with Officials of Public Benefit Organization (NGOs, CBOs, etc.) and purposively selected boys on ART, whereas 12 individual In-depth Interviews were done with purposively selected boys from the six Sub County health facilities. Quantitative data was analysed through descriptive and inferential statistics and presented in tables, while thematic analysis was used to analyze qualitative data which have been presented in verbatim. Findings showed that perceptions of masculine identities have influenced VL suppression in some boys (M=3.315; SD=1.046), and the more they accept the identities, the poorer their VL suppression (B= -.376; P=.000). Findings also showed that boys who participate in active sexual activities (n=73; 27.8%) also engage in multiple sexual partners, while the 73.16% who were sexually inactive cited being young and inability to finance intimate relationships as the main barrier. Findings, additionally, revealed that alternative policy interventions have influenced VL suppression in some boys (M=3.06; SD=.992), and contribute significant unit changes to VL suppression (B= 0.721; p=.000). Together, 27.2% (R2 = .272) change in VL suppression among the boys in the study is attributed to masculinity factors. It is concluded that perceptions of masculine identities and conceptions of sexual behaviour together intersect with social factors including age, peer pressure, and orphanhood, among others, to shape VL suppression of the adolescent boys. Concerted efforts should be directed at reconstructing how sleeping arrangement is fulfilled to enable closer supervision of the boys. Similarly, robust sensitization on masculinity-related risky sexual behaviour should be conducted for the boys at early age. Additionally, interventions should be tailored to individual needs of patients, especially social needs of individual adolescent boys. | en_US |
