# “It was like climbing a mountain and not reaching the top”: experiences of South African youth living with HIV who became parents during COVID-19 lockdowns

## TL;DR

This study explores how South African youth living with HIV managed their reproductive health during the pandemic, highlighting challenges and the need for better support systems.

## Contribution

The study provides new insights into the SRH service-access experiences of young people living with HIV who became parents during the pandemic in South Africa.

## Key findings

- Young people struggled to navigate an altered health system during the pandemic despite being knowledgeable about their care.
- Service gaps significantly impacted their health and well-being, emphasizing the need for resilient health systems.
- Practice theory revealed how gender, relationships, and geography shaped their SRH experiences.

## Abstract

The COVID-19 pandemic negatively affected sexual and reproductive health and rights (SRHR) and increased unwanted pregnancies among young people, yet scant evidence documents SRH service-access trajectories and experiences of young people living with HIV during this time. We conducted a remote study, comprised of qualitative Facebook and telephonic data collection with adolescents living with HIV and young parents in South Africa (n = 41, ages 16–29) in 2020/2021. Following this, we conducted in-depth research through calls, WhatsApp and Facebook to explore narratives of two young people living with perinatally-acquired HIV who accessed SRH services and became parents during the COVID-19 lockdowns. We engage a narrative approach to illustrate the trajectories of these two young people – documenting their biopsychosocial lives and experiences accessing SRH services – with attention to personal, structural and relational factors. Findings illustrate their agency while detailing gaps in provisions that significantly affected their health and well-being. This study applies practice theory, exploring how gendered, relational, social and geographic factors shaped young people’s experiences and SRH. Despite being well-acquainted with the biomedical technologies and relationships governing their care, they struggled to navigate an altered health landscape. Findings document how they were subject to narratives of individual responsibility for their SRH amidst system-level shortcomings. Results highlight significant gaps in service provision and an imperative to enhance the material conditions for young parents living with HIV in South Africa. They underscore the need for resilient, shock-responsive health and social protection systems to maintain continuous SRH services for adolescents living with HIV during crises.

This study explored the experiences of young South Africans living with HIV who became parents during the COVID-19 pandemic. It considered the personal, structural and relational factors that affected this group, and their experiences of seeking sexual and reproductive health services during COVID-19. In 2020 and 2021, we conducted research online and over the phone with 41 young people living with and affected by HIV and young parents, aged 16–29. We then conducted in-depth research with two young people living with HIV who became parents during COVID-19, and this paper focuses on their stories. The study found that while these young people were knowledgeable about their healthcare, they struggled to navigate the changed health system during the pandemic. It shows their efforts to manage their health, despite significant gaps in health and social services. This research used practice theory to understand how gender, relationships, social factors and geography affected their experiences. It highlights the need for resilient health and social systems that can continue providing essential SRH services to young people living with HIV, even during crises.