Unseen Struggles and Silent Strength: A Qualitative Exploration of the Emotional Burden and Coping Strategies of Family Caregivers of Adolescents Living With HIV in Ghana

Background Adolescents living with HIV (ALHIV) face unique challenges that extend beyond medical management to impact their caregivers’ mental and emotional well‐being. Despite growing literature on HIV care, limited research has explored family caregivers’ experiences in West African contexts. Aim This study aimed to explore the emotional challenges experienced by family caregivers of ALHIV, highlighting their coping strategies. Methods A qualitative study employing an interpretivist paradigm was conducted using focus group discussions with 13 family caregivers of ALHIV in the Lower Manya Krobo District, Ghana. Participants were purposively selected from the hospital’s HIV clinic. Data were collected through two focus group discussions using a semi‐structured guide informed by the transactional model of stress and coping. Discussions were audio‐recorded and analyzed using reflexive inductive thematic analysis following Braun and Clarke’s approach. Results Four major themes emerged from the analysis: (1) emotional burden of caregiving (2) adaptive coping strategies (3) practical caregiving challenges, and (4) social dimensions of caregiving. Analysis revealed that caregivers engage in emotional invisible labor—a pattern of concealed distress where they deliberately hide grief, fear, and anxiety to protect adolescents’ psychological well‐being. This emotional regulation functions as a caregiving strategy itself, requiring caregivers to simultaneously manage their own profound emotional burden (persistent worry, future uncertainty, and anticipatory grief) while maintaining a composed exterior. Caregivers employed diverse coping strategies, including purposeful distraction through sensory experiences, spiritual resources as meaning‐making tools, and conscious emotional self‐regulation. However, these adaptive responses occurred within constraining social contexts marked by HIV‐related stigma, selective disclosure practices necessitated by fear of discrimination, and substantial practical challenges, including medication management demands and financial strain requiring normalized self‐sacrifice. Conclusion Family caregivers of adolescents with HIV perform significant emotional invisible labor—concealing their own distress as a protective caregiving strategy. This finding extends the understanding of caregiver burden beyond practical demands to encompass the psychological costs of emotional regulation performed to safeguard adolescent well‐being. Interventions should recognize caregivers’ emotional labor, integrate mental health support with existing coping mechanisms (spiritual resources and peer support), and address stigma that necessitates concealment while providing economic strengthening to reduce practical stressors. Trial Registration ClinicalTrials.gov identifier: NCT06701942