The role of housing conditions, air quality and green spaces on the psychological Well–being of adolescents living with HIV

Background The psychological well-being of adolescents is often associated with environmental factors such as air pollution, green spaces and housing conditions; however, little is known about how these factors shape the experiences of adolescents living with HIV in under-resourced communities. Aim This study explored the role of urban environmental factors, including housing conditions, air quality and green spaces, on the psychological well-being of ALHIV in Durban, South Africa. Methods A cross-sectional, qualitative design was used, nested within the Caregiver Well-being PLUS (CWeL+) study, evaluating a cash transfer and gender-transformative economic intervention. Twenty-four ALHIV, aged 13–19 years, were purposively selected to ensure gender and area representation. Data were collected through an art-based approach, where adolescents drew their home environment and discussed it in semi-structured interviews with trained staff. Results Nineteen adolescents aged 13–19 years were included in the analysis. The mean age was 15.7years (SD=2.3), with 10 males and 9 females participating. Participants resided in either informal dwellings or formal housing. We identified four primary themes: namely, home as a source of comfort or distress, air quality and well-being, green spaces as sources of joy and peace or frustration and hopes for change: housing, clean environments, and community cohesion. Adolescents reported stress from overcrowded, poorly ventilated homes, often small corrugated-iron structures, and inadequate waste management. Green spaces offered relief but were limited and, in some areas, unsafe. These findings were consistent across interviews and drawings. Conclusion These findings highlight the need for integrated public health strategies that improve housing quality, enhance ventilation, ensure safe waste management, and expand access to secure green spaces.