“Why is it so hard to stay on treatment?” challenges to antiretroviral therapy engagement among Indonesian adolescents living with HIV

Antiretroviral therapy (ART) is essential for preventing HIV transmission and improving health outcomes among adolescents and young people living with HIV. However, little is known about the factors shaping ART engagement among these adolescents in Indonesia. This study explored the individual, familial, and social challenges or barriers to ART engagement among twenty adolescents living with HIV, aged 16-18 years, in Yogyakarta, Indonesia. One-to-one in-depth interviews were analysed using a qualitative framework informed by the socio-ecological model. The findings showed that individual-level barriers to ART engagement included post-diagnosis mental health challenges, fatalistic beliefs and disrupted imagined futures. Familial barriers included limited privacy in shared household living arrangements, rejection of same-sex sexuality, difficult family dynamics, and lack of family support. At the societal level, perceived, anticipated, and experienced stigma in healthcare, school, and community settings further undermined adolescents' engagement in HIV treatment. The findings highlight the importance of developing policies and interventions that strengthen psychosocial support, family engagement, and stigma reduction to improve ART engagement among adolescents and young people living with HIV in Indonesia.