Resilience and coping strategies after HIV disclosure among pregnant adolescent refugees in Uganda

Pregnant adolescent refugees living with HIV face intersecting vulnerabilities, including stigma, displacement, poverty, and gender-based violence, which complicate HIV disclosure and treatment adherence. Limited research exists on the coping strategies and resilience mechanisms employed by this group, particularly in refugee settlements. This study explored resilience and coping strategies following HIV disclosure among pregnant adolescent refugees in Nakivale Refugee Settlement, Uganda. This qualitative study employed a phenomenological approach, conducting in-depth semi-structured interviews with 40 pregnant adolescent refugees aged 15–19 years, living with HIV and receiving care at Rwekubo Health Center IV. Participants were purposively sampled to capture diverse experiences related to HIV disclosure, coping, and resilience. Interviews were conducted in local languages, transcribed, and analyzed thematically using descriptive phenomenology. Five major themes emerged: (1) HIV disclosure as a selective, gradual process influenced by age, emotional readiness, and social support; (2) emotional resilience following initial shock, fear, and shame; (3) reliance on social support, spirituality, and personal resilience to cope with HIV diagnosis and disclosure; (4) stigma, discrimination, and social isolation shaping disclosure decisions and emotional well-being; and (5) aspirations for motherhood and a stigma-free future serving as powerful motivators for treatment adherence and emotional strength. Older adolescents disclosed earlier and more confidently, often relying on partners, while younger adolescents delayed disclosure, depending more on parental or healthcare provider support. Pregnant adolescent refugees living with HIV employ varied resilience and coping strategies shaped by their age, social environment, and personal motivations. Social support, maternal aspirations, and spiritual faith emerged as key enablers of coping and treatment adherence. Interventions addressing stigma and enhancing multi-layered support systems are critical to improving HIV outcomes in this vulnerable population.