Experiences of social support in HIV care and mental health among adolescents living with HIV in rural KwaZulu-Natal, South Africa

Background Adolescents living with HIV (ALHIV) face unique and complex challenges. Beyond managing a chronic condition, they often experience significant psychological burdens, such as depression, anxiety, and social isolation. Social support has been identified as a protective factor, but faces significant barriers in its provision especially in rural contexts. This study explored how ALHIV in rural KwaZulu-Natal experience HIV-related stressors and social support, and how different relationships shape their mental health, coping, disclosure, and engagement in HIV care. Methods A qualitative study design was used, involving small-group interviews with 31 adolescents aged 16–19 years, all of whom were living with HIV and receiving care at rural clinics in KwaZulu-Natal. Data were collected using a semi-structured interview guide and analyzed thematically to identify key patterns and insights. Results This study found that strong family and peer support systems play an important role in mental health and treatment adherence of ALHIV. Adolescents described family encouragement and medication reminders as helping them cope emotionally and manage their treatment. Through shared experiences, peer support groups foster a sense of belonging and help reduce stigma and isolation. However, not all adolescents had access to supportive networks, and stigma continued to hinder disclosure and support-seeking behaviors. Conclusion Although social support can be a powerful protective factor, not all ALHIV experience it equally. Interventions should focus on strengthening family engagement, expanding peer support, and reducing stigma to improve mental health and HIV care outcomes among adolescents in rural South Africa.