Coping With Adversity: Exploring the Role of Protective Factors and Their Impact on School Enrollment and Satisfaction Among Adolescents Living With HIV in Low-Resource Settings
Doctoral Dissertation, Washington University in St. Louis, Brown School
Author: Jennifer Nattabi
This dissertation examined how cumulative adversity and protective factors shaped educational outcomes among adolescents living with HIV (ALHIV) in low-resource settings, with a particular focus on school enrollment and school life satisfaction in Uganda. Using data from the M-Suubi longitudinal randomized controlled trial, the study analyzed survey data from 833 adolescents aged 10–17 years and incorporated qualitative interviews to better understand how young people coped with overlapping HIV-related, social, and educational challenges.
Guided by cumulative risk, resilience, and stress and coping theories, the research found that greater exposure to multiple adversities—including poverty, stigma, orphanhood, and other psychosocial risks—was significantly associated with lower school life satisfaction at baseline and declines in satisfaction over 12 months. The M-Suubi intervention did not demonstrate significant short-term effects on school life satisfaction or moderate the effects of cumulative risk. Older age was also strongly associated with a lower likelihood of remaining enrolled in school. Protective factors, including self-esteem, family cohesion, and social support, partially mediated the relationship between cumulative risk and changes in school satisfaction but did not fully offset the effects of adversity.
Qualitative findings highlighted the multilevel strategies adolescents used to cope, including spirituality, academic focus, treatment adherence, family encouragement, peer support, and school-based assistance. Overall, the dissertation demonstrated that improving educational outcomes for ALHIV required sustained, multilevel interventions that addressed structural, psychosocial, developmental, family, school, and community factors rather than focusing solely on HIV treatment adherence.