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The subjective experiences and perceptions of care among depressed adolescents

living with HIV attending a community adolescent HIV programme in Harare,


by Nicola Willis

Thesis presented in fulfilment of the requirements for the Degree of Master of Philosophy

in Public Mental Health at Stellenbosch University

Supervisor: Professor Ashraf Kagee

Co-supervisor: Dr Webster Mavhu

December 2016

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By submitting this thesis electronically, I declare that the entirety of the work contained

therein is my own original work, that I am the authorship owner thereof (unless to the extent

explicitly otherwise stated) and that I have not previously in its entirety or in part submitted it

for obtaining any qualification.


Date: December 2016

Copyright © 2016 Stellenbosch University of Stellenbosch

All rights reserved

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(Kudzanai, 17 years). Another participant also conveyed her low self-worth in the context of

relatives when describing her lack of relationship with her older brother: …(my brother) is

HIV negative so when l compare him with me l just realise that l may not be that

loveable…because he is learned, he has a good job and all that”. But l don’t have anything

(Mitchell, 19 years).

One male participant conveyed his sense of low self-worth when he painted a picture to

symbolise depression. He painted a ‘pawn’ in a chess set, explaining that “a pawn is

worthless among other pieces” (Wangaa, 17 years). He then went on to describe the way a

pawn is alone at the front on a chess board and is attacked before all the other pieces, using

the chess piece as a metaphor for his own life.

Participants’ low self-worth was also evident in the way they blamed themselves for their

families’ burdens. A few participants suggested that their families’ lives would have been

easier without them, particularly as they felt unable to contribute financially to the household.

“I regret being born. I blame myself for my mother falling pregnant and having to conceive

me” (Mitchell, 19 years).

4.2.7 A lack of protection

Participants described events in their lives where they had not been protected by the people

closest to them, and the pain they felt as a result of those people not only not protecting

them, but being the ones who inflicted abuse. A sense of betrayal and disillusionment was

evident in their narratives, particularly by those whom had been sexually abused, both by the

perpetrator and by family members who did not then seek justice. The colour black was

often used to explain “the way the people in my life have ill-treated me” (Pain, 19 years).

One female participant painted her entire body black and explained “my mother died…

father l have but he doesn’t care about me. ….. He was sexually abusing me (Janet, 19

Stellenbosch University

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years). This girl’s case is being co-managed by the study site’s psychologist and the

Department of Social Services.

Others also used colour to illustrate this pain and betrayal and to link their life experiences

with the bodily experience, particularly in the case of sexual abuse. When explaining the use

of the colour black, another female participant explained that the black parts of her painting

refer to the events that stress her, stating

“I will be wishing (they) would come off me, but you find them all there. ...Like the

things of mischief and naughtiness (the rape) l was talking about, you will be wishing

if they would leave me. The black l have drawn there reflects the people who want to

hurt me. Those who want to rape and sleep with me (Tarisai, 18 years).

This girl is also being co-managed by the study site’s psychologist and Department of Social


4.2.8 The Future

Participants described or illustrated their future in two

different ways. Most participants depicted high expectations

for a successful, brighter future, where their definition of

‘success’ was clearly conveyed through their drawings of

getting married, having children, academic achievement at school and gaining employment.

The need for independence from unsupportive caregivers was significant for some

participants and was linked to the desire to be employed and economically stable. They also

conveyed that marital status and children of their own, along with completing their education

and becoming employed, would improve their sense of self-worth. They longed to be valued

by others, as illustrated by one girl when she drew a picture of a graduation cap to symbolise

her desire to graduate, explaining “l should be a graduate and l should be a worthy person

among other people” (Runyararo, 18 years).

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