South African adolescents and young adults (AYAs) with HIV experience worse HIV-related clinical and psychological outcomes compared to older South Africans. Psychological resilience is protective against poorer outcomes, but little is known about disparities in psychological resilience among AYAs with HIV nor the mechanisms by which these differences arise. This study analyzed baseline data from a cohort of 100 AYA ages 18–24 years in Cape Town and Buffalo City. Mediation analyses revealed that high health literacy was associated with a more satisfactory patient-provider relationship, a more satisfactory patient-provider relationship was associated with a greater degree of psychological resilience, and the indirect effect of health literacy on psychological resilience was significant. These findings suggest that high health literacy and strong patient-provider relationships may be associated with greater psychological resilience among AYAs with HIV. By identifying these modifiable factors, this study highlights how public health interventions aimed at strengthening health literacy and the patient-provider relationship may enhance psychological resilience in this vulnerable population.
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