Digital commentary activities for managing spoiled identities among young South African women and girls (16–24) living with HIV: A sociologically informed content and thematic analysis

Abstract

Objectives

This study examines how young South African women and girls (YSAWGs) engage with digital spaces to navigate culturally sensitive issues surrounding HIV, gender norms, and sexuality – topics that are often stigmatised and socially silenced in offline environments. The research focuses particularly on how digital engagement supports mental health and emotional self-management and assesses the potential of digital platforms to compensate for deficits in formal and informal support systems.

Methods

Guided by Goffman's stigma and Butler's performativity, this study analysed content from Springster, a moderated digital platform for young women operated by Girl Effect. Ethical approval and a data-use licence were obtained in September 2021. Over four months, 135 stories and 12,764 user comments were collected. Some participants self-reported living with HIV and discussed HIV-related risks. An integrated content and thematic analysis examined the content dimension of digital usage, focusing on how YSAWGs mobilise the platform to negotiate HIV-related and socially spoiled identities.

Results

Five dominant forms of digital commentary were identified: (1) advising and suggesting (n = 437); (2) sharing concerns and seeking advice (n = 328); (3) reflection and critical thinking (n = 299); (4) inspiration and learning (n = 228); and (5) self-representation (n = 94). These interactions functioned as substitutes for limited school-based sexual-health education, inadequate mental-health resources and gaps in supportive interpersonal relationships. Users frequently sought non-judgemental peers and reciprocal support to navigate emotional and social challenges related to HIV, gender, and sexuality.

Conclusion

The study demonstrates the potential of digital platforms to support the mental and sexual health of YSAWGs, particularly amid persistent social and digital inequalities in South Africa. While digital engagement offers valuable opportunities for connection, learning, and emotional regulation, it also carries risks that may limit its benefits. The findings highlight the urgent need for systematic, educationally interactive interventions for YSAWGs.

Introduction

Over the past four decades, the Human Immunodeficiency Virus (hereafter HIV) has been recognised as a persistent global epidemic, affecting an estimated 39 million people worldwide. ¹ Although global HIV-related morbidity and mortality have declined, inequalities in new HIV infections remain pronounced along gendered and geographic lines. In Southern Africa, these disparities are particularly stark. South Africa continues to record disproportionately high rates of new HIV infections among young women (aged 15 and over), almost twice those of their male counterparts in 2022. ¹ Understanding why Young South African Women and Girls (YSAWGs) remain disproportionately vulnerable to new HIV infections forms the central impetus for this study.

Although the study is anchored in questions of HIV-related identity and stigma, its empirical focus is not confined to clinically confirmed HIV-positive users. Instead, it examines how young South African women and girls aged 16–24 engage with the digital platform Springster to discuss a wide range of HIV-related concerns, including living with HIV (as self-disclosed), testing, disclosure, prevention, intimate relationships, and stigma. This broader framing reflects the realities of a high-prevalence context, in which experiences of living with HIV and conditions of vulnerability to infection are deeply entangled. On Springster, these dimensions frequently intersect within young women's everyday narratives, rendering it analytically necessary to consider both lived experiences of HIV and the wider social, relational, and structural conditions that shape risk and resilience.

Much prior scholarship has explained HIV-related disparities primarily through individual behaviour-based frameworks rooted in modernist, rationalist, and individualist assumptions. ² While such approaches have contributed important insights, they inadequately account for the broader social conditions that shape young women’s vulnerability to HIV infection. These include stigma,^3,4 gendered and sexual identity constructions,^5,6 religious and patriarchal norms, ⁷ and the enduring legacies of apartheid and structural inequality in South Africa.^8–10 Within these intersecting contexts, HIV risk is not only biomedical but also socially produced, influencing young women’s willingness and ability to access information, articulate concerns, seek care, and mobilise support.

Alongside these structural dynamics, digital environments increasingly mediate how young people encounter and respond to sexual health risks, including HIV. Crucially, in this study, digital usage is not conceptualised in terms of how frequently digital platforms are accessed, but rather how they are used as social spaces for meaning-making, communication, and negotiation of sensitive issues. In South Africa, young women’s digital engagement cannot be understood as a neutral or purely technological activity. Rather, digital usage constitutes a socially embedded practice through which YSAWGs navigate emotional, relational, and health-related challenges.^11,12

Specifically, this study defines ‘digital usage’ sociologically as the qualitative ways in which young South African women engage with digital platforms to discuss, interpret, and manage socially stigmatised topics – such as HIV, sexuality, and intimate relationships – that are often difficult or unsafe to articulate in offline contexts. This definition foregrounds how digital spaces are mobilised rather than how often they are accessed. Within this framework, digital usage is analytically operationalised across three interrelated dimensions: (1) the degree of usage, understood not simply as frequency, but as the intensity and depth of engagement with particular topics or interactions; (2) the extent of usage, referring to the range and forms of practices undertaken – such as reading others’ experiences, narrating personal concerns, seeking advice, or offering emotional support; and (3) the content of usage, which captures the substantive themes, narratives, and discourses produced around HIV, sexuality, stigma, religion, and gendered expectations. Together, these dimensions enable an examination of how digital platforms function as alternative communicative arenas rather than as mere channels of information consumption.

This study focuses specifically on Springster, a mobile-first digital platform designed to support adolescent girls and young women through access to health information, peer interaction, and moderated commentary spaces. Viewed sociologically, digital usage on Springster illuminates how YSAWGs appropriate online environments to engage with sensitive and socially stigmatising issues – particularly those surrounding HIV and sexuality – in ways that may be constrained, silenced, or morally regulated in offline social settings. In this sense, digital platforms operate as spaces where silence can be managed, stigma negotiated, and collective meaning constructed.

However, existing HIV-related digital research – largely conducted in digitally privileged Global North contexts – has tended to prioritise functional dimensions of digital engagement, such as information-seeking or service uptake,^11,12 rather than examining the social drivers shaping why and how young South African women engage digitally around stigmatised sexual health concerns. By contrast, this study centres digital usage as a socially situated practice shaped by stigma, inequality, and gendered power relations, rather than as a measure of exposure or frequency alone.

Understanding digital engagement in South Africa further requires attention to structural constraints, including affordability, access, and digital literacy, ¹³ collectively conceptualised as the digital divide.^14,15 These inequalities structure who participates online, how participation unfolds, and what forms of expression become possible or constrained. Building on medical sociology and feminist theory, this study therefore conceptualises digital engagement as a form of social and emotional care practice, embedded within broader systems of inequality, cultural norms, and relational belonging.

Within this framework, digital commentary activities (DCA) refer to the forms, purposes, and interactional patterns of user-generated comments on Springster, including seeking advice, disclosing fears, sharing experiences, offering emotional support, and engaging in collective reflection. Analysing DCA allows this study to empirically examine how digital usage operates in practice – revealing how YSAWGs use online commentary to negotiate HIV-related vulnerability, sexuality, and gendered expectations in ways that are often foreclosed offline. Guided by interpretive and decolonial feminist approaches, this study challenges dominant binary paradigms rooted in White, male-centred modernist and essentialist traditions ² and instead centres the lived, situated experiences of YSAWGs.

Drawing on the conceptual clarifications above, the following research questions guide this study:

What kinds of digital commentary activities (DCA) emerge among Springster users, particularly YSAWGs living with (or without) HIV?

What social landscapes shape the digital experiences of YSAWGs living with (or without) HIV?

What are the implications of YSAWGs’ DCA for their sexual health rights and for navigating HIV-related issues?

Literature review

Social landscapes of South Africa

The social landscapes around the HIV epidemic impact HIV-positive young women and girls in South Africa in a multitude of ways, including their health conditions, social roles as women in their households or communities, emotional situations such as trauma, stigma, and grief from the likely loss or absence of their parents or relational support systems, or sexual abuse or violence from romantic or sexual relationships, any other uncertain futures including education attainment, job opportunity, or marriage, etc. ¹⁶ From sociological and anthropological perspectives, these daily challenges can be interpreted as a social product intertwined in the context of South African histories, political or economic structures, ⁹ sociocultural (i.e., religious ¹⁰ or patriarchal ¹⁷ norms), and relationships (i.e., families, ¹⁸ partnerships ¹⁹ and peers ²⁰ ).

As many scholars argue,^8,9 the appearances of contemporary poli-economic landscapes in South Africa have been constructed with their colonised histories in the apartheid era (1948–1994). A study of Harris ²¹ analyses the constitutional foundations through which the ruling National Party systematically assembled social formations structured across racial and social categories and reinforced through vertical hierarchies of authority and control. These social blocks prevented interactions and movement between populations classified by race and class hierarchy and gender politics, perpetuating socially divided landscapes with varied inequalities in South Africa, even in the post-apartheid era.^8,9 In particular, the inequalities in education, ²² digital use, ¹⁵ and health access ²³ (William's ²⁴ study highlights racial discrimination in clinical settings as a structural barrier in the USA context) can be viewed as structural barriers, which are crucial in comprehending how these factors influence the knowledge and experiences of young women in South Africa regarding HIV.

Among cultural dynamics in South Africa, the influence of the norms of Christianity and Patriarchy is imperative to understand behaviours and choices among young women. This is because they intervene in the sense-making process of femininities or masculinities in relationships. Douglas ²⁵ emphasises on the religious interpretation of behaviours, and provides a framework for understanding what is culturally considered good or bad, or morally right or wrong, for women in the context of sexual practices and feminine conduct. This includes considerations of virginity, childbirth, and reproductive health; in the opposite of premarital sex, teen pregnancy, and sexually transmitted diseases such as HIV.

Furthermore, within the framework of Christianity and patriarchy, which premise heterosexual relationships and a binary division of biological sex into men and women, ²⁶ there exist culturally and morally acceptable boundaries specific to particular societies. Societies guided by these norms tend to impose subordinate roles on women in romantic relationships and sexual practices, often characterised by expectations of silence, passivity, and docility. ²⁷ In contrast, men are typically associated with leading, active, and aggressive masculinities (ibid.). These cultural disciplines shape gendered health behaviours in families or romantic partnerships, which are closely related to the incidence of sexual violence and new HIV infections.^28,29

Theoretical frameworks

This study is informed by three interrelated sociological frameworks: Goffman's theory of stigma, Butler's concept of performativity and normative regulation, and relational sociology as articulated by Smart. ³⁰ These frameworks are explicitly operationalised to analyse how digital relationships shape identity development and enable navigation of stigmatised experiences related to gender, sexuality, and HIV. Together, they foreground identity as socially constructed and relational, formed through interaction under conditions of moral regulation and structural inequality. While symbolic interactionism, as developed by Blumer, ³¹ provides conceptual grounding for understanding how meaning emerges through interaction, it is not applied as a separate analytic framework. Rather, relational sociology anchors the analysis by situating digital commentary within broader sociocultural structures, treating it as a relational practice through which young women negotiate stigma and construct socially intelligible identities.

Global digital communities for illness management

Since 1990, digital communities have emerged as one alternative solution to counter an increased sense of psychological exclusion or social isolation constructed in physical settings in illness management. ³² Specifically, there are manifold digital support groups for those living with health conditions such as diabetes and anorexia, ³³ cancer,^34,35 dementia,^36,37 asthma, ³⁸ HIV/AIDS,^39,40 and any other health conditions. Such digital phenomena seem prominent for people with chronic rather than acute illnesses. ³³ These phenomena coincide with increasing acknowledgement of the limitations of prior approaches that emphasised immediate actions or short-term therapeutic outcomes. This highlights the need for a paradigm shift in conceptualising social care for people living with long-term illnesses.

Robins and Webster ⁴¹ explain the features of digital communities in which community members are a bit contingent, transitory, and self-oriented, but dependent on newly shared interests or values in comparison with the traditional form of communities. Another hallmark of a digital community is that the community's members have the option of maintaining either an anonymous or an identified presence. Notably, digital anonymity seems to help individuals who experienced social exclusion or discrimination, like stigma, firstly to blur the boundaries of social identities (i.e., race, class, gender, and health status) and secondly, to liberate the rather suppressed sphere of personal expressions to some extent, which was pre-conceptualised by physical conditions. ⁴²

Some benefits of digital communities, as Castells ⁴³ also posits, seem clear to enable individuals with health conditions to obtain psychological support in their illness journey. From the interactionist standpoints, their digitalised representations of their experiences may give them opportunities to (re)shape their pre-existing thoughts, values, and identities. ⁴⁴ While the critics of digital performances as self-representations exist in terms of how sustainable their new identities’ generation or development would be, ⁴⁵ it appears at least attentive to the fact that such digital interactions in health communities can play a bridging role in the gaps their physical settings produced to some extent. This can be viewed as a reconstructive or therapeutic process in their illness management through digital peer-support. ⁴²

Digital communities’ potential risks

Despite such digital benefits, the digital use simultaneously retains a risk of deception, known as digital trustworthiness. ⁴⁶ In light of illness management, Hargreaves and colleagues^11,47 explain four possible risks to participating in digital health forums: 1) through digital anonymity use, deceiving, pretending, or exploitative messages can be exchanged, 2) micro-aggressive messages, for example, disputation or conflicts among users can occur, making them feel overwhelmed or bullied by others and upset, 3) empathy can remind of a certain situations or embodiments. For example, digital engagements in sharing experiences between those living with a particular illness have the potential to re-traumatise those with trauma stemming from similar experiences of their psycho-socio conditions, 4) misrepresentation or misrecognition of illness-related issues can appear on the digital health forum, leading to magnified viewpoints of certain negativity. When any one or combination of these risks is experienced by a digital community participant, the risks of mental distress may outdo the therapeutic value gained from participation in these digital spaces. Thus, such digital forums’ ambivalence must be taken into account, depending on the users’ purpose and interests.

To mitigate the risk of adverse incidents related to participation in a digital community, Hargreaves and researchers ⁴⁷ highlight that the intervening role of digital forum moderators is central to resolving any arguments, removing harmful messages, and providing some recommendations for heedfulness while monitoring the digital forum. This can be understood as an endeavour of systematic approaches to making the digital environment feel welcome and secure. Nevertheless, it is noteworthy that such systematic management can constrain users’ perceptions of ownership over the platform, leading to rather passive participation in the digital forum, such as those who observe other participants’ digital activities rather than sharing their actual concerns with digital communities. ⁴⁸

Digital communication among young people living with HIV

The 16–24 age range reflects both epidemiological and socio-cultural considerations. In South Africa, young women within this bracket experience disproportionately high HIV prevalence and share overlapping conditions of schooling transitions, economic precarity, gendered vulnerability, and heightened exposure to stigma. Although this span includes late adolescence and emerging adulthood, it represents a culturally contiguous life stage marked by relational dependency and constrained autonomy. Digital technologies are particularly significant for this cohort – especially those living with chronic illness – because they enable alternative forms of community and identity negotiation beyond socially marginalising offline environments. The analysis, therefore, treats this age group as a socially situated cohort rather than a strictly developmental category.

In previous empirical studies, digital help-seeking phenomena among youths living with HIV have been highlighted with clinical evidence.^49,50 In particular, one study from Bacigalupe and researchers ⁵⁰ clearly demonstrates the role of digital communities among youths living with HIV in obtaining health information, emotional guidance, and a sense of community that spans geographical barriers. In this sense, it can be contended that digital interactions can help them overcome place-based barriers and expand the empathy sphere of physical and psycho-social impacts from their virtual peers to some extent in their chronic illness management.

In terms of identity development in adolescents, digital communication can be significant as it allows them to give opportunities to experiment with their capability of how present their situations and concerns living with a certain illness condition. Through such a digitally representing skill, young users may shape their sense of selfhood. ⁵¹ This is in resonance with the concept of ‘personhood’ denoted by Smart, ³⁰ suggesting constitutive and interactive meanings in relationships. Smart's concept of ‘personhood’, in light of interactive performances, can be seen as similar to Goffman's ⁵² concept of ‘performative self, meaning that agents disguise new roles conforming to digital counterparts’ expectations. However, Smart's stance of the interaction's presence seems to adopt a more extensive and in-depth one of interactions, compared with Goffman's one, as she accentuates social environments’ influence embedded in relationships, such as structural and socio-cultural factors. These were not considered in Goffman's concept, as Finzen ⁵³ notes.

Besides, digital storytelling about young users’ emotional experiences or situations can psychologically serve as a narrative therapy (see Willis and colleagues’ ⁵⁴ pilot study). This echoes a concept referred to as Mead's ‘reflexive self’. ⁵⁵ Goffmanian and Meadian concepts throughout the literature have been harnessed for those who need the treatment of internalised stigma, ⁶ Goffman ⁵⁶ coined this ‘spoiled identity management’. What differentiates this study from previous research is that this study focuses on applying these concepts to the cases of young South African women living with HIV in the digital realm.

Meanwhile, young people's sentiments in digital spaces often influence one another, generating effects at multiple levels. Reactions to individuals’ digital outputs – such as posts, comments, and indicators of approval (e.g., likes or preference counts) – function as influential mechanisms. These interactions not only amplify particular viewpoints and contribute to broader social awareness at a macro level, ⁵⁷ but also influence users’ emotional vibration (in up or down ways) on a micro level. ⁵⁸ On the positive side, as adolescence is a learning process of identity development or self-discovery, ⁵⁹ the digital domain can be a virtual playground for them to explore their aspirations, preferences, and envision life trajectories. ⁴⁴ However, on the negative side, digital peer interactions may be a stimulus encouraging youths to engage in high-risk behaviours physically and mentally, such as impulsively imitating virtual peers’ conduct of self-harms or suicides. ⁶⁰ Besides, recognising the potential hazards of digital engagement among youths is important when they are exposed to misinformation ⁶¹ or abusive messages ⁶² created by digital peers regarding their social and health status.

Social and digital divides in the Global South

The lack of research in digital communities in the Global South context may be attributed to digital inaccessibility, especially in low to middle-income countries with limited Internet penetration. Such a digital divide in the Global South, including South Africa, may hinder young people's digital literacy, leaving them ill-equipped to handle digital harms and risks of participation in online support groups, ⁶³ and thereby, they could lose the chance to become digitally critical agents in harnessing their subjectivity. This argument can be supported by the discussion suggested by Livingstone and researchers ⁶⁴ on children's digital rights in the Global North context. This helps us infer a possible situation that the challenges posed by societal situations are likely to be even more acute or unsolved for those socially susceptible to stigma, those affected by HIV, and those living in socially marginalised households, primarily due to the potential of deficiencies of both physical and digital support aspects. In summary, the impetus for digital usage among Global South socially marginalised groups – those living with social stigmas, misrecognition, and health conditions – should be discerned distinctly from individuals with both digital access and literacy, primarily in Global North contexts. In this regard, this study focusing on YSAWGs’ digital use in their illness or mental health management can be important to suggest a paramount public health consideration in the Global South context.

Methods

Study design and ethical approval

This qualitative study adhered to the Standards for Reporting Qualitative Research (SRQR) and employed a remote secondary-data design necessitated by COVID-19 restrictions and considerations of researcher safety. The study was conducted during the global COVID-19 pandemic (30 January 2020–5 May 2023), with data analysis commencing on 6 January 2021.

Data were drawn from Springster, a digital platform operated by the UK-based non-profit organisation Girl Effect. Ethical approval was granted in September 2021 by the College of Social Sciences Research Ethics Committee at a UK university, and a supplementary data-use licence was obtained from Girl Effect. Prior to analysis, all usernames were pseudonymised, and no identifiable or contactable individuals were involved in the research.

Introduction to Springster

Girl Effect, a non-profit organisation, manages a range of digital initiatives aimed at empowering marginalised young women and girls worldwide. This study focused on one of these initiatives, Springster, a mobile-based digital platform. Springster was selected because it provides access to a substantial body of user-generated content, notably online comments authored predominantly by South African women and girls aged 13–24. In line with ethical guidance, only comments from users aged 16 and over were quoted in the manuscript. These comments reflect users’ lived concerns, closely aligning with the study's aim to examine how the target population utilises digital platforms to address HIV-related issues, sexual practices, relationships, and sexual health rights.

Since its launch in June 2017, the Springster project (www.heyspringster.com), operated by Girl Effect, has retained the intellectual property rights to all digital outputs (e.g., posts, comments) generated on the platform. South Africa was one of four flagship countries for the project, alongside Nigeria, Tanzania, and Indonesia, at the time the researcher accessed the platform in 2021. By 2023, however, only the South African domain remained active. ⁶⁵ A distinctive feature of Springster is its provision of digital access for young users living in low-bandwidth conditions. The platform enables users to access digital resources and seek peer support anonymously, without requiring registration. This is facilitated through a partnership with Facebook's Free Basics programme. ⁶⁶ Springster's Terms and Conditions guide young users, as follows:

Springster is intended for people between the ages of 13 and 24. If you are under the age of 13, please do not use Springster, as it will not be appropriate for you. If you are under the age of 16, please make sure you check with your parent or guardian first before using Springster (The Springster website accessed on 27/10/2023).

Rationale for research design

Two key considerations informed the use of Springster's user comments as the primary data source. First, consistent with Mason, ⁶⁷ digital environments are increasingly recognised as contemporary cultural spaces in which emotional, expressive, relational, and embodied practices become publicly visible. The digital commentaries authored by YSAWGs about HIV were particularly distinctive, as they reflected the lived experiences of socially and digitally marginalised populations. This may be attributable to Springster's relatively accessible digital environment, which enables the capture of life decisions shaped by hybrid (online and offline) contexts.

Second, as a virtual exploratory space characterised by anonymised personas,^44,68 digital platforms may allow young women to feel freer from social expectations or judgment, thereby facilitating disclosure of culturally sensitive topics, including sexuality, gender roles, and HIV/AIDS treatment, as demonstrated in comparable empirical studies.^69–71 In turn, Springster's commentary data is particularly well-suited to addressing the study's research questions concerning the digital practices and social landscapes shaping the lives of YSAWGs. Unlike studies focused on digitally privileged populations, this research captures hybrid (online–offline) decision-making processes of socially marginalised young women.

Data collection procedures

Following ethical approval, secondary data were collected between September and December 2021. Springster's South African domain contained two types of digital content: editorial stories and user comments. Because editorial stories may reflect organisational framing, only user comments were included in the analysis; however, the stories were consulted to contextualise users’ responses.

To define the dataset, the researcher selected stories associated with seven pre-existing keywords (The seven hashtags were pre-existing, platform-curated labels used by Springster to organise content for adolescent girls and young women in South Africa. They were selected because, collectively, they map onto the study's analytic focus on HIV-related discussion and adjacent domains. To narrow the study scope, the researcher conducted an initial scoping review of the content of 135 stories on the platform and then sorted the hashtags by aligning them with the three research questions. This process yielded seven keyword categories.) (hashtags) curated by Springster: 1) HIV (20 stories), 2) Sex (17 stories), 3) Relationships (56 stories), 4) Puberty (18 stories), 5) Health (10 stories), 6) Family (7 stories), and 7) Online (7 stories). This resulted in a total dataset of 135 stories and 12,764 user comments (Appendix A).

All 12,764 comments were initially collected to capture the full discursive field using hashtag-based selection. During the first stage of qualitative content analysis, comments were systematically screened for relevance to the research questions, and off-topic, duplicated, or non-substantive comments (e.g., emojis, spam, or near-identical reposts) were excluded. Where multiple comments by the same user conveyed similar meanings, these were consolidated into a single commentary activity. As a result, fewer than 2000 analytically relevant and interpretable commentary activities were retained for the subsequent thematic analysis.

Although the platform was geographically restricted to South Africa, users’ HIV status and nationality could not be clinically verified. Users who self-disclosed their HIV status through comments such as ‘I am HIV positive’ or ‘I have lived with HIV for 3 years’ were included accordingly. The dataset, therefore, captures experiences from both HIV-positive and HIV-negative users, offering a broader perspective on the social and digital contexts in which HIV are discussed.

Content and thematic analysis

Digital usage in this study was assessed through an integrated content and thematic analysis approach, consistent with SRQR guidelines for transparent and systematic qualitative inquiry. This study examines the content dimension of digital usage rather than behavioural frequency or platform metrics. The analytic focus therefore centres on how YSAWGs mobilise the digital platform to negotiate HIV-related and socially stigmatised identities, interpreted through a relational sociological lens. Three research questions guided the coding process: 1) what forms of digital commentary activities (DCA) emerge among Springster users, particularly YSAWGs living with (or without) HIV; 2) what social landscapes shape their digital experiences; and 3) what implications these activities hold for sexual health rights and HIV-related navigation.

Rather than relying on frequency metrics alone, intensity and depth were operationalised through thematic coding of narrative elaboration, emotional disclosure, reflexive self-positioning, relational conflict, and sexual engagement with peer responses. Posts demonstrating sustained discussion, personal storytelling, or explicit negotiation of stigma were coded as higher in depth. To assess how usage was socially situated, analysis examined how participants positioned themselves in relation to gender norms, moral regulation, peer audiences, and structural constraints. Coding therefore focused on relational language, identity claims, references to offline contexts, and discursive strategies used to navigate stigma, allowing digital participation to be interpreted as socially embedded practice rather than exposure or volume alone.

Phase 1: inductive content analysis

The first phase involved an inductive qualitative content analysis of users’ digital comments. All comments were read iteratively and manually by the researcher to develop familiarity with the dataset and to identify recurrent wordings and phrases. ⁷² At this early stage, the analysis focused on surface-level lexical patterns rather than pre-defined theoretical categories. For example, several religion-related wordings were repeatedly observed in users’ comments, including ‘God,’ ‘Bible,’ ‘sin,’ ‘marriage,’ ‘abortion,’ ‘purity,’ and ‘virginity.’

Keywords were provisionally treated as salient when they appeared more than five times across comments authored by different users, rather than through repetition within a single comment. Identified keywords were then organised using Excel into preliminary thematic groupings, which functioned as sensitising concepts for subsequent interpretive analysis.

Phase 2: inductive–deductive thematic development

In the second phase, the researcher grouped iterative wordings into higher-order conceptual themes, such as ‘religious discourses.’ This process followed the thematic analysis framework proposed by Braun and Clarke. ⁷³ Subsequently, themes were deductively organised into broader analytical categories. The overarching analytical framework drew on the social ecological model (SEM), ⁷⁴ comprising four levels: psychological, relational, socio-cultural, and structural (see Appendix B: Coding and Categorising System). For example, Theme 9 (‘religious discourses’) was classified within the socio-cultural framework, informed by Douglas's ⁷⁵ anthropological approach to cultural analysis.

This study diverges from conventional applications of the SEM by conceptualising emotions and psychological challenges as relationally embedded rather than individualised. This approach aligns with sociological theories of emotion articulated by Smart, ³⁰ Lupton, ⁷⁶ and Richardson,^77,78 and critiques positivist and individualist assumptions prevalent in public health and cognitive science. This theoretical stance informed the interpretation of users’ concerns related to HIV.

Following manual sorting and initial keyword identification, data and preliminary codes were imported into NVivo for systematic data management. NVivo was used to organise manually generated codes, examine their distribution across comments, and support the development of coding nodes. All codes originated from prior inductive manual analysis rather than automated coding functions.

Phase 3: commentary patterns and digital selves

During analysis, a third phase emerged as patterns in users’ digital interactions became evident. These patterns were interpreted using Goffman's concept of the performative self, shaped by social expectations, and Mead's notion of the reflexive self, guided by internalised values even when these conflict with social norms. These theoretical perspectives enabled analysis of how YSAWGs used digital spaces to navigate emotional distress, stigma, and sexual health decision-making. This paper primarily reports findings from Phases 2 and 3, with Phase 1 providing the foundational analytical context.

Findings and analysis

Five digital commentary activities were identified on Springster's platform, as outlined below: 1) Advising and Suggesting (n = 437), 2) Sharing Concerns and Seeking Advice (n = 328), 3) Reflection and Critical Thinking (n = 299), 4) Inspiration and Learning (n = 240), and 5) Representing Themselves (n = 94). This order was arranged based on their frequency of occurrence within the online comment data (see Table 1 below).

Table 1.

Digital commentary activities on the Springster platform.

Mode of communication (a)	thematic domains (b)	Total frequency = (a) + (b)
1. Advising & suggesting	Lived experiences	437
2. Sharing concerns & seeking advice	Friends, family, future, love, self-representation	328
3. Reflection	Critical suggestions, different opinions	299
4. Inspiration & learning	Agreements & cheering, compliments, recognition, thanks	240
5. Representing themselves	Desires, hopes, dreams, envy, and curiosity	94
Others: Admins’ interventions	Deleting, emotional agreement, professional advice	202

Note 1: Modes of communication (a) and thematic domains (b) represent distinct analytic dimensions. Totals are presented to reflect overall engagement and should not be interpreted as cumulative across categories. Frequencies indicate coded references (segments of comments), not unique users; individual users may have contributed multiple comments across categories. The distinction between (a) and (b) differentiates how young women communicate (interactional practices) from what they communicate about (substantive topics), enabling analysis of the relationship between commentary practices and HIV-related concerns.

Some YSAWGs who read digital narratives describing analogous situations or challenges showed proactive actions by engaging in sharing their own experiences with virtual peers who had no relationship offline. Specifically, Digital Activity 1) Advising and Making Suggestions (n = 437), can be seen as a reciprocal response to Digital Writing Activity 2) Sharing Concerns and Seeking Advice (n = 328). Representative cases of Jolly and Babie below demonstrate this digital phenomenon on the Springster site:

Jolly: Hey, sister. Last year, in November, I found out I am HIV positive, and my partner is negative. I have been taking my medication since that day I found out. But the problem is that I am scared to tell my partner the truth about my status. I really need advice (Story no. 10).

Babie: Hi. I was also in the same situation. I also kept quiet about my status. I didn’t tell my boyfriend about it because I was afraid, he was going to leave if I told him the truth. But telling him was the best decision I have ever made because he has accepted my status and loves me very much (Story no 10)

Given the prevalent HIV-related stigmatisation in South Africa, as shown in a study, ⁷⁹ a survey in this regard, Jolly's comment presented a concern about disclosure of her HIV status to her partner. Babie showed empathetically response to Jolly's experience, commenting, ‘I was also in the same situation’. In short, Jolly's digitalised narratives are resonant with Babie's experiences, and consequently, the common apprehensions between Jolly and Babie – the potential loss of their male partners’ affection upon disclosing their HIV status – appeared to be a trigger making Babie engage in online commentary activities on the Springster. Moreover, in Babie's ending remark, ‘Telling him was the best decision […] because he has accepted my status’, it appears to be an encouraging message to Jolly, as if to say, ‘You can do it as I did’. This can be seen as a digitally supportive interaction among a peer group.

The question is why they wrote their concerns about such fears on the digital platforms remains. To understand this digitalised phenomenon, it seems to need further understanding of the social landscapes prevailing in South Africa around HIV. In turn, due to the likelihood of stigmatisation against women living with HIV in South Africa, disclosing their health status in the physical settings cannot be easy for them. In this context, it can be said that the Springster platform seemed to offer a more friendly environment to them to discuss topics related to HIV, known as social taboos. In this sense, the digital aligns with the substitution of space for the physical environments in South Africa.

In particular, the meaning of the digital use can be differentiated for YSAWGs who are socially and digitally marginalised and live with HIV from those who have access in both arenas, such as from the cases of the economically privileged. As demonstrated in previous studies, South African religious and patriarchal landscapes demand that YSAWGs comply with social norms surrounding gender- and sexuality-related issues ⁷ (e.g., early sexual debut, ⁸⁰ premarital sex, and sexual practices such as condom use^81,82), such a digital interaction on the Springster may be a rare chance to generate a sense of solidarity among virtual peer groups in their HIV journey. Meaning-making process through digital interactions is likely to play a significant role, especially in alleviating their psychological challenges in chronic illness management like HIV. In similar empirical studies, this phenomenon seems to be acknowledged especially, among population who experienced social exclusion or similar situations in their illness management journey; for example, showing help-seeking behaviour of the USA adolescents ⁸³ ; feeling empowered among more than 100 adults (a mean age 46 year old) living with HIV, mostly from the Global North, including North America, Europe. ⁶¹ Comparison of many sources of the results from the Global North context, it is barely to show the contexts of the Global South in marginalised youths’ engagement in digital forums.

Unlike the interactive digital commentaries above, Digital Activity 3) Reflection and Critical Thinking (n = 299) on the Springster site seemed to manifest another feature of it in a monologue form. Kami's comment below shows the case of self-reflection, describing her HIV journey:

Kami: I think I have issues, too. I usually feel bad about myself when I found out about my [HIV] status, that I am positive and am not normal, or maybe I am angry about my status, it seems I found out I am always nervous, frustrated, rude, and just ready to die. I am judgmental of others, hate the company, and am always scared to face the world [….] I always ask God to heal me inside and stop complaining about who I am… All I need is prayers from you guys (Story No.99).

Kami's comment vividly expressed her emotional distress at the diagnosis stage of her HIV journey, stating that I usually feel bad about myself when I found out my [HIV] status […] I am always nervous, frustrated, rude, and just ready to die. Through the sociological lens of emotions (Lupton, 1998), these negative feelings can be considered as a product, reflecting the agent's socio-cultural understandings or judgements of HIV. For example, Kami's ending remarks revealed her reliance on religion, stating, ‘I always ask God to heal me inside and stop complaining about who I am.’ This means that the evaluation of her ontological value is heavily reliant upon her religious faith.

The thing is that such socio-cultural interpretation can significantly impact the agent's self-evaluation as well as one's HIV management. For instance, as Kami says, I am not normal or maybe am angry [at] my status […] I am always nervous, frustrated, rude…’ this statement entails a symptom of internalised stigma. As psychological studies substantiate, such internalised stigma about health conditions can lead to suicidal behaviour, ⁸⁴ with the manifestations of low self-esteem and self-hatred. ⁶ Particularly, Kami's statement, ‘just ready to die’ or ‘I am not normal’ implies the likelihood that she underestimates the value of her life living with HIV. Given the presence of religion within Kami's mind above, Kami's comment can be interpreted as a help-seeking behaviour, as saying that ‘All I need is prayers from you guys’. This can be a rather active action to obtain emotional support from virtual peers on the Springster site, due to the likely lack of support systems or relationships in their emotional journey, living with HIV, in alleviating their psychological distress in their HIV journey.

Furthermore, reflexive writing in a digital commentary form can function in offering YSAWGs living with HIV a space to express their emotionally painful memories without imposing social burdens on anyone. This echoes the concept of digital storytelling known as having therapeutic effects, which was identified in previous studies,^85,86 meaning that the agent can feel a sense of relief by reflecting on negative emotions, and written work on the digital platform connects dots with others who were similarly situated. In this sense, digital commentaries shown on the Springster site may help young South African women analyse, reinterpret, and reorganise their selfhood, values, and identities living with HIV. This can be a (new) meaning-making process for them.

Additionally, digital narratives of YSAWGs on the Springster seemed to function as a repository for peers’ learning about indirect experiences in regard to HIV-related topics. This could happen when other users read online comments about HIV or live with HIV. This featured codified as Digital Activity 4) Inspiration and Learning (n = 240), in Table 1 above. The following Deisy's comment contains her insights on being able to instruct other users about living with HIV:

Deisy: I’ve also been living with HIV for about a year now. I was losing a lot of weight over the years. Until one day became very sick. I decided to get tested, and the results came back positive. I was really heartbroken and very sad. But because I have a very supportive family and a supportive boyfriend, I am able to accept myself and live with the fact that I am HIV Positive. I joined an HIV support group, and they really helped me overcome the hardship of living with the virus. I also made friends while I was in the support group. They taught me to love myself and accept myself. HIV doesn’t define who you are. HIV doesn’t stop you from achieving your goals. Being HIV doesn’t make you any less human (Story No. 10).

Unlike any other socially marginalised cases described in the comments of YSAWGs living with HIV, Deisy's comment seemed to possess ‘supportive’ relations in her physical environments, including her family members, boyfriend, and an HIV-Positive group. Among them, as she stresses, ‘… [due to them], I am able to accept myself and live with the fact that I am HIV Positive’, and ‘They [an HIV support group] taught me to love myself and accept myself’, the role of a peer group consisting of those living with HIV seems imperative, in addressing their emotional challenges in the transitional stages from diagnosis to treatment, as well as in the reconstructive process of meaning-making living with HIV. These analyses align with findings in prior research,^85,87 highlighting the importance of emotional and relational support in HIV journeys, and also substantiating that in terms of the HIV medication uptake and adherence.^88,89 It differentiates from the fact that these expressions were identified in a digital form rather than in a physical setting in the context of young South African women.

In light of whether digital comments on the Springster, an educational resource for other users can be, as Deisy's ending remarks show – ‘HIV doesn’t define who you are. HIV doesn’t stop you from achieving your goals. Being HIV doesn’t make you any less human,’ her argument delivers an informative and encouraging message to others who may struggle with their HIV status or stigmatised experiences around HIV. Thus, it can be argued that Springster's comments may play a conduit role for the socially marginalised group who have not been instructed about HIV and those who are feeling hard in seeking help about information or emotional support from their relationships in physical environments.

Lastly, the feature of Digital Activity 5) Representation Themselves (n = 94) appears closely interrelated with that of Digital Activity 3) Reflection and Critical Thinking (n = 299). Errica demonstrates these interconnected features in her comments, as follows:

Errica: It is not a shame to be HIV positive, but a mistake; nobody chooses that kind of life. At least you could do is to accept and take your medications. Remember, worldwide statistics say 99.9 [percentages] people are sick, but nobody knows they're sick[-ness] because they do their things in secret, and it's not an everyday thing to go to the clinic (Story No. 10).

Errica's statement, ‘It is not a shame to be HIV positive but a mistake; nobody chooses that kind of life..’ implicitly reflects the societal attitude in South Africa towards those living with HIV. This attitude suggests that individuals should feel shame and that the infection is a consequence of their personal misconduct. As Smart (2007) posits, the meaning of being personal entails the socio-cultural embeddedness in a given society, influencing the decision-making process. In this context, Errica's subsequent phrase appears to advocate for the possibility that some HIV infections in South Africa could occur inadvertently rather than independently.

To deeply understand the context of Errica's digitalised voices, it seems imperative to have a sense of the social landscape of South Africa. Given the prevalence of HIV-related stigma and its influence throughout the entire life of people living with HIV in South Africa, her digital comment above can be interpreted as an attempt to alarm a society where religious and patriarchal norms shape expectations of womanhood and require individuals to take responsibility for the trajectory of HIV infection in general. In other words, such a social demand can be too harsh for young women to handle, especially in case of that they do not have an appropriate safety net in their circumstances. The following statement elaborates on this regard, as follows: ‘99.9% of people are sick, but nobody knows their sickness because they do their things in secret’. This highlights that disclosing one's HIV status should be an individual's private sphere, akin to any other health condition, unless the provision of protection for those living with HIV from social stigmatisation or discrimination. Thus, her digitalised voices can be a symbol, representing her personal desire which demands a social shift from blaming individuals’ behaviours to advocating for them with a more empathetic and understanding glance.

Conceptually, Errica’s comment can be understood as ‘performative’ – reflecting socially taken-for-granted views – and ‘reflexive’ – representing her own critique of those undertakings within a digital medium. In the former stance, Errica’s digital representation can be a source of criticism towards the individual-centred approaches to HIV prevention in the country, as well as towards the doctrine stance of women's ideal image, what Goffman called ‘social expectations’. The difference of Goffman's interpretation of this concept is that this study used more extensive meanings of embeddedness; he used that in the relational boundary, while this study uses that in the socio-cultural spectrum in the context of YSAWGs’ digital use. In the latter stance, Errica's digital engagement can be meaningful for her to shape her femininities by listening to her inner voices and writing about them on this platform. This interpretation echoes Mead's ⁵⁵ argument that the significance of raising critical and reflexive voices in the identity development process in adolescence, which can be differentiated from a point where the context was occurring on the digital platform and by the socially marginalised population like YSAWGs living with HIV. This adds additional meanings that her reflection of HIV can also function as an informative source for other users who do not know how to enhance their inner voices, as well as those who are socially vulnerable to be stigmatised about their HIV status or sexual practices, such as premarital sex or unprotected sex.

Discussion

As the Springster platform encourages users to engage through digital anonymity, this systematic intervention may enable YSAWGs to perceive the digital space as a relatively secure sphere in which to articulate HIV-related challenges that remain difficult to disclose in offline settings. Consistent with digital health scholarship, anonymity functions as both an enabler of engagement and a source of tension, particularly when digital platforms are positioned as sites of illness identity management rather than supplementary care resources. On the enabling side, anonymity offers protection from social judgment rooted in intersecting inequalities of gender, class, race, sexuality, and health status. For socially marginalised users, this protection may support emotional expression, peer solidarity, and the reclamation of a sense of normality, as noted in previous digital sociological research.^90–92

However, sustained reliance on anonymity may also constrain opportunities for disclosure and identity integration in offline contexts, potentially reinforcing fragmented self-concepts, ⁹³ particularly for YSAWGs living with HIV. These findings align with empirical research documenting similar tensions among marginalised populations, including LGBTQ + youth, ⁶⁹ Indigenous youth with HIV, ⁹⁴ and young women in patriarchal contexts.^95,96 Within this broader literature, Springster users’ digitalised voices can be interpreted as proactive and resistant forms of help-seeking that address shared emotional vulnerabilities. The identified digital commentary practices – advising, seeking support, reflection, learning, and self-representation – function as adaptive responses to gaps in offline support systems and contribute to emotional resilience and wellbeing, as observed in comparable studies.^47,97,98

Nevertheless, solidarity formed primarily through digital engagement may be transient, with limited capacity to translate into sustained coping strategies beyond the platform. As Robins and Webster ⁴¹ and Castells ⁴³ caution, digital participation among young people is often episodic, raising questions about the durability of its emotional and behavioural benefits. The temporality of digital engagement presents a particular challenge for HIV identity management, which typically requires long-term psychosocial adjustment and consistent support.

Furthermore, digital anonymity entails recognised risks. Online harms – including deception, sexual exploitation, and exposure to harmful content – can undermine trust and heighten vulnerability among young users. ⁶² In addition, the circulation of misinformation and the contagion of negative emotions within online peer networks pose risks to mental health and wellbeing – including the spread of misinformation within virtual peer groups, ⁹⁹ risks of self-harm and suicide^100,101 – as well as to effective HIV self-management. Evidence from studies of marginalised populations highlights how such misinformation can reinforce stigma and distort health-related knowledge, as demonstrated by Evans, Gridley. ¹⁰² These concerns are particularly salient for YSAWGs living with HIV, as inaccurate information may negatively affect treatment adherence, disclosure decisions, and long-term health outcomes. For example, misinformation can amplify fears around viral diseases such as COVID-19 and contribute to anti-vaccination sentiments, ¹⁰³ as well as lead to misunderstandings about treatment adherence, disclosure practices, and long-term health trajectories, thereby undermining effective HIV identity management. ⁶¹

Within this risk landscape, Springster's infrastructural and managerial interventions are much more critical. In a context marked by significant digital inequality in South Africa, ¹⁵ the platform's partnership with Facebook to provide free access represents a meaningful effort to reduce barriers to digital participation. Such access supports health literacy, emotional coping, and peer connection among YSAWGs, particularly those who are socially and digitally marginalised.

However, digital empowerment should not be conflated with comprehensive care. Digital platforms cannot replace in-person counselling, clinical services, or community-based support systems, all of which remain essential for sustainable HIV-related wellbeing. Effective digital health platforms, therefore, require balanced governance structures that prioritise user safety without suppressing authentic self-expression. While excessive moderation may discourage participation, ⁴⁸ Springster's content moderation practices – such as removing harmful material and personal identifiers – suggest an appropriate level of oversight consistent with culturally sensitive, women-centred digital health platform design.

These findings should be interpreted in light of several methodological considerations. Springster is designed for users aged 13–24; however, because the dataset consists of anonymised online commentary, researchers could not independently verify users’ age, specific location, HIV status, or other demographic characteristics. Age is self-reported at registration, and no identifiable geographic data are accessible due to privacy protections. For this reason, a conventional table of baseline characteristics is not presented.

Comment frequencies reflect the overall dataset, which indicates socio-cultural and relational dynamics around HIV-related issues and thereby cannot isolate contributions from HIV-positive users specifically. Variation in post length and narrative depth may also influence thematic visibility. While these factors limit representativeness, the study does not aim for statistical generalisability but offers an interpretive account of the social and digital contexts through which YSAWGs engage with HIV-related issues. Analytic rigour was maintained through an audit trail and iterative engagement with the raw data, consistent with interpretive qualitative methodologies.

Conclusion

This study contributes to a more nuanced understanding of YSAWGSG's digitalised voices in relation to HIV, offering sociological insights grounded in the Global South. Rather than functioning solely as channels for information exchange, YSAWGs’ engagement with the Springster platform constitutes a socially embedded form of digital care through which vulnerability, stigma, and sexual health decision-making are collectively negotiated under conditions shaped by structural inequality and gendered power relations. In this sense, digital participation emerges as a meaningful site for the development of agency and empowerment, particularly for those living with HIV.

Across the analysis, five forms of digital commentary practices – advising and suggesting, sharing concerns and seeking advice, reflection and critical thinking, inspiration and learning, and self-representation – illustrate how YSAWGs actively respond to social environments in which access to safe, supportive, and confidential assistance remains limited offline. These practices reflect broader structural and relational deficits in South African contexts where discussions of HIV, sexuality, and sexual health continue to be socially silenced or stigmatised. Within such constraints, digital engagement functions as a comparatively candid archive of lived experiences, emotions, and negotiations that are difficult to articulate in face-to-face settings, thereby contributing to emotional resilience and mental well-being.

The findings further underscore the significance of anonymity in shaping digital health engagement. On the Springster platform, anonymity enables YSAWGs to articulate experiences of injustice, vulnerability, and uncertainty related to HIV infection, early relationships, and premarital sex without immediate fear of physical or psychological stigmatisation. At the same time, these digital expressions illuminate unmet needs within existing support systems, particularly in relation to sexual health education, emotional support, and rights-based information. For YSAWGs living with HIV, digital commentary practices appear to facilitate reflection, knowledge-building, and identity negotiation across intersecting personal aspirations and social expectations, offering a mechanism for managing what may be considered spoiled identities associated with HIV status and sexual activity while shaping approaches to long-term women's health and HIV care.

These contributions must, however, be understood alongside the ambivalent nature of digital peer spaces. While digital anonymity can foster emotional safety and solidarity, such affordances coexist with risks related to misinformation, uneven moderation, and the fragility of digitally mediated support. As such, platforms like Springster should be positioned as complements to – rather than substitutes for – sustained offline psychosocial, clinical, and community-based care, which remain essential to HIV-related wellbeing.

In line with Wessels's ⁴² argument that interactive narratives across online and offline spaces shape everyday understandings and life choices, interventions and approaches to HIV prevention and care should be reconceptualised in hybrid terms. In the South African context, the development of digitally women-friendly spaces must account for pre-existing structural barriers – including inequalities in education, digital access, and healthcare shaped by race, class, and gender – as well as pervasive cultural influences such as patriarchal^104,105 and religious norms, ⁷ and heteronormative assumptions surrounding family and sexual practices. Attending to these sociological conditions is essential for fostering empowerment-oriented digital environments that may help mitigate gender-based violence^106–108 and improve communicative dynamics within intimate relationships, ¹⁰⁹ thereby advancing YSAWGs sexual and reproductive health rights.

Despite its contributions, this study has limitations inherent to qualitative research using anonymised, digitally mediated data. Reliance on text-based user commentary constrains insight into participants’ embodied, relational, and longitudinal experiences beyond the platform, including how digital expressions are translated into offline practices over time. While anonymity facilitates candid disclosure of sensitive issues, it also limits examination of identity trajectories, the durability of empowerment across life stages,^110,111 and radical structural transformations. Comparative research across multiple digital health platforms operating in low-resource settings may further illuminate how platform-specific affordances – including moderation practices, anonymity structures, data costs, and access models – shape peer support, emotional wellbeing, and the circulation of misinformation.^62,112,113 Together, these methodological directions can inform the development of ethically grounded, context-sensitive digital health interventions that respond to the lived realities of young women in Global South settings.

Supplemental Material

sj-docx-1-dhj-10.1177_20552076261433085 - Supplemental material for Digital commentary activities for managing spoiled identities among young South African women and girls (16–24) living with HIV: A sociologically informed content and thematic analysis

Supplemental material, sj-docx-1-dhj-10.1177_20552076261433085 for Digital commentary activities for managing spoiled identities among young South African women and girls (16–24) living with HIV: A sociologically informed content and thematic analysis by SunHa Ahn in DIGITAL HEALTH