Identification of Intrinsic Motivation for HIV Self-Care: Photovoice of Young People Living with Perinatal HIV in Northern Thailand

Abstract

Objective

Young people with perinatally acquired HIV (YPHIV) in Thailand face psychosocial, developmental, and structural challenges. Intrinsic motivation strongly shapes health behaviors, including treatment adherence and Human immunodeficiency virus (HIV) self-care.

Methods

A qualitative study was conducted in March 2025 at the Chiang Mai University in Thailand enrolling 32 YPHIV aged 16-30 years (median age 22.9). Using photovoice and focus group discussions, participants shared their experiences and motivations for self-care.

Results

Thematic analysis revealed key sources of motivation: supportive family ties, self-value, ambitious life goals, and inspiration from nature. While medication adherence and HIV self-care were seen as manageable, disclosure of HIV status remained highly stressful.

Conclusion

Findings suggest YPHIV demonstrates resilience and intrinsic motivation despite ongoing challenges. Strengthening intrinsic motivation may enhance adherence, self-care, and long-term health outcomes through timely interventions and social support.

Plain Language Summary Title

Using Photovoice to Identify HIV Self-Care Motivation in Young People with HIV

Plain Language Summary

Young people who had HIV from perinatal transmission in Thailand encountered many challenges. There is a need for intrinsic motivation for them to take medication and receive HIV care regularly. We conducted focus group discussion in young people aged 16-30 years who have been living with HIV and are being treated with antiretroviral medication since childhood using a photovoice approach. There were 32 participants at the median age of 22.9 years who joined the study. Major themes emerged from the photovoice discussions including family relationships, self-appreciation, the pursuit of ambitious goals, and inspiration from nature. While the perceived burden of HIV self-care was low, participants reported feeling overwhelmed by the challenges of HIV disclosure. From this study, YPHIV demonstrated intrinsic motivation and resilience despite facing adverse experiences, psychosocial issues, and health challenges associated with living with HIV. Enhancing intrinsic motivation regarding HIV self-care and treatment adherence is essential for ensuring timely interventions and social support, ultimately leading to improved health outcomes.

Introduction

Many young people living with perinatally acquired HIV (YPHIV) in Thailand are now in their second and third decades of life. ¹ They face complex psychosocial, developmental, and structural challenges that somehow influence their ability to engage in effective self-care and long-term adherence to antiretroviral therapy (ART). ² Despite being on effective medications, maintaining consistent human immunodeficiency virus (HIV) care among adolescents remains a major concern, particularly in low- and middle-income countries.^3–5 In Northern Thailand, where cultural beliefs, stigma, and few programs for young people come together,^6,7 tackling these issues needs new, youth-focused methods that encourage young people to take charge of their health and feel motivated to manage it themselves.

This study is grounded on the Self-Determination Theory, ⁸ which emphasizes the importance of autonomy, competence, and relatedness in fostering internal motivation. It emphasized the importance of the ability of individuals to make choices and manage their lives. The theory explains that people would engage or disengage in specific behaviors or activities for the inherent reward, like weight control or smoking cessation. ⁹ Previous studies in individuals living with HIV demonstrated that autonomous motivation is important to maintain adherence to antiretroviral treatment.^10,11 In the US study in 201 people living with HIV, median age 40 years, documented autonomy support led to autonomous motivation for adherence. The study in 115 Chinese people living with HIV, median age 37 years, reported that autonomous motivation was strongly associated with perceived competency, although it was not a predictor for medication adherence. ¹¹ Besides adherence, another study utilized self-determinant theory to explain self-determined motivation to disclose HIV status among adolescents living with HIV. ¹² They identified HIV-related stigma as a source of amotivation (non-disclosure), while autonomous motivation was associated with the perspective that HIV was a part of their lives and valuing educating others.

In Thailand, most YPHIV did not always express their feelings or share much of their thoughts during daily conversation with either caregivers or healthcare providers. To facilitate sharing, we adopted photovoice as a tool to enhance the identification of intrinsic motivation for HIV self-care; using photovoice might help them to extract internal motivation and make visible their values, goals, and strengths to inform personal health behaviors. Photovoice is a participatory action research methodology that empowers individuals to capture and reflect upon their lived experiences through photography; it offers a unique avenue for engaging youth in their health narratives.^13,14 We hypothesize that each YPHIV had intrinsic motivation that guided them through the life course while living with HIV. By enabling participants to document their realities, express emotions, and share insights within a supportive group setting, photovoice can promote critical self-reflection, build social support, and enhance self-efficacy. The findings have implications for designing culturally grounded, youth-responsive interventions that promote resilience and sustained engagement in HIV care.

Methods

Study Design and Study Population

A cross-sectional qualitative study was conducted at the Research Institute for Health Sciences, Chiang Mai University, Thailand, from January to March 2025. In relevant to the study objective, we employed a purposive convenience sampling strategy to invite young people to participate in the study. The inclusion criteria were (1) YPHIV aged 16-30 years; (2) having perinatal HIV infection; (3) receiving antiretroviral treatment from the National AIDS Program; and (4) willing to participate in the focus group discussion and share their experiences. Researchers excluded individuals with profound mental health problems or neurocognitive impairment that would compromise the study outcome data. The recruitment process involved the efforts of research nurses who had close connections with YPHIV who had been enrolled in clinical research during the past decade. Before enrollment, participants provided written informed consent for study participation, inclusion, and use of data in publication; for those under 20 years of age, consent and assent were obtained from the caregiver and the participant, respectively.

Data Collection

We adopted a combination of the photovoice approach and a focus group discussion to encourage participants to start thinking about themselves, share their stories, and reveal what was on their minds. The potential participants were invited for screening from January to February 2025. Those who were eligible to participate were enrolled. Upon enrollment, they were asked to select a photograph for sharing under the themes “My inspiration” or “Myself,” which could be taken by oneself or picked up from any media (it is allowed as we did not want to exclude those who did not have access to a smartphone or camera). Data collection occurred in March 2025 at a recreational venue near the city. We used a focus group discussion to gain rich insights and a deeper discussion from participants. Four groups of 8-9 YPHIV of similar ages were set up, one at a time on the same day, with two researchers (male and female) with master's degrees in psychology being group facilitators. They had experience working with YPHIV for years, with continuing studies. They had no personal relationships with any participants. Following an ice-breaking session, printed photos guided the main discussion. Each participant took his/her turn to talk about his/her selected photo, explain the context behind it, and its meaning to him/her. The facilitators explored their intrinsic motivation for HIV self-care and their perceived burden of the need to take medication and HIV-related issues. Participants were informed that they could say or share any of their thoughts in the group without being judged or criticized by others. Each group discussion lasted from 50 to 65 min. All participants were aware of the audio recording and presence of note takers in the room during the activities. The group discussion ended with a recap by the lead facilitator and self-hugging practice before adjourning. The focus group was conducted until data saturation was reached.

Qualitative Data Organization and Analysis

The digital files were transcribed and reviewed for accuracy by the facilitators. The cleaned transcription files were imported into Dedoose (version 9.2.12). We used the Consolidated criteria for reporting qualitative research (COREQ) checklist in developing the manuscript. ¹⁵ We applied an inductive thematic analysis approach, including line-by-line coding. ¹⁶ Two researchers (an MD and a psychologist) reviewed all transcripts to become familiar with the data. We then developed a codebook. This codebook was iteratively tested on the first group transcripts and developed and further adapted as new themes emerged. The codebook was presented to the study team in study staff meetings to discuss and refine the codes. We also discussed data saturation during the meetings. Once the codebook was finalized, two team members used it to double code the remaining transcripts. Coded excerpts were categorized into themes. All analysis was conducted in Thai, and selected quotes were translated into English to support data presentation.

Results

We enrolled 32 YPHIV at the median age of 22.9 years (interquartile range, IQR 19.2-24.7). A female YPHIV was excluded due to intellectual disability. All resided in communities with active social lives; 16 worked full-time, and 16 were studying in secondary, vocational, or college schools. They were assigned to one of the four groups according to their ages. Table 1 displays the characteristics of each group.

Table 1.

Characteristic of Photovoice Participatory Groups.

Groups	Number of Participants	Age Range (years)	Female: Male Ratio
1	8	15.0-18.5	4:4
2	8	24.4-29.2	4:4
3	7	19.4-23.2	4:3
4	9	19.7-25.0	6:3

The following major themes emerged in the photovoice discussions with YPHIV: family relationships, self-appreciation, aiming for achievement with ambitious goals, and inspiration from nature. The perceived burden of HIV self-care was low but overwhelming, with the feeling of unease associated with HIV disclosure (Figure 1).

Figure 1.

Conceptual framework: Intrinsic motivation to HIV self-care of young people living with perinatal HIV in our study.

Family Relationships Play a Crucial Role as a Primary Source of Support

Many YPHIV shared photos of their family and described them as their source of social support and inspiration to move on. Emotional support could build competence and an enhanced sense of self-value. A male adolescent resides in a rural area with his family. They earned money for living in the agricultural sector; while he was studying, he also worked part-time to help his parents. At present he attended an HIV clinic in a tertiary care hospital with good adherence. He mentioned his supportive family when sharing his photo.

‘Here is my mom, my brother, and me in the photo. It was taken by my dad. It is not often that we do this together, I mean taking a photo. Every time I look at it, when I am tired or sad, I always feel good.’ [Male037, 18 years]

The definition of family varied from one YPHIV to another. It did not need to be a perfect one; some of them grew up with a single biological parent, to whom they were attached. While strong bonding fostered open discussion about HIV and adherence in the family, it also reinforced self-efficacy and competence. A female YPHIV with hematologic comorbidities who had been through an uneven childhood and struggled with treatment adherence during her adolescent years shared a photo of herself on graduation day in the group. At present, she was healthy with virologic suppression and looking for a full-time job.

‘I named this photo “Graduation for dad”. Yes, it was for him, I got my bachelor's degree because of him. My mom died since I was young. I lived with dad, his new wife, and her mother who raised me as a part of the family. I have two siblings, but I am the one closer to dad than others are. He always inspired me and supported me during my studies until I finally graduated’ [Female 005, 26 years]

Not only was the supportive relationship with biological parents mentioned, but YPHIV who grew up with their grandparents, also stated that they felt grateful and planned to live into their adulthood to take good care of them. A male YPHIV who grew up in an orphanage shared that he feels close to his housemates because they have a strong bond and mutual understanding with one another. Not everyone in the orphanage had HIV, but they lived together and went through a tough time during adolescent years. Without biological parents, he needed to take care of himself and be responsible for his medication. Receiving supportive relationships from the people around him, which made him feel less isolated and more capable. Currently, he is attending vocational school and looking forward to graduating.

‘I feel that they are my family. I can share my story with them, and they always seem to understand me more than adults do. Although we are not the real siblings, we are at the same age.’ [Male 026, 19 years]

Self-Appreciation, Autonomy and Self-Valued

YPHIV who shared photos of themselves stated their pride in their own life. They could pass through many events, some of which were so painful and difficult to get over. With resilience and grit, they could stand up and continue their lives like others without HIV or those with better life opportunities. A female participant shared her self-photo that she named it “Twenty,” as she felt so proud to survive for 20 years. It inspired her to engage with HIV care and adhere to her medications.

‘I could not imagine that I would grow up and reach the age of 20. I felt so bad when I was young, but now I am alive. I am so proud, and I still want to see myself at the age of 21-22-23, and so on. I want to watch myself growing up.’ [Female 029, 20 years]

YPHIV, especially those in young adulthood, mentioned the importance of self-value. They had to confront other people in the community who might not always be kind to them. Some experienced HIV-related discrimination since childhood and during adolescent years. One of their coping mechanisms was ignorance and focusing on themselves. A male participant described his photo named “Right focus,” which reflected his development of autonomy.

‘Here is a photo of me with a nice view behind, you see! However, only my picture is clear, other things are blurred. It means I did not focus on them much, beauty or ugly it could be. What I think is, wherever we go or whatever we do, we should focus on ourselves, not others. People might say or think about us badly. We don't need to care or keep them in mind. Just focus on yourself, that's all.’ [Male033, 26 years]

In response to a question about the challenges of ART and HIV self-care, a young lady mentioned her feeling of responsibility for her own health. She explained that taking medication was important to her, as it allowed her to be healthy, look good, and move on towards her goal.

‘I deserve it. I want to see myself achieving my goal. So, I need to take care of myself. No one could do this for me; I need to take my med to survive and be in good shape. Others can only cheer me up, but this is my own life.’ [Female023, 21 years]

Inspiration from Nature

Some participants mentioned nature as their inspiration to live. Many YPHIV grew up having caregivers who were able to provide them with instrumental support like food and clothes, but not the mental support they required. They had to stand by themselves and be strong. Time in nature allowed quiet, non-judgmental moments that supported self-reflection and helped them separate self-value from social pressure, which is a key step in autonomy. A male participant shared a photo of the sunset, explaining its special meaning to him.

'The Sunset, I took this photo myself. Sunset makes me feel good. The nature is beautiful. When I am down or anxious about life, I always look around. Looking at green trees or scenery is like healing. They make me feel better and inspired me to move on. Yes, I like the sun set.’ [Male 026, 19 years]

Some share their early adolescent years, when they were struggling with adherence and feeling desperate with life with HIV. A female participant mentioned the colorful sky as something she could appreciate every time she looked up. The sunrise in the morning was like a symbol of forgiveness that allowed her to restart a new day. Daily moments in nature fostered a sense of inner clarity, which made her feel better and gain back her self-value.

‘This is a photo of the sky I captured on an evening. When I feel discouraged, I can see sun rise and sun set, like it is telling me every day can be a new day to start. Even I have missed something, I can start on the next day… and yes, I always think that I am great to live until present.’ [Female 027, 20 years]

Some YPHIV were inspired and felt supported by domestic animals like cats that they could talk to; they felt relieved, like someone was listening to them. Pets offered companionship, and they perceived competence while caring for them. A female participant shared a picture of a jellyfish. She described it as a simple creature that no one seemed to care about. To her, it is a part of nature that requires attention. It could become extinct without protection. It needed to be protected. She identified herself with Jellyfish. During childhood, she lived with her dad's new family and was treated badly. Later, she moved in with her aunt during her adolescent years. At present, she is a college student who works part-time to support her education.

‘This is a photo of Jelly fish. I am studying fishery. Of course, I love the ocean and all sea animals, but jellyfish are so special. It was like me. People might think Jellyfish is unimportant as they always see them on the beach. However, it is among endangered species. If we don’t do anything, sooner or later they will be extinct. If you care about something, but you do nothing, someday you might lose it forever…like me, I felt lonely without anyone really support me. Now I turn to myself, to love myself and I am thankful to myself for being alive.’ [Female 008, 24 years]

Aiming for Achievement with Specific Goals

While living with HIV and needing daily medications, YPHIV internalized social values. Having life goals allowed them to focus on their success and reinforced their perceived need to stay healthy. Some mentioned their dream of working in a specific job or being a professional, while some indicated their need for something like money or a house that they could share with ones they loved. A male participant shared his plan to be a mechanic after finishing school. He had no problem taking medication because he viewed it as necessary for his health.

‘It is a photo of me working in a garage. I wore a pair of black gloves. Here you can see a toolbox, a shaft, and a car hood. I dream of being an automobile repair shop owner. Now I am in training. Last summer I worked in my brother's garage and learned to fix vehicles. I want to be a good mechanic in the future.’ [Male 017, 19 years]

All study participants were healthy, and they were like general young people who had their future, ambition, and dreams. Each participant had a different perspective on their own experiences. Observing nurses at the hospital she regularly visited for HIV care inspired a female adolescent living with grandparents.

‘…when I grow up, I want to be a nurse so that I can help sicked people who cannot afford treatment costs’ [Female 016, 16 years]

A young male living in an orphanage found inspiration in the work of missionaries who provided them with social and educational support. Instead of focusing on himself, he aspired to grow up and pursue a career that would enable him to earn a substantial income, not for his fulfillment but for the benefit of others. He realized that he would not do that without his medication.

‘I want to build a dorm for children who have no place to stay. They can live there happily until they can decide where to go or what to do. I want to create a warm welcoming facility for children like those foreigners made for us where I grew up. [Male 022, 23 years]

A few YPHIV mentioned simple life goals, which included growing up, earning enough money to live comfortably, having time to enjoy life, and creating a family of their own. A young woman in her last year in a vocational school stated her plan for the future, which explained why she cared about adherence and self-care.

‘I want to have a family. I need to be healthy so that I can live, and do whatever I want to’ [Female 001, 20 years]

Low Perceived Burden of Human Immunodeficiency Virus Medication

We explored the perception of HIV medication in YPHIV, as they have been living with HIV for their whole lives. Many of them stated that they felt taking medication was among their routines and it was truly his/her own business. A female participant stated that the virus was within her body, and she knew how to deal with it. She shared a photo of the flower bouquet she received from her boyfriend, who lived with her and knew her serostatus.

‘I have never told anyone that I have HIV. It is within me, and I protect myself. No one needs to know. If I share it out, people might not want to talk to me. Anyway, for partner, it is another story. We want to live together as a family. I disclosed to my boyfriend, …fortunately, he can accept it. [Female 007, 26 years]

A male YPHIV shared a photo of his computer within his room at the university dorm. Working on it, he had inspiration to grow up and be a website developer. When asked about his perception of his life with HIV, he mentioned taking medication as his routine. Thus, he did not feel any burden. His parents modeled positive health behaviors by normalizing HIV medication in their lives, and this reinforced his competence.

‘At first when I was young, I followed what my mom and dad did, we took our own pills after meal. It was like a daily routine. Now that I am on my own, I still do the same thing and do not feel anything.’ [Male 025, 21 years]

Struggling with HIV Disclosure Anxiety

We spent time during the FG discussion asking participants about HIV disclosure and their plans for it. Many young adults could manage their health, including HIV care and medication; they could hardly spread the virus out. A young man shared his experiences of disclosing his HIV status to his friends. The outcome was better than he had expected, as his friend did not seem to care, and they were still friends.

‘I disclose to my friends when I was a freshman. At that time, we had known each other for 3-4 years, and I wanted to know how they would react. I prepare myself for the bad reaction. We were walking to catch a bus, and I said I had HIV. I asked if they were OK with that. One replied -you only have HIV; you don’t have AIDS so there is no problem-. I told them that they could leave me and stop being friends if they wanted to. They did not do that, and we are still friends now.’ [Male 031, 25 years]

Some YPHIV decided not to disclose their status to others. However, they relocated to live with individuals who were HIV-negative. They had to hide their medication or explain why they needed to take it. A young adult described how his girlfriend abandoned him after finding the hidden ARV bottle.

‘I was living with my girlfriend, whom I planned to marry. I did not tell her about HIV, and I hid my med under the motorcycle seat. She found it one day, and she Googled it to learn more before leaving me. I felt sad, but later I could accept it. It was my fault… I should have told her earlier during our relationship.’ [Male 003, 29 years]

Some decided to disclose their HIV status and had to deal with unfavorable situations, like a young man who was left by his girlfriend after HIV disclosure. He ended up turning back to love himself and continuing life as a single without a relationship.

‘I was unhappy worrying about her. I thought repeatedly if I should tell her, and how she would feel about me having HIV. One day, I decided to talk to her. At first, she said it was OK, then a few months later, she left me. …now I am OK. I am happy being on my own and spending all of money on what I want to.’ [Male 002, 21 years]

Discussion

Our study identified several intrinsic motivations for HIV self-care in YPHIV, including the crucial role of family relationships, their aims for achievement with specific goals, their self-appreciation, and autonomy/being self-focused with inspiration from nature. The perceived burden of HIV medication was low, but they continued to struggle with anxiety related to disclosing their HIV status.

The study identified the supportive role of family, which was crucial along the life course of YPHIV. Since they were young, one or more family members had a caregiver role in ART medication and adherence to treatment and care. Based on the discussion with YPHIV in our study, when they grew up, the need for physical support decreased, while psychological support remained important for many of them. This finding is similar to what was reported in a qualitative study among adolescents living with HIV in Kenya, where having a supportive system, such as parents, helped them overcome their distress. ¹⁷ For most Asian people, family remains an important part of individuals’ lives which can be both a cause of stress and a source of support. According to a survey, 71% of respondents in Asia cited family as their main source of support in cases of illnesses and diseases. ¹⁸ We found that YPHIV identified someone as their family, in many cases, not only biological parents but also grandparents, other caregivers, or housemates with whom they felt close. Perceiving support from those people, they lead their own lives in the right way, adhere to medication and HIV self-care, and move towards their life goals. Family or peer support served as a source of power and a safe zone where they could stay calm and be motivated. Without companionship and mental support, young people might feel isolated, hopeless, or lonely. ¹⁹ A study in Nigerian adolescents living with HIV reported the presence of family support as a protective factor against depression. ²⁰

The study revealed that many YPHIV had specific life goals. With a goal-oriented mindset, they could not only develop stronger resilience against stigma but also plan their own lives and be self-disciplined. Our finding was in line with the results from a survey among adolescents in the UK; specific life goals were identified as a self-motivation that is advantageous in HIV treatment compliance. ²¹ We found that YPHIV valued themselves. This attitude enabled them to engage in HIV self-care and perform other healthy behaviors. Self-appreciation is a crucial component of effective healthcare, as it can impact both mental and physical well-being. In contrast, HIV-related stigma had a negative impact on ART adherence, engagement, and retention in HIV care. ²² A US study reported HIV-related stigma affected perceived goal difficulty in people living with HIV but was not significantly associated with perceived goal importance. ²³ In this study, a young man identified focusing on himself as a barrier to negative social interactions, such as HIV-related stigma and discrimination. Being self-focused and embracing autonomy allowed YPHIV to live independently and foster self-confidence. This was observed in our study. YPHIV continued their medications, as they wanted to be healthy, to graduate, and to make the one they loved happy; life goals are important, as they provide motivation to accomplish tasks in each step of one's life.

The low burden of taking ART in our participants was in line with the French study among youth with perinatal HIV aged 14–20, where they viewed HIV as having only a minor impact on their daily lives and had positive expectations for adulthood. ²⁴ YPHIV have perceived HIV-related stigma as they have heard and learned from people around them, which could affect HIV self-care, treatment adherence, and quality of life. ²⁵ In addition, it affected their decision not to disclose HIV status to others. ²⁶ Most YPHIV did not socially disclose their HIV status, except for selected individuals to whom they would like to. A previous study revealed that HIV disclosure had both positive and negative social effects. ⁶ Thus, YPHIV would have to carefully consider whether to disclose or not in different situations when they encountered new people or relocated to new places. It remains challenging for them and for healthcare providers, who might see the adverse health outcomes resulting from either inadvertent disclosure or inappropriate handling of social discrimination.

The study's strengths include various perspectives gathered from focus groups with participants in a wide age range, from mid-adolescents to young adults. It allows us to observe dynamics in different developmental stages. The use of photovoice allows researchers to learn more about YPHIV than we did in clinical practice and regular HIV clinic visits. Increasing use of assistive tools, i.e., large language models (LLMs), to generate summaries of each transcription and highlight recurring codes might complement qualitative data analysis, including photovoice discussion like ours. However, it could not totally replace human interpretation of the study's meaning.

For the study limitations, first, the study included a small sample size with limited geographic coverage. We recruited by social networking; some participants were from the same peer groups who shared similar values. Second, social desirability bias may have influenced study participants to present reasons or attitudes that they believed would be acceptable to other group members and the facilitator. Third, the study was conducted in Northern Thailand, where most participants were from rural or suburban areas; the results might not be generalizable in other settings like big inner cities. Fourth, participants’ views might not represent perspectives from young people who are less engaged in HIV care. However, we addressed “facilitators,” and more research to identify “barriers” to HIV self-care is required. Fifth, we conducted the focus group in the local language. Translation to English might reduce the power of words. Interventions targeting factors related to intrinsic motivation for HIV self-care among YPHIV are essential for achieving sustained treatment outcomes in this population. Several implications arise from the qualitative results. Based on self-determination theory, certain LLMs may be utilized for the co-design and scaling of interactive supportive interventions for youth. Examples include coaching gamification that incorporates positive feedback to enhance competency and peer-like conversation applications aimed at fostering relatedness. Subsequent research may investigate the potential of these interventions to identify and bolster motivation for HIV self-care, as well as to offer mental support for future cohorts of YPHIV. These strategies may provide benefits for individuals facing challenges with retention in HIV care or adherence to treatment. In conclusion, YPHIV demonstrated resilience in the face of adverse childhood experiences, psychosocial difficulties, and the physical challenges associated with living with HIV. Autonomy, self-appreciation, and a self-focused approach are essential. The identification of intrinsic motivation influencing HIV self-care and treatment adherence is essential for facilitating timely interventions and social support, ultimately leading to improved health outcomes.

Conclusion

Young people who acquired HIV infection perinatally faced numerous challenges. There is a need for intrinsic motivation for them to take medication and receive HIV care regularly. We conducted focus group discussion with 32 participants at the median age of 22.9 years using a photovoice approach. Major themes emerged from the photovoice discussions, including family relationships, self-appreciation, the pursuit of ambitious goals, and inspiration from nature. While the perceived burden of HIV self-care was low, participants reported feeling overwhelmed by the challenges of HIV disclosure. From this study, YPHIV demonstrated intrinsic motivation and resilience despite facing adverse experiences, psychosocial issues, and health challenges associated with living with HIV. Enhancing intrinsic motivation regarding HIV self-care and treatment adherence is essential for ensuring timely interventions and social support, ultimately leading to improved health outcomes.

The reporting of this study conforms to Consolidated criteria for reporting qualitative research (COREQ) (Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. Dec 2007;19(6):349-57. doi:10.1093/intqhc/mzm042) [supplementary file citation].

Supplemental Material

sj-pdf-1-jia-10.1177_23259582251400817 - Supplemental material for Identification of Intrinsic Motivation for HIV Self-Care: Photovoice of Young People Living with Perinatal HIV in Northern Thailand

Supplemental material, sj-pdf-1-jia-10.1177_23259582251400817 for Identification of Intrinsic Motivation for HIV Self-Care: Photovoice of Young People Living with Perinatal HIV in Northern Thailand by Linda Aurpibul, MD, MPH, Chintana Khamrong, MS, Kalunyu Kotchawat, MS, Rattika Thammalangka, BNs, Wanvisa Taweehorm, BNs, Supunnee Masurin, BNs, and Nuttawadee Maneerat, BA in Journal of the International Association of Providers of AIDS Care (JIAPAC)