South Africa has achieved significant milestones in its antiretroviral therapy (ART) roll-out, emerging as a global leader. The Harry Gwala district in KwaZulu-Natal became the country’s first district to meet the 90/90/90 UNAIDS targets in 2019. Despite this achievement, ensuring ART adherence remains crucial in stemming the spread of the virus, particularly among adolescents.

This research employed a qualitative methodology with in-depth interviews conducted with 21 participants, including adolescents aged 15-19 receiving highly active antiretroviral therapy (HAART), primary caregivers and healthcare practitioners involved in disclosure processes. Thematic analysis revealed that while all clinicians were aware of professional disclosure guidelines, their implementation was inadequate, with only 29% adhering to them effectively.

Opinions among caregivers and clinicians diverged regarding the responsibility for initiating disclosure, highlighting a lack of consensus and clarity. Challenges such as fear of stigma and inadequate support post-disclosure were identified, compounded by caregivers’ insufficient confidence and knowledge in addressing related issues. The study underscored the importance of timely disclosure before adolescents discover their HIV status independently. It also revealed shortcomings in post-disclosure care and follow-up in primary healthcare facilities.