Spirituality, social capital and service: Factors promoting resilience among Expert Patients living with HIV in Ethiopia

People living with HIV (PLHIV) in Ethiopia and other developing nations face numerous challenges to their health and well-being, including poverty, limited healthcare infrastructure and high levels of societal stigma. Despite these challenges, resilient trajectories have been observed even within such resource-limited settings. In Ethiopia, such resilience is exemplified by the Expert Patients (EPTs)', HIV-positive lay health workers who function as adherence counsellors, health educators, outreach workers and community advocates. We conducted a multi-method qualitative study with 20 EPTs in Addis Ababa, Ethiopia in order to understand pathways to resilience in this selected population. Participants described three key mechanisms of resilient coping: (1) the use of spirituality and faith-based practices to manage psychological difficulties associated with living with HIV; (2) utilisation of social capital from family and community networks as a buffer against the psychological and economic consequences of societal stigma; and (3) serving others as a mechanism for finding optimism and purpose in life. Interventions designed to facilitate and/or augment these social processes in the wider community may be promising strategies for improving health among PLHIV in Ethiopia and other resource-limited settings.