Intimate partner violence (IPV) negatively impacts antiretroviral therapy (ART) adherence among people living with HIV (PLWH); however, psychosocial resources may buffer this effect. This cross-sectional study examined whether meaning in life (ML), sense of coherence (SOC) and spirituality moderated the IPV-ART adherence relationship among 200 PLWH in Johannesburg, South Africa, a setting with high HIV and IPV prevalence. Participants completed measures of IPV exposure (Violence Against Women Instrument), ART adherence (ACTG adherence questionnaire), ML (Meaning in Life Questionnaire), SOC (SOC-13), and spirituality (Spiritual Well-Being Scale).


Participants were mostly women (67% women) with a mean age of 34.90 years (SD = 7.90). Average ART adherence was 79.0%, and 51.0% of participants reported experiencing IPV. Moderation analyses (Hayes' PROCESS macro) revealed a significant negative association between IPV and ART adherence (b = -7.90, p = .007). While ML's moderating influence was non-significant (p = .069), SOC significantly attenuated the IPV-adherence link (b = 0.53, p = .013). Spirituality demonstrated the strongest buffering effect (b = 0.72, p < .001), with high levels of spiritual well-being reducing the negative impact of IPV on ART adherence.


South Africa's strong affiliation with spirituality may account for its enhanced protective effect relative to the more individual-centred constructs of ML and SOC. Findings suggest that interventions leveraging spirituality (e.g., faith-based partnerships) and SOC (e.g., coping skills training) could enhance adherence among IPV-affected PLWH, particularly in high-stigma settings.