The World According to Girls: A Qualitative Study of School, Work, and Identity Among Adolescent Girls and Young Women Living with HIV in Ghana.

Background: Adolescent girls and young women (AGYW) living with HIV in Ghana face multiple, intersecting forms of marginalization. Beyond the clinical management of HIV, little is known about how they construct meaning, navigate identity, and imagine their futures within structural contexts shaped by stigma, gender inequity, economic precarity and colonial legacies. Objective: To explore how AGYW living with HIV in Ghana understand and negotiate their social identities in work and school. We then aimed to understand how their lived experiences at school and work are shaped by broader systems of power. Methods: This qualitative study drew on semi-structured interviews with AGYW (ages 11-24, N = 24) receiving HIV care in Kumasi, Ghana. Data were coded both inductively and deductively. Themes were interpreted through the Ghanian context using intersectionality, Critical Disability Studies, spoiled identity theory and African Feminist decolonial theory. The analysis was conducted iteratively and reflexively, with attention to positionality, gender, and structural power dynamics. Results: Seven major themes were identified: (1) social support; (2) concrete plans for the future; (3) unattainability of the future; (4) coping via detachment; (5) need for privacy and confidentiality; (6) role as arbiter of HIV information; and (7) financial stress. Across these themes, AGYW described dynamic processes of identity negotiation, moral and emotional labor, and structural constraint. HIV was rarely the sole barrier-rather, it intersected with gender norms, family dynamics, age hierarchies, economic marginalization, and misinformation to shape participants' social worlds. Some participants coped through detachment or concealment, while others reclaimed agency through caregiving roles, education, or aspirational goals. Conclusions: AGYW living with HIV in Ghana are not only navigating a chronic illness but also resisting a layered matrix of social and structural injustice. Their stories reveal both vulnerability and strategic agency. Interventions and policy must go beyond biomedical care to address stigma, provide confidential and affirming school and work environments, and offer structural supports for emotional, educational, and economic well-being.