Date Published: February 13, 2017
Publisher: Springer US
Author(s): Malebogo Tlhajoane, Jeffrey W. Eaton, Albert Takaruza, Rebecca Rhead, Rufurwokuda Maswera, Nadine Schur, Lorraine Sherr, Constance Nyamukapa, Simon Gregson.
The correlation between mental health and sexual risk behaviours for HIV infection remains largely unknown in low and middle income settings. The present study determined the prevalence of psychological distress (PD) in a sub-Saharan African population with a generalized HIV epidemic, and investigated associations with HIV acquisition risk and uptake of HIV services using data from a cross-sectional survey of 13,252 adults. PD was measured using the Shona Symptom Questionnaire. Logistic regression was used to measure associations between PD and hypothesized covariates. The prevalence of PD was 4.5% (95% CI 3.9–5.1%) among men, and 12.9% (95% CI 12.2–13.6%) among women. PD was associated with sexual risk behaviours for HIV infection and HIV-infected individuals were more likely to suffer from PD. Amongst those initiated on anti-retroviral therapy, individuals with PD were less likely to adhere to treatment (91 vs. 96%; age- and site-type-adjusted odds ratio = 0.38; 95% CI 0.15, 0.99). Integrated HIV and mental health services may enhance HIV care and treatment outcomes in high HIV-prevalence populations in sub-Saharan Africa.
Depression is the leading cause of disability worldwide, affecting an estimated 350 million people . Despite the large burden of mental and behavioural disorders across the world, resources for mental health care remain limited, especially in low and middle income countries (LMIC). The World Health Organization (WHO) estimates that between 76 and 85% of individuals with a severe psychological disorder in LMIC receive no treatment . In addition, the total population (in millions) per mental health outpatient facility was 3.31 in the WHO Africa region compared to 0.08 in Europe . By 2030, depression alone is predicted to be the highest contributor to the global burden of disease .
13,252 respondents aged 15–54 years were interviewed in the Manicaland survey and had complete SSQ, psychological health data. The demographic characteristics of the study population are summarized in Table 1. HIV prevalence was 12.7% (648/5099) and 18.3% (1484/8122) for males and females, respectively, including self-reported data for 27 individuals (1 HIV positive and 26 HIV negative) with missing HIV test results in the survey.Table 1Characteristics of the study population stratified by genderMenn = 5124 (38.7%)Womenn = 8128 (61.3%)Mean age28.931.7Age group 15–242159 (42.1%)2622 (32.3%) 25–341412 (27.6%)2359 (29.0%) 35–44989 (19.3%)1657 (20.4%) 45–54564 (11.0%)1490 (18.3%)Site type Estates1477 (28.8%)1995 (24.5%) Small towns933 (18.2%)1399 (17.2%) Roadside trading center1009 (19.7%)1673 (20.6%) Subsistence farming areas1705 (33.3%)3061 (37.7%)Employed3257 (63.6%)2429 (29.9%)Highest level of education None or primary965 (18.8%)2822 (34.7%) Secondary3991 (77.9%)5201 (64.0%) Higher167 (3.3%)105 (1.3%)Relationship status Never been in long term relationship2190 (42.8%)1378 (17.0%) Separated or divorced148 (2.9%)647 (8.0%) Widowed83 (1.6%)946 (11.7%) Still in union2696 (52.7%)5152 (63.4%)HIV positive648 (12.7%)1484 (18.3%)STI symptoms298 (5.8%)677 (8.3%)
In a general population sample in east Zimbabwe, we found evidence that psychological distress (PD) is more common in PLHIV. Sexual risk behaviours occurred more frequently in uninfected individuals (particularly in women) with PD which suggests that poor mental health may be a risk factor for HIV acquisition. There was little evidence though that PD contributes to high risk behaviour for HIV transmission from previously infected individuals. HIV-infected individuals with psychological distress were more likely to have had an HIV test—in part, perhaps due to worry arising from the knowledge of potentially being infected, especially at more advanced stages of infection. Amongst those who knew their infection status, those with psychological distress were no more likely to have taken up ART. Those on ART with psychological distress, were less likely to be adhering well to their medication.