Journal Article

Common mental disorders and HIV status in the context of DREAMS among adolescent girls and young women in rural KwaZulu-Natal, South Africa

Chimbindi, Natsayi, Shahmanesh, Maryam, Seeley, Janet, Floyd, Sian, Tanser, Frank, Harling, Guy, Zuma, Thembelihle, Baisley, Kathy, Dreyer, Jaco, Birdthistle, Isolde, McGrath, Nuala, Mthiyane, Nondumiso, Sherr, Lorraine

2021

Overview

Background HIV affects many adolescent girls and young women (AGYW) in South Africa. Given the bi-directional HIV and mental health relationship, mental health services may help prevent and treat HIV in this population. We therefore examined the association between common mental disorders (CMD) and HIV-related behaviours and service utilisation, in the context of implementation of the combination DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) HIV prevention programme in rural uMkhanyakude district, KwaZulu-Natal. DREAMS involved delivering a package of multiple interventions in a single area to address multiple sources of HIV risk for AGYW. Methods We analysed baseline data from an age-stratified, representative cohort of 13–22 year-old AGYW. We measured DREAMS uptake as a count of the number of individual-level or community-based interventions each participant received in the last 12 months. CMD was measured using the validated Shona Symptom Questionnaire, with a cut off score ≥ 9 indicating probable CMD. HIV status was ascertained through home-based serotesting. We used logistic regression to estimate the association between CMD and HIV status adjusting for socio-demographics and behaviours. Results Probable CMD prevalence among the 2184 respondents was 22.2%, increasing steadily from 10.1% among 13 year-old girls to 33.1% among 22 year-old women. AGYW were more likely to report probable CMD if they tested positive for HIV (odds ratio vs. test negative: 1.88, 95% confidence interval: 1.40–2.53). After adjusting for socio-demographics and behaviours, there was evidence that probable CMD was more prevalent among respondents who reported using multiple healthcare-related DREAMS interventions. Conclusion We found high prevalence of probable CMD among AGYW in rural South Africa, but it was only associated with HIV serostatus when not controlling for HIV acquisition risk factors. Our findings highlight that improving mental health service access for AGYW at high risk for HIV acquisition might protect them. Interventions already reaching AGYW with CMD, such as DREAMS, can be used to deliver mental health services to reduce both CMD and HIV risks. There is a need to integrate mental health education into existing HIV prevention programmes in school and communities.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adolescents / Adult / Age / Biostatistics / Child & adolescent mental health / Confidence intervals / Context / Demographic aspects / Demographics / Demography / Diagnosis / Economic aspects / Environmental Health / Epidemiology / Female / Girls / Health aspects / Health risks / HIV / HIV infection / HIV Infections - epidemiology / HIV prevention / Human immunodeficiency virus / Humans / Intervention / Medicine / Medicine & Public Health / Mental Disorders / Mental health / Mental illness / Prevention / Psychological aspects / Public Health / Regression analysis / Research Article / Risk analysis / Risk factors / Risk management / Rural Population / Sexual Behavior / South Africa / South Africa - epidemiology / Statistical analysis / Teenagers / Vaccine / Women / Young Adult / Young adults / Young women