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

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

doi:10.1186/s12889-021-10527-z

Abstract

BackgroundHIV 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.MethodsWe 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.ResultsProbable 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.ConclusionWe 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.

Highlights

HIV affects many adolescent girls and young women (AGYW) in South Africa
We found that food insecurity, which is linked to poverty, was associated with increased odds of probable common mental disorders (CMD), in line with evidence from previous studies [46, 47], including evidence from Zimbabwe that people with suicidal ideation who reported a history of food insecurity were more likely to have CMD [48]
Common mental disorders are prevalent among adolescent girls and young women in this rural South African setting, and are associated with poverty, HIV and violence

Summary

Introduction

HIV affects many adolescent girls and young women (AGYW) in South Africa. Adolescent girls and young women (AGYW) face disproportionately high HIV risks, including of acquisition [2]. The drivers of HIV acquisition among AGYW relate to a complex array of biological, psychological, interpersonal and structural factors, leading to what has been termed a unique vulnerability [3]. In South Africa, a 2012 nationally representative population-based survey highlighted the need to address multiple concerns – including economic, educational, alcohol-related and sexual factors – in order to mitigate young females’ vulnerability to HIV [5]. People with mental health challenges are at greater risk of HIV exposure and acquisition [17,18,19]. In sub-Saharan Africa (SSA), the situation is made more complex by the relative lack of resources for mental health support [20] – despite emerging data on effective interventions [21] – and the need for locally validated, culturally relevant screening tools to identify mental health problems

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