Abstract
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.
Highlights
Depression is the leading cause of disability worldwide, affecting an estimated 350 million people [1]
The 2010 Global Burden of Disease (GBD) study estimated that major depressive disorders were among one of the top five causes of years lived with a non-fatal disability (YLD) in Zimbabwe [7]
In cross-sectional studies conducted amongst attendees at HIV care facilities in sub-Saharan Africa, psychological distress has been associated with treatment interruptions and sub-optimal adherence to antiretroviral therapy (ART), increasing the potential for virological failure, poor disease outcomes and further spread of infection [20,21,22,23,24,25]
Summary
Depression is the leading cause of disability worldwide, affecting an estimated 350 million people [1]. In cross-sectional studies conducted amongst attendees at HIV care facilities in sub-Saharan Africa, psychological distress has been associated with treatment interruptions and sub-optimal adherence to ART, increasing the potential for virological failure, poor disease outcomes and further spread of infection [20,21,22,23,24,25]. Large population-based studies are needed in low-income, high HIV-prevalence countries to establish the nature and extent of interactions between poor mental health, HIV risk, uptake of HIV services and adherence to ART in these settings. We aim to: (i) determine the prevalence of psychological distress in a general population sample in eastern Zimbabwe, a low-income country suffering hyper-endemic HIV; (ii) describe patterns of association between psychological distress and hypothesized socio-demographic, behavioural and clinical risk factors based on a theoretical framework; (iii) assess the relationship between psychological distress and sexual risk behaviours that may increase the likelihood of HIV acquisition and transmission; and (iv) evaluate associations between psychological distress and use of HIV testing services, receipt of cotrimoxazole, and uptake and adherence to ART within the population
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