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

Abstract

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.

The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa

“…These findings are worrisome given the high prevalence of abuse found in this study, and because mental health and substance use concerns among AGYW go largely undetected and untreated in South Africa [ 3 , 13 ]. As these behavioral health problems increase AGYW’s risk for HIV [ 23 , 26 ], there is an urgent need to develop and implement early interventions to reduce risk of mental health and substance use problems among AGYW who have been abused. Such interventions are likely to hold both individual and societal benefits if they are integrated into comprehensive HIV prevention strategies for this key population.…”

“…The results from drug testing were used to assess for recent polydrug use—a pattern of drug use associated with elevated risk of mental and physical health problems, including risk for HIV [ 26 , 49 ]. Polydrug use was coded as present (testing positive for at least two substances) or absent.…”

“…Risk of HIV acquisition is of particular concern for South Africa, with a quarter of the country’s estimated 270,000 incident HIV infections occurring among AGYW [ 21 ]. The impact of mental health and substance use concerns on sexual risk for HIV and incident infections is well documented for AGYW in this setting [ 22 , 23 , 24 , 25 , 26 , 27 ]. Evidence suggests that these problems may decrease AGYWs’ sexual agency, compromise adaptive coping, and contribute to suboptimal decision-making during sex, making it more difficult to resist pressure to have sex and to negotiate condom use, should they have the skills to do so [ 23 , 25 , 26 , 27 , 28 ].…”

“…The relationship between multiple types of abuse exposure and recurrence of abuse on mental health outcomes remains underexplored, with available evidence being inconclusive and contradictory [ 41 , 44 , 45 ]. Furthermore, none of these earlier studies examined mental health vulnerabilities among out-of-school and sexually active AGYW, a key population at risk for HIV [ 23 , 26 ]. Understanding the dimensions of abuse that heighten vulnerability for mental health and substance use concerns is important for identifying AGYW who may benefit most from these early interventions.…”

Isisekelo Sempilo study protocol for the effectiveness of HIV prevention embedded in sexual health with or without peer navigator support (Thetha Nami) to reduce prevalence of transmissible HIV amongst adolescents and young adults in rural KwaZulu-Natal: a 2 × 2 factorial randomised controlled trial

“…HIV programmes have not successfully tackled psychosocial needs of youth: in the Africa Health Research Institute's (AHRI) demographic surveillance area in rural KwaZulu-Natal, over 85% of school-leavers are unemployed [20] and there are high levels of common mental disorders (CMD) which increase with age (rising to 32% of those aged [20][21][22] [21]. Efforts to reduce structural vulnerabilities through multi-level interventions (social asset building and parenting interventions) was less successful in reaching older adolescents, those out of school, and those with CMD were less likely to access structural interventions [6].…”