Knowledge of HIV Status Is Associated With a Decrease in the Severity of Depressive Symptoms Among Female Sex Workers in Uganda and Zambia

Abstract

When I launched the 90-90-90 targets three years ago, many people thought they were impossible to reach. Today, the story is very different. Families, communities, cities and countries have witnessed a transformation, with access to HIV treatment accelerating in the past three years. A record 19.5 million people are accessing antiretroviral therapy, and for the first time more than half of all people living with HIV are on treatment. More countries are paying for HIV treatment themselves. More people living with HIV are employed, more girls are in school, there are fewer orphans, there is less ill health and less poverty. Families and communities are feeling more secure. With science showing that starting treatment as early as possible has the dual benefit of keeping people living with HIV healthy and preventing HIV transmission, many countries have now adopted the gold-standard policy of treat all. Our efforts are bringing a strong return on investment. AIDS-related deaths have been cut by nearly half from the 2005 peak. We are seeing a downward trend in new HIV infections, especially in eastern and southern Africa, where new HIV infections have declined by a third in just six years. This good news is a result of the combined effect of a rapid scale-up of treatment and existing HIV prevention interventions. Moving forward, every additional dollar invested in AIDS will deliver a US$ 8 return. But our quest to end AIDS has only just begun. We live in fragile times, where gains can be easily reversed. The biggest challenge to moving forward is complacency. Global solidarity and shared responsibility has driven the success we have achieved so far. This must be sustained. But for several years now, resources for AIDS have remained stagnant, and we are not on track to reach the US$ 26 billion of investment we need by 2020. Without more domestic investments and international assistance, we cannot push faster on the Fast-Track. More people will become infected with HIV and lives will be lost. Without more community health workers, health systems will remain stretched. Without changing laws, key populations will be left behind. We must not fail children, women and girls, young people and key populations. We must engage with men differently. Men are being left behind in the push to 90-90-90, in turn affecting the lives of women and children. I remain optimistic. This report clearly demonstrates the power of the 90-90-90 targets and what can be achieved in a short time. It shows that innovations are possible at every level-from communities to research laboratories, from villages to cities. It illustrates the power of political leadership to make the impossible possible.

Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis

“…Forty-four studies examined depression among FSWs, with 37 reporting prevalence estimates ( Table 1 ) [ 9 , 10 , 23 , 27 , 32 – 37 , 39 , 43 – 69 ]. A meta-analysis was conducted with 23 studies ( Fig 2 ).…”

“…Seventeen studies reported on suicidal ideation [ 10 , 36 , 39 , 46 , 47 , 55 , 57 , 58 , 61 , 69 , 71 , 75 – 80 ]. Most assessed suicidal ideation by asking about suicidal thoughts, for example, “have you thought about killing yourself?” and “have you ever felt like you wanted to end your life?” For the meta-analysis, we divided studies based on timeframe into ‘recent’ or ‘ever’ suicidal ideation and removed 3 studies due to limitations in how questions were operationalized [ 46 , 47 ], including one study that combined suicidal thoughts with attempting suicide [ 65 ].…”

“…Eight studies reported on HIV/STI and mental health problems [ 36 , 44 , 47 – 49 , 60 , 69 , 73 ]. One study [ 48 ] was excluded from the meta-analyses because it did not use a validated tool to measure depression, and one study was excluded because it only sampled HIV-negative women [ 44 ].…”

“…Seventeen studies reported on suicidal ideation [10,36,39,46,47,55,57,58,61,69,71,[75][76][77][78][79][80]. Most assessed suicidal ideation by asking about suicidal thoughts, for example, "have you thought about killing yourself?"…”

Unintended uses, meanings, and consequences: HIV self-testing among female sex workers in urban Uganda

“…Our findings are largely consistent with HIVST research in Uganda. Quantitative research with the same cohort of FSWs found that learning one's HIV status led to decreases in the severity of depressive symptoms (Ortblad et al, 2020) and knowledge of an HIVnegative status led to increases in condom use (Ortblad et al, 2019), both factors that may be at least partially explained by the qualitative data showing that HIVST sparked feelings of self-worth, and a desire to live healthy, full lives (Wachinger et al, 2020). A qualitative study among FSWs in Rakai, Uganda, which preempted the distribution of HIVST kits, found that FSWs perceived HIVST as advantageous because it bolsters privacy and convenience, but problematic because it circumvents formal counseling, which is echoed in our data stemming from actual experience (Burke et al, 2017).…”