Prospective Study of the Mental Health Consequences of Sexual Violence Among Women Living With HIV in Rural Uganda

Abstract

The association between sexual violence and depression is well known, but the temporal aspects of the association have not been well established. We analyzed data from a cohort of 173 HIV-positive women in rural Uganda who were interviewed every 3 months for a median of 1.8 years of follow-up. The method of generalized estimating equations (GEE) was used to model the marginal expectation of depression symptom severity (Hopkins Symptom Checklist for Depression), mental health–related quality of life (MOS-HIV Mental Health Summary), and heavy drinking (Alcohol Use Disorders Identification Test) as a function of self-reported forced-sex victimization in the 3 months prior to interview. Estimates were adjusted for variables known to confound the association between victimization and mental health status. To assess any potential reciprocal relationships, we reversed the temporal ordering of the exposures and outcomes and refitted similar GEE models. In multivariable analyses, victimization was associated with greater depression symptom severity (b = 0.17; 95% CI = [0.02, 0.33]) and lower mental health–related quality of life (b = −5.65; 95% CI = [−9.34, −1.96]), as well as increased risks for probable depression (adjusted relative risk [ARR] = 1.58; 95% CI = [1.01, 2.49) and heavy drinking (ARR = 3.99; 95% CI = [1.84, 8.63]). We did not find strong evidence of a reciprocal relationship. Our findings suggest that forced sex is associated with adverse mental health outcomes among HIV-positive women in rural Uganda. Given the substantial mental health–related impacts of victimization, effective health sector responses are needed.

Socio-demographic correlates of depression and anxiety among female caregivers living with HIV in rural Uganda

“…Average scores were generated for depression (15 item) and anxiety (10 item) subscales; higher scores indicating greater severity. To estimate a cutoff for clinically relevant symptoms, we averaged all 25 items into a single score; an average HSCL-25 score of 1.75 or higher was considered clinically significant (Kinyanda, Hoskins, Nakku, Nawaz, & Patel, 2011; Tsai et al, 2015). Internal consistency (Cronbach’s alpha) was 0.73, and 0.84 for the depression and anxiety subscales, respectively.…”

Relationship Power and Sexual Violence Among HIV-Positive Women in Rural Uganda

“…Trained research assistants conversant in the local language (Runyankole) administered the surveys through face-to-face interviews in private rooms of the ISS clinic. In August 2007, the survey was modified for a sub-study to include measures on relationship power, intimate partner violence, stigma, social support, health behaviors, and food security [45]. We performed a cross-sectional analysis using baseline data on all female participants from the sub-study (i.e., women who were enrolled into the cohort after the relationship power and other measures were introduced).…”

A Review of Recent Literature on Trauma Among Individuals Living with HIV

“…Although the association of victimization and depression is well elucidated, the temporal aspect of this association has not been well established. Study results indicated that victimization predicted greater depression symptom severity and lower mental health-related quality of life as well as heavy drinking [31]. Although substance abuse has been consistently associated with trauma and IPV [2, 21], this study was one of the few recent studies identified to explore this relationship.…”

“…IPV and other forms of gender violence have been consistently related to psychiatric symptoms among PLWH [10, 31]. Recent literature provides additional evidence of this relationship.…”