Psychological distress and HIV after financial meltdown in Zimbabwe

Prevalence and associations of psychological distress, HIV Infection and HIV care service utilization in East Zimbabwe.

Tlhajoane M, Eaton JW, Takaruza A, Rhead R, Maswera R, Schur N, Sherr L, Nyamukapa C, Gregson S. AIDS Behav. 2017 Feb 13. doi: 10.1007/s10461-017-1705-x. [Epub ahead of print]

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.

Abstract access [1]

Editor’s notes: Psychological distress can lead to increased use of alcohol and drugs, sexual risk behaviour, and hence increased risk of HIV acquisition. In rural Manicaland, the fifth survey round of an open population cohort measured psychological distress for the first time in 2009-2011, following the Zimbabwe hyperinflation crisis of 2008-2009.

Psychological distress was highly prevalent, especially among women, as was HIV infection. Overall, HIV prevalence was 12.7% in men and 18.3% in women. Psychological distress and HIV were also clearly associated. Among people with psychological distress HIV prevalence was 18.8% for men and 27.2% for women, compared to 12.4% and 17.1% for men and women respectively without psychological distress.

People living with HIV (identified by anonymous testing) who had psychological distress were more likely to have had an HIV test than people without psychological distress, although this could be reversed to mean that people with HIV who knew their status were more likely to have psychological distress than people who did not. If diagnosed and on antiretroviral therapy, people with psychological distress also had poorer adherence, supporting findings of other studies.

A main challenge to interpreting these results is a lack of information on poverty and how it may have impacted both psychological distress and risk of HIV acquisition. Only one survey round used the Shona Symptom Questionnaire so the study is essentially a cross-sectional survey. Women with psychological distress were more likely to have transactional sex, engage in sex work and not use condoms, but it is not clear that these behaviours were consequences of psychological distress. Instead, both the behaviours and the distress could have been caused by poverty constraints and lack of options. The only economic variables measured were time of year (as a proxy for food availability) and employment status (employed/unemployed). Being employed was associated with lower risk of psychological distress for women, but had no effect for men.

Africa [5]
Zimbabwe [6]
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