AIDS and Behavior

, Volume 22, Issue 5, pp 1639–1651 | Cite as

Depressive Symptoms, Disclosure, HIV-Related Stigma, and Coping Following HIV Testing Among Outpatients in Uganda: A Daily Process Analysis

  • Susan M. Kiene
  • Meredith Dove
  • Rhoda K. Wanyenze
Original Paper


As efforts to end the HIV epidemic accelerate there is emphasis on reaching those living with undiagnosed HIV infection. Newly diagnosed individuals face a number of psychosocial challenges, yet we know little about depressive symptoms in the weeks immediately following diagnosis and how disclosure, coping, and other factors may affect short and longer-term depressive symptoms. Purposively sampled Ugandan outpatients completed structured interviews immediately prior to testing for HIV, daily for 28 days after receiving their test results, and at 3 and 6 months post-test. The sample included a total of 244 participants: 20 who tested HIV positive at baseline and who provided 342 daily data points, and 224 who tested HIV negative at baseline and who provided 4388 daily data points. We used linear mixed effects modeling to examine changes in depressive symptom scores over the 28 day daily interview period and predictors of depressive symptom scores and changes over time. Results from the mixed modeling revealed that while those diagnosed with HIV showed initially high depressive symptoms following diagnosis, their symptoms decreased significantly and on average fell below the cutoff for possible depression approximately 15 days after diagnosis. Among those who tested HIV-negative, on average their depressive symptoms were below the cutoff for possible depression and did not change over time. Among those diagnosed with HIV, disclosure, especially to a partner, on a particular day was associated with higher depressive symptoms that day. However, those who disclosed to their partner during the 28 days after diagnosis had significantly lower depression scores by the end of the 28 days as well as lower depression scores 3 and 6 months after diagnosis than did those who did not disclose to their partner during the 28 days after diagnosis. Scoring higher on HIV-related stigma on a particular day was associated with higher depressive symptoms that day and engaging in positive coping on a particular day was associated with lower depressive symptoms that day. Positive coping also accelerated the decrease in depressive symptoms over time. These data underscore the importance of timely disclosure to partners and suggest that regular depression screening after diagnosis and provision of mental health services could improve HIV care engagement and treatment outcomes.


Depression HIV Disclosure HIV stigma Coping HIV testing sub-Saharan Africa Daily process 



We are grateful for the Gombe Hospital staff’s support of the study.


This study was funded by National Institute of Mental Health (K01 MH083536).

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional (Makerere University School of Public Health and Rhode Island Hospital) and national research committee (Uganda National Council for Science and Technology) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All participants provided written informed consent. This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Susan M. Kiene
    • 1
  • Meredith Dove
    • 2
  • Rhoda K. Wanyenze
    • 3
  1. 1.Division of Epidemiology and Biostatistics, Graduate School of Public HealthSan Diego State UniversitySan DiegoUSA
  2. 2.Department of PsychologyUniversity of Massachusetts DartmouthDartmouthUSA
  3. 3.Department of Disease Control and Environmental HealthMakerere University School of Public HealthKampalaUganda

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