Skip to main content

Relationship Between Mental Health and HIV Transmission Knowledge and Prevention Attitudes Among Adolescents Living with HIV: Lessons from Suubi + Adherence Cluster Randomized Study in Southern Uganda

Abstract

We assessed the effect of depression, hopelessness, and self-concept on HIV prevention attitudes and knowledge about infection, transmission and sexual risk behavior among adolescents living with HIV in Uganda. Utilizing longitudinal data from 635 adolescents living with HIV, multiple ordinary least square regression was used to evaluate associations between the three indicators of mental health functioning at baseline and HIV knowledge and prevention attitudes at 12-months follow-up. We found that depression (β = − 0.17; 95% CI − 0.31, − 0.04) and hopelessness (β = − 0.16; 95% CI − 0.28, − 0.04) scores at baseline were associated with a 0.17 and 0.16 average reduction in HIV prevention attitudes and HIV knowledge scores, respectively at 12-months follow-up. However, self-concept was not significantly associated with HIV knowledge or prevention attitudes. Adolescents living with HIV with greater levels of hopelessness are at increased risk of having limited HIV knowledge while those with greater symptoms of depression had less favorable HIV prevention attitudes.

This is a preview of subscription content, access via your institution.

References

  1. Kharsany ABM, Karim QA. HIV Infection and AIDS in sub-Saharan Africa: current status, challenges and opportunities. Open AIDS J. 2016;10:34–48.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  2. Commission UA. Uganda HIV/AIDS Country Progress Report July 2016–June 2017. 2017.

  3. World Bank Group. The Uganda Poverty Assessment Report 2016. Farms, cities and good fortune: Assessing poverty reduction in Uganda from 2006 to 2013. Uganda; 2016. Report No.: ACS18391.

  4. Uganda Bureau of Statistics (UBOS), ICF. Uganda Demographic and Health Survey 2016. Kampala, Uganda; 2018.

  5. Joint United Nations Programme on HIV/AIDS. UNAIDS data 2017. Geneva, Switzerland: UNAIDS; 2017.

    Google Scholar 

  6. UPHIA. UGANDA POPULATION-BASED HIV IMPACT ASSESSMENT UPHIA 2016–2017. Uganda; 2018.

  7. Vreeman RC, McCoy BM, Lee S. Mental health challenges among adolescents living with HIV. J Int AIDS Soc. 2017;20(Suppl 3):21497.

    PubMed  PubMed Central  Article  Google Scholar 

  8. Dow DE, Turner EL, Shayo AM, Mmbaga B, Cunningham CK, O’Donnell K. Evaluating mental health difficulties and associated outcomes among HIV-positive adolescents in Tanzania. AIDS Care. 2016;28(7):825–33.

    PubMed  PubMed Central  Article  Google Scholar 

  9. Smith Fawzi MC, Ng L, Kanyanganzi F, Kirk C, Bizimana J, Cyamatare F, et al. Mental Health and antiretroviral adherence among youth living With HIV in Rwanda. Pediatrics. 2016;138(4):e20153235.

    PubMed  PubMed Central  Article  Google Scholar 

  10. Kamau JW, Kuria W, Mathai M, Atwoli L, Kangethe R. Psychiatric morbidity among HIV-infected children and adolescents in a resource-poor Kenyan urban community. AIDS Care. 2012;24(7):836–42.

    PubMed  Article  Google Scholar 

  11. Kim MH, Mazenga AC, Devandra A, Ahmed S, Kazembe PN, Yu X, et al. Prevalence of depression and validation of the Beck Depression Inventory-II and the Children’s Depression Inventory-Short amongst HIV-positive adolescents in Malawi. J Int AIDS Soc. 2014;17(1):18965.

    PubMed  PubMed Central  Article  Google Scholar 

  12. Musisi S, Kinyanda E. Emotional and behavioural disorders in HIV seropositive adolescents in urban Uganda. East Afr Med J. 2009;86(1):16–24.

    CAS  PubMed  Article  Google Scholar 

  13. Boyes ME, Cluver LD, Meinck F, Casale M, Newnham E. Mental health in South African adolescents living with HIV: correlates of internalising and externalising symptoms. AIDS Care. 2019;31(1):95–104.

    PubMed  Article  Google Scholar 

  14. Ngui EM, Khasakhala L, Ndetei D, Roberts LW. Mental disorders, health inequalities and ethics: a global perspective. Int Rev Psychiatry. 2010;22(3):235–44.

    PubMed  PubMed Central  Article  Google Scholar 

  15. Nalukenge W, Martin F, Seeley J, Kinyanda E. Knowledge and causal attributions for mental disorders in HIV-positive children and adolescents: results from rural and urban Uganda. Psychol Health Med. 2019;24(1):21–6.

    CAS  PubMed  Article  Google Scholar 

  16. Ramaiya MK, Sullivan KA, O’ Donnell K, Cunningham CK, Shayo AM, Mmbaga BT, et al. A qualitative exploration of the mental health and psychosocial contexts of HIV positive adolescents in Tanzania. PLOS ONE. 2016;11(11):0165936.

    Article  CAS  Google Scholar 

  17. Lommerse K, Stewart RC, Chilimba Q, van den Akker T, Lund C. A descriptive analysis of HIV prevalence, HIV service uptake, and HIV-related risk behaviour among patients attending a mental health clinic in rural Malawi. PLoS ONE. 2013;8(8):e72171.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  18. Smith Fawzi MC, Jagannathan P, Cabral J, Banares R, Salazar J, Farmer P, et al. Limitations in knowledge of HIV transmission among HIV-positive patients accessing case management services in a resource-poor setting. AIDS Care. 2006;18(7):764–71.

    CAS  PubMed  Article  Google Scholar 

  19. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice Hall; 1986.

    Google Scholar 

  20. Ssewamala FM, Byansi W, Bahar OS, Nabunya P, Neilands TB, Mellins C, et al. Suubi+Adherence study protocol: a family economic empowerment intervention addressing HIV treatment adherence for perinatally infected adolescents. Contemp Clin Trials Commun. 2019;16:100463.

    PubMed  PubMed Central  Article  Google Scholar 

  21. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global Report 2012: UNAIDS Report on the Global AIDS Epidemic. UN. 2012.

  22. Bennett DA. How can I deal with missing data in my study? Aust N Z J Public Health. 2001;25(5):464–9.

    CAS  PubMed  Article  Google Scholar 

  23. Han C-K, Ssewamala FM, Wang JS-H. Family economic empowerment and mental health among AIDS-affected children living in AIDS-impacted communities: evidence from a randomised evaluation in southwestern Uganda. J Epidemiol Community Health. 2013;67(3):225–30.

    PubMed  Article  Google Scholar 

  24. Karimli L, Ssewamala FM. Do savings mediate changes in adolescents’ future orientation and health-related outcomes? Findings from randomized experiment in Uganda. J Adolesc Health. 2015;57(4):425–32.

    PubMed  PubMed Central  Article  Google Scholar 

  25. Kivumbi A, Byansi W, Ssewamala FM, Proscovia N, Damulira C, Namatovu P. Utilizing a family-based economic strengthening intervention to improve mental health wellbeing among female adolescent orphans in Uganda. Child Adolesc Psychiatry Ment Health. 2019;13(1):1–7.

    Article  Google Scholar 

  26. Ssewamala FM, Neilands TB, Waldfogel J, Ismayilova L. The impact of a comprehensive microfinance intervention on depression levels of AIDS-orphaned children in Uganda. J Adolesc Health. 2012;50(4):346–52.

    PubMed  Article  Google Scholar 

  27. Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol. 1974;42(6):861–5.

    CAS  PubMed  Article  Google Scholar 

  28. Brown GK, Beck AT, Steer RA, Grisham JR. Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. J Consult Clin Psychol. 2000;68(3):371–7.

    CAS  PubMed  Article  Google Scholar 

  29. Sun S, Wang S. The Children’s Depression Inventory in worldwide child development research: a reliability generalization study. J Child Fam Stud. 2015;24(8):2352–63.

    Article  Google Scholar 

  30. Thompson RD, Craig AE, Mrakotsky C, Bousvaros A, DeMaso DR, Szigethy E. Using the children’s depression inventory in youth with inflammatory bowel disease: support for a physical illness-related factor. Compr Psychiatry. 2012;53(8):1194–9.

    PubMed  PubMed Central  Article  Google Scholar 

  31. Traube D, Dukay V, Kaaya S, Reyes H, Mellins C. Cross-cultural adaptation of the Child Depression Inventory for use in Tanzania with children affected by HIV. Vulnerable Child Youth Stud. 2010;5(2):174–87.

    PubMed  PubMed Central  Article  Google Scholar 

  32. Cavazos-Rehg P, Xu C, Borodovsky J, Kasson E, Byansi W, Nabunya P, et al. The impact of discomfort with HIV status and hopelessness on depressive symptoms among adolescents living with HIV in Uganda. AIDS Care. 2020. https://doi.org/10.1080/09540121.2020.

    Article  PubMed  Google Scholar 

  33. Kovacs M. Children’s Depression Inventory. A measure of depressive symptoms in children and adolescents. North Tonawanda: Multi-Health Systems Inc; 1992.

    Google Scholar 

  34. Fitts WH, Warren WL. Tennessee self-concept scale, TSCS 2. Manual. 2nd ed. Los Angeles: Western Psychological Services; 1997.

    Google Scholar 

  35. Ssewamala FM, Han C-K, Neilands TB. Asset ownership and health and mental health functioning among AIDS-orphaned adolescents: findings from a randomized clinical trial in rural Uganda. Soc Sci Med. 2009;69(2):191–8.

    PubMed  PubMed Central  Article  Google Scholar 

  36. Mellins CA, Malee KM. Understanding the mental health of youth living with perinatal HIV infection: lessons learned and current challenges. J Int AIDS Soc. 2013;16:18593.

    PubMed  PubMed Central  Article  Google Scholar 

  37. Remien RH, Stirratt MJ, Nguyen N, Robbins RN, Pala AN, Mellins CA. Mental health and HIV/AIDS: the need for an integrated response. AIDS. 2019;33(9):1411–20.

    PubMed  Article  Google Scholar 

  38. Uganda Ministry of Health. Uganda National Policy on HIV counselling and testing. Kampala; 2005.

  39. Agbor J. Poverty, inequality and Africa’s education crisis. Washington, DC: The Brookings Institute; 2012.

    Google Scholar 

  40. Colclough C, Rose P, Tembon M. Gender inequalities in primary schooling: The roles of poverty and adverse cultural practice1. The work presented in this paper is part of a research programme on Gender and Primary Schooling in Africa, directed by Christopher Colclough. The first phase of this programme was conducted in three African countries, under the auspices of the Forum for African Women Educationalists (FAWE), with funding from the Rockefeller Foundation.1. Int J Educ Dev. 2000;20(1):5–27.

  41. Ombati V, Ombati M. Gender inequality in education in sub-Saharan Africa. JWEE. 2012;3–4:114–36.

    Google Scholar 

  42. Jukes M, Simmons S, Bundy D. Education and vulnerability: the role of schools in protecting young women and girls from HIV in southern Africa. AIDS. 2008;22:S41–56.

    PubMed  Article  Google Scholar 

  43. Ssewamala FM, Ismayilova L, McKay M, Sperber E, Bannon W Jr, Alicea S. Gender and the effects of an economic empowerment program on attitudes toward sexual risk-taking among AIDS-orphaned adolescent youth in Uganda. J Adolesc Health. 2010;46(4):372–8.

    PubMed  PubMed Central  Article  Google Scholar 

  44. Magadi MA. Understanding the gender disparity in HIV infection across countries in sub-Saharan Africa: evidence from the Demographic and Health Surveys. Sociol Health Illn. 2011;33(4):522–39.

    PubMed  PubMed Central  Article  Google Scholar 

  45. Uganda. Ministry of Health, ICF International. Uganda AIDS indicator survey 2011: ICF International; 2012.

  46. Nabunya P, Ssewamala FM, Mukasa MN, Byansi W, Nattabi J. Peer mentorship program on HIV/AIDS knowledge, beliefs, and prevention attitudes among orphaned adolescents: an evidence based practice. Vulnerable Child Youth Stud. 2015;10(4):345–56.

    PubMed  PubMed Central  Google Scholar 

  47. Mellins CA, Nestadt D, Bhana A, Petersen I, Abrams EJ, Alicea S, et al. Adapting evidence-based interventions to meet the needs of adolescents growing up with HIV in South Africa: the VUKA case Example. Glob Soc Welf. 2014;1(3):97–110.

    PubMed  PubMed Central  Article  Google Scholar 

  48. Bhana A, Mellins CA, Petersen I, Alicea S, Myeza N, Holst H, et al. The VUKA family program: piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa. AIDS Care. 2014;26(1):1–11.

    PubMed  Article  Google Scholar 

  49. McKernan McKay M, Alicea S, Elwyn L, McClain ZR, Parker G, Small LA, et al. The development and implementation of theory-driven programs capable of addressing poverty-impacted children’s health, mental health, and prevention needs: CHAMP and CHAMP+, evidence-informed, family-based interventions to address HIV risk and care. J Clin Child Adolesc Psychol. 2014;43(3):428–41.

    PubMed  Article  Google Scholar 

  50. Petersen I, Mason A, Bhana A, Bell CC, McKay M. Mediating social representations using a cartoon narrative in the context of HIV/AIDS: the AmaQhawe Family Project in South Africa. J Health Psychol. 2006;11(2):197–208.

    PubMed  Article  Google Scholar 

  51. Pardo G, Saisaengjan C, Gopalan P, Ananworanich J, Lakhonpon S, Nestadt DF, et al. Cultural adaptation of an evidence-informed psychosocial intervention to address the needs of PHIV+ youth in Thailand. Glob Soc Welf. 2017;4(4):209–18.

    PubMed  PubMed Central  Article  Google Scholar 

  52. Nestadt DF, Saisaengjan C, McKay MM, Bunupuradah T, Pardo G, Lakhonpon S, et al. CHAMP+ Thailand: pilot randomized control trial of a family-based psychosocial intervention for perinatally HIV-infected early adolescents. AIDS Patient Care STDS. 2019;33(5):227–36.

    PubMed  PubMed Central  Article  Google Scholar 

  53. Brandt R. The mental health of people living with HIV/AIDS in Africa: a systematic review. Afr J AIDS Res. 2009;8(2):123–33.

    PubMed  Article  Google Scholar 

  54. Pence BW, Mills JC, Bengtson AM, Gaynes BN, Breger TL, Cook RL, et al. Association of increased chronicity of depression With HIV appointment attendance, treatment failure, and mortality among HIV-infected adults in the United States. JAMA Psychiatry. 2018;75(4):379–85.

    PubMed  PubMed Central  Article  Google Scholar 

Download references

Acknowledgements

Suubi+Adherence study was funded by the Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD) (Grant #1R01HD074949–01, PI: Fred M. Ssewamala). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

Authors

Contributions

RB and WB conducted data analysis. MC, WB, and RB contributed to literature review. RB and WB drafted first draft of the manuscript. PN, and OSB contributions to revisions of the manuscript. CD, FN supervised study implementation in the field, CM and MMM are co-investigators on the study, and FMS, conceptualized, received funding for the study, and led and supervised all aspects of study implementation. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to William Byansi.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare that are relevant to the content of this article.

Ethical Approval and Informed Consent

Adolescents provided voluntary written assent and caregivers provided consent for the adolescent to participate in the study. The recruitment and interaction with human subjects and their health information were completed according to protocols reviewed and approved by Columbia University (Protocol AAAK3852), the Makerere University School of Public Health (Protocol 210) and the Uganda National Council for Science and Technology (Protocol SS 2969) Ethics and Institutional Review Boards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

William Byansi and Rachel Brathwaite are Joint first authors

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Byansi, W., Brathwaite, R., Calvert, M. et al. Relationship Between Mental Health and HIV Transmission Knowledge and Prevention Attitudes Among Adolescents Living with HIV: Lessons from Suubi + Adherence Cluster Randomized Study in Southern Uganda. AIDS Behav 25, 3721–3733 (2021). https://doi.org/10.1007/s10461-021-03243-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03243-7

Keywords

  • Adolescent
  • HIV
  • Knowledge
  • Attitude
  • Mental health