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A Prospective Study of Depressive Symptoms, Condomless Sex, and HIV Viral Load in HIV-Positive Female Sex Workers in Kenya

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Abstract

The relationships between depressive symptoms, viral suppression, and condomless sex were examined in a prospective cohort study of 369 HIV-positive Kenyan female sex workers. Participants were screened for depressive symptoms at baseline and every six months until completion of the study (up to 66 months). HIV viral load (VL) was measured every six months and prostate specific antigen (PSA) testing in vaginal secretions was performed quarterly. Mild or greater depressive symptoms were found in 100 (27.1%) women and were associated with increased risk of detectable VL (aRR 1.41, 95%CI 0.97–2.07, p-value = 0.07), but were not associated with detectable PSA. The co-occurrence of PSA detection and detectable VL at the same visit suggests the potential for HIV transmission but was uncommon (2.4% of visits). The prevalence of depressive symptoms and the association with detectable VL suggests the need for screening and treatment of depression for comprehensive HIV care in this population.

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Acknowledgements

We thank all study participants for their involvement in this study and for our research, clinical, laboratory, outreach, and administrative staff for their support.

Funding

This research was supported by a Grant from the National Institute of Child Health and Human Development (R01 HD072617), and the Center for AIDS Research at the University of Washington (P30 AI27757). RSW was supported by a Grant from the National Institute for Child Health and Human Development (K24 088229).

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Authors and Affiliations

  1. Department of General Internal Medicine, University of California, San Francisco, 1001 Portrero Ave, Box 0862, San Francisco, CA, 94110, USA

    Molly A. Rosenthal

  2. Department of Medicine, University of Washington, Seattle, USA

    George Wanje, Juma Shafi, Linnet Masese, Danielle N. Poole & R. Scott Mcclelland

  3. Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya

    George Wanje, Walter Jaoko & R. Scott Mcclelland

  4. Department of Biostatistics, University of Washington, Seattle, USA

    Barbra A. Richardson

  5. Department of Global Health, University of Washington, Seattle, USA

    Barbra A. Richardson, Juma Shafi, Lei Wang & R. Scott Mcclelland

  6. Department of Psychology, University of Washington, Seattle, USA

    Jane Simoni

  7. Department of Epidemiology, University of Washington, Seattle, USA

    R. Scott Mcclelland

Authors
  1. Molly A. Rosenthal
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  2. George Wanje
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  3. Barbra A. Richardson
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  4. Juma Shafi
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  5. Lei Wang
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  8. Walter Jaoko
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  9. Jane Simoni
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  10. R. Scott Mcclelland
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Contributions

Study design (R. Scott McClelland, Barbra A. Richardson, Walter Jaoko), analysis of data (Lei Wang, Barbara A. Richardson), drafting of article (Molly A. Rosenthal, R. Scott McClelland), critical revision of article (all authors), and final approval of submitted version (all authors).

Corresponding author

Correspondence to Molly A. Rosenthal.

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Conflict of interest

RSM has received honorarium for consulting for Lupin Pharmaceuticals and research funding, paid to the University of Washington, from Hologic Corporation.

Ethical Approval

The ethics committees of Kenyatta National Hospital/University of Nairobi and the University of Washington approved this study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All participants provided written informed consent.

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Rosenthal, M.A., Wanje, G., Richardson, B.A. et al. A Prospective Study of Depressive Symptoms, Condomless Sex, and HIV Viral Load in HIV-Positive Female Sex Workers in Kenya. AIDS Behav 25, 3047–3056 (2021). https://doi.org/10.1007/s10461-021-03258-0

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