Depression associated with HIV risk factors for young people in South Africa

Symptoms of depression are common among young people in South Africa and associated with relationship characteristics and behaviours that increase the risk of HIV infection, an international team of investigators report in the Journal of the International AIDS Society.

“Our findings show that depressive symptoms are associated with behaviours and relationship characteristics that put young South African women and men at risk of sexually transmitted HIV,” comment the researchers. They call for interventions to “prevent depression and associated risky sexual behaviour”.

South Africa has one of the worst HIV epidemics in the world and prevention efforts have had only limited success.

Prevention research has largely ignored the importance of psychological factors in HIV risk behaviours. This is despite the fact that depression and other forms of psychological distress are known to be widespread in low- to middle-income countries such as South Africa.

Researchers from the Stepping Stones Study therefore designed a study to see if there was a relationship between depressive symptoms and HIV risk factors.

Their study population included 1002 females and 976 males, all of who were aged between 15 and 26.

Demographic information was gathered, and the participants completed questionnaires to see if they had depressive symptoms and if they were at risk of acquiring HIV sexually. The questionnaires were completed on entry to the study and again after 12 months.

At baseline, 21% of females and 14% of males reported symptoms of depression.

For women, depression at baseline was associated with experiencing violence from an intimate partner (adjusted odds ratio [AOR] = 2.56; 95% CI, 1.89 to 3.46), and having a partner who was at least three years older (AOR = 1.37; 95% CI, 1.03 to 1.83).

One year later, symptoms of depression were associated with transactional sex (AOR = 2.06; 95% CI, 1.37 to 4.92) and intimate partner violence (AOR = 1.67; 95% CI, 1.18 to 2.36) in the past 12 months.

“It is known that, for women, being in an abusive relationship causes depression, and our prospective findings show that a depressive state predicted vulnerability to abuse,” comment the researchers. They add, “addressing intimate partner violence is important as it has been shown to increase risky sexual behaviours and risk of HIV infections.”

At baseline, the young men with symptoms of depression were more likely to report transactional sex (AOR = 1.48; 95% CI, 1.01to 2.17), being the perpetrator of violence on an intimate partner (AOR = 1.50; 95% CI, 0.98 to 2.28), having raped a stranger or acquaintance ( AOR = 1.81; 95% CI, 1.14 to 2.87), and not using condoms (AOR = 0.50; 95% CI, 0.32 to 0.78).

At the follow-up assessment, depressive symptoms were associated with a failure to use condoms with the most recent sex partner (AOR = 0.60; 95% CI, 0.40 to 0.89).

These findings lead the investigators to believe that depressive symptoms are associated with an increased HIV risk. They comment, “while baseline associations can be bidirectional…the associations found in the prospective analysis confirm that depressive mood predicted sexual risk 12 months later.”

Mental health is neglected in South Africa. However, the investigators believe that investment in services that address psychological need “could have an enormous impact on public health and specifically on the HIV epidemic.”