Depression and HIV in Botswana: A Population-Based Study on Gender-Specific Socioeconomic and Behavioral Correlates

Instituto de Pesquisa Clinica Evandro Chagas, FIOCRUZ, Brazil
PLoS ONE (Impact Factor: 3.23). 12/2010; 5(12):e14252. DOI: 10.1371/journal.pone.0014252
Source: PubMed


Depression is a leading contributor to the burden of disease worldwide, a critical barrier to HIV prevention and a common serious HIV co-morbidity. However, depression screening and treatment are limited in sub-Saharan Africa, and there are few population-level studies examining the prevalence and gender-specific factors associated with depression.
We conducted a cross-sectional population-based study of 18-49 year-old adults from five districts in Botswana with the highest prevalence of HIV-infection. We examined the prevalence of depressive symptoms, using a Hopkins Symptom Checklist for Depression (HSCL-D) score of ≥ 1.75 to define depression, and correlates of depression using multivariate logistic regression stratified by sex.
Of 1,268 participants surveyed, 25.3% of women and 31.4% of men had depression. Among women, lower education (adjusted odds ratio [AOR] 2.07, 95% confidence interval [1.30-3.32]), higher income (1.77 [1.09-2.86]), and lack of control in sexual decision-making (2.35 [1.46-3.81]) were positively associated with depression. Among men, being single (1.95 [1.02-3.74]), living in a rural area (1.63 [1.02-2.65]), having frequent visits to a health provider (3.29 [1.88-5.74]), anticipated HIV stigma (fearing discrimination if HIV status was revealed) (2.04 [1.27-3.29]), and intergenerational sex (2.28 [1.17-4.41]) were independently associated with depression.
Depression is highly prevalent in Botswana, and its correlates are gender-specific. Our findings suggest multiple targets for screening and prevention of depression and highlight the need to integrate mental health counseling and treatment into primary health care to decrease morbidity and improve HIV management efforts.

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    • "Similarly, experience of domestic violence and food insecurity seems to be associated with depression among the general population (Gupta et al. 2010a) as well as among people living with HIV/AIDS (Wong et al. 2008). Hazardous alcohol use is associated with physical and sexual violence (Koenig et al. 2004; D'Costa et al. 2007; Nayak et al. 2010). "
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    ABSTRACT: Objective To investigate associations between background characteristics (psychosocial adversity, risk behaviours/perception of risk and HIV-related knowledge, perceptions and beliefs) and psychological and cognitive morbidity among people coming for testing for HIV/AIDS in Goa, India.Methods Analysis of cross-sectional baseline data (plus HIV status) from a prospective cohort study. Participants were recruited at the time of coming for HIV testing.ResultsConsistent with associations found among general population samples, among our sample of 1934 participants, we found that indicators of psychosocial adversity were associated with CMD (Common Mental Disorder-major depression, generalised anxiety and panic disorder) among people coming for testing for HIV. Similarly, perpetration of intimate partner violence was associated with AUD (Alcohol Use Disorder). Two STI symptoms were associated with CMD, and sex with a non-primary partner was associated with AUD. Sub-optimal knowledge about HIV transmission and prevention were associated with low cognitive test scores. In contrast with other studies, we found no evidence of any association between stigma and CMD. There was no evidence of modification of associations by HIV status.Conclusions Among people coming for testing for HIV/AIDS in Goa, India, we found that CMD occurred in the context of social and economic stressors (violence, symptoms of STI, poor education and food insecurity) and AUD was associated with violence and risky sexual behaviour. Further research is necessary to understand the role of gender, stigma and social norms in determining the relationship between sexual and mental health. Understanding associations between these background characteristics and psychological morbidity may help inform the design of appropriate early interventions for depression among people newly diagnosed HIV/AIDS.This article is protected by copyright. All rights reserved.
    Tropical Medicine & International Health 11/2014; 20(3). DOI:10.1111/tmi.12435 · 2.33 Impact Factor
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    • "Continued UNAIDS General Survey and the Department of Health Services AIDS module Gupta et al. 2010 "
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    ABSTRACT: Background: In the era of enhanced access to ART, many people live longer lives but with episodes of disability re- sulting from HIV, HIV-related conditions, and/or as side-effects of ART. It is crucial to understand the extent of dis- ability among people living with HIV in high-prevalence settings to inform choices regarding care, policy and research. This article presents the results of the first scoping review to examine the extent, nature and range of disability among people living with HIV in HIV hyper-endemic countries. Methods: This scoping review used the World Health Orga- nization’s International Classification of Functioning, Disability and Health (ICF) to conceptualize “disability”. A sys- tematic search of electronic databases was conducted using specific keyword and subject heading combinations. Iden- tified publications were screened and reviewed according to inclusion/exclusion criteria. Data were systematically ex- tracted and reviewed for quality. Extracted data were reviewed for patterns related to methods or results. Results were aligned with the corresponding ICF code. Results: Forty-one articles were included, reporting data from 38 unique studies. Most (78%) of the studies were conducted in South Africa; five in Botswana, one in Zimbabwe and Lesotho, and none in Swaziland. Almost all studies recruited more females than males. All studies except two were in adults. The studies indicate that people living with HIV experience a variety of disabilities. Impairments in body structure/function comprise the majority of data, with particular focus on mental function. Data on activity limitations and participations restriction were limited, however were recorded it indicates severe impact on peoples life’s and possible adherence. Conclusions: We argue that the time has come to elevate the focus holistically on health and life-related consequences of living with HIV and to integrate disability into the discussions and approaches to HIV care.
    World Journal of AIDS 11/2013; 3(03). DOI:10.4236/wja.2013.33034
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    • "Although the estimated prevalence of depression, on the basis of reported symptoms, in our study was high, only a very small proportion of the study participants reported ever having been diagnosed with depression by a health worker and a few of those were on treatment. This is not surprising since depression screening in primary health care system in South Africa, as in many low and middle income countries (LMIC), is not routine, even among older people at high risk of depression (Luijendijk et al., 2008; Gupta et al., 2010). "
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    ABSTRACT: BACKGROUND: Little is known about depression in older people in sub-Saharan Africa, the associated impact of HIV, and the influence on health perceptions. OBJECTIVES: Examine the prevalence and correlates of depression; explore the relationship between depression and health perceptions in HIV-infected and -affected older people. METHODS: In 2010, 422 HIV-infected and -affected participants aged 50+ were recruited into a cross-sectional study. Nurse professionals interviewed participants and a diagnosis of depressive episode was derived from the Composite International Diagnostic Interview (Depression module) using the International Classification of Diseases diagnostic criteria and categorised as major (MDE) or brief (BDE). RESULTS: Overall, 42.4% (n=179) had a depressive episode (MDE: 22.7%, n=96; BDE: 19.7%, n=83). Prevalence of MDE was significantly higher in HIV-affected (30.1%, 95% CI 24.0-36.2%) than HIV-infected (14.8%, 95% CI 9.9-19.7%) participants; BDE was higher in HIV-infected (24.6%, 95% CI 18.7-30.6%) than in HIV-affected (15.1%, 95% CI 10.3-19.8%) participants. Being female (aOR 3.04, 95% CI 1.73-5.36), receiving a government grant (aOR 0.34, 95% CI 0.15-0.75), urban residency (aOR 1.86, 95% CI 1.16-2.96) and adult care-giving (aOR 2.37, 95% CI 1.37-4.12) were significantly associated with any depressive episode. Participants with a depressive episode were 2-3 times more likely to report poor health perceptions. LIMITATIONS: Study limitations include the cross-sectional design, limited sample size and possible selection biases. CONCLUSIONS: Prevalence of depressive episodes was high. Major depressive episodes were higher in HIV-affected than HIV-infected participants. Psycho-social support similar to that of HIV treatment programmes around HIV-affected older people may be useful in reducing their vulnerability to depression.
    Journal of Affective Disorders 05/2013; 151(1). DOI:10.1016/j.jad.2013.05.005 · 3.38 Impact Factor
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