Mental health and sexual risk behaviours in a South African township: A community-based cross-sectional study

Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
Public Health (Impact Factor: 1.43). 07/2006; 120(6):534-42. DOI: 10.1016/j.puhe.2006.01.009
Source: PubMed


Despite the high prevalence of both mental illness and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in developing countries, there are few data on the association between different forms of mental illness and sexual risk behaviours in resource-poor settings. The objective of this study was to examine the association between mental illness and HIV risk behaviours in a South African township.
A cross-sectional study was performed among 645 individuals living in households selected at random.
A self-administered translated questionnaire investigated sexual risk behaviours [including sexual partners, condom use, casual sexual contacts, and sex in exchange for money, drugs or a place to stay (transactional sex)], depression (measured using the Center for Epidemiological Studies Depression Scale), alcohol abuse (from the Alcohol Use Disorders Identification Test), and post-traumatic stress disorder (based on the Life Event Checklist).
Of the 645 individuals who completed the survey, 33% reported depression, 17% reported alcohol abuse, and 15% reported post-traumatic stress disorder. After adjusting for demographic characteristics, the presence of any of these three conditions was strongly associated with experiences of forced sex [adjusted odds ratio (AOR) 2.53; 95% confidence intervals (CI) 1.60-4.02], transactional sex (AOR 2.88; 95% CI 1.29-6.48) and increased condom use (AOR 2.07; 95% CI 1.32-3.25).
These findings emphasize the substantial burden of mental illness in this setting, and its association with forced and transactional sex. The temporal nature of these associations is not always clear from this cross-sectional study, and additional prospective research is required. Public health interventions are needed to address the dual burden of HIV/AIDS and mental illness in this and similar settings.

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    • "sive disorders . Approximately one fifth of the study participants screened positive for significant levels of de - pressive symptomatology . While the figure seems relatively high , a community - based study of a South Africa township estimated that one third ( 33% ) of its inhabitants reported significant levels of de - pressive symptomatology ( Smit et al . , 2006 ) . The use of screening tools based on self - report is a limitation of our study , possibly biasing the estimate . Notwithstanding these limitations , it is clear that spatial segregation and discriminatory policies under the apartheid regime contributed to both the creation and neglect of concentrated , disadvantaged neigh - borhoods"
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    ABSTRACT: The apartheid regime that governed South Africa from 1948-1994 established spatial segregation that is understood to have contributed to the magnitude of neighborhood social disorder in the postapartheid era. Although a number of neighborhood social disorder characteristics, such as perceived violence and crime in the community, are prominent issues in South Africa, the extent to which these perceived spatial attributes are linked to depression is unknown at the population level. Multilevel modeling of data from the second wave of the South African National Income Dynamics Study (SA-NIDS) was utilized to examine the relationship between depressive symptomatology and neighborhood social disorder as indicated by the perceived frequency of violent, criminal and illicit activities in the community. Depressive symptomatology was assessed using the 10-item version of the Center for Epidemiologic Studies Depression Scale. A cut-off score of 10 or higher was used to indicate the presence of significant depressive symptomatology. Results showed that perception of neighborhood social disorder was independently associated with significant levels of depressive symptomatology. Gender, race or ethnicity, perceived health status, and education were significant for individual-level covariates of depression. Community intervention strategies that reduce the risk of neighborhood disorganization and emphasize positive social norms in the neighborhood are warranted. Taking into account the residential deracialization of a country transitioning from apartheid to nonracial democracy, a longitudinal spatial study design assessing the dynamics between depression and the aforementioned perceptions of neighborhood attributes may also be warranted. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    American Journal of Orthopsychiatry 02/2015; 85(1):56-62. DOI:10.1037/ort0000049 · 1.36 Impact Factor
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    • "These findings are consistent with other reports that have linked sexual risk behaviors with mental health symptomatology and exposure to traumatic experiences.[4], [42], [43] While caution must be used in assigning causal interpretations to observational data, the contemporaneous changes in PTS symptoms and reported sexual risk during longitudinal follow-up support an effect of trauma-related mental health symptomatology on risk behaviors in this Tanzanian population of newly diagnosed and established HIV patients. "
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    ABSTRACT: The reduction of HIV transmission risk behaviors among those infected with HIV remains a major global health priority. Psychosocial characteristics have proven to be important correlates of sexual transmission risk behaviors in high-income countries, but little attention has focused on the influence of psychosocial and psychological factors on sexual transmission risk behaviors in African cohorts. The CHAT Study enrolled a representative sample of 499 HIV-infected patients in established HIV care and 267 newly diagnosed HIV-infected individuals from the Kilimanjaro Region of Tanzania. Participants completed in-person interviews every 6 months for 3 years. Using logistic random effects models to account for repeated observations, we assessed sociodemographic, physical health, and psychosocial predictors of self-reported unprotected sexual intercourse. Among established patients, the proportion reporting any recent unprotected sex was stable, ranging between 6-13% over 3 years. Among newly diagnosed patients, the proportion reporting any unprotected sex dropped from 43% at baseline to 11-21% at 6-36 months. In multivariable models, higher odds of reported unprotected sex was associated with female gender, younger age, being married, better physical health, and greater post-traumatic stress symptoms. In addition, within-individual changes in post-traumatic stress over time coincided with increases in unprotected sex. Changes in post-traumatic stress symptomatology were associated with changes in sexual transmission risk behaviors in this sample of HIV-infected adults in Tanzania, suggesting the importance of investing in appropriate mental health screening and intervention services for HIV-infected patients, both to improve mental health and to support secondary prevention efforts.
    PLoS ONE 12/2013; 8(12):e82974. DOI:10.1371/journal.pone.0082974 · 3.23 Impact Factor
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    • "Drug use emerged as associated with depressive symptoms for women and alcohol misuse for men. The link between depressive symptoms, smoking and alcohol abuse has been reported in other South African samples (Amoateng, Barber and Erickson 2006; Fernander et al. 2006; Smit et al. 2006). Black African adolescents from lower socio-economic status families in traditional communities, such as the Eastern Cape, are less likely to engage in substance use, however, substances may be used excessively by youths with depressive symptoms as a coping mechanism in the face of family-level stress (Amoateng et al. 2006; Reddy et al. 2010). "
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    ABSTRACT: There is little research on prevalence of depressive symptoms and associated factors among youth in sub-Saharan Africa. This paper explores factors associated with depressive symptomatology in South Africa. A cross-sectional analysis of interviews with 1 415 women and 1 368 men aged 15-26 was undertaken. The Centre for Epidemiological Studies on Depression Scale (CESD Scale) was used to establish depressive symptomatology. The prevalence of depressive symptoms was 20.5% in women and 13.5% in men. For women, depressive symptoms were associated with increased childhood adversity (aOR 1.34 95% CI 1.116, 1.55); drug use (aOR 1.98 CI 1.17, 3.35); experience of intimate partner violence (aOR 2.21 CI 1.16, 3.00); sexual violence before the age of 18 years (aOR 1.45 CI 1.02, 2.02) and lower perceptions of community cohesion (aOR 1.23 CI 1.07, 1.40). For men, depressive symptoms were associated with a mother's death (aOR 2.24 CI 1.25, 4.00); childhood adversity (aOR 1.61 CI 1.38, 1.88); alcohol abuse (aOR 1.63 CI 1.13, 2.35), sexual coercion by a woman (aOR 2.36 CI 1.47, 3.80) and relationship conflict (aOR 1.07 CI 1.01, 1.12). Depressive symptoms were more highly prevalent in women than in men. Depressed mood was associated with childhood adversity, sexual violence and substance misuse in both women and men. This study further suggests gender differences in that for women, depressive symptoms were associated with intimate partner violence and lower perceptions of community cohesion, while for men the associations were with a mother's death and relationship conflict.
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