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Knowledge of HIV status is associated with a decrease in the severity of depressive symptoms among female sex workers in Uganda and Zambia

Ortblad, Katrina F. ScD, MPH1; Musoke, Daniel Kibuuka MBChB2; Chanda, Michael M. MBChB3; Ngabirano, Thomson MBChB4; Velloza, Jennifer MPH1; Haberer, Jessica E. MD, MPH5; McConnell, Margaret PhD6; Oldenburg, Catherine E. ScD, MPH7,8,9; Bärnighausen, Till MD, ScD1,10,11

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 16, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002224
Original article: PDF Only

Background: Knowledge of HIV-positive status may result in depressive symptoms, which may be a concern to scaling novel HIV testing interventions that move testing outside the health system and away from counselor support.

Setting: Uganda and Zambia.

Methods: We used longitudinal data from two female sex worker (FSW) cohorts in Uganda (n=960) and Zambia (n=965). Over four-months participants had ample opportunity to HIV test using standard-of-care services or self-tests. At baseline and four months, we measured participants’ perceived knowledge of HIV status, severity of depressive symptoms (continuous PHQ-9 scale, 0-27 points), and prevalence of likely depression (PHQ-9 scores ≥10). We estimated associations using individual fixed effects estimation.

Results: Compared to unknown HIV status, knowledge of HIV-negative status was significantly associated with a decrease in depressive symptoms of 1.06 point in Uganda (95%CI -1.79, -0.34) and 1.68 points in Zambia (95%CI -2.70, -0.62). Knowledge of HIV-positive status was significantly associated with a decrease in depressive symptoms of 1.01 points in Uganda (95%CI -1.82, -0.20) and 1.98 points in Zambia (95%CI -3.09, -0.88). The prevalence of likely depression was not associated with knowledge of HIV status in Uganda, but was associated with a 14.1% decrease with knowledge of HIV-negative status (95%CI -22.1%, -6.0%) and 14.3% decrease with knowledge of HIV-positive status (95%CI -23.9%, -4.5%) in Zambia.

Conclusions: Knowledge of HIV status, be it positive or negative, was significantly associated with a decrease in depressive symptoms in two FSW populations. The expansion of HIV testing programs may have mental health benefits for FSWs.

1University of Washington, Department of Global Health, Seattle, USA

2International Research Consortium, Kampala, Uganda

3John Snow, Inc., Lusaka, Zambia

4Uganda Health Marketing Group, Kampala, Uganda

5Massachusetts General Hospital, Boston, USA

6Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, USA

7Francis I. Proctor Foundation, University of California San Francisco, San Francisco, USA

8Department of Ophthalmology, University of California, San Francisco, San Francisco, USA

9Department of Epidemiology & Biostatistics, University of California, San Francisco, USA

10Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa

11Heidelberg University, Heidelberg Institute of Public Health, Heidelberg, Germany

Contact details of the corresponding author: Katrina F. Ortblad, ScD, MPH International Clinical Research Center, University of Washington, Department of Global Health 908 Jefferson St, Seattle, WA 98104; +1-206-265-1856

Conflicts of interest: The authors declare no conflicts of interest.

Conferences: Ortblad K, Kibuuka Musoke D, Chanda M, Ngabirano T, Velloza J, McConnell M, Oldenburg C, Bärnighausen T. Knowledge of HIV status decreases depressive symptoms among female sex workers. Conference on Retroviruses and Opportunistic Infections 2019. Seattle, WA.

Sources of Support: International initiative for impact evaluation (3ie).

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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