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.
Uganda and Zambia.
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.
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.
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 firstname.lastname@example.org; +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.