Prevalence and factors associated with psychological distress among pregnant and non-pregnant youth living with HIV in rural Uganda: A comparative study

Abstract

Youth living with HIV (YLHIV) are prone to psychological distress, which may have detrimental effects on health outcomes. Pregnant youth have poor access to HIV care increasing the risk of vertical transmission of HIV to their infants. Both HIV and pregnancy are independently associated with poor mental health among adolescents. The factors that predispose women to poor mental health may also increase their risk of contracting HIV. Despite their desire to have children YLHIV are at a high risk of psychological distress. However, factors associated with psychological distress among YLHIV in rural Uganda are not well explored. Therefore, the purpose of this study was to determine the prevalence of, and factors associated with psychological distress among pregnant and non-pregnant YLHIV in south western Uganda. We enrolled 224 YLHIV aged 15–24 years both pregnant and non-pregnant (ratio 1:1) between December 2018 and March 2019. We obtained information on psychological distress and factors hypothesized to affect mental health outcomes among people living with HIV including internalized HIV stigma, intimate partner violence, self-esteem and social support. Bivariate and multivariable logistic regression analysis were used to estimate factors independently associated with psychological distress. The prevalence of psychological distress was 48.2%% among pregnant YLHIV and 32.14% among non-pregnant YLHIV. Factors significantly associated with psychological distress among pregnant YLHIV were HIV stigma (AOR=4.61; 95% CI 1.63– 13.84; P=0.004), physical abuse (AOR=4.97; 95% CI 1.41–17.56; P= 0.013), and separation from partner (AOR =0.03; 95% CI 0.001–0.580; P=0.020); while among non-pregnant YLHIV factors associated with psychological distress included physical abuse (AOR=4.97; 95% CI 1.41–17.56; P=0.013), and lack of social support (AOR=6.22; 95% CI 1.20–32.20; P=0.029). Overall psychological distress was significantly higher among pregnant youth compared to the non-pregnant ones. Internalized HIV stigma was significantly associated with psychological distress among pregnant YLHIV compared to non-pregnant YLHIV while lack of social support was associated with psychological distress among the non-pregnant YLHIV compared to the pregnant ones. Psychosocial interventions aimed at reducing HIV stigma and improve social support should be incorporated within mainstream HIV care for YLHIV