Community beliefs, HIV stigma, and depression among adolescents living with HIV in rural Uganda
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Date
2019Author
Ashaba, Scholastic
Cooper-Vince, Christine E
Vořechovská, Dagmar
Rukundo, Godfrey Zari
Maling, Samuel
Akena, Dickens
Tsai, Alexander C
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The availability of and increased access to antiretroviral therapy (ART) has significantly reduced the morbidity and
mortality associated with HIV. As a result, perinatally infected youth are increasingly able to reach adolescence.
There is limited information about the psychosocial challenges facing adolescents living with HIV (ALWH) in rural
settings of sub-Saharan Africa. We sought to understand psychosocial challenges facing ALWH in rural Uganda
and their effects on mental health and HIV treatment outcomes. We conducted 5 focus group discussions and
40 one-on-one in-depth interviews in Mbarara, Uganda with adolescents (aged 13–17 years) and adult women
caregivers. All interviews were audio-recorded, transcribed directly into English, and coded using thematic
analysis to identify themes related to psychosocial adversities and mental health. Adversities faced by adolescents
included negative community perceptions (perceived aggression, presumed early mortality), HIV stigma (enacted
and internalized), vulnerability factors (loss of parents, poverty), and health challenges (depression, ART
non-adherence). In the conceptual model that emerged from the findings, negative community perceptions (about
perceived aggression or presumed early mortality) predisposed ALWH to experience enactments and internalization
of stigma that led to depression and ART non-adherence. The data also identified several protective factors,
including counselling, family and religious support, and timely serostatus disclosure. Interventions to correct
community misperceptions about HIV can potentially reduce stigma and thereby improve physical and mental
health outcomes of ALWH.
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