Knowledge of HIV Status Is Associated With a Decrease in the Severity of Depressive Symptoms Among Female Sex Workers in Uganda and Zambia

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 83; no. 1; pp. 37 - 46
• Main Authors: Ortblad, Katrina F., Musoke, Daniel Kibuuka, Chanda, Michael M., Ngabirano, Thomson, Velloza, Jennifer, Haberer, Jessica E., McConnell, Margaret, Oldenburg, Catherine E., Bärnighausen, Till
• Format: Journal Article
• Language: English
• Published: United States JAIDS Journal of Acquired Immune Deficiency Syndromes 01-01-2020; Copyright Wolters Kluwer Health, Inc. All rights reserved; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; Depression - psychology; Female; HIV; HIV Infections - diagnosis; HIV Infections - psychology; Human immunodeficiency virus; Humans; Knowledge; Longitudinal Studies; Medical tests; Mental depression; Mental disorders; Mental health; Prevention Research; Randomized Controlled Trials as Topic; Self tests; Severity of Illness Index; Sex; Sex Work - psychology; Sexually transmitted diseases; STD; Uganda; Zambia; Uganda; Zambia
• ISSN: 1525-4135; 1944-7884
• DOI: 10.1097/QAI.0000000000002224

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 2 female sex worker (FSW) cohorts in Uganda (n = 960) and Zambia (n = 965). Over 4 months, participants had ample opportunity to HIV testing using standard-of-care services or self-tests. At baseline and 4 months, we measured participantsʼ 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 with unknown HIV status, knowledge of HIV-negative status was significantly associated with a decrease in depressive symptoms of 1.06 points in Uganda (95% CI −1.79 to −0.34) and 1.68 points in Zambia (95% CI −2.70 to −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 to −0.20) and 1.98 points in Zambia (95% CI −3.09 to −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% to −6.0%) and a 14.3% decrease with knowledge of HIV-positive status (95% CI −23.9% to −4.5%) in Zambia.
CONCLUSIONS:Knowledge of HIV status, be it positive or negative, was significantly associated with a decrease in depressive symptoms in 2 FSW populations. The expansion of HIV testing programs may have mental health benefits for FSWs.