Researchers warn that poor mental health may increase vulnerability to HIV

30 April 2021

South African study finds one in five young women have poor mental health as researchers urge HIV prevention programmes to provide mental health support.

Two adolescent female friends

Researchers are warning that high levels of mental health issues seen among adolescent girls and young women in KwaZulu-Natal, South Africa may be increasing their vulnerability to HIV.

In places with high HIV prevalence, adolescent girls and young women are particularly vulnerable to HIV due to a unique and complex set of factors linked to their age, sex and gender. But little research has been done to assess the role mental health may play in making young women vulnerable to HIV, and how HIV may impact young women’s mental health.

To examine this issue, researchers spent 12 months following 2,180 young women aged 13-22 in uMkhanyakude, KwaZulu-Natal, a mainly rural area where HIV prevalence and new infections are particularly high. All participants were enrolled in DREAMS, an HIV prevention programme that provides a variety of services and support to adolescent girls and young women.

They found one in five (22%) had a mental health issue, ranging from 10% of 13-year-olds to a third (33%) of 22-year-olds.

Around half had tested for HIV and knew their status, and 11% were living with HIV. Young women living with HIV were more likely to have a mental health issue than other participants, but this association reduced when other factors were taken into consideration.

One third of young women in the study had experienced gender-based violence, for example, and this was strongly associated with poor mental health. One third were food insecure, and this also increased the likelihood of poor mental health.

A link between pregnancy and having a mental health issue was also found, but this association reduced with age. In South Africa, most adolescent pregnancies are unplanned and often result in girls being socially excluded and getting little support from families and partners – all things that can cause mental health issues.

Regularly drinking alcohol, migration, and living in an urban area were also linked with poor mental health.

Young women with mental health issues were more likely than others to use multiple DREAMS services, suggesting DREAMS was successful in reaching vulnerable young women. In similar settings, the DREAMS model could be used to prevent, screen and treat mental health issues among young women.

The cross-sectional nature of this study means conclusions cannot be drawn on cause and effect. Much of the data was self-reported, meaning stigmatised conditions, such as mental health or gender-based violence, may have been underreported.

Despite these limitations, the results provide further evidence that many adolescent girls and young women at heightened risk of HIV would benefit from accessing age- and gender-appropriate mental health screening and services, such as group therapy and peer support. As mental health issues increase with age, early interventions could be particularly effective.

Protecting young women from gender-based violence, tackling food insecurity, offering mental health screening as part of young women’s antenatal care, and covering mental health topics in HIV prevention education would also be of use.

These efforts could not only improve mental health, but also stop so many adolescent girls and young women from contracting HIV.

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Written by Hester Phillips