Social support and self-esteem found to ‘mitigate’ against the psychological damage of violence
Study of young South Africans living with HIV finds a third have experienced violence and a similar proportion are depressed – but those with support and self-esteem are less likely to suffer
A study among young people living with HIV in rural South Africa suggests a third have experienced violence and a similar proportion are clinically depressed.
Although depression was higher among those who had experienced violence, participants with high levels of social support and self-esteem were less likely to be depressed whether they experienced violence or not.
Researchers surveyed around 330 young people (aged 12 to 24) living with HIV in the rural province of Mpumalanga. About half were orphans. Most were female (71%), single (81%) and attending school (53%). Among those out of school, most were unemployed (85%). Participants' median age was 21 and 70% were aged 18+.
Just under a third (28%) had experienced physical or sexual violence.
Clinical depression was significantly higher among participants who had experienced violence than those who had not, and most common among those who had experienced both physical and sexual violence.
But higher levels of self‐esteem or social support appeared to mitigate against this. Among individuals with low social support or low self-esteem, those who had experienced violence were more likely to have depression than those who had not experienced it. But among those with high levels of social support or self-esteem, there was no significant association between experiencing violence and having depression.
Around 18% of participants reported experiencing violence within the last 12 months. Among those who had experienced violence, 62% had experienced physical violence only, 23% had experienced both physical and sexual violence, and 15% experienced sexual violence only. Among those who had experienced physical violence, 66% experienced it from partners and 70% from family members. Among those who had experienced sexual violence, 31% had been forced to have sex by a partner, 11% by a family member, and 14% by someone else.
There was no significant difference between males and females in terms of experiencing violence. But those with a partner, low self‐esteem, only primary-level education or who were depressed were more likely to have experienced violence than others.
Just under a third of participants (27%) were clinically depressed with no significant difference between males and females. There was also no difference between males and females in terms of levels of self‐esteem, resilience or social support.
Despite researchers taking a varied recruitment approach, a number of eligible young people could not be located or refused to participate in the study, and these were likely to be vulnerable to violence and poor mental health. Pregnant women, who are also at heightened risk of violence, were also excluded. As a result, the findings may underestimate the levels of violence and depression among young people living with HIV in Mpumalanga.
The study provides further evidence of the unmet need for mental healthcare among young people living with HIV, particularly those who have experienced violence. In resource-limited settings, it is unlikely that comprehensive mental health services will be available anytime soon. But less expensive ways to improve self‐esteem and social support, for instance by using lay counsellors and peer support groups, should be considered.
Addressing depression could help young people living with HIV have a better quality of life, not only by relieving the direct effects of mental illness but by tackling damaging secondary impacts, such as the ability to start and stay on antiretroviral treatment.