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Abstract
Background: Nigeria has the second highest number of people living with HIV with a national prevalence of 3.2% among young people aged 15 to 24 years. In Young People Living with HIV (YPLHIV), depression is the most prevalent mental health condition which adversely impacts disease progression if left untreated. Studies suggest that rates of depression and other psychosocial factors in young people vary by gender. There is a gap in evidence concerning the interplay of gender on both the prevalence of depression and associated psychosocial factors among YPLHIV in Nigeria. The aim of this study is to explore the gender similarities and differences in the prevalence and correlates of depression among YLHIV in Nigeria.
Method: The study utilised data collected as part of the baseline assessment of the pilot study of the Intensive Collaboration Approach to Roll back the Epidemic in Nigerian Adolescents (iCARE)- Treatment study in Nigeria. This was a randomized stepped wedge trail of combination intervention of peer navigation and text message reminder delivered to youth over a period of 48 weeks to promote viral suppression in six treatment sites in Nigeria. Patients aged 15-24years who were on antiretroviral therapy for at least 3 months were recruited from the clinics and received the intervention for a period of 1 year between 2019-2020. The analysis included a sample of 541 youths (aged 15 – 24 years) that was retrieved from the data. The outcome variable (Depression) was assessed using the Patient Health Questionnaire Version 9 (PHQ-9). The exploratory variables included HIV Status Disclosure, diagnosis of AIDS, Lifetime Substance Use, Social Support, HIV-Related Stigma, Medication Adherence Barriers, Medication Self-Efficacy, and Outcome Expectancy. Multivariate logistic regression was employed to identify predictors of depression in both the male and female gender. Level of significance was set at 0.05.
Result: The mean age of the participants was age 18.47 ± 2.43 years and 54% were females. The prevalence of depression 29.2%. While 20.5% had mild depression, 6.3% had moderate depression, 1.3% had moderately severe depression, and 1.1% had severe depression. The prevalence of depression in females was higher (33.6%) than in males (24.1%), (X2=5.82 p= 0.02). For males, the predictors found to be independently associated with depression included facing barriers to adherence (aOR = 1.145, p = 0.010), and experience of HIV related stigma (aOR = 2.225, p =0.012). In comparison for females, the predictors independently associated with depression were disclosing HIV status (aOR = 3.143, p < 0.001) and facing adherence barriers (aOR = 1.139, p = 0.004) whereas older age (20–24) was protective (aOR = 0.484, p = 0.025).
Conclusion: The prevalence of depression among YPLHIV is high with 3 out of 10 young people having depressive symptoms. Females are more affected than males. For the young females having disclosed HIV status and facing adherence barriers were predictors of depression while for the males’ facing barriers to adherence and experience of HIV related stigma were predictors of depression. These findings highlight the necessity for focused mental health interventions aimed at reducing adherence barriers and the effects of stigma, as well as interventions to manage the impact of disclosure for young living with HIV in Nigeria.
Key words: Depression, Gender differences, Young people living with HIV
