Depression and hiv : exploring experience of women and health care providers in Ethiopia

Abstract

Mental disorders such as depression and anxiety are common comorbid with HIV. They are also more prevalent in WLHIV particularly in low-income countries, yet, it is vastly undetected and under-served. The purpose of this study is to explore the experience of depression among WLHIV and understand the HCP’s practice towards the management of depression in WLHIV.A sequential explanatory mixed-method design was used. In the quantitative part, a facility-based cross-sectional study was conducted. The study participants were identified using systematic random sampling method and HADS was used for anxiety and depression screening. The gathered data was analyzed using SPSS version 23. In the second phase of the study, a generic qualitative design was employed. An-in-depth interview was carried out among women who follow-up ART and HCPs in the selected health facilities. The transcript of the in-depth interview was analyzed with application of N-Vivo (version 11.0). A total of 357 women participated in the first phase of the study. The results revealed the prevalence of both depression and anxiety amidst HIV positive women were 32.5% and 28.9%, respectively. In the multivariate analysis, it was discovered that lack of formal education, being divorced, unemployed, and earning a monthly income less than 1400 ETB (37.5 USD) were significantly associated with depression and anxiety. Women with symptomatic HIV clinical stage III and IV, with CD4 cell count below 250, and with co-infections also suffered from depression and anxiety. In addition to this, PSS was negatively associated whereas stigma was positively associated with depression and anxiety. A total of twenty-one women and twelve HCPs completed in the second phase (qualitative part). Women mostly described experience of stressful life events, lower participation of social activities, poor community acceptance, negative self-perception, and hopelessness as their main experience of living with these comorbid illnesses. Considering the HCPs, majority of them described absence of screening practice, low professional ownership and readiness as the main gap on the introduction of depression care and management in the ART set-up. This finding has shown, in the course of the multifaceted nature of HIV and depression comorbidity, both women’s and HCP’s experience was dynamic in terms of the different psychosocial and clinical dimensions. In conclusion depression and anxiety was highly prevalent in WLHIV and circumstances like the psychosocial and clinical attributes, Perceived Social Support and stigma were associated with developing depression and anxiety. This study presents an insightful understanding of the social, psychological and clinical determinants from the women and the HCPs perspectives. Hence, future interventions should focus on the integration of mental health in HIV clinical set up. Keywords: Human Immuno-Deficiency Virus, depression, anxiety, comorbidity, Ethiopia.