Experiencing depression puts these adolescent girls at even higher risk of HIV infection, reveals analyses conducted by a consortium of researchers from the University of the Witwatersrand, South Africa, University of California, Berkeley, University of North Carolina, and the University of Oxford.
The findings, which appear online in the American Journal of Epidemiology, suggest that interventions targeted at improving mental health among adolescent girls may help stem the spread of HIV in South Africa and throughout the rest of sub-Saharan Africa.
It has been known for many years that people who have HIV are more likely to become depressed.
"We were able to show that, at least in this population, that depression leads to HIV. This could have important implications for where interventions might lie," said Jennifer Ahern, Professor of Epidemiology at UC Berkeley and senior author on the study.
As part of the study, the team looked at which aspects of adolescents' social lives and behaviours might explain the relationship between depression and HIV incidence. A number of factors appeared to be key in this pathway, particularly low levels of parental involvement and partner violence in response to condom negotiations.
The study drew on data collected from 2,533 females between the ages of 13 and 21 living in rural Mpumalanga Province, South Africa. Each adolescent was screened for symptoms of depression at the beginning of the study, and then tested for HIV annually for six years.
A little more than 18 percent of the adolescents had depression at the outset of the study — about twice the national average of South Africa. Of those with depression, nearly 11 percent went on to develop HIV, while only six and a half percent of those without depression eventually became infected.
A consortium led from the University of Oxford and the University of the Witwatersrand in South Africa is currently working to develop community-based interventions that can help identify and support girls who are experiencing depression.
There is increasing evidence that proven psychological treatments for depression, such as behavioural activation, can be delivered by lay counsellors and community healthcare workers, which provides a feasible way of delivering treatment for depression in the community. There is also the possibility of delivering these kinds of treatments using the internet or mobile phones, with the support of phone calls from peer mentors, and this is something we are working on.Professor Alan Stein, Department of Psychiatry, University of Oxford.
"Many low- and middle- income settings, including much of Africa, lack skilled mental health personnel. Interventions that can be delivered by non-specialist workers, lay health workers or community health workers, which are appropriate across different cultures should be vigorously pursued. This is what our work now focuses on," adds Kathleen Kahn, Professor and Senior Scientist at the Medical Research Council / Wits University Rural Public Health and Health Transitions Research Unit (Agincourt) at the School of Public Health, University of the Witwatersrand and co-author on the paper.
*One in four South African girls will be HIV positive.