Dear HIFA and HIFA-Zambia colleagues,
This paper finds that knowledge of HIV status, be it positive or negative, was significantly associated with a decrease in depressive symptoms among female sex workers in Uganda and Zambia.
Citation, abstract and a comment from me below.
J Acquir Immune Defic Syndr. 2020 Jan 1; 83(1): 37–46.
Knowledge of HIV Status Is Associated With a Decrease in the Severity of Depressive Symptoms Among Female Sex Workers in Uganda and Zambia
Katrina F. Ortblad et al.
Background: Knowledge of HIV-positive status may result in depressive symptoms, which may be a concern to scaling novel HIV testing interventions that move testing outside the health system and away from counselor support.
Setting: Uganda and Zambia.
Methods: We used longitudinal data from 2 female sex worker (FSW) cohorts in Uganda (n = 960) and Zambia (n = 965). Over 4 months, participants had ample opportunity to HIV testing using standard-of-care services or self-tests. At baseline and 4 months, we measured participants' perceived knowledge of HIV status, severity of depressive symptoms (continuous PHQ-9 scale, 0–27 points), and prevalence of likely depression (PHQ-9 scores ≥10). We estimated associations using individual fixed-effects estimation.
Results: Compared with unknown HIV status, knowledge of HIV-negative status was significantly associated with a decrease in depressive symptoms of 1.06 points in Uganda (95% CI −1.79 to −0.34) and 1.68 points in Zambia (95% CI −2.70 to −0.62). Knowledge of HIV-positive status was significantly associated with a decrease in depressive symptoms of 1.01 points in Uganda (95% CI −1.82 to −0.20) and 1.98 points in Zambia (95% CI −3.09 to −0.88). The prevalence of likely depression was not associated with knowledge of HIV status in Uganda but was associated with a 14.1% decrease with knowledge of HIV-negative status (95% CI −22.1% to −6.0%) and a 14.3% decrease with knowledge of HIV-positive status (95% CI −23.9% to −4.5%) in Zambia.
Conclusions: Knowledge of HIV status, be it positive or negative, was significantly associated with a decrease in depressive symptoms in 2 FSW populations. The expansion of HIV testing programs may have mental health benefits for FSWs.
COMMENT (NPW): This is a complex subject and it is not clear whether knowledge is simply associated with decrease in depressive symptoms, as described in the abstract, or whether it causes such benefit (as suggested in the full text).
On the HIFA forum we have recently been discussing how knowledge of one's personal health data (such as access to one's own medical records) is an important determinant of the HIFA vision (a world where everyone has access to the information they need to protect their own health and the health of others). It would be interesting to know more about the benefits of knowledge of one's own personal data, including both mental and physical health aspects.
Best wishes, Neil
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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG firstname.lastname@example.org