Body mapping session.

<p>Body mapping session.</p

Understanding the experience and manifestation of depression in adolescents living with HIV in Harare, Zimbabwe

<div><p>Background</p><p>Studies have found that adolescents living with HIV are at risk of depression, which in turn affects adherence to medication. This study explored the experience and manifestation of depression in adolescents living with HIV in Zimbabwe in order to inform intervention development.</p><p>Methods</p><p>We conducted a body mapping exercise with 21 HIV positive 15–19 years olds who had been diagnosed with major depressive disorder. Participants created a painted map of their body to assist them in expressing their somatic and emotional experiences in qualitative interviews. The interviews were transcribed and thematically coded using NVivo 10.</p><p>Results</p><p>Participants attributed their experiences of depression to their relationships and interactions with significant people in their lives, primarily family members and peers. A sense of being different from others was common among participants, both due to their HIV status and the impact HIV has had on their life circumstances. Participants described a longing to be important or to matter to the people in their lives. A sense of isolation and rejection was common, as well as grief and loss, including ambiguous and anticipated loss. Participants’ idioms of distress included ‘thinking deeply’ (‘<i>kufungisisa</i>’), ‘pain’, darkness, ‘stress’ or a lack of hope and ambiguity for the future. Suicidal ideation was described, including slow suicide through poor adherence. Supportive factors were also relational, including the importance of supportive relatives and peers, clinic staff and psychosocial support programmes.</p><p>Conclusions</p><p>An understanding of HIV positive adolescents’ own narratives around depression can inform the development and integration of appropriate mental health interventions within HIV care and treatment programmes. Study findings suggest that family and peer-led interventions are potentially useful in the prevention and management of depression in adolescents living with HIV.</p></div

Proportion of participants reporting individual wealth indicators.

<p>Proportion of participants reporting individual wealth indicators.</p

Survival time to age at sexual debut by food sufficiency status.

<p>Survival time to age at sexual debut by food sufficiency status.</p

Risk factors for HIV infection excluding socio-economic position.

<p>¹ Adjusted for age and age of household head.</p><p>² Adjusted for age and age of household head and other variables higher in conceptual framework (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0115290#pone.0115290.g002" target="_blank">Fig. 2</a>) that remain associated (at p≤0.1) with HIV after adjustment.</p><p>^a Likelihood ratio p-value.</p><p>Risk factors for HIV infection excluding socio-economic position.</p

Socio-economic position as a risk factor for HIV infection among females by socio-economic domain.

<p>¹ Adjusted for age, age of household head, education, marital status & alcohol consumption.</p><p>² Adjusted for variables in model 3 & knowledge around pregnancy prevention, attitudes around sexual partners & condom self-efficacy.</p><p>³ Adjusted for variables in model 4 & age of sexual partners.</p><p>⁴ Adjusted for variables in model 5 & condom use at last sex & HSV-2 infection.</p><p>⁵ Food insufficiency—reported adult skipping meals and/or going day without food; going to bed hungry; <2 meals per day.</p><p>Socio-economic position as a risk factor for HIV infection among females by socio-economic domain.</p

Socio-economic position as a risk factor for reporting risky sexual behaviour by socio-economic domain.

<p>¹ ‘High risk’ behaviour defined as 2 or more risky behaviours: sexual debut ≤17yrs; ≥2 lifetime partners; any partner ≥6 years older; not using a condom at last sex.</p><p>² Adjusted for age, age of household head & orphanhood.</p><p>³ Adjusted for variables in model 1 & education, marital status & alcohol consumption.</p><p>⁴ Adjusted for variables in model 2, risk of depression & anxiety, suicide ideation, attitudes around sexual refusal and sexual partners and condom self-efficacy.</p><p>⁵ Food insufficiency—reported adult skipping meals and/or going day without food; going to bed hungry; <2 meals per day.</p><p>Socio-economic position as a risk factor for reporting risky sexual behaviour by socio-economic domain.</p

A conceptual framework for the association between domains of socio-economic position and HIV infection in young rural Zimbabwean women.

<p>A conceptual framework for the association between domains of socio-economic position and HIV infection in young rural Zimbabwean women.</p

Characteristics of female participants by socio-economic position (SEP) and SEP domain.

<p>¹ Wealthiest category (SEP1);</p><p>² Poorest category (SEP3);</p><p>³ P-value from Chi-square test, Mantel-Haenszel test-for-trend (<i>given in italics where chi-square p</i>≤0.05) or Cox proportional hazard depending on type of data;</p><p>⁴ Column percentages (%);</p><p>⁵ Reference category includes those who have never had sex.</p><p>Characteristics of female participants by socio-economic position (SEP) and SEP domain.</p

Sources of information about VMMC among males aged 15–49.

<p>Sources of information about VMMC among males aged 15–49.</p