Prevalence of depression and it’s association to internalized stigma and other psychosocial factors among women living with HIV in Tanzania

Abstract

Background: Globally in 2019 there was an estimate of 19.2 million women aged 15 and older living with HIV and the prevalence of depression among people living with HIV/AIDS was 31%. The prevalence of depression in South Wollo Ethiopia was high among women (21.07%) than men (18.3%) living with HIV. In a study done in the United States, women living with HIV had experienced more negative effects of HIV internalized stigma than men and increased levels of HIV-related stigma were associated with more severe depressive symptoms. Aim of the study: The aim of the study was to determine the prevalence of depression and its association to internalized stigma and other psychosocial factors among women living with HIV in Tanzania. Materials and methods: This was a healthy facility-based study that used a quantitative approach and a cross-sectional descriptive design. The study population was of women living with HIV aged 18 and above attending the selected HIV/AIDS care and treatment clinics in Dar-es-salaam and Tanga region in Tanzania. Non-proportionate stratified sampling and systematic sampling technique was used to select participants for data collection. A tablet device with instruments such as Internalized HIV stigma Scale, PHQ-9, Rosenberg Self-esteem scale, coping self-efficacy scale, and a tool for ART-adherence self-report for HIV care preloaded in Kiswahili and English were used. Data were analyzed using SPSS version 23.0 bivariate association was calculated using the Chi-square test to determine the presence of a significant association. All variables were then subjected for multiple logistic regression for identification of independent associated risk factors for depression. Odds ratio and 95% confidence interval were reported. A variable with a p-value of less than 0.05 was considered statistically significant. Results: A total of 210 women were studied the mean age of women was 31.55 years with a standard deviation of 12.32. Among 210 women who participated in this study 38.1% had depression, 90.5% had low self-esteem and 20% had poor ART-adherence, 51% had high internalized stigma and 51.9 % had low self-efficacy. In the bivariate analysis age, marital status, level of education, household income, self-esteem and coping self-efficacy had no significant association with depression. Internalized stigma and ART-adherence were significantly associated with depression in the bivariate analysis, 51.4% of the participants with high internalized stigma had depression compared to 24.3 % who had low internalized stigma and the difference in the proportion of participants were statistically significant (p= <0.001). Also 61.9% of participants who had poor ART-adherence had depression compared to 32.1% who had good ART-adherence and the difference in the proportion of participants were statistically significant (p=<0.001). In the Multivariate analysis internalized stigma was significantly associated with depression (AOR=2.56, CI =1.36-4.83; P=0.004) and ART-adherence was significantly associated with depression (AOR= 3.13, CI=1.43-6.83; P=0.004). Conclusion: The findings revealed that the prevalence of depression was 38.1%. Internalized stigma and ART-adherence were significantly associated with depression. It is recommended that screening for depression should be done at the CTC clinics and early interventions for internalized stigma and depression should be done at the CTC clinics.