Violence, HIV and mental health: opportunities for improved health in adolescents

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1 Violence, HIV and mental health: opportunities for improved health in adolescents SVRI, Brazil September 2017 Nataly Woollett, Lucie Cluver, Heena Brahmbhatt

2 Introduction Violence and HIV are intersecting epidemics in South Africa, especially amongst adolescents Mental health is a key health condition at the nexus of both violence and HIV/AIDS Adolescence key developmental phase for prevention and intervention ability to change, period of experimentation with alternative ways of being/alter trajectories While there is growing evidence of the impact of these conditions on youth in general, little is known about how HIV positive youth experience violence, the state of their mental health, and how this contributes to the burden of disease in South Africa.

3 Adolescent HIV is global Estimated number of adolescents (10 19 years) living with HIV, 2013 Note: The boundaries and the names shown and the designations used on these maps do not imply official endorsement or acceptance by the United Nations. Source: UNAIDS, HIV and AIDS unpublished estimates, July 2014

4 Why Adolescents? #2 2.1m 64% 1.2b HIV is now #2 largest contributor to adolescent (aged years) mortality globally, and the #1 in Africa. 2.1 million adolescents were living with HIV in 2013 more than 80% of whom live in sub- Saharan Africa, and many of whom still do not know their status. About two-thirds of the 250,000 new infections among year olds were among adolescent girls in At 1.2 billion, this is the largest generation of adolescents in history.

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6 Every week, over 7000 young women become newly infected with HIV

7 Data source: WHO Inspire 2016

8 Methods 343 HIV positive adolescents between the ages of 13-19yrs were interviewed from 5 health facilities in Johannesburg using questionnaires administered on tablet computers. All were accessing treatment for HIV and were retained in care for many years. Scales used to assess mental health depression (Children s Depression Inventory), anxiety (Children s Manifest Anxiety Scale), PTSD (Child PTSD Checklist), suicidality (MINI International Psychiatric Interview ) Data was analyzed using Statistica (v13) and descriptive analyses run on all variables.

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11 Significant variables in relation to Depression, Anxiety, and PTSD

12 Relative risk of being symptomatic

13 Conclusions There are strong relationships between HIV, mental health and violence exposure in perinatally infected HIV positive adolescents Violence was experienced at home (78%), in the community (49%), and at school (70%). Violence amongst peers was significantly related to poor outcomes Not feeling safe in different environments also plays a role in mental health Suicidality was high in this population and rarely screened for Females were at a higher risk for poorer mental health outcomes Lack of feeling in control of their future or not having a dream for their future was linked to more negative mental health outcomes

14 Conclusions Youth are frequently referred to as hard to reach in terms of prevention and intervention, yet this captive audience s mental health and violence exposure was largely untreated and unrecognized. Considering that patients are more likely to seek healthcare for HIV than for mental health or violence, providers of HIV care could be the optimal entry point for identifying adolescent patients with other significant comorbidities.

15 Conclusions Improving skills in managing mental health and violence in HIV positive adolescent patients will lead to better health consequences for them. It will provide opportunity to healthcare providers who are obligated to safeguard minors in the care and may halt the magnitude of the burden of disease likely to be experienced in adulthood. This focus might ultimately help health systems deal with complex cases that rarely achieve positive health outcomes.

16 By 2050, Sub-Saharan Africa is projected to have more adolescents than any other region Population of adolescents years old in millions, by region,

17 Prevalence of perinatally HIVinfected adolescents

18 Acknowledgements All adolescents who volunteered to undertake this research Provincial and District Departments of Health for granting access to facilities Research counsellors who conducted interviews