Youth Living with HIV in Rural Namibia: Psychosocial Factors Affecting Self-Esteem

Background: Young people under 18 years of age living with HIV, one of the fastest growing populations of people living with HIV, is emerging as an increasingly important practice area in Sub-Saharan Africa. Youth living with HIV not only face medical and treatment challenges but are also confronted with a myriad of psychosocial challenges, such as parental illness and death, stigma, and mental health challenges, all which can have important implications for their well-being. Therefore, to enhance youth’s self-esteem, it is critical to understand the various psychosocial and contextual factors associated with self-esteem of youth living with HIV.

Methods: Data were collected using a cross-sectional design between April and November 2019.This study recruited 188 youth and young adults living with HIV from a healthcare center in Namibia. A structured survey questionnaire was created in English first and a bilingual researcher who speaks Silozi and English translated it into Silozi. The Case Adherence Index questionnaire (Mannheimer et al., 2006) was employed to measure participants’ HIV adherence (a=.63). The Major Depression subscale of Revised Child Anxiety and Depression Scale (Chorpita, Ebesutani & Spence, 2015) was used to measure depressive symptomology (a=.79). HIV/AIDS Transmission Literacy was measured by a set of questions that were developed to estimate the level of knowledge about HIV transmission. Disclosure of HIV status was measured as a binary variable. The Rosenberg Self-Esteem Scale (Rosenberg, 1965) was used to measure the level of self-esteem among participants. This study also used socio-demographic variables as control variables: age, gender, having caregivers as a primary caregiver, and food insecurity was measured as a binary variable.

Results: The average age in the samples is 16 years, ranging from 10 to 21. About 63% of the sample were comprised of females, 15% percent lived with their grandparents, 22% had not disclosed their status to anybody, and more than one-third experienced food insecurity. A hierarchical regression analysis revealed that a higher level of HIV/AIDS transmission literacy was significantly associated with a higher level of self-esteem among youth living with HIV (B = .348, p < .05). A higher level of HIV adherence to treatment medication was significantly related to a higher level of self-esteem (B = .261, p < .01). On the other hand, HIV status disclosure (B = -1.754, p < .05) had a negative effect on self-esteem in this sample. A higher level of depressive symptoms was significantly related to a lower level of self-esteem (B = -.277, p < .001). In addition, having grandparents as primary caregivers (B = 2.157, p < .05) can have a positive effect on self-esteem.

Conclusion & Implications: This study found that youth living with HIV who had higher levels of HIV/AIDS transmission literacy, greater adherence to HIV treatment, disclosed their HIV status to someone, and lower levels of depressive symptoms had higher self-esteem. These findings call for the development of more culturally appropriate, community-based youth-focused interventions that have potential to enhance self-esteem and better health outcomes for youth living with HIV in rural Namibia.