Abstract: HIV Shame and the Mental Health Functioning of Adolescents Living with HIV: Findings from a Pilot Study in Uganda (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)

Schedule:

Thursday, January 12, 2023

Valley of the Sun D, 2nd Level (Sheraton Phoenix Downtown)

* noted as presenting author

Proscovia Nabunya, MSW, PhD, Assistant Professor, Washington University in Saint Louis, St. Louis, MO

Flavia Namuwonge, MBA, Study Coordinator, International Center for Child Health and Development, Uganda

Ozge Sensoy Bahar, PhD, Research Assistant Professor, Washington University in Saint Louis, St. Louis, MO

Phionah Namatovu, MPH, Research Coordinator, International Center for Child Health and Development, Uganda

Vicent Ssentumbwe, BA,, Student, Washington University in St. Louis, St. Louis, MO

Herbert Migadde, Study Coordinator, International Center for Child Health and Development, Uganda

Edward Nsubuga, Study Coordinator, International Center for Child Health and Development, Uganda

Fred Ssewamala, PhD, William E. Gordon Distinguished Professor, Washington University in Saint Louis, St. Louis, MO

Background and Purpose: Shame, defined as a self-conscious emotion resulting from negative self-evaluation following a perceived deviation from a social or moral code, is a public health challenge. It has been documented as a barrier to combating the spread of HIV, as well as undermining HIV treatment outcomes. Shame negatively impacts the behavioral, physical, clinical and psychosocial outcomes of individuals. However, fewer studies have investigated shame among children and adolescents living with HIV in sub–Saharan Africa. Yet, compared to stigma, shame is considered a more proximal predictor of mental health difficulties. This study examined the relationship between HIV shame and the mental health of adolescents living with HIV in Uganda.

Methods: Cross sectional data from a two-year pilot study (2020-2022) for adolescents living with HIV were analyzed. A total of 89 child-caregiver dyads (N=178) were recruited into the study Adolescents were eligible to participate if they were: 1) living with HIV and aware of their status; 2) between 10-14 years; 3) enrolled on antiretroviral therapy in participating clinics; and 4) living within a family, including with extended family. Multivariate regression analyses were conducted to determine the relationship between shame, as measured by the Shame Questionnaire and adolescents’ mental health functioning, assessed using the Child Depression Inventory, Beck Hopelessness Scale, UCLA Loneliness Scale, Childhood Post-Traumatic Stress Reaction Index, and Tennessee Self-Concept Scale.

Results: The average age was 12.2 years, and 56% of participants were female. HIV-related shame was associated with high levels of depressive symptoms (b=0.63, 95% CI=0.41, 0.86, p<.001), hopelessness (b=0.35, 95% CI =0.12, 0.57, p=0.003), PTSD symptoms (b=3.10, 95% CI =1.63, 4.58, p<.001), loneliness (b=1.02, 95% CI=0.22, 1.82, p=0.013), and low levels of self-concept (b=-1.13, 95% CI = -1.93, -0.32, p =0.007). In addition, gender (being a female child) was associated with high levels of depressive symptoms (b=0.71, 95% CI = 0.37, 0.62, p=0.013), hopelessness (b= 1.90, 95% CI =0.57, 3.24, p=0.006), PTSD symptoms (b=10.50, 95% CI =1.81, 19.18, p=0.018), and low self-concept (b=-8.06, 95% CI =-12.82, -3.31, p=0.001).

Implication and Conclusion: Study findings contribute to the limited literature examining HIV-related shame and the mental health of young people living with HIV in SSA. Findings support the need for the development of strategies to help adolescents overcome the shame of living with HIV and mitigate the effects of shame on adolescents’ mental health and treatment outcomes.