Mental Health and Suicidal Ideation Among Prisoners Living with HIV in Namibia

Background and Purpose: Sub-Saharan Africa remains the most affected region of the world, within sub-Saharan Africa, Namibia is one of the most deeply impacted countries where, as of 2020 approximately 12% of adults were living with HIV (UNAIDS, 2022). In addition to being the leading cause of death in Namibia (U.S. Department of State, 2020), among the general population HIV/AIDS is also associated with a myriad of issues including depression ( Kalomo et al., 2020), suicidality (Ashaba et al., 2018), anxiety (Besthorn et al., 2018), and posttraumatic stress disorder ([PTSD]; Woollett et al., 2017).

Incarceration is also widely accepted as being a human rights issue, partly due to health inequities faced by incarcerated individuals (Mhlanga-Gunda et al., 2020). Getaneh et al. (2019) found the prevalence of depression among incarcerated adults with HIV in Ethiopia was nearly 67%. Moreover, in Lesotho, Mahlomaholo et al. (2021) found the prevalence of depression and suicidality to be 53% and 8.2%, respectively. These authors found that females were more likely to report depressive symptoms, and HIV-related stigma was indirectly associated with suicidality, through higher levels of depression.

Method: This study utilized a purposive sampling method and a cross-sectional method to survey 154 adult prisoners with HIV in Namibia. To measure suicidal ideation, one question was used: “Have you ever thought of committing suicide?” If participants answered “yes”, it coded as 1; “no” was coded as 0. To assess symptoms of PTSD, PTSD (PSS-SR) Foa, Cashman, Jaycox, & Perry, 1997) was utilized. Cronbach’s alpha of the scale was .92. The Patient Health Questionnaire (PHQ-9; Kroenke, Spitzer, & Williams, 2001) was used to measure depressive symptoms. Cronbach’s alpha of the scale was .85. In addition, five socio-demographic variables were used as control variables.

Results: The age of 154 participants ranged from 21 to 84 years, with a mean age of 39.45 years. There were about 94.1% males and over 58% were single. Over 17% of participants were did not receive an education. Over 95% of participants were on antiretroviral treatment and 81.5% have disclosed their HIV status to other. A logistic multivariate regression method revealed that a higher level of PTSD was significantly associated with a higher level of suicidal ideation (B = 0.21, SE = 0.10, p ≤ .05). A higher level of depressive symptoms was significantly related to a higher level of suicidal ideation (B = 0.55, SE = 0.20, p ≤ .01). Lastly, this study found that unmarried prisoners were more likely to have suicidal ideation than prisoners with other marital status (B = 3.98, SE = 1.98, p ≤ .05). Female prisoners were less likely to have suicidal ideation than male prisoners (B = -5.28, SE = 2.21, p ≤ .05).

Conclusion and Implications: These findings call for culturally appropriate interventions to support this population in improving mental health and are especially important given that social workers in Namibia are increasingly being called to work with individuals living with HIV.