Sexual Relationship Power and Depression among HIV-Infected Women in Rural Uganda
Open Access
- 26 December 2012
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 7 (12), e49821
- https://doi.org/10.1371/journal.pone.0049821
Abstract
Depression is associated with increased HIV transmission risk, increased morbidity, and higher risk of HIV-related death among HIV-infected women. Low sexual relationship power also contributes to HIV risk, but there is limited understanding of how it relates to mental health among HIV-infected women. Participants were 270 HIV-infected women from the Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of individuals initiating antiretroviral therapy (ART) in Mbarara, Uganda. Our primary predictor was baseline sexual relationship power as measured by the Sexual Relationship Power Scale (SRPS). The primary outcome was depression severity, measured with the Hopkins Symptom Checklist (HSCL), and a secondary outcome was a functional scale for mental health status (MHS). Adjusted models controlled for socio-demographic factors, CD4 count, alcohol and tobacco use, baseline WHO stage 4 disease, social support, and duration of ART. The mean HSCL score was 1.34 and 23.7% of participants had HSCL scores consistent with probable depression (HSCL>1.75). Compared to participants with low SRPS scores, individuals with both moderate (coefficient b = −0.21; 95%CI, −0.36 to −0.07) and high power (b = −0.21; 95%CI, −0.36 to −0.06) reported decreased depressive symptomology. High SRPS scores halved the likelihood of women meeting criteria for probable depression (adjusted odds ratio = 0.44; 95%CI, 0.20 to 0.93). In lagged models, low SRPS predicted subsequent depression severity, but depression did not predict subsequent changes in SPRS. Results were similar for MHS, with lagged models showing SRPS predicts subsequent mental health, but not visa versa. Both Decision-Making Dominance and Relationship Control subscales of SRPS were associated with depression symptom severity. HIV-infected women with high sexual relationship power had lower depression and higher mental health status than women with low power. Interventions to improve equity in decision-making and control within dyadic partnerships are critical to prevent HIV transmission and to optimize mental health of HIV-infected women.This publication has 85 references indexed in Scilit:
- Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural UgandaSocial Science & Medicine (1982), 2012
- Prevalence and correlates of HIV unsafe sex and STIs among women working in China's entertainment industryAIDS Care, 2011
- Synaptic potentiation onto habenula neurons in the learned helplessness model of depressionNature, 2011
- Gender Power Control, Sexual Experiences, Safer Sex Practices, and Potential HIV Risk Behaviors Among Young Asian-American WomenAIDS and Behavior, 2011
- A Marginal Structural Model to Estimate the Causal Effect of Antidepressant Medication Treatment on Viral Suppression Among Homeless and Marginally Housed Persons With HIVArchives of General Psychiatry, 2010
- Multilevel Social Influences on Female Condom Use and Adoption Among Women in the Urban United StatesAIDS Patient Care and STDs, 2010
- Poverty, life events and the risk for depression in UgandaSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2009
- HIV Infection, Stressful Life Events, and Intimate Relationship Power: The Moderating Role of Community Resources for Black South African WomenWomen & Health, 2009
- Remodeling of Hippocampal Spine Synapses in the Rat Learned Helplessness Model of DepressionBiological Psychiatry, 2009
- Alcohol Use, Depressive Symptoms and the Receipt of Antiretroviral Therapy in Southwest UgandaAIDS and Behavior, 2007