Adolescents living with HIV (ALHIV) are at heightened risk of experiencing mental health problems. However, research on the impact of mental health problems on ALHIV's everyday life is scanty. This article explores the effects of anxiety, depression and suicidal behaviour on the social functioning of ALHIV in a low-resource setting. The three mental health conditions were screened using the Patient Health Questionnaire modified for adolescents (PHQ-A) and Screen for Child Anxiety Related Disorder (SCARED), while social functioning was defined by normative role expectations of adolescents in the study setting. We conducted in-depth interviews with 31 ALHIV receiving care at two hospitals in Central Uganda. Data were analysed using thematic analysis techniques. We found that mental health problems impair the social functioning of ALHIV by obstructing them from realising normative expectations of adolescents within their socio-cultural milieu, including academic excellence, maintaining amicable relationships and good physical health. In a context of scarcity, impaired social functioning has grave implications for ALHIV's physical, psychological and social and economic wellbeing and concomitantly HIV treatment outcomes in the immediate and long term. Integration of mental health into HIV care is imperative, if the global goal to end AIDS is to be achieved.
Keywords: Uganda; adolescents living with HIV; anxiety; depression; mental health; social functioning; suicidal behaviour.
The effects of mental health problems on the daily lives and functioning of adolescents living with HIV in UgandaAdolescents living with HIV (ALHIV) have an elevated risk of suffering from mental health problems particularly depression, anxiety and suicidal behaviour (which includes suicidal ideation, suicide attempts and self-harm) compared to their negative peers. In spite of the high burden of mental health problems among ALHIV, there is little research on how they impact their daily life and functioning. This article examines the effects of depression, anxiety and suicidal behaviour on ALHIV’s ability to meet standards of behaviour, attitudes and roles and responsibilities expected of adolescents in their communities. Interviews were held with 31 ALHIV receiving HIV treatment at two health facilities in Uganda. We found that having suicidal behaviour and symptoms of depression and anxiety made it immensely difficult for ALHIV to live by expected standards for adolescents in their communities, including academic excellence, ability to initiate and maintain good relationships with others in their social network and looking physically healthy. In a low-resource setting, problems in conforming to expected social and behavioural standards increases ALHIV’s risk for social isolation, poverty and poor physical and mental health and consequently poor HIV treatment adherence in the present and future. High levels of adherence to HIV treatment are critical for ending the HIV/AIDS epidemic. Therefore, it is important that the mental health needs of ALHIV are urgently addressed by integrating mental health into child and adolescent HIV care, if real progress towards achieving the global goal to end HIV/AIDS by 2030 is to be realised.