Depression symptoms and HIV risk among hospital outpatients in rural Uganda

Background: HIV prevalence in Uganda is 6.5% and depression is common among HIV positive individuals. One explanation is that depression is a manifestation of learning one's HIV status. Alternatively, it is unknown if depression is associated with risk for HIV infection and risk behavior among those unaware of their HIV status.

Methods: 82 female and 78 male outpatients who received provider-initiated HIV-testing at a rural hospital in Uganda completed an interview assessing sexual risk behavior, prior HIV-testing, perceived likelihood of testing HIV-positive, and depression symptoms using the Hopkins Symptom Checklist-15.

Results: 13.1% had scores above the common cutoff value of 1.85 on the HSCL, indicating significant distress. Higher depression scores were associated with reporting more unprotected sex ×2 8.33, p< .01. Participants were more likely to think they would test HIV positive if they had higher depression symptom scores ×2 14.79, p< .001 and were also more likely to test HIV positive ×2 4.53, p< .05. No gender differences were observed.

Conclusion: Depression was common in this population of Ugandans unaware of their HIV status and was associated with sexual risk taking and risk for HIV infection. In light of these results, the high prevalence of depression observed among HIV positive individuals in Uganda may reflect prior undiagnosed depression which may be a risk factor for acquiring HIV through increased risk behavior. Diagnosis and treatment of depression is needed and may help reduce risk for HIV.