The association between self-Esteem, stigma, and mental health among South African youth living with HIV: the need for integrated HIV care services

ABSTRACT

Treatment among pYLHIV focuses on their physical health. However, they also experience depression and anxiety, compounded by developmental challenges and the stress of managing a chronic illness. However, limited services are available to help pYLHIV manage the emotional stressors of living with a stigmatized condition. Data are from 37 caregiver-child dyads in the VUKA EKHAYA study, in Durban, South Africa. Outcomes were self-esteem and stigma. Predictors included symptoms of depression and anxiety, and HIV treatment and transmission knowledge. Outcomes and predictors were standardized (mean: 0, standard deviation: 1). Pearson correlation, bivariate and multivariate associations between predictors and outcomes were examined. Self-esteem was negatively correlated with symptoms of anxiety (r=-0.5675; p<0.001) and depression (r=-0.6836; p<0.001), suggesting higher self-concept was correlated with fewer symptoms. In multivariate analyses, increased depressive and anxiety symptoms were associated with lower self-esteem, B=0.68 and 0.57, respectively. Higher depressive and anxiety symptoms connected to more internalized stigma B=0.38 and 0.34, respectively. Conversely, HIV knowledge was not related to self-esteem or stigma. HIV treatment and transmission knowledge are not enough to reduce stigma and improve the self-esteem of pYLHIV. Integrated mental and physical health care is needed to help pYLHIV manage psychological stressors that can mitigate their emotional wellbeing.

KEYWORDS:

• Youth
• HIV
• mental health
• stigma
• South Africa
• Integrated Care

Acknowledgments

We would like to acknowledge Arvin Bhana and Sphindile Machanyangwa for their work on this study. We would also like to thank the VUKA Family Program (R01 HD074052; PI: McKay) and VUKA EKHAYA teams for their support and work on this study.

Author contributions

L.S. led the conceptualization of the manuscript, wrote the literature review and the discussion sections. A.K.H. helped to conceptualize the manuscript, completed the data analysis and methods section. T.M.P. assisted in conceptualizing the paper, edited, revised, and organized the manuscript. All authors have read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the International AIDS Society (IAS), Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) Grant Programme; [Eunice Kennedy Shriver National Institute of Child Health and Human Development] under Grant [R01 HD074052, P.I.: McKay].