Social support and mental health among adults prior to HIV counseling and testing in Durban, South Africa

Abstract

Poor social support and mental health may be important modifiable risk factors for HIV acquisition, but they have not been evaluated prior to HIV testing in South Africa. We sought to describe self-perceived mental health and social support and to characterize their independent correlates among adults who presented for voluntary HIV testing in Durban. We conducted a large cross-sectional study of adults (≥18 years of age) who presented for HIV counseling and testing between August 2010 and January 2013 in Durban, South Africa. We enrolled adults presenting for HIV testing and used the Medical Outcomes Study’s Social Support Scale (0 [poor] to 100 [excellent]) and the Mental Health Inventory (MHI-3) to assess social support and mental health. We conducted independent univariate and multivariable linear regression models to determine the correlates of lower self-reported Social Support Index and lower self-reported MCH scores. Among 4874 adults surveyed prior to HIV testing, 1887 (39%) tested HIV-positive. HIV-infected participants reported less social support (mean score 66 ± 22) and worse mental health (mean score 66 ± 16), compared to HIV-negative participants (74 ± 21; 70 ± 18; p < 0.0001). In a multivariable analysis, significant correlates of less social support included presenting for HIV testing at an urban hospital, not having been tested previously, not working outside the home, and being HIV-infected. In a separate multivariable analysis, significant correlates of poor mental health were similar, but also included HIV testing at an urban hospital and being in an intimate relationship less than six months. In this study, HIV-infected adults reported poorer social support and worse mental health than HIV-negative individuals. These findings suggest that interventions to improve poor social support and mental health should be focused on adults who do not work outside the home and those with no previous HIV testing.

Keywords:

• HIV/AIDS
• social support
• mental health
• HIV testing
• South Africa

Acknowledgements

We would like to acknowledge the excellent work and valuable contributions of our research staff and nurses. We thank each of the clinical sites for sharing their enthusiasm and space, as well as the men and women who participated in this study.

Disclosure statement

We declare that we have no conflicts of interest.

Additional information

Funding

This research was supported by the Harvard Global Health Institute, the Fogarty International Clinical Research Scholars and Fellows Program at Vanderbilt University [grant number R24 TW007988]; the Program in AIDS Clinical Research Training [grant number T32 AI007433] (PKD); the National Institute of Mental Health [grant number R01 MH090326] (IVB), [grant number R01 MH073445] (RPW); the National Institute of Allergy and Infectious Disease [grant number R01 AI058736] (KAF); the Harvard University Center for AIDS Research [grant number P30 AI060354]; the National Institute of Arthritis and Musculoskeletal and Skin Diseases [grant number K24 AR057827] (EL); the National Center for Research Resources (the Harvard Catalyst) [grant number UL1 RR 025758].