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. 2024 Jul 1;2(1):39.
doi: 10.1186/s44263-024-00072-3.

Stigma and discrimination faced by adolescents living with HIV and experiencing depression in Malawi

Maria Faidas  1 , Melissa A Stockton  2 , Steven M Mphonda  3 , Griffin Sansbury  4 , Haley Hedrick  5 , Jackson Devadas  6 , Twambilile Phanga  3 , Laura Ruegsegger  6 , Jack Kramer  3 , Hillary Mortensen  6 , Kazione Kulisewa  7 , Brian W Pence  6 , Nivedita L Bhushan  8 , Bradley N Gaynes  6
Affiliations

Stigma and discrimination faced by adolescents living with HIV and experiencing depression in Malawi

Maria Faidas et al. BMC Glob Public Health. .

Abstract

Background: In Malawi, approximately 25% of adolescents living with HIV (ALWH) also suffer from depression. Not only is HIV stigma a major contributor to depression but it also adversely impacts HIV care engagement. ALWH can experience HIV stigma as stereotyping, social exclusion, low social support, and abuse, and these experiences are associated with poor mental health. Despite recognition of the deleterious effects of HIV stigma, we have limited knowledge of how stigma is experienced by ALWH with comorbid depression. Guided by the Health Stigma and Discrimination Framework, we describe stigma faced by ALWH and comorbid depression in Malawi and its implications for future interventions.

Methods: As part of a larger formative study to adapt a mental health counseling intervention, we conducted in-depth interviews, social support mapping sessions, and focus-group discussions with 25 ALWH, 4 caregivers of ALWH, 3 HIV providers, and 5 participants and 5 staff of a prior mental health counseling intervention. After analyzing the stigma codes, we used the Health Stigma and Discrimination Framework to organize the data into four key domains: drivers, manifestations, outcomes, and health and social impacts.

Results: Major drivers of HIV stigma included fear of HIV transmission, negative effects of antiretroviral therapy (ART), association with death, inaccurate knowledge, and negative attitudes towards ALWH. The most common manifestations of HIV stigma were gossip, insults and mocking, and physical and social distancing. Decreased ART adherence and missed HIV appointments were commonly cited outcomes of HIV stigma. Broader health impacts of HIV stigma were notable for mental health comorbidities including depression, anxiety, substance use, and suicidality. Identified resilience strategies included support for HIV care engagement and psychosocial support from family and friends.

Conclusions: This study systematically describes the stigmatization process faced by ALWH and experiencing depressive symptoms in Malawi. Notably, HIV stigma continues to disrupt HIV care and detrimentally impacts mental health during adolescent development. Further studies focused specifically on stigma are needed to better characterize this process and identify additional resilience factors. Investment in stigma-reduction interventions for ALWH is needed to avert poor mental health and HIV outcomes.

Keywords: Adolescents; Depression; Discrimination; HIV; Malawi; Stigma.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Institutional Review Boards of the University of North Carolina at Chapel Hill (IRB no. 22-0462) and the Malawi National Health Sciences Research Committee (IRB no. 22201) approved this study. All participants aged 18 and above provided written informed consent. All participants aged 13–17 provided written assent with guardian written consent. In accordance with NHSRC ethical standards, emancipated minors below age 18, who were legally married or university students, did not require guardian consent. Before study enrollment, research staff engaged participants in a consent comprehension activity, which asks a series of questions to ensure participant understanding of the study. All participants (and guardian if present) received travel reimbursement equivalent to US $10. This study conformed to the principles outlined in the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Health Stigma and Discrimination Framework, adapted for ALWH and comorbid depression in Malawi
See this image and copyright information in PMC

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