Differential associations of violence and mental health outcomes by HIV status among adolescent girls and young women aged 15-24 years in 5 countries in Sub-Saharan Africa, 2018/2019.

Background: It is unclear if having both prior violence experiences and HIV interact on mental health (MH) among adolescent girls and young women (AGYW).

Methods: We used 2018/2019 Violence Against Children and Youth Survey data on 7,593 AGYW who ever had sex and had a known HIV status from five sub-Saharan African countries. We assessed the interactions between HIV status and violence-exposures- childhood physical violence (PV), childhood emotional violence, childhood sexual violence (SV), lifetime SV, lifetime PV/SV, and age at first SV experienced on four mental health outcomes, adjusting for the socio-demographic covariates. We applied the Benjamini-Hochberg procedure to address multiple comparisons and presented adjusted odds ratio (aOR) with 95% confidence intervals (CIs) stratified by HIV status.

Results: Of the total AGYW sample, 2.08% were HIV-positive, 37.06% had moderate psychological distress (PD), 10.03% had severe PD, 10.64% had substance misuse, and 13.53% had suicidality history. Two models had significant interactions between HIV and violence. The likelihood of severe PD among AGYW with childhood SV experiences was significantly higher if they were diagnosed with HIV (aOR: 83.89, 95% CI: 18.26-385.36) versus those without HIV diagnoses (aOR: 2.86, 95% CI: 1.91-4.29). Similarly, the aOR for the association of lifetime SV and severe PD was 12.95 times higher among AGYW with HIV (aOR: 31.85, 95% CI: 7.62-133.11) versus those without HIV (aOR: 2.46, 95% CI: 1.54-3.92).

Conclusion: Our results emphasize the need for trauma-informed HIV care with integrated violence and mental health services, particularly for AGYW who have HIV and prior SV experiences.