20.1 The mental health of children and adolescents living with HIV in Western Kenya

Abstract

Adolescence is associated with the onset of various mental health challenges such as anxiety, depression, suicidality, and self-harm. For those living with HIV, HIV-related stigma compounds the psychosocial challenges of this already precarious period. These challenges may contribute to the decreased adherence to antiretroviral therapy and clinic visits that is observed among this age cohort. We sought to better characterize the mental health challenges faced by children and adolescents living with HIV (CALHIV) in western Kenya.

We screened 52 CALHIV ages 6 to 17 years in Trans Nzoia County, Kenya for anger (American Psychiatric Association [APA] Anger-Parent of Child 6-17 years), depression (Patient Health Questionnaire-9), generalized anxiety disorder (Generalized Anxiety Disorder-7), and alcohol addiction (Car, Relax, Alone, Forget, Friends, Trouble, [CRAFFT]) between October 2018 and February 2019. We also administered open-ended interview questions aimed at qualifying their responses. Among the CALHIV screened, 42% were males (22/52; mean age 12 years), 54% (28/52) had full disclosure of their HIV status, 61% (32/52) had viral loads less than 400 copies/ml, and 43% of the CALHIV screened positive for anger (38% moderate, 5% severe), 48% for depression (15% moderate/moderately severe, 0% severe), and 69% for anxiety (16% moderate, 2% severe). None screened positive for alcohol addiction. Among those with full disclosure of their status, 83% screened positive for anger (64% moderate, 7% severe) and 28% for moderate/moderately severe depression. Adolescents reported feeling angry, anxious, and/or stressed when they look at their medications due to the bad taste from their medications, when they must hide to take their pills or when caregivers hide their drugs, and due to side effects from their medications (eg, nausea and vomiting). They also reported feeling this way due to nightmares and frequent illnesses. A few mentioned being stigmatized by their caregivers and mocked and alienated by peers. One mentioned having been kicked out of school due to frequent illness. Conclusions CALHIV report high levels of anger, depression, and anxiety, particularly after disclosure of their HIV status. There is need for proactive screening for mental health challenges among them, with responsive psychological support.