Association between Childhood Trauma, Mental Health Symptoms and Adherence Among Youth Living with HIV in Botswana

Background

People living with HIV experience traumatic incidents at higher rates than the general population; and research has documented significant association between trauma exposure and the development of mental disorders. Mental health problems have a a negative impact on anti-retroviral treatment adherence. All of these psychosocial concerns play a role in potentially increasing HIV transmission to sexual partners resulting in increased incidence rates. To inform interventions that improve quality of life, and decrease risky behaviors for adolescents and youth, it is critical to understand the extent to which childhood trauma, mental health problems, and poor adherence occur and coexist in this population of adolescents living with HIV. Thus, this study examined the associations between childhood trauma, mental health problems (depression, anxiety, and substance use) and adherence to ART among HIV infected youth in Botswana.

Methods

A cross-sectional quantitative survey was conducted among youth aged 15 and 24-years old living with HIV. The Childhood Trauma Questionnaire- Short Form; Depression, Anxiety, Stress Scale (DASS-21; Car Relax Alone Forget Friends Trouble” or CRAFFT 2.1 + N were used to collect data on exposure to childhood trauma, mental health symptoms and problematic substance use respectively. Adherence was assessed objectively with viral load and subjectively with Simplified Medication Adherence Questionnaire. Data analysis was conducted using Stata version 15. Bivariate logistical regression analysis testing for associations between mental health symptoms, substance use and adherence, and childhood trauma was conducted. Multivariate logistic regression was subsequently performed controlling for variables found to be significantly associated with childhood trauma.

Results

Of the 119 youth, 47% of the participants reported experiencing at least one type of childhood trauma, and physical neglect was the most frequently reported. Emotional abuse, emotional neglect, physical abuse, sexual abuse and physical neglect were significantly associated with non-adherence, OR 5.83; OR 3.10; OR 5.97, and OR 2.52, respectively.

Conclusion

Our findings revealed that exposure to all domains of childhood trauma except physical abuse were significantly associated with non-adherence. Sexual abuse and emotional neglect had the highest odds of predicting non-adherence. This highlights the need for trauma focused psychosocial interventions in managing youth living with HIV.