AIDS and Behavior

, Volume 22, Issue 5, pp 1435–1445 | Cite as

Changes in Anxiety and Depression Symptoms Predict Sexual Risk Behaviors Among Young Men Living in Dar es Salaam, Tanzania

  • Lauren M. Hill
  • Nisha C. Gottfredson
  • Lusajo J. Kajula
  • Brian W. Pence
  • Vivian F. Go
  • James Moody
  • Suzanne Maman
Original Paper
First Online:

Abstract

Young men are important targets in HIV prevention in Tanzania and throughout sub-Saharan Africa. Anxiety and depression are common among youth and may be important predictors of HIV risk behaviors; evidence of these relationships in high-risk populations is needed. Using baseline and 1 year follow-up assessments from an HIV prevention trial we assessed the association between changes in symptoms of anxiety and depression and follow-up sexual risk behaviors (condom use and sexual partner concurrency) controlling for baseline sexual risk behaviors among 1113 male members of social groups known as “camps” in Dar es Salaam, Tanzania. Anxiety and depression were measured using the HSCL-25 and condom use and sexual partner concurrency were assessed through self-report. In separate models, increases in anxiety and depression were associated with sexual partner concurrency and with lower levels of condom use. In a combined model, both anxiety and depression appeared to independently affect concurrency but only depression was independently associated with condom use, with the association between anxiety and condom use being likely attributable to covariance with depression symptoms. The results of this study indicate the importance of screening and providing treatment for depression and anxiety disorders in high HIV-prevalence contexts, and the need to develop effective HIV prevention interventions targeting young men living with anxiety and depression.

Keywords

Tanzania Sexual behaviors Anxiety Depression Men 
This is a preview of subscription content, log in to check access

Notes

Acknowledgements

This research was made possible by funding from the National Institute of Mental Health (R01MH098690), the National Institute of Allergy and Infectious Diseases (T32AI007001), and the National Institute of Drug Abuse (K01DA035153). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Joint United Nations Programme on HIV/AIDS (UNAIDS). The gap report. Geneva: UNAIDS; 2014.Google Scholar
  2. 2.
    Idele P, Gillespie A, Porth T, Suzuki C, Mahy M, Kasedde S, et al. Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps. J Acquir Immune Defic Syndr. 2014;66(Suppl 2):S144–53.CrossRefPubMedGoogle Scholar
  3. 3.
    ICF International. Tanzania HIV/AIDS and malaria indicator survey; 2013.Google Scholar
  4. 4.
    Swai RO, Somi GGR, Matee MIN, Killewo J, Lyamuya EF, Kwesigabo G, et al. Surveillance of HIV and syphilis infections among antenatal clinic attendees in Tanzania-2003/2004. BMC Public Health. 2006;6:91.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Barker G, Ricardo C. Young men and the construction of masculinity in sub-Saharan Africa: implications for HIV/AIDS, conflict, and violence. Washington, DC: World Bank; 2005.Google Scholar
  6. 6.
    Yamanis TJ, Maman S, Mbwambo JK, Earp JAE, Kajula LJ. Social venues that protect against and promote HIV risk for young men in Dar es Salaam, Tanzania. Soc Sci Med. 2010;71:1601–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sommer M, Likindikoki S, Kaaya S. Tanzanian adolescent boys’ transitions through puberty: the importance of context. Am J Public Health. 2014;104:2290–7.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Noar SM, Morokoff PJ. The relationship between masculinity ideology, condom attitudes, and condom use stage of change: a structural equation modeling approach. Int J Mens Health. 2002;1:43–58.CrossRefGoogle Scholar
  9. 9.
    Pleck JH, Sonenstein FL, Ku LC. Masculinity ideology: its impact on adolescent males’ heterosexual relationships. J Social Issues. 1993;49:11–29.CrossRefGoogle Scholar
  10. 10.
    Sinn JS. The predictive and discriminant validity of masculinity ideology. J Res Personal. 1997;31:117–35.CrossRefGoogle Scholar
  11. 11.
    Yamanis TJ, Doherty IA, Weir SS, Bowling JM, Kajula LJ, Mbwambo JK, et al. From coitus to concurrency: sexual partnership characteristics and risk behaviors of 15-19 year old men recruited from urban venues in Tanzania. AIDS Behav. 2013;17:2405–15.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    ICF Macro. Tanzania Demographic and Health Survey, 2010. National Bureau of Statistics; 2011.Google Scholar
  13. 13.
    Agardh A, Odberg-Pettersson K, Ostergren P-O. Experience of sexual coercion and risky sexual behavior among Ugandan university students. BMC Public Health. 2011;11:527.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lundberg P, Rukundo G, Ashaba S, Thorson A, Allebeck P, Ostergren P-O, et al. Poor mental health and sexual risk behaviours in Uganda: a cross-sectional population-based study. BMC Public Health. 2011;11:125.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Zhan W, Shaboltas AV, Skochilov RV, Kozlov AP, Krasnoselskikh TV, Abdala N. Depressive symptoms and unprotected sex in St. Petersburg, Russia. J Psychosom Res. 2012;72:371–5.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    de Peixoto ERM, de Barros FCR, Guimarães MDC. Factors associated with unprotected sexual practice among men and women with mental illnesses in Brazil. Cad Saúde Pública. 2014;30:1475–86.CrossRefPubMedGoogle Scholar
  17. 17.
    Turner AK, Latkin C, Sonenstein F, Tandon SD. Psychiatric disorder symptoms, substance use, and sexual risk behavior among African-American out of school youth. Drug Alcohol Depend. 2011;115:67–73.CrossRefPubMedGoogle Scholar
  18. 18.
    Elkington KS, Bauermeister JA, Zimmerman MA. Psychological distress, substance use, and HIV/STI risk behaviors among youth. J Youth Adolesc. 2010;39:514–27.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Bachanas PJ. Psychological adjustment, substance use, HIV knowledge, and risky sexual behavior in at-risk minority females: developmental differences during adolescence. J Pediatr Psychol. 2002;27:373–84.CrossRefPubMedGoogle Scholar
  20. 20.
    Bennett DL, Bauman A. Adolescent mental health and risky sexual behaviour. Young people need health care that covers psychological, sexual, and social areas. BMJ (Clinical research ed.). 2000;321:251–2.CrossRefGoogle Scholar
  21. 21.
    Agardh A, Cantor-Graae E, Ostergren P-O. Youth, sexual risk-taking behavior, and mental health: a study of university students in Uganda. Int J Behav Med. 2012;19:208–16.CrossRefPubMedGoogle Scholar
  22. 22.
    Traube D, Holloway I, Zhang J. National study of the role of recent illicit substance use on the relationship between depressive symptoms and sexual risk behavior among child welfare-involved adolescents. J Stud Alcohol Drugs. 2013;74:589–97.CrossRefPubMedGoogle Scholar
  23. 23.
    Sterk CE, Theall KP, Elifson KW. The impact of emotional distress on HIV risk reduction among women. Subst Use Misuse. 2006;41:157–73.CrossRefPubMedGoogle Scholar
  24. 24.
    Nduna M, Jewkes RK, Dunkle KL, Shai NPJ, Colman I. Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape, South Africa. J Int AIDS Soc. 2010;13:44.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Chesney MA, Koblin BA, Barresi PJ, Husnik MJ, Celum CL, Colfax G, et al. An individually tailored intervention for HIV prevention: baseline data from the EXPLORE study. Am J Public Health. 2003;93:933–8.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Rogers G, Curry M, Oddy J, Pratt N, Beilby J, Wilkinson D. Depressive disorders and unprotected casual anal sex among Australian homosexually active men in primary care. HIV Med. 2003;4:271–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Reisner SL, Mimiaga MJ, Skeer M, Bright D, Cranston K, Isenberg D, et al. Clinically significant depressive symptoms as a risk factor for HIV infection among black MSM in Massachusetts. AIDS Behav. 2009;13:798–810.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Bass JK, Bolton PA, Murray LK. Do not forget culture when studying mental health. Lancet. 2007;370:918–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Kaaya SF, Fawzi MCS, Mbwambo JK, Lee B, Msamanga GI, Fawzi W. Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatr Scand. 2002;106:9–19.CrossRefPubMedGoogle Scholar
  30. 30.
    Kessler RC, Gruber M, Hettema JM, Hwang I, Sampson N, Yonkers KA. Co-morbid major depression and generalized anxiety disorders in the National comorbidity survey follow-up. Psychol Med. 2008;38:365–74.PubMedGoogle Scholar
  31. 31.
    Kajula L, Balvanz P, Kilonzo MN, Mwikoko G, Yamanis T, Mulawa M, et al. Vijana Vijiweni II: a cluster-randomized trial to evaluate the efficacy of a microfinance and peer health leadership intervention for HIV and intimate partner violence prevention among social networks of young men in Dar es Salaam. BMC Public Health. 2016;16:113.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Weir SS, Pailman C, Mahlalela X, Coetzee N, Meidany F, Boerma JT. From people to places: focusing AIDS prevention efforts where it matters most. AIDS. 2003;17:895–903.CrossRefPubMedGoogle Scholar
  33. 33.
    Hesbacher PT, Rickels K, Morris RJ, Newman H, Rosenfeld H. Psychiatric illness in family practice. J Clin Psychiatry. 1980;41:6–10.PubMedGoogle Scholar
  34. 34.
    Lee B, Kaaya SF, Mbwambo JK, Smith-Fawzi MC, Leshabari MT. Detecting depressive disorder with the Hopkins Symptom Checklist-25 in Tanzania. Int J Soc Psychiatry. 2008;54:7–20.CrossRefPubMedGoogle Scholar
  35. 35.
    Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins symptom checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19:1–15.CrossRefPubMedGoogle Scholar
  36. 36.
    Sandanger I, Moum T, Ingebrigtsen G, Dalgard OS, Sørensen T, Bruusgaard D. Concordance between symptom screening and diagnostic procedure: the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview I. Soc Psychiatry Psychiatr Epidemiol. 1998;33:345–54.CrossRefPubMedGoogle Scholar
  37. 37.
    Noar SM, Cole C, Carlyle K. Condom use measurement in 56 studies of sexual risk behavior: review and recommendations. Arch Sex Behav. 2006;35:327–45.CrossRefPubMedGoogle Scholar
  38. 38.
    Zelaya CE, Go VF, Davis WW, Celentano DD. Improving the validity of self-reported sexual concurrency in South Africa. Washington: USAID; 2012.Google Scholar
  39. 39.
    Filmer D, Pritchett LH. Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India. Demography. 2001;38:115–32.PubMedGoogle Scholar
  40. 40.
    Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21:459–68.CrossRefPubMedGoogle Scholar
  41. 41.
    Keinan G. Decision making under stress: scanning of alternatives under controllable and uncontrollable threats. J Personal Soc Psychol. 1987;52:639–44.CrossRefGoogle Scholar
  42. 42.
    Leith KP, Baumeister RF. Why do bad moods increase self-defeating behavior? Emotion, risk tasking, and self-regulation. J Personal Soc Psychol. 1996;71:1250.CrossRefGoogle Scholar
  43. 43.
    Isen AM. Toward understanding the role of affect in cognition. Handb Soc Cogn. 1984;3:179–236.Google Scholar
  44. 44.
    Morris WN, Reilly NP. Toward the self-regulation of mood: theory and research. Motiv Emot. 1987;11:215–49.CrossRefGoogle Scholar
  45. 45.
    Aneshensel CS, Huba GJ. Depression, alcohol use, and smoking over one year: a four-wave longitudinal causal model. J Abnorm Psychol. 1983;92:134–50.CrossRefPubMedGoogle Scholar
  46. 46.
    Cooper ML, Russell M, Skinner JB, Windle M. Development and validation of a three-dimensional measure of drinking motives. Psychol Assess. 1992;4:123.CrossRefGoogle Scholar
  47. 47.
    Cooper ML, Shapiro CM, Powers AM. Motivations for sex and risky sexual behavior among adolescents and young adults: a functional perspective. J Personal Soc Psychol. 1998;75:1528.CrossRefGoogle Scholar
  48. 48.
    McKirnan DJ, Ostrow DG, Hope B. Sex, drugs and escape: a psychological model of HIV-risk sexual behaviours. AIDS Care. 1996;8:655–70.CrossRefPubMedGoogle Scholar
  49. 49.
    Parkinson B, Totterdell P, Briner RB, Reynolds SA. Changing moods: the psychology of mood and mood regulation. London: Longman; 1996.Google Scholar
  50. 50.
    Quadland MC. Compulsive sexual behavior: definition of a problem and an approach to treatment. J Sex Marital Ther. 1985;11:121–32.CrossRefPubMedGoogle Scholar
  51. 51.
    Beck AT. Depression: clinical, experimental, and theoretical aspects. Philadelphia: University of Pennsylvania Press; 1967.Google Scholar
  52. 52.
    Beck AT, Steer RA, Beck JS, Newman CF. Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. Suicide Life Threat Behav. 1993;23:139–45.PubMedGoogle Scholar
  53. 53.
    Ruscio AM, Lane M, Roy-Byrne P, Stang PE, Stein DJ, Wittchen H-U, et al. Should excessive worry be required for a diagnosis of generalized anxiety disorder? Results from the US national comorbidity survey replication. Psychol Med. 2005;35:1761–72.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Gray JA. Perspectives on anxiety and impulsivity: a commentary. J Res Personal. 1987;21:493–509.CrossRefGoogle Scholar
  55. 55.
    Agerup T, Lydersen S, Wallander J, Sund AM. Longitudinal course of diagnosed depression from ages 15 to 20 in a community sample: patterns and parental risk factors. Child Psychiatry Hum Dev. 2014;45:753–64.CrossRefPubMedGoogle Scholar
  56. 56.
    Wu P-C. Longitudinal stability of the Beck Depression Inventory II a latent trait-state-occasion model. J Psychoeduc Assess. 2016;34:39–53.CrossRefGoogle Scholar
  57. 57.
    Nivard MG, Dolan CV, Kendler KS, Kan KJ, Willemsen G, van Beijsterveldt CEM, et al. Stability in symptoms of anxiety and depression as a function of genotype and environment: a longitudinal twin study from ages 3 to 63 years. Psychol Med. 2015;45:1039–49.CrossRefPubMedGoogle Scholar
  58. 58.
    Kalichman SC, Weinhardt L. Negative affect and sexual risk behavior: comment on Crepaz and Marks (2001). Health Psychol. 2001;20:300–1.CrossRefPubMedGoogle Scholar
  59. 59.
    Lennon CA, Huedo-Medina TB, Gerwien DP, Johnson BT. A role for depression in sexual risk reduction for women? A meta-analysis of HIV prevention trials with depression outcomes. Soc Sci Med. 2012;75:688–98.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Gaynes BN, Pence BW, Atashili J, O’Donnell JK, Njamnshi AK, Tabenyang ME, et al. Changes in HIV outcomes following depression care in a resource-limited setting: results from a pilot study in Bamenda, Cameroon. PLoS ONE. 2015;10:e0140001.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Wagner GJ, Ngo V, Glick P, Obuku EA, Musisi S, Akena D. Integration of depression treatment into HIV care in Uganda (INDEPTH-Uganda): study protocol for a randomized controlled trial. Trials. 2014;15:248.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    WHO. Mental health atlas. Bull World Health Organ. 2015;93:516.Google Scholar
  63. 63.
    Pappin M, Wouters E, Booysen FLR, Lund C. Public sector antiretroviral treatment programme in South Africa: health care workers’ attention to mental health problems. AIDS Care. 2015;27:458–65.CrossRefPubMedGoogle Scholar
  64. 64.
    Chibanda D, Mesu P, Kajawu L, Cowan F, Araya R, Abas MA. Problem-solving therapy for depression and common mental disorders in Zimbabwe: piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV. BMC Public Health. 2011;11:828.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Petersen I, Hanass Hancock J, Bhana A, Govender K. A group-based counselling intervention for depression comorbid with HIV/AIDS using a task shifting approach in South Africa: a randomized controlled pilot study. J Affect Disord. 2014;158:78–84.CrossRefPubMedGoogle Scholar
  66. 66.
    Iheanacho T, Obiefune M, Ezeanolue CO, Ogedegbe G, Nwanyanwu OC, Ehiri JE, et al. Integrating mental health screening into routine community maternal and child health activity: experience from prevention of mother-to-child HIV transmission (PMTCT) trial in Nigeria. Soc Psychiatry Psychiatr Epidemiol. 2015;50:489–95.CrossRefPubMedGoogle Scholar
  67. 67.
    Whittier AB, Gelaye B, Deyessa N, Bahretibeb Y, Kelkile TS, Berhane Y, et al. Major depressive disorder and suicidal behavior among urban dwelling Ethiopian adult outpatients at a general hospital. J Affect Disord. 2016;197:58–65.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Jenkins R, Mbatia J, Singleton N, White B. Common mental disorders and risk factors in urban Tanzania. Int J Environ Res Public Health. 2010;7:2543–58.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Sipsma H, Ofori-Atta A, Canavan M, Osei-Akoto I, Udry C, Bradley EH. Poor mental health in Ghana: who is at risk? BMC Public Health. 2013;13:288.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Nseluke MT, Siziya S. Prevalence and socio-demographic correlates for mental illness among inmates at Lusaka central prison, Zambia. Med J Zamb. 2011;38:3–7.Google Scholar
  71. 71.
    Kebede D, Alem A. Major mental disorders in Addis Ababa, Ethiopia. II. Affective disorders. Acta Psychiatr Scand. 1999;100:18–23.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Lauren M. Hill
    • 1
  • Nisha C. Gottfredson
    • 1
  • Lusajo J. Kajula
    • 2
  • Brian W. Pence
    • 3
  • Vivian F. Go
    • 1
  • James Moody
    • 4
    • 5
  • Suzanne Maman
    • 1
  1. 1.Department of Health BehaviorUNC Chapel HillChapel HillUSA
  2. 2.Department of Psychiatry and Mental HealthMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
  3. 3.Department of EpidemiologyUNC Chapel HillChapel HillUSA
  4. 4.Department of SociologyDuke UniversityDurhamUSA
  5. 5.King Abdulaziz UniversityJeddahSaudi Arabia

Personalised recommendations