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Social support attenuates the syndemic of poor HIV care and stigma on suicidal tendencies among South African young women living with HIV

Title
Social support attenuates the syndemic of poor HIV care and stigma on suicidal tendencies among South African young women living with HIV
Presenter
Wylene Saal
Authors
W. Saal * (1), B. Banougnin (1), L. Hertzog (1), E. Toska (1,2,3), L. Cluver (3,4)
Institutions
(1) University of Cape Town, Centre for Social Science Research, Cape Town, South Africa, (2) University of Cape Town, Department of Sociology, Cape Town, South Africa, (3) University of Oxford, Department of Social Policy and Intervention, London, United Kingdom, (4) University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa

BACKGROUND: Young women living with HIV (YWHIV) are at increased risk of developing suicidality. Yet little is known about the combined effects of living with HIV on suicidality among YWHIV.
METHODS: We analysed data from 791 YWHIV who participated in two large prospective South African cohort studies, Mzantsi Wakho (2017-2018) and HEY BABY (2018-2019). Standardised questionnaires were used to measure the syndemic factors, mental health issues (mediator), social support (moderator) and suicidality (outcome). A moderated mediation analysis was used to investigate (1) the direct (individual and syndemic) effects of poor HIV care retention and HIV-related stigma on suicidality, (2) the indirect effects as mediated through mental health issues, and (3) the moderating effects of social support on mental health issues, and suicidality, controlling for potential confounders (age, rural residence, informal housing, household poverty, and mode of HIV acquisition).
RESULTS: Higher HIV-related stigma (AOR=2.19, p=0.012) and poor HIV care retention (AOR=3.47, p < 0.001) were directly associated with higher suicidality. The combined direct effects of poor HIV care retention and HIV-related stigma on suicidality (14% points increased risks of suicidality, p<0.001) are higher than their individual effects (12% points increased risks of suicidality,p<0.001). Furthermore, both HIV-related stigma and poor HIV care retention were indirectly associated with suicidality via mental health issues. Social support buffered the direct and indirect effects of poor HIV care retention and HIV-related stigma on suicidality.
CONCLUSIONS: Combined effects of poor HIV care retention and HIV-related stigma are associated with higher suicidality, indicating a syndemic interaction. Programmes that simultaneously address these factors and strengthen social support services may improve mental health and reduce suicidality among YWHIV.