Trajectories of depressive symptoms and HIV-related sexual behaviors among adolescent girls and young women in Rural South Africa (HPTN 068)


BACKGROUND: In sub-Saharan Africa, adolescent girls and young women (AGYW) are twice as likely to experience depression and HIV infection as their age-matched male counterparts. Yet little is known about trajectories of depressive symptoms amongst this population or how trajectories of depressive symptoms overlap with engagement in HIV-related sexual behaviors such as early sexual debut, condomless sex, transactional sex, and age-disparate partnerships.
METHODS: We used data from the HIV Prevention Trials Network (HPTN) 068 study in rural South Africa (2012-2019). AGYW, aged 14-20 at baseline, were followed approximately annually for up to 6 years. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D-10) and group-based trajectory modeling was used to identify longitudinal patterns of depressive symptoms. After model fit was assessed, each AGYW was assigned to the trajectory group for which they had the highest posterior probability of membership and HIV-related sexual behaviors (early sexual debut (< 15), condomless sex, transactional sex, and age-disparate partnerships (partner> 5 years older)) for each group were descriptively compared using chi-square tests.
RESULTS: Among 1753 AGYW included in our analysis, at baseline the median age was 16 (IQR 15-17), 28% were sexually active (n=507), and 33% (n=587) reported depressive symptoms. We identified three distinct depressive symptoms trajectories: 'increasing across adolescence' (n=69, 4%), 'decreasing across adolescence' (n=257, 15%), and 'no depression across adolescence' (n=1437, 81%). Across all visits, the 'increasing across adolescence' and 'decreasing across adolescence' groups, compared to the 'no depression across adolescence' group, were more likely to have early sexual debut (26% 'increasing', 37% 'decreasing', 21% 'no depression': p < 0.001) and ever engage in condomless sex (45% 'increasing', 55% 'decreasing', 39% 'no depression'; p < 0.001), transactional sex (35% 'increasing', 45% 'decreasing', 24% 'no depression; p < 0.001), and age-disparate partnerships (42% 'increasing', 49% 'decreasing', 36% 'no depression'; p < 0.001).
CONCLUSIONS: In rural South Africa, AGYW who experience depressive symptoms during adolescence are potentially more at risk of engaging in HIV-related sexual behaviors than AGYW who experience no depressive symptoms, particularly AGYW who experience depressive symptoms earlier in adolescence.

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