title: Depression and HIV in Botswana: a population-based study on gender-specific socioeconomic and behavioral correlates.
abstract: BACKGROUND
  Depression is a leading contributor to the burden of disease worldwide, a critical barrier to HIV prevention and a common serious HIV co-morbidity. However, depression screening and treatment are limited in sub-Saharan Africa, and there are few population-level studies examining the prevalence and gender-specific factors associated with depression.
  
  
  METHODS
  We conducted a cross-sectional population-based study of 18-49 year-old adults from five districts in Botswana with the highest prevalence of HIV-infection. We examined the prevalence of depressive symptoms, using a Hopkins Symptom Checklist for Depression (HSCL-D) score of ≥ 1.75 to define depression, and correlates of depression using multivariate logistic regression stratified by sex.
  
  
  RESULTS
  Of 1,268 participants surveyed, 25.3% of women and 31.4% of men had depression. Among women, lower education (adjusted odds ratio [AOR] 2.07, 95% confidence interval [1.30-3.32]), higher income (1.77 [1.09-2.86]), and lack of control in sexual decision-making (2.35 [1.46-3.81]) were positively associated with depression. Among men, being single (1.95 [1.02-3.74]), living in a rural area (1.63 [1.02-2.65]), having frequent visits to a health provider (3.29 [1.88-5.74]), anticipated HIV stigma (fearing discrimination if HIV status was revealed) (2.04 [1.27-3.29]), and intergenerational sex (2.28 [1.17-4.41]) were independently associated with depression.
  
  
  CONCLUSIONS
  Depression is highly prevalent in Botswana, and its correlates are gender-specific. Our findings suggest multiple targets for screening and prevention of depression and highlight the need to integrate mental health counseling and treatment into primary health care to decrease morbidity and improve HIV management efforts.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America. r44gupta@yahoo.com
authors.forename: Reshma
authors.initials: R
authors.lastname: Gupta
authors.forename: Madhavi
authors.initials: M
authors.lastname: Dandu
authors.forename: Laura
authors.initials: L
authors.lastname: Packel
authors.forename: George
authors.initials: G
authors.lastname: Rutherford
authors.forename: Karen
authors.initials: K
authors.lastname: Leiter
authors.forename: Nthabiseng
authors.initials: N
authors.lastname: Phaladze
authors.forename: Fiona Percy-de
authors.initials: FP
authors.lastname: Korte
authors.forename: Vincent
authors.initials: V
authors.lastname: Iacopino
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
mesh_terms: D000293:Adolescent; D000328:Adult; D001519:Behavior; D001902:Botswana; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology* / Q000208:ethnology; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012737:Sex Factors; D012923:Social Class