title: Social support and mental health among adults prior to HIV counseling and testing in Durban, South Africa.
abstract: Poor social support and mental health may be important modifiable risk factors for HIV acquisition, but they have not been evaluated prior to HIV testing in South Africa. We sought to describe self-perceived mental health and social support and to characterize their independent correlates among adults who presented for voluntary HIV testing in Durban. We conducted a large cross-sectional study of adults (≥18 years of age) who presented for HIV counseling and testing between August 2010 and January 2013 in Durban, South Africa. We enrolled adults presenting for HIV testing and used the Medical Outcomes Study's Social Support Scale (0 [poor] to 100 [excellent]) and the Mental Health Inventory (MHI-3) to assess social support and mental health. We conducted independent univariate and multivariable linear regression models to determine the correlates of lower self-reported Social Support Index and lower self-reported MCH scores. Among 4874 adults surveyed prior to HIV testing, 1887 (39%) tested HIV-positive. HIV-infected participants reported less social support (mean score 66 ± 22) and worse mental health (mean score 66 ± 16), compared to HIV-negative participants (74 ± 21; 70 ± 18; p < 0.0001). In a multivariable analysis, significant correlates of less social support included presenting for HIV testing at an urban hospital, not having been tested previously, not working outside the home, and being HIV-infected. In a separate multivariable analysis, significant correlates of poor mental health were similar, but also included HIV testing at an urban hospital and being in an intimate relationship less than six months. In this study, HIV-infected adults reported poorer social support and worse mental health than HIV-negative individuals. These findings suggest that interventions to improve poor social support and mental health should be focused on adults who do not work outside the home and those with no previous HIV testing.
authors.affiliation: a Division of Infectious Diseases , Massachusetts General Hospital , Boston , MA , USA.|b Medical Practice Evaluation Center , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Drain
authors.affiliation: b Medical Practice Evaluation Center , Massachusetts General Hospital , Boston , MA , USA.|c Department of Orthopedic Surgery , Brigham and Women's Hospital , Boston , MA , USA.|d Boston University School of Public Health , Boston , MA , USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.affiliation: d Boston University School of Public Health , Boston , MA , USA.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Coleman
authors.affiliation: e Children's Hospital , Boston , MA , USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Bogart
authors.affiliation: f McCord Hospital , Durban , South Africa.
authors.forename: Janet
authors.initials: J
authors.lastname: Giddy
authors.affiliation: g St. Mary's Hospital , Durban , South Africa.
authors.forename: Douglas
authors.initials: D
authors.lastname: Ross
authors.affiliation: c Department of Orthopedic Surgery , Brigham and Women's Hospital , Boston , MA , USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.affiliation: a Division of Infectious Diseases , Massachusetts General Hospital , Boston , MA , USA.|b Medical Practice Evaluation Center , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: Ingrid V
authors.initials: IV
authors.lastname: Bassett
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D012944:Social Support; D013019:South Africa
keywords: HIV testing; HIV/AIDS; South Africa; mental health; social support