Substance use among HIV-infected adolescents in Uganda: rates and association with potential risks and outcome factors.

This article sets out to investigate alcohol and substance use (ASU) among adolescents living with HIV (ALWH) in the sub-Saharan African setting of Uganda. A cross-sectional analysis of the records of 479 adolescents (aged between 12and 17 years) attending the study, "Mental health among HIV infected CHildren and Adolescents in KAmpala and Masaka, Uganda (the CHAKA study)" was undertaken. ASU was assessed through both youth self-report and caregiver report using the Diagnostic and Statistical Manual of Mental Disorders-5 referenced instruments, the Youth Inventory-4R and the Child and Adolescent Symptom Inventory-5 (CASI-5). Rates and association with potential risk and outcome factors were investigated using logistic regression models. The rate of ASU was 29/484 (5.9%) with the most frequently reported ASU being alcohol 22/484 (4.3%) and marijuana 10/484 (2.1%). Functional impairment secondary to ASU was reported by 10/484 (2.1%) of the youth. ASU was significantly associated with urban residence, caregiver psychological distress and the psychiatric diagnosis of post-traumatic stress disorder. On associations with negative outcomes, ASU was significantly associated with only "ever had sex". Health care for ALWH in sub-Saharan Africa should include ASU prevention and management strategies.

The relationship between cognitive change and physical health and behavioural outcomes in a Ugandan cohort of adults living with HIV - a longitudinal study.

We investigated changes in cognitive function and physical health and behavioural outcomes (HIV disease progression, health-seeking behaviour, adherence to HIV medications and risky sexual behaviour) at baseline and 12 months later among 1126 Ugandan adults living with HIV. Overall, cognitive function improved from baseline to follow-up, except for gait speed, which was slower at follow-up compared to baseline. There were improvements in physical health and behavioural outcomes by follow-up, with greater improvements among individuals on ART compared to those not on ART. Change in gait speed over time significantly predicted risky sexual behaviours at follow-up. This is the first study to investigate the longitudinal relationships between cognitive function and health outcomes among Ugandan adults living with HIV and provide insights into the possible links between cognitive function and negative clinical and behavioural health outcomes in people living with HIV.

Knowledge and causal attributions for mental disorders in HIV-positive children and adolescents: results from rural and urban Uganda.

Increasing availability of antiretroviral treatment (ART) has led HIV to be considered a chronic disease, shifting attention to focus on quality of life including mental wellbeing. We investigated knowledge and causal attributions for mental disorders in HIV-positive children and adolescents in rural and urban Uganda. This qualitative study was nested in an epidemiological mental health study among HIV-positive children and adolescents aged 5-17 years in rural and urban Uganda. In-depth interviews were conducted with caregivers of HIV-positive children (5-11 years) and adolescents (12-17 years) in HIV care. Interviews were audio recorded with permission from participants and written consent and assent sought before study procedures. Thirty eight participants (19 caregivers, 19 children/adolescents) were interviewed. Age range of caregivers was 28-69 years; majority were female (17). Caregivers had little knowledge on mental disorders ;only 3 related the vignette to a mental problem  and attributed it to: improper upbringing, violence, poverty and bereavement. Five adolescents identified vignettes as portraying mental disorders caused by: ill-health of parents, bereavement, child abuse, discrimination, HIV and poverty. Caregivers are not knowledgeable about behavioural and emotional challenges in HIV-positive children/adolescents. Mental health literacy programmes at HIV care clinics are essential to enhance treatment-seeking for mental health.

Psychiatric disorders and psychosocial correlates of high HIV risk sexual behaviour in war-affected Eastern Uganda.

This article sets out to investigate the psychiatric and psychosocial risk factors for high risk sexual behaviour in a war-affected population in Eastern Uganda. A cross-sectional survey was carried out in four sub-counties in two districts in Eastern Uganda where 1560 randomly selected respondents (15 years and above) were interviewed. The primary outcome was a derived variable "high risk sexual behaviour" defined as reporting at least one of eight sexual practices that have been associated with HIV transmission in Uganda and which were hypothesised could arise as a consequence of psychiatric disorder or psychosocial problems. Multivariable logistic regression was used to assess factors associated with high risk sexual behaviour in this population. Males were more likely to have at least one "high risk sexual behaviour" than females (11.8% vs. 9.1% in the last year). Sex outside marriage was the most commonly reported high risk sexual behaviour. Among males, the factors independently associated with high risk sexual behaviour were: being married, belonging to non-Catholic/non-Protestant religions, poverty, being a victim of intimate partner violence and having a major depressive disorder (MDD). Among females, the factors that were independently associated with high risk sexual behaviour were: being in the reproductive age groups of 25-34 and 35-44 years, not seeing a close relative killed and having experienced war-related sexual torture. Holistic HIV/AIDS prevention programming in conflict and post-conflict settings should address the psychiatric and psychosocial well-being of these communities as a risk factor for HIV acquisition.

Emotional and behavioural disorders in HIV seropositive adolescents in urban Uganda.

OBJECTIVE: To investigate the emotional and behavioral problems of HIV sero-positive adolescents. DESIGN: A cross-sectional descriptive study. SETTING: A specialised HIV/AIDS Health Care Centre, the Mildmay Centre, in Kampala, Uganda. SUBJECTS: Eighty two HIV sero-positive adolescents were consecutively enrolled for the study. RESULTS: Over half (55.6%) of the subjects were females. They were mostly (88.9%) under the age of 15 years, orphans (97.6%) and stayed with non-parental relatives (68.3%). Almost two thirds (60.9%) of them were in the HIV/AIDS clinical disease stage III or IV and were not on ARVs drugs. Forty two (51.2%) of the subjects had significant psychological distress (SRQ-25 scores > or = 6) and 14 (17.1%) had attempted suicide within the last 12 months. Their specific psychiatric disorders, made using ICD-10 criteria, were: Anxiety 45.6%, depression 40.8%, somatisation 18.0%, seizures 8.4%, mania 1.2% and HIV-associated progressive encephalopathy 4.8%. CONCLUSION: HIV/AIDS infection in adolescence was associated with considerable psychological problems and the presence of major psychiatric disorders. With the current increasing availability of effective antiretroviral therapy, many of these children are surviving into adolescence, thus calling for the development of adolescent friendly HIV medical and psychological support and treatment services in developing countries such as Uganda.

Negative life events associated with deliberate self-harm in an African population in Uganda.

Negative life events associated with deliberate self-harm (DSH) were investigated in an African context in Uganda. Patients admitted at three general hospitals in Kampala, Uganda were interviewed using a Luganda version (predominant language in the study area) of the European Parasuicide Study Interview Schedule I. The results of the life events and histories module are reported in this paper. The categories of negative life events in childhood that were significantly associated with DSH included those related to parents, significant others, personal events, and the total negative life events load in childhood. For the later-life time period, the negative life events load in the partner category and the total negative life events in this time period were associated with DSH. In the last-year time period, the negative life events load related to personal events and the total number of negative life events in this time period were associated with DSH. A statistically significant difference between the cases and controls for the total number of negative life events reported over the entire lifetime of the respondents was also observed, which suggests a dose effect of negative life events on DSH. Gender differences were also observed among the cases. In conclusion, life events appear to be an important factor in DSH in this cultural environment. The implication of these results for treatment and the future development of suicide interventions in this country are discussed.

Suicide in urban Kampala, Uganda: a preliminary exploration.

BACKGROUND: Suicide was investigated in the urban setting of Kampala, Uganda. OBJECTIVES: Firstly, to explore the use of two research methodologies, a retrospective review of patient records and the psychological autopsy methodology in suicide research in Uganda. Secondly to investigate the characteristics and correlates of urban suicide in Uganda. RESULTS: A male to female ratio of suicide of 3.4:1 and a peak age of suicide in the 20-39 years age group were found. The main methods of suicide were hanging and ingestion of poison (organophosphates). Problems with social networks, negative life events, higher psychological distress and lower quality of life were associated with suicide at univariate analysis. It was only psychological distress that retained significance at multivariate analysis. CONCLUSION: The retrospective review of records at Mulago hospital was beset by incomplete records whereas a pilot psychological autopsy study was well accepted and might contribute valuable data in African settings.

A comparison of the clinical features of depression in HIV-positive and HIV-negative patients in Uganda.

OBJECTIVE: Depressive illness is the most common psychiatric disorder in HIV/AIDS with prevalence 2 to 3 times higher than the general population. It's still questionable whether HIV related depression is clinically different from depression in HIV-negative populations, a fact that could have treatment implications. This study compared the clinical features of major depression between HIV-Positive and HIV-negative patients with a view to intervention strategies. METHOD: A comparative, descriptive, cross-sectional study was carried out on 64 HIV-Positive depressed patients and 66 HIV-negative depressed patients in Butabika and Mulago hospitals. They were compared along the parameters of clinical features of depression, physical examination and laboratory findings. Pair wise comparisons, logistic regression and Multivariate analysis were done for the two groups on a number of variables. RESULTS: Compared to HIV-Negative patients, HIV-Positive patients were more likely to be widowed; older (≥30years), less likely to have a family member with a mental illness; a later onset of depressive illness (≥30years); more likely to have a medical illness and taking medication before onset of depressive, symptomatically compared to HIV-Negative patients, HIV-Positive patients were more critical of themselves; had significantly more problems making decisions; had poorer sleep; felt more easily tired; more appetite changes; more cognitive impairment. Low CD4 counts were not significantly associated with depression, but HIV related depression was more likely to occur in stages II and III illness. CONCLUSION: These findings show that the clinical and associated features of depression differ between HIV-Positive and HIV-Negative patients, thus requiring different management approaches and further studies related to HIV-related depression.

Suicide in Urban Kampala; Uganda: a Preliminary Exploration

Background: Suicide was investigated in the urban setting of Kampala; Uganda. Objectives: Firstly; to explore the use of two research methodologies; a retrospective review of patient records and the psychological autopsy methodology in suicide research in Uganda. Secondly to investigate the characteristics and correlates of urban suicide in Uganda. Results: A male to female ratio of suicide of 3.4:1 and a peak age of suicide in the 20-39 years age group were found. The main methods of suicide were hanging and ingestion of poison (organophosphates). Problems with social networks; negative life events; higher psychological distress and lower quality of life were associated with suicide at univariate analysis. It was only psychological distress that retained significance at multivariate analysis. Conclusion: The retrospective review of records at Mulago hospital was beset by incomplete records whereas a pilot psychological autopsy study was well accepted and might contribute valuable data in African settings

A comparison of the clinical features of depression in hiv-positive and hiv-negative patients in Uganda

Objective: Depressive illness is the most common psychiatric disorder in HIV/AIDS with prevalence 2 to 3 times higher than the general population. It's still questionable whether HIV related depression is clinically different from depression in HIV-negative populations; a fact that could have treatment implications.This study compared the clinical features of major depression between HIV-Positive and HIV-negative patients with a view to intervention strategies. Method: A comparative; descriptive; cross-sectional study was carried out on 64 HIV-Positive depressed patients and 66 HIV-negative depressed patients in Butabika and Mulago hospitals. They were compared along the parameters of clinical features of depression; physical examination and laboratory findings. Pair wise comparisons; logistic regression and Multivariate analysis were done for the two groups on a number of variables. Results: Compared to HIV-Negative patients; HIV-Positive patients were more likely to be widowed ; older (? 30years); less likely to have a family member with a mental illness; a later onset of depressive illness (?30years); more likely to have a medical illness and taking medication before onset of depressive; symptomatically compared to HIV-Negative patients; HIV-Positive patients were more critical of themselves ; had significantly more problems making decisions ; had poorer sleep; felt more easily tired; more appetite changes; more cognitive impairment. Low CD4 counts were not significantly associated with depression; but HIV related depression was more likely to occur in stages II and III illness. Conclusion: These findings show that the clinical and associated features of depression differ between HIV-Positive and HIV-Negative patients; thus requiring different management approaches and further studies related to HIV-related depression

A comparison of the Behavioral and Emotional Disorders of Primary School-Going Orphans and Non-Orphans in Uganda

"Background: This study investigated the emotional and behavioral problems of orphans in Rakai District; Uganda; and to suggest interventions. Studies; elsewhere; have shown orphans to have high levels of psychological problems. However; in Uganda such studies are limited and no specific interventions have been suggested. Methods: The study employed a cross-sectional unmatched case control design to compare emotional and behavioral problems of 210 randomly selected primary school-going orphans and 210 non-orphans using quantitative and qualitative methods employing standardized questionnaires; Focus Group discussions and selected Key Informant interviews. All children were administered Rutter's Children's Teacher Administered Behavior Questionnaire to measure psychological distress and a modified version of Cooper's Self-Report Measure for Social Adjustment. Standardized psychiatric assessments were done on children scoring 9 on the Rutter's Scale; using the WHO-ICD-10 diagnostic checklists. Results: Both orphans and non-orphans had high levels of psychological distress as measured using Rutter's questionnaire but with no significant statistical difference between the two groups (Rutter score 9; 45.1 et 36.5respectively; p= 0.10) and no major psychiatric disorders such as psychotic; major affective or organic mental syndromes. Psychological distress was associated with poor academic performance (p=0.00) in both groups. More orphans; than non-orphans had more common emotional and behavioral problems e.g. more orphans reported finding ""life unfair and difficult"" (p=0.03); 8.3 orphans compared to 5.1 of the non-orphans reported having had past suicidal wishes (p=0.30) and more reported past ""forced sex / abuse "" (p=0.05). Lastly; the orphans' social functioning in the family rated significantly worse compared to the non-orphans (p= 0.05). Qualitatively; orphans; compared to non-orphans were described as ""needy; sensitive; isolative with low confidence and self-esteem and who often lacked love; protection; identity; security; play; food and shelter."" Most lived in big poor families with few resources; faced stigma and were frequently relocated. Community resources were inadequate. Conclusion: In conclusion; more orphans compared to non-orphans exhibited common emotional and behavioral problems but no major psychiatric disorders. Orphans were more likely to be emotionally needy; insecure; poor; exploited; abused; or neglected. Most lived in poverty with elderly widowed female caretakers. They showed high resilience in coping. To comprehensively address these problems; we recommend setting up a National Policy and Support Services for Orphans and Other Vulnerable Children and their families; a National Child Protection Agency for all Children; Child Guidance Counselors in those schools with many orphans and lastly social skills training for all children."

Frequency with which psychiatric disorder associated with a positive HIV- serostatus as seen in persons attending a TASO Clinic in Mulago

The prevalence of HIV-1 infection among adults in Uganda is estimated to be about 12. However the rate and nature of psychological disorder among persons living with HIV/AIDS in Uganda is unknown.This study was therefore carried out to determine the nature and pattern of psychological disorder in HIV/AIDS. A total of 252 HIV-1 positive patients attending the specialised AIDS clinic at TASO Mulago had a physical examination and were interviewed using the General Health Questionnaire (GDQ-28). Forty eight percent of the patients fulfilled the criteria for AIDS related complex; 49.2for AIDS and 2.8 were asymptomatic according to WHO diagnostic criteria. At least 74 of the patients suffered from psychological disorder using a thershold cut off point of 5/6 on the GHQ-28The HIV clinical stage was significantly related to the overall psychological disorder (p=0.007); depression (p=0.01) and social dysfunction (p=0.02) but not anxiaety and somatic symptoms. At multivariant analysis the HIV clinical stage and the number of counselling sessions attended before the study were the two factors that had a significant effect on psychological disorder. Two other factors which had a significant association with psychological disorder namely age of the patient (p=0.04) and duration since HIV test was done (p=0.02) did not feature as significant factors at multivariant analysis. In conclusion HIV-1 infection appears to be associated with significant psychological morbidity. It appears that current counselling services do not adequately address personal psychological needs of people living with HIV/AIDS. There is therefore a need for further studies where the actual prevalence of psychological disorder; the specific psychiatric diagnoses; and hence the appropriate remedial measures can be determined

HIV related risk behaviour and Psychological disorder among U.T.O.D.A. Taxi drivers in the new Taki Park; Kampala

Three hundred and thirty (330) tax drivers registered with The Uganda Taxi Owners and Drivers Association (U.T.O.D.A.) were interviewed using a semi-structured questionnaire. The questionnaire contains the following variables; socio-demographics; variables about the occupation; questions about knowledge; attitudes and practice with reference to HIV/AIDS and psychological assessment instruments; General Health Questionnaires (GHQ-12); ICD-10 checklists for depression; anxiety; somatoform disorder and alcohol abuse disorders. The results are presented; discussed and recomdendations made

HIV Risk Behaviour among Street Children Attending U.Y.D.E.L Clinic in Bakuli - Kampala

Introduction: A study was undertaken to investigate the nature; pattern and correlates of high HIV risk behaviour among street children attending the Uganda Youth Development Link (U.Y.D.E.L) Clinic in Bakuli; Kampala. Methodology: A total of 136 street children were consecutively interviewed with a semi-structured questionnaire. This instrument contained; socio-demographic variables; reasons for leaving home; nature of street childr career; previous attempts at resettlement; substance abuse behaviour; knowledge and attitudes about HIV/AIDS; high HIV risk behaviour and medical illness. Data analysis was undertaken using EPI-Info statistical package 6.0; this involved generating frequencies and frequency tables. Results: Most of the street children seen were male 129(94.8) with a male to female ratio of 18:1 and were largely 130(95.6) between the ages of 10-19 years of age. Mistreatment 66(48.5) and poverty leading to premature discontinuation of formal education 62(52.6) appears to be the main social factors underlying the decision to opt for the street. Substance abuse behaviour was reported 99(72.8) with the following substances abused; aviation fuel (tina) 90(66.2); cigarettes 31(22.8); marijuana 21(15.4); khat 14(10.3) and alcohol 11(8.1). Some of the children 20(20.2) abused more than one substance. Perceived causes of HIV/AIDS as reported by the children included organism 111(81.6) but 25(18.9) did not know the cause or reporting a wrong answer. For the perceived mode of transmission of HIV/AIDS; 105(77.2) correctly reported sex; 31(22.8) reported infected needles 29(21.3) blood transfusion and 10(7.4) mother to baby. The misperceived ideas about HIV transmission included; sharing food/drink 7(5.1) and hand shake 4(2.9) with 15(11) reporting ignorance about mode of transmission of HIV/AIDS. The majority of street children 100(73.5) were not sexually active. But those who were sexually active 36(26.5) displayed high HIV risk behaviour with; 27(58.3) reporting unprotected sex; 4(11.1) sex for money; 2(5.6) having suffered genital ulcers/discharge 2(5.6) multiple sexual partners. Only 6(16.6) reported regular use of a condom with 1(2.8) having taken an HIV test before. Conclusions and REcommendations: There is need for the design and development of HIV/AIDS awareness programmes that specifically target street children. These programmes need to address the deficits in knowledge and the small but high HIV risk group of sexually active children