Preliminary information on the relationship between HIV and depression is available largely from developed countries. Most ofthese studies have been conducted among homosexual/bisexual men in the U.S. and there is even less information on this association among women in developing countries. The WHO neuropsychiatric AIDS study observer a higher mean depression score for those with symptomatic HIV compared with an HIV seronegative group. Given the preliminary nature of this cross-section analysis, it is unclear whether depressive symptoms resulted from HIV-related symptomatology or if depressive symptoms facilitated the progression of HIV infection. In order to assess the temporal sequence of HIV-related symptoms and depression, this association will be examined within the context of a prospective study among HIV-positive women in Tanzania. This study of depressive symptoms will be nested within a larger study in which the main objective is to determine whether the oral administration of vitamin supplements during and after pregnancy reduces the risk of perinatal transmission of HIV; a secondary objective is to determine whether the vitamin supplements slow the rate of progression of HIV in this population.
The aims for the proposed sub-study are as follow: 1) To determine if depressive symptomatology among HIV-positive women at baseline is associated with faster progression of HIV, poorer quality of life, and greater disability at follow-up; 2) To assess the occurrence of HIV-related symptoms and negative social consequences of HIV-test result notification, such as domestic violence, at baseline in relation to depressive symptoms at follow-up; 3) To examine the association between HIV serostatus notification and the occurrence of depressive symptoms; 4) To validate depression screening measures for use in Tanzania. This study will provide preliminary information on the association between HIV and depression among women in Tanzania and will potentially be the basis for future studies examining the effect of relevant therapeutic interventions (e.g. individual counselling, social support groups) on the quality of life and survival of individuals with HIV. Identifying modifiable factors, such as depression, that improve survival is particularly important for developing countries where access to zidovudine is limited and progression to AIDS occurs more rapidly. This study is also the first systematic assessment of the occurrence of potentially negative consequences of HIV antibody testing in Tanzania, possibly contributing to the public health information available to policy-makers who are examining the relative risks/benefits of providing wider accessibility of HIV testing in Sub-saharan Africa.
