Association between Internalized Mental Health Symptoms and HIV Status Among Women of Reproductive Age In Zambia

Background and Purpose: HIV remains a major public health crisis in sub-Saharan Africa, with Zambia experiencing a high burden among women of reproductive age in low-resource settings. In addition to developing physical health problems, women living with HIV are disproportionately affected by poor internalized mental health outcomes, including depression and anxiety, which can negatively influence treatment adherence and overall well-being. Despite growing recognition of the link between HIV and internalized mental health conditions, there is a lack of nationally representative, population-based studies in Zambia. Therefore, this study examined association between internalized mental health symptoms and HIV status among women of reproductive age in Zambia.

Methods: This study used cross-sectional data from the 2024 Zambia Demographic and Health Survey (ZDHS), a nationally representative survey of women aged 15–49 years. The analytic sample included women who completed both the HIV testing component and mental health measures (N≈11542 ). The primary outcome was HIV status (positive vs. negative), determined through biomarker diagnostic testings. The two primary independent variables were internalized mental health status. (1) Depressive symptoms were assessed through validated Patient Health Questionnaire (PHQ-9) with scores ranging form 0 to 27. (2) Anxiety symptoms were assessed through Generalized Anxiety Disorder scale (GAD-7) during the two weeks. Both PHQ-9 and GAD-7 were coded as none/minimal (0-4), mild (5-9) and moderate-to-severe (10-27). Covariates included age, education, marital status, religion, work status, household wealth index, residence, region (or province), frequency of internet use, health status, and access to health insurance. Weighted descriptive statistics were performed to obtain frequencies and percentages. While logistic regression were performed to estimate the odds ratios (OR) between internalized mental health and HIV positive status while controlling for potential confounders using SPSS vs. 31.0 (p<.05).

Results: Out of 11542 women who were tested for HIV, 9.0% (n=1,037) were HIV positive and 91.0 % (n=10,505) comprising majority were tested negative. In terms of internalized mental health symptoms, 33.5% reported mild depressive symptoms, and 47.7% mild anxiety symptoms during the past two weeks. After controlling for other factors, women with mild depressive symptoms were associated with higher odds of being tested for HIV positive compared to those none/minimal depressive symptoms (OR=1.30; p=.020). However, women who reported moderate-to-severe anxiety symptoms during the past 2 weeks had lower odds of being tested for HIV positive compared to those with none/minimal anxiety symptoms after controlling for other factors (OR=0.50; p=.034).

Conclusion and Implications: This study has shown that depressive symptoms were strongly linked to increased likelihood of HIV positivity among vulnerable women, emphasizing mental health as a key risk factor in HIV prevention efforts. Interventions may need increasing social support and adding routine mental health screening services into HIV prevention and treatment services using culturally validated tools. Social work practice should focus on trauma-informed and culturally responsive interventions that address both mental health and HIV-related issues. Moreover, strong policy actions are essential to improve the integration of mental health services into HIV programs and to expand access to care for vulnerable populations in resource-limited settings in Zambia.