The effects of sexual trauma, intimate partner violence (IPV) and mental health on early versus late antiretroviral therapy (ART) initiation amongst women in South Africa

Crookes, Charles

The effects of sexual trauma, intimate partner violence (IPV) and mental health on early versus late antiretroviral therapy (ART) initiation amongst women in South Africa

Thesis / Dissertation

2024

Publisher

University of Cape Town

Department

Department of Psychiatry and Mental Health

Faculty

Faculty of Health Sciences

Abstract

OBJECTIVES This study had two objectives. Firstly, to determine the prevalence of physical and sexual IPV, sexual trauma and mental health symptoms in a sample of women initiating ART at two primary healthcare facilities in Khayelitsha, Cape Town. Secondly, to investigate associations between socio-demographics, sexual trauma and mental health variables on ART initiation times. METHODS This study used data from participants screening into a larger RCT of an intervention for 16 sexual trauma in women living with HIV (WLWH). This study incorporated a cross-sectional data analytic design. Electronically administered surveys collected data on demographics (age and pregnancy status), sexual trauma, physical and sexual IPV, mental health symptoms (depression, PTSD and suicidality). The outcome of interest included firstly the intention to determine the prevalence of trauma experiences and mental health symptoms in this sample of women initiating ART at two primary health care facilities in Khayelitsha. Secondly, to investigate for associations of significance between the demographic, trauma and mental health variables on ART initiation times. Early initiation was defined as ART commencement within 21 days from HIV diagnosis and late was after 21 days from diagnosis. RESULTS In total, 170 participants were included in this study. The mean age of participants was 30.65 (SD = 8.7). Most of the participants (80%) were initiated on ART early. Lifetime sexual trauma was reported by 38,2 % (n = 65). More than half the participants reported physical and or sexual IPV (57%; n = 97), more than a third reported depressive symptoms (39,4%; n = 67), half reported PTSD symptoms (50%; n = 85) and acute, high risk, suicidality was noted in (4,7%; n = 9) of the participants. In both univariate and multivariate analysis, no associations between demographic, mental health variables and most notably sexual trauma with ART initiation time were found. Logistic regression also found no association with the variables when compared with early versus late ART initiation. CONCLUSION Despite the high prevalence of sexual trauma and lifetime physical and sexual IPV, no 17 association with delays to ART initiation were found. This study could have been limited by its small sample size and we recommend future studies explore the effects of the variables in broader samples and in other areas of South Africa