Depression and its implications for human immunodeficiency virus (HIV) prevention among youth in the United States
Molino, Janine Denise
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Human immunodeficiency virus (HIV) is a leading cause of morbidity among youth in the United States (US) and imposes substantial economic burden on the healthcare system. Youth account for more than 1 in 5 new HIV diagnoses annually, a two-fold increase since 2004. Annual direct medical costs associated with youth HIV care in the US range between $5.6 billion and $6.3 billion. Early sexual debut, high rates of condom nonuse, large numbers of sexual partners, and low rates of HIV testing drive the spread of HIV among this cohort. Emergence of depression during adolescence and young adulthood may exacerbate these issues. In order to reduce the incidence of youth HIV and curtail its burden on the healthcare system, it is critical to develop a comprehensive understanding of how depression impacts HIV acquisition and case detection. Three quantitative studies using nationally representative samples of American youth were performed to examine the relationship between depression and: (1) sexual debut; (2) inconsistent condom use and multiple sexual partners; and (3) HIV testing. Findings from these studies were used to offer recommendations to improve the delivery of sexual health counseling, HIV testing, and mental health services to youth in the US. Analysis on data from three large population databases suggested depression is an important mental health indicator to be considered in future youth HIV prevention efforts. Study 1 and Study 2 found depressive symptoms were associated with a greater likelihood of sexual debut before age 16 and condomless vaginal or anal sexual intercourse among 18 to 24 year olds. Study 3 found depression was associated with a higher likelihood of ever being tested for HIV but not associated with past year testing. Overall, these findings suggest a need for primary care providers to screen for depression during well child visits and provide sexual health counseling and mental health treatment referrals to youth exhibiting above threshold symptom levels. Youth HIV testing rates may be increased by promoting testing services at mental health treatment facilities and at offices of mental health professionals. Care coordination and organization are critical to the implementation of these recommendations.