Seven in Ten Young Zambians Living with HIV Screen Positive for Mental Health Disorders

Adolescents and young people living with HIV in Zambia’s capital are carrying a burden that extends far beyond the virus itself. A new cross-sectional study conducted at Chipata Level 1 Hospital in Lusaka has found that 71.4 percent of young people aged 15 to 24 receiving routine antiretroviral therapy screened positive for at least one common mental health disorder, a figure that ranks among the highest reported for this population anywhere in sub-Saharan Africa. The research, embedded within the AdoMinds mixed-methods implementation study and published in PLOS Mental Health, offers one of the most detailed portraits yet of the psychological toll of growing up with HIV in an urban African setting, and it points squarely at HIV-related stigma as a modifiable driver of that toll.

The study team, led by Kwame Shanaube and colleagues, recruited participants from the hospital’s adolescent and young adult antiretroviral therapy cohort between September 2023 and May 2024. Of the 583 young people registered in care during the study period, 416 agreed to take part, an enrollment rate of 71.4 percent. The cohort was predominantly female, with 268 participants, or 64.4 percent, being women, and the median age was 20 years, with an interquartile range of 18 to 23. This demographic profile mirrors the broader epidemiology of pediatric and perinatal HIV transmission in the region, where children born with the virus are now surviving into adolescence and young adulthood in large numbers thanks to two decades of expanded antiretroviral treatment programs.

Methodologically, the researchers opted for a tablet-based questionnaire administered by trained research assistants rather than self-completed paper forms, a design choice that matters in a setting where literacy levels vary and sensitive topics can be difficult to discuss. The instrument incorporated validated screening tools for four conditions: depression, anxiety, post-traumatic stress disorder, and substance use. Screening tools do not deliver clinical diagnoses on their own, but they are the standard first step in identifying people who need fuller assessment, and their use in this study allowed the team to capture a snapshot of psychological morbidity across an entire clinic population rather than only among those who volunteer distress during routine consultations.

The headline numbers are stark. Depression emerged as the most prevalent condition, with 279 of 416 participants, or 67.1 percent, screening positive. Anxiety followed at 35.3 percent, affecting 147 participants. Because many young people screened positive for more than one condition, the overall proportion with at least one disorder, 71.4 percent, reflects substantial comorbidity. For clinicians, the implication is that mental distress in this population is not an occasional complication but the statistical norm, and that a young person attending an HIV clinic in Lusaka is more likely than not to be experiencing depression at a level that would warrant further evaluation.

To understand who was most at risk, the team used logistic regression, a statistical technique that estimates the odds of an outcome while adjusting for other variables in the model. The clearest signal was stigma. Young people who reported feeling stigmatised because of their HIV status had nearly twice the odds of screening positive for at least one mental health disorder compared with those who did not, with an adjusted odds ratio of 1.99 and a 95 percent confidence interval of 1.10 to 3.63, a statistically significant association with a p-value of 0.024. This finding aligns with a large body of international literature linking enacted and perceived stigma to depression and anxiety among people living with HIV, but it is particularly consequential in a cohort of young people who must navigate disclosure, dating, schooling, and employment while managing a chronic, transmissible condition.

A second association hovered at the edge of statistical significance. Participants with a history of smoking showed markedly higher odds of having at least one disorder, with an adjusted odds ratio of 4.24, but the confidence interval ranged from 0.98 to 18.30 and the p-value of 0.053 fell just short of the conventional threshold. The authors are careful to describe this as borderline evidence rather than a confirmed association. The wide confidence interval reflects the small number of smokers in the cohort, a common limitation in studies of adolescent populations where substance use is less established than in older adults. Still, the direction of the effect is consistent with the well-documented overlap between nicotine use and mental ill health, and it suggests that tobacco screening may be a useful adjunct to psychological screening in this setting.

Perhaps the most counterintuitive finding concerned orphanhood. Compared with participants whose parents were both alive, those who had lost one parent had lower odds of screening positive for a mental health disorder, with an adjusted odds ratio of 0.46, and those who had lost both parents had still lower odds, with an adjusted odds ratio of 0.38. Both associations were statistically significant, with p-values of 0.042 and 0.010 respectively. On its face, this seems to defy expectations, since parental death is a recognized risk factor for psychological distress in young people. The authors do not overinterpret the result, but several explanations are plausible. Orphaned adolescents in HIV care programs may be more likely to be in stable guardian arrangements, to have longer and better-supported engagement with clinic services, or to benefit from peer and community support structures that buffer against distress. Alternatively, the finding could reflect unmeasured confounding, such as differences in socioeconomic circumstances, disclosure experiences, or family dynamics that the survey did not capture. Cross-sectional data of this kind can identify patterns but cannot explain them, and the orphanhood result is best read as a prompt for further research rather than a settled conclusion.

What the study does establish firmly is the scale of unmet need. Mental health disorders among adolescents and young people living with HIV are not merely a quality-of-life issue; they have direct clinical consequences. Depression and anxiety are consistently associated with poorer adherence to antiretroviral therapy, more frequent interruptions in care, and worse virological outcomes. In a cohort where more than two-thirds of patients screen positive for depression, the risk that psychological distress undermines the very treatment keeping them alive is substantial. Yet mental health services in much of sub-Saharan Africa remain scarce, concentrated in urban specialist facilities, and largely separate from the HIV care cascade that these young people already navigate. A teenager may attend the same clinic every three months for years without anyone asking a single structured question about their mood, sleep, trauma history, or substance use.

The authors argue that the practical response is to embed mental health screening and referral pathways directly into adolescent HIV services, rather than waiting for distress to announce itself. The AdoMinds study, within which this survey was nested, is an implementation study, meaning its explicit goal is to test how psychological interventions can be woven into routine care in real-world clinics. The prevalence data collected here serve as the baseline evidence for that effort: they demonstrate that the problem is common enough, and the risk factors identifiable enough, that systematic screening is justified. Because stigma emerged as the one factor clearly associated with higher odds of disorder, interventions that reduce stigma, whether through peer support groups, community education, or clinic-based counseling, may deliver psychological benefits alongside their social ones.

The study’s limitations are worth keeping in view. It was conducted at a single hospital in Lusaka, so the findings may not generalize to rural Zambia or to other countries, and the cross-sectional design means the associations reported cannot establish causation. Screening tools identify probable cases rather than confirmed diagnoses, so the true clinical prevalence could differ from the figures reported. Even so, the consistency of the depression and anxiety findings with earlier research from the region, and the size and completeness of the cohort, lend the results considerable weight. For the 416 young people who took part, and the hundreds of thousands like them across eastern and southern Africa, the message of the study is unambiguous: surviving HIV is no longer the hardest part. The harder task, now measurable and now visible, is ensuring that the minds of a generation raised with the virus are cared for as diligently as their immune systems have been.

Subject of Research: Prevalence and correlates of common mental health disorders among adolescents and young people living with HIV receiving antiretroviral therapy in Lusaka, Zambia

Article Title: Prevalence of common mental health disorders and associated factors among adolescents and young people living with HIV in Lusaka, Zambia

Article References: Shanaube, K., Simwanza, S., Tapisha, B., Ngosa, D., Sigande, L., Mshanga, I., Mulungu, C., Mwenya, O., Mwamba, J. G., Moyo, L. T., Moyo, C., Mbambara, T., Lungu, G., Mbewe, M., Moonga, G., & Maila, B. (2026). Prevalence of common mental health disorders and associated factors among adolescents and young people living with HIV in Lusaka, Zambia. PLOS Mental Health, 3(10), e0000710. https://doi.org/10.1371/journal.pmen.0000710

Image Credits: AI Generated

DOI: 10.1371/journal.pmen.0000710

Keywords: HIV, mental health, adolescents, Zambia, depression, anxiety, stigma, antiretroviral therapy, cross-sectional study, Lusaka, screening, orphanhood