Young key population groups are more likely to suffer from mental health disorder, engage in risky sexual behaviour, and are at higher risk of HIV infection.
Depression is an ever-increasing epidemic. According to the World Health Organisation (WHO), more than 300 million people of all ages suffer from depression, and it is also the leading cause of disability worldwide and a major contributor to the overall global burden of disease.
Young key population groups (YKP) are identified as gender minority youth (transgender or gender non-conforming), sexual minority youth (homosexual or bisexual youth), runaway and homeless youth, detained or incarcerated youth, as well as youth involved in sex work. There are several risk factors to consider when attempting to understand why YKPs are more likely to be vulnerable to these challenges, in comparison to their typical, heterosexual and cisgender youth counterparts.
YKPs are more likely to be subjected to experiences of victimisation, family conflict, family or peer rejection, social isolation, poverty and housing instability. This is because there is still a great deal of stigma and ignorance in society surrounding sexual and gender minorities, as well as society’s discriminatory perception of incarceration and youth that engage in transactional sex. Shame, low self-worth, substance abuse (as self-medication), as well as anxiety and depression, can be directly associated with these societal prejudices.
Ironically, these prejudices and alienating attitudes in society further propagate the prevalence of substance abuse, post-traumatic stress disorder and the need for sex work or other forms of transactional sex used amongst YKPs to survive. And this, in turn, further amplifies the incidents of mental health disorders in YKPs too.
Studies have consistently reported higher rates of mental health disorders among this demographic, as well as a two-fold excess in suicide attempts. In one study of 515 gender minority persons, more than 60% reported having depression. The WHO reports that close to 800 000 people die from suicide each year and that suicide is the second cause of death in all 15 to 29-year-olds.
How does this relate to HIV? YKPs are more likely to engage in risky sexual behaviour as well as a higher chance of using an HIV infected needle when injecting drugs, putting them at more risk. YKPs are also more likely to engage in transactional sex, putting them further at risk.
“The patterning of the HIV epidemic within YKPs highlights disproportionate burden by mental disorders in these populations.” Mutumba, M. Harper, G. (2015, February 26). Mental health and support among young key populations: an ecological approach to understanding and intervention. Journal of the International Aids Society p.1/17
Furthermore, depression, anxiety and the fear of stigma can also have a detrimental effect on ARV adherence for those YKPs that are HIV-positive. Adversely, HIV may affect central nervous system structures involved in the regulation of emotion and behaviour increasing the risk of mental health disorders among the HIV-positive youth.
Mental health can be effectively treated through psychological treatments such as cognitive behavioural therapy and other psychotherapeutic modalities. They can also be treated by anti-depressants, but these, as well as the therapies, are not available to the average person in sub-Saharan Africa and this is a hindrance to the elimination of HIV in this region. Scope for availing mental, neurological and substance use disorders to more youth in the region would do much to lower the scourge of HIV.
Bruce J. Little is a contributing writer for Anova Health Institute. These are his views, which may or may not reflect those of Anova and affiliates.