Perceived risk of HIV infection and mental health in rural Malawi

BACKGROUND The emerging literature on HIV/AIDS and mental health in sub-Saharan Africa stresses that HIV-positive status is significantly related to mental illness. However, the literature has neglected an equally important concern in contexts where HIV is highly prevalent, namely, whether and how an HIV/AIDS epidemic affects the mental well-being of individuals in the general population, regardless of their HIV status. OBJECTIVE This paper adopts an innovative perspective for addressing this public mental health concern in sub-Saharan Africa. It examines the relationship between perceived risk of HIV infection and mental health in rural Malawi and evaluates four psychosocial mechanisms that potentially influence the relationship, including (1) worry about being infected and fear of death, (2) health and economic conditions, (3) social support, and (4) the stigma of HIV/AIDS. METHODS The analysis uses data from the Malawi Longitudinal Study of Families and Health collected in 2006 and 2008. Random-effects and fixed-effects linear regression models are used to predict mental health status (measured by the SF-12 Mental Component Summary scale). RESULTS Regardless of HIV status, the perceived risk of infection has a strong negative relationship with mental health outcomes. This relationship is in part associated with the individual's health, fear of death (or pessimism about survival), and marital/cohabitation status CONCLUSIONS Mental health concerns in the context of an HIV/AIDS epidemic need to be addressed not only for HIV-infected individuals, but also for those who are not infected but are uncertain and fearful about being infected and about the ensuing life changes.