Psychosocial Factors affecting Self-Esteem among Youth Living with HIV in Namibia

Overview: Findings from this study, based on 188 youth living with HIV in Namibia, revealed that having grandparents as caregivers, HIV knowledge, adherence to HIV treatment, HIV disclosure, and having lower levels of depressive symptomatology were associated with higher levels self-esteem. Findings point to the expansion of preventative youth-focused HIV interventions.Proposal text: Worldwide, the protection and promotion of human rights are critical catalysts in preventing the spread and mitigating the impacts of HIV (United Nations Human Rights Office of the High Commissioner, 2021). Sub-Saharan Africa (SSA) accounts for over 20% of the estimated 1.8 billion adolescents and young adults who are infected globally (Somefun et al., 2021). Within SSA, Namibia is one of the most deeply impacted countries where, as of 2020 approximately 12% of adults were living with HIV (UNAIDS, 2022); and HIV remains the leading cause of death (U.S. Department of State, 2020). A myriad of factors are associated with vulnerabilities related to HIV among youth including depression (Kalomo et al., 2020), anxiety (Besthorn et al., 2018), bullying (Ashaba, 2018), poor adherence to medication (Bachman et al., 2018), and HIV-related stigmatization (Kalomo, 2017).

It is widely recognized that HIV and human rights are inextricably linked, partly due to health inequities faced by vulnerable populations, including youth (Avert, 2019). Despite this recognition, to date, no studies have examined impacts of various psychosocial factors (i.e., HIV transmission literacy, HIV medication adherence, HIV [non-]disclosure, and self-esteem) among youth living with HIV in Namibia

Methods
For this study, 188 youth living with HIV were recruited from a healthcare center in Namibia to complete a structured survey. The survey included The Case Adherence Index (Mannheimer et al, 2006), the Major Depression subscale of the Revised Child Anxiety and Depression Scale (Chorpita et al., 2015), The Rosenberg Self-Esteem Scale (Rosenberg, 1965), as well as questions developed to estimate levels of knowledge related to HIV transmission, and a single item to measure disclosure of HIV status. Questions related to socio-demographic variables were also included.

Results
The average age in the sample was 16 years, ranging from 10 to 21. About 63% of the sample were female, 15% percent lived with grandparents, 22% had not disclosed their status to anybody, and more than one-third experienced food insecurity. A hierarchical regression analysis revealed that higher levels of HIV transmission literacy ( = .348, p < .05) and adherence to treatment medication ( = .261, p < .01) were both positively and significantly associated with self-esteem. Conversely, HIV status disclosure ( = -1.754, p < .05) had a significant negative effect on self-esteem in this sample. Higher levels of depressive symptoms were significantly related to lower levels of self-esteem ( = -.277, p < .001). Finally, having grandparents as primary caregivers ( = 2.157, p < .05) had a positive effect on self-esteem.

Conclusion
This study found that youth living with HIV who reported higher levels of HIV transmission literacy, greater adherence to HIV treatment, and had grandparents as primary caregivers had higher self-esteem. Whereas disclosure of HIV status and higher levels of depressive symptoms had negative effects on self-esteem. These findings call for the development and expansion of more culturally appropriate, preventative, and youth-focused HIV interventions.