{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T19:20:26Z","timestamp":1780514426200,"version":"3.54.1"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["AI128792"],"award-info":[{"award-number":["AI128792"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec013\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>Adolescent girls are at high risk for depression and human immunodeficiency virus (HIV) acquisition. Poor mental health can increase vulnerability to risky sexual behaviours. Therefore, this study aims to determine the prevalence of depressive symptomology and explore the convergence of HIV risk factors with depressive symptoms amongst cis-gender adolescent girls and young women (AGYW) in rural KwaZulu-Natal (KZN) and peri-urban Western Cape (WC) communities in South Africa.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec014\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Cross-sectional survey data from two sites in South Africa was used - the rural Vulindlela community in KZN and the peri-urban Philippi East community in the WC. Study inclusion criteria included being sexually active with at least one male partner, and not planning to relocate in the next 12 months. The PHQ-9 scale was used to determine depressive symptomology, a socio-behavioural questionnaire was used to determine sexual behaviours, odds ratios and confidence intervals derived from logistic regression models were used to explore the associations between depressive symptomology and socio-behavioural factors associated with HIV acquisition.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec015\">\n<jats:title>Results<\/jats:title>\n<jats:p>The cohort consisted of 274 adolescent girls, 38.6% from the WC site and 61.4% from the KZN site. Overall, 15.7% (43\/274) of AGYW reported depressive symptoms. Participants from the peri-urban WC site were more likely to experience depressive symptoms (OR 8.34; 95% CI 3.80\u201318.30) compared to those living in the rural KZN site. Depressive symptoms were less likely to occur in adolescent girls between the ages of 14 to 17 as compared to those between the ages of 18 and 19 (OR 0.44; 95% CI 0.22\u20130.90). Socio-behavioural HIV risk factors associated with depressive symptoms include: age disparate relationships (OR 2.98; 95% CI 1.52\u20135.84), high (four or more) numbers of lifetime partners (OR 8.15; 95% CI 3.60\u201318.45) and engaging in sex under the influence of alcohol (OR 2.58; 95% CI 1.32\u20135.04). Multivariate analysis showed that participants from the WC site (AOR 5.25; 95% CI 1.95\u201314.17) had higher odds of experiencing depressive symptoms while participants with four or more lifetime partners (AOR 3.46; 95% CI 1.24\u20139.60) were at higher odds of experiencing depressive symptoms.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec016\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>In this cross-sectional study, depressive symptomology is associated with certain HIV risk behaviours. Longitudinal studies are required to test the causal relationship between depression and HIV acquisition and to better understand the geospatial differences observed.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0317732","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T18:32:00Z","timestamp":1738175520000},"page":"e0317732","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Exploring the relationship between established HIV risk factors and depressive symptoms amongst young women without HIV in two sites in South Africa"],"prefix":"10.1371","volume":"20","author":[{"given":"Zanenhlanhla","family":"Gumbi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Mehou-Loko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindi","family":"Masson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makhosazana","family":"Mdladla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nokuthula","family":"Maphumulo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo-Ann","family":"Passmore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanele","family":"Mbeje","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda Gail","family":"Bekker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Disebo","family":"Potloane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Jaspan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Radzey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Abrahams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rushil","family":"Harryparsad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Mkhize","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8503-4127","authenticated-orcid":true,"given":"Hilton","family":"Humphries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"pone.0317732.ref001","volume-title":"Global HIV & AIDS statistics - fact sheet","author":"Joint United Nations Programme on HIV\/AIDS (UNAIDS)","year":"2024"},{"key":"pone.0317732.ref002","author":"World Health Organization (WHO)","year":"2024"},{"issue":"3","key":"pone.0317732.ref003","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/j.1469-7610.2007.01824.x","article-title":"Promoting child and adolescent mental health in low and middle income countries","volume":"49","author":"V Patel","year":"2008","journal-title":"J Child Psychol Psychiatry"},{"issue":"11","key":"pone.0317732.ref004","doi-asserted-by":"crossref","first-page":"e1001547","DOI":"10.1371\/journal.pmed.1001547","article-title":"Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010","volume":"10","author":"AJ Ferrari","year":"2013","journal-title":"PLoS Med"},{"issue":"4","key":"pone.0317732.ref005","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1503\/jpn.150205","article-title":"Why is depression more prevalent in women?","volume":"40","author":"PR Albert","year":"2015","journal-title":"J Psychiatry Neurosci"},{"issue":"1","key":"pone.0317732.ref006","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s12939-019-0996-0","article-title":"Subjective social status and inequalities in depressive symptoms: a gender-specific decomposition analysis for South Africa","volume":"18","author":"C Mutyambizi","year":"2019","journal-title":"Int J Equity Health"},{"issue":"5","key":"pone.0317732.ref007","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1093\/aje\/kwz238","article-title":"Depression and Incident HIV in adolescent girls and young women in HIV prevention trials network 068: targets for prevention and mediating factors","volume":"189","author":"DE Goin","year":"2019","journal-title":"Am J Epidemiol"},{"issue":"7","key":"pone.0317732.ref008","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1177\/0956462420920423","article-title":"Depression and HIV risk behaviors among adolescent girls and young women seeking family planning services in Western Kenya","volume":"31","author":"A Larsen","year":"2020","journal-title":"Int J STD AIDS"},{"issue":"1","key":"pone.0317732.ref009","doi-asserted-by":"crossref","first-page":"40","DOI":"10.7196\/SAMJ.2020.v111i1.14520","article-title":"Substance use and depressive and anxiety symptoms among out-of-school adolescent girls and young women in Cape Town, South Africa","volume":"111","author":"CP Bonner","year":"2020","journal-title":"S Afr Med J"},{"issue":"6 Suppl","key":"pone.0317732.ref010","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1016\/j.jadohealth.2014.08.020","article-title":"The association between social support and mental health among vulnerable adolescents in five cities: findings from the study of the well-being of adolescents in vulnerable environments","volume":"55","author":"Y Cheng","year":"2014","journal-title":"J Adolesc Health"},{"issue":"4","key":"pone.0317732.ref011","doi-asserted-by":"crossref","first-page":"e0195369","DOI":"10.1371\/journal.pone.0195369","article-title":"Childhood traumas as a risk factor for HIV-risk behaviours amongst young women and men living in urban informal settlements in South Africa: a cross-sectional study","volume":"13","author":"A Gibbs","year":"2018","journal-title":"PLoS One"},{"issue":"7","key":"pone.0317732.ref012","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1080\/17441692.2016.1214281","article-title":"An exploratory analysis of factors associated with depression in a vulnerable group of young people living in informal settlements in South Africa","volume":"13","author":"A Gibbs","year":"2018","journal-title":"Glob Public Health"},{"issue":"8","key":"pone.0317732.ref013","doi-asserted-by":"crossref","first-page":"e0221053","DOI":"10.1371\/journal.pone.0221053","article-title":"Prevalence and correlates of depression and anxiety symptoms among out-of-school adolescent girls and young women in Tanzania: a cross-sectional study","volume":"14","author":"E Kuringe","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"pone.0317732.ref014","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12981-019-0237-z","article-title":"Impact of HIV testing and treatment services on risky sexual behaviour in the uMgungundlovu District, KwaZulu-Natal, South Africa: a cross-sectional study","volume":"16","author":"G George","year":"2019","journal-title":"AIDS Res Ther"},{"issue":"sed-3","key":"pone.0317732.ref015","first-page":"54","article-title":"Social complexity of drug abuse, gangsterism and crime in Cape Flats\u2019 schools, Western Cape.","author":"R Chetty","year":"2015","journal-title":"Acta Criminologica"},{"key":"pone.0317732.ref016","article-title":"The PHQ-9 validity of a brief depression severity measure","author":"K Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"pone.0317732.ref017","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.jad.2014.06.003","article-title":"Validity of the Patient Health Questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa","volume":"167","author":"R Cholera","year":"2014","journal-title":"J Affect Disord"},{"issue":"5","key":"pone.0317732.ref018","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/j.1751-7176.2010.00264.x","article-title":"Comparison of statistical approaches to evaluate factors associated with metabolic syndrome","volume":"12","author":"D Fekedulegn","year":"2010","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"pone.0317732.ref019","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/1471-2288-3-21","article-title":"Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio","volume":"3","author":"AJD Barros","year":"2003","journal-title":"BMC Med Res Methodol"},{"key":"pone.0317732.ref020","author":"SAS Institute Inc","year":"2023"},{"key":"pone.0317732.ref021","doi-asserted-by":"crossref","first-page":"986531","DOI":"10.3389\/fpubh.2022.986531","article-title":"The prevalence of probable depression and probable anxiety, and associations with adverse childhood experiences and socio-demographics: a national survey in South Africa","volume":"10","author":"A Craig","year":"2022","journal-title":"Front Public Health"},{"issue":"Suppl 1","key":"pone.0317732.ref022","doi-asserted-by":"crossref","first-page":"A179.3","DOI":"10.1136\/sextrans-2011-050108.192","article-title":"P1-S5.14\u2005Risk factors associated with HIV acquisition: a comparative analysis of older and younger women who participated in the MDP301 trial in Johannesburg","volume":"87","author":"S Delany-Moretlwe","year":"2011","journal-title":"Sex Transm Infect"},{"issue":"7","key":"pone.0317732.ref023","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1007\/s10461-015-1002-5","article-title":"Risk Factors for HIV Acquisition in high risk women in a generalised epidemic setting","volume":"19","author":"N Naicker","year":"2015","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0317732.ref024","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1363\/48e8316","article-title":"Older sexual partners and adolescent females\u2019 mental health","volume":"48","author":"A Meier","year":"2016","journal-title":"Perspect Sex Reprod Health"},{"issue":"6","key":"pone.0317732.ref025","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.jadohealth.2013.10.203","article-title":"Social and emotional adjustment following early pregnancy in young Australian women: a comparison of those who terminate, miscarry, or complete pregnancy","volume":"54","author":"CA Olsson","year":"2014","journal-title":"J Adolesc Health"},{"key":"pone.0317732.ref026","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1186\/s12889-015-2179-2","article-title":"Strengthening HIV surveillance in the antiretroviral therapy era: rationale and design of a longitudinal study to monitor HIV prevalence and incidence in the uMgungundlovu District, KwaZulu-Natal, South Africa","volume":"15","author":"ABM Kharsany","year":"2015","journal-title":"BMC Public Health"},{"issue":"8","key":"pone.0317732.ref027","doi-asserted-by":"crossref","first-page":"e427","DOI":"10.1016\/S2352-3018(18)30104-8","article-title":"Community-based HIV prevalence in KwaZulu-Natal, South Africa: results of a cross-sectional household survey","volume":"5","author":"ABM Kharsany","year":"2018","journal-title":"Lancet HIV"},{"issue":"7","key":"pone.0317732.ref028","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1080\/09540121.2020.1861179","article-title":"\u201cYou are not alone\u201d: a qualitative study to explore barriers to ART initiation and implications for a proposed community-based youth treatment club among young adults newly diagnosed with HIV in South Africa","volume":"33","author":"MF Nardell","year":"2021","journal-title":"AIDS Care"},{"issue":"1","key":"pone.0317732.ref029","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1186\/s13063-020-04760-x","article-title":"Combined HIV Adolescent Prevention Study (CHAPS): comparison of HIV pre-exposure prophylaxis regimens for adolescents in sub-Saharan Africa-study protocol for a mixed-methods study including a randomised controlled trial","volume":"21","author":"S Nash","year":"2020","journal-title":"Trials"},{"issue":"2","key":"pone.0317732.ref030","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1177\/1748895817750436","article-title":"New social bandits? a comparative analysis of gangsterism in the Western and Eastern Cape provinces of South Africa","volume":"19","author":"T Petrus","year":"2018","journal-title":"Criminol & Criminal Just"},{"issue":"2b","key":"pone.0317732.ref031","doi-asserted-by":"crossref","first-page":"71","DOI":"10.7196\/SAJCH.2018.v12i2b.1509","article-title":"Rural-urban differences in the prevalence and predictors of depression among adolescents in South Africa","volume":"12","author":"CK Ajaero","year":"2018","journal-title":"S Afr J CH"},{"issue":"3","key":"pone.0317732.ref032","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1080\/17450128.2016.1198854","article-title":"High prevalence of depression symptomology among adolescents in Soweto, South Africa associated with being female and cofactors relating to HIV transmission","volume":"11","author":"B Barhafumwa","year":"2016","journal-title":"Vulnerable Child Youth Stud"},{"issue":"6","key":"pone.0317732.ref033","doi-asserted-by":"crossref","first-page":"e25938","DOI":"10.1002\/jia2.25938","article-title":"Women of worth: the impact of a cash plus intervention to enhance attendance and reduce sexual health risks for young women in Cape Town, South Africa.","volume":"25","author":"T Naledi","year":"2022","journal-title":"J Int AIDS Soc"},{"issue":"3","key":"pone.0317732.ref034","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1177\/1468018108095633","article-title":"Urbanization, social capital and mental health","volume":"8","author":"K Mckenzie","year":"2008","journal-title":"Glob Soc Pol"},{"issue":"4","key":"pone.0317732.ref035","article-title":"The South African Stress and Health (SASH) Study: 12-month and lifetime prevalence of common mental disorders","volume":"98","author":"A Herman","year":"2008","journal-title":"S Afr Med J"},{"key":"pone.0317732.ref036","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12991-015-0054-2","article-title":"Risky HIV sexual behaviour and depression among University of Nairobi students","volume":"14","author":"CJ Othieno","year":"2015","journal-title":"Ann Gen Psychiatry"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0317732","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T18:32:14Z","timestamp":1738175534000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0317732"}},"subtitle":[],"editor":[{"given":"Denise","family":"Evans","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0317732","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]}}}