{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T10:05:59Z","timestamp":1792663559883,"version":"4.5.0"},"reference-count":47,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2020,3,27]],"date-time":"2020-03-27T00:00:00Z","timestamp":1585267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["MR\/M014290\/1"],"award-info":[{"award-number":["MR\/M014290\/1"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Young women in South Africa remain most at risk for HIV infection. Several factors contribute to the high incidence rate in this population, including hazardous drinking and depression. Addressing common mental disorders (CMDs) such as depression and alcohol use disorders is key to effective HIV treatment. We explored the experiences and perceptions of young South African women on antiretroviral therapy (ART) of a lay health worker (LHW)-delivered psychosocial intervention based on motivational interviewing (MI) and problem-solving therapy (PST) to reduce heavy drinking and depression. We conducted 27 in-depth interviews with young women (aged 18\u201335) recruited from 16 primary care clinics in the Western Cape province of South Africa. Discussion topics included young women\u2019s life experiences leading to their enrollment in the program, their perceptions of the counselling sessions and the quality of their interaction with the counsellor. Qualitative data were analyzed using a framework approach. The findings highlighted the impact adverse life experiences and stressful life circumstances have on young women\u2019s use of alcohol and symptoms of depression and the effect this has on ART adherence. The findings suggest that women found the intervention components that helped them develop strategies for coping with their past experiences, managing current life stressors, and regulating negative thoughts and emotions most beneficial. Taken together, these findings confirm the acceptability of LHW-delivered MI-PST counselling for this population, but suggest that the relevance of the MI-PST intervention for this highly vulnerable population could be further enhanced by including a focus on psychological trauma.<\/jats:p>","DOI":"10.3390\/ijerph17072249","type":"journal-article","created":{"date-parts":[[2020,3,31]],"date-time":"2020-03-31T10:29:38Z","timestamp":1585650578000},"page":"2249","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Young South African Women on Antiretroviral Therapy Perceptions of a Psychological Counselling Program to Reduce Heavy Drinking and Depression"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5535-2458","authenticated-orcid":false,"given":"Petal","family":"Petersen Williams","sequence":"first","affiliation":[{"name":"Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa"},{"name":"Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie","family":"Brooke-Sumner","sequence":"additional","affiliation":[{"name":"Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa"},{"name":"Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Joska","sequence":"additional","affiliation":[{"name":"HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Kruger","sequence":"additional","affiliation":[{"name":"Western Cape Department of Health., 8 Riebeeck Street, Cape Town 8000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9012-3308","authenticated-orcid":false,"given":"Lieve","family":"Vanleeuw","sequence":"additional","affiliation":[{"name":"Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6816-2116","authenticated-orcid":false,"given":"Siphokazi","family":"Dada","sequence":"additional","affiliation":[{"name":"Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Sorsdahl","sequence":"additional","affiliation":[{"name":"Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0235-6716","authenticated-orcid":false,"given":"Bronwyn","family":"Myers","sequence":"additional","affiliation":[{"name":"Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa"},{"name":"Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.2174\/1874613601610010034","article-title":"HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities","volume":"10","author":"Kharsany","year":"2016","journal-title":"Open AIDS J."},{"key":"ref_2","unstructured":"World Health Organisation (2019, May 20). Number of Women Living with HIV. Available online: https:\/\/www.who.int\/gho\/hiv\/epidemic_status\/cases_adults_women_children_text\/en\/."},{"key":"ref_3","unstructured":"UNAIDS (2019, September 06). \u2018Women and HIV\u2014A Spotlight on Adolescent Girls and Young Women\u2019. Available online: https:\/\/www.unaids.org\/en\/resources\/documents\/2019\/women-and-hiv."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/j.socscimed.2012.06.020","article-title":"Gender-based violence and HIV sexual risk behavior: Alcohol use and mental health problems as mediators among women in drinking venues, Cape Town","volume":"75","author":"Pitpitan","year":"2012","journal-title":"Soc. Sci. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.drugpo.2015.10.006","article-title":"A qualitative study of methamphetamine initiation in Cape Town, South Africa","volume":"30","author":"Hobkirk","year":"2016","journal-title":"Int. J. Drug Policy"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e25114","DOI":"10.1002\/jia2.25114","article-title":"Linkage to care, mobility and retention of HIV-positive postpartum women in antiretroviral therapy services in South Africa","volume":"21","author":"Phillips","year":"2018","journal-title":"J. Int. AIDS Soc."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Floyd, S., Ayles, H., Schaap, A., Shanaube, K., MacLeod, D., Phiri, M., Griffith, S., Bock, P., Beyers, N., and Fidler, S. (2018). Towards 90-90: Findings after two years of the HPTN 071 (PopART) cluster-randomized trial of a universal testing-and-treatment intervention in Zambia. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0197904"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1186\/s12889-018-5208-0","article-title":"Progress towards the UNAIDS 90-90-90 goals by age and gender in a rural area of KwaZulu-Natal, South Africa: A household-based community cross-sectional survey","volume":"18","author":"Huerga","year":"2018","journal-title":"BMC Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1089\/apc.2018.0320","article-title":"Recent Interventions to Improve Retention in HIV Care and Adherence to Antiretroviral Treatment Among Adolescents and Youth: A Systematic Review","volume":"33","author":"Casale","year":"2019","journal-title":"AIDS Patient Care STDS"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1177\/008124630803800304","article-title":"Mental Disorder in People Living with HIV\/Aids in South Africa","volume":"38","author":"Freeman","year":"2008","journal-title":"S. Afr. J. Psychol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1089\/apc.2007.0102","article-title":"Common mental disorders among HIV-infected individuals in South Africa: Prevalence, predictors, and validation of brief psychiatric rating scales","volume":"22","author":"Myer","year":"2008","journal-title":"AIDS Patient Care STDS"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.drugpo.2015.12.019","article-title":"\"Not on the agenda\": A qualitative study of influences on health services use among poor young women who use drugs in Cape Town, South Africa","volume":"30","author":"Myers","year":"2016","journal-title":"Int. J. Drug Policy"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3209","DOI":"10.1007\/s10461-016-1617-1","article-title":"Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa","volume":"21","author":"Watt","year":"2017","journal-title":"AIDS Behav."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/s10461-013-0587-9","article-title":"Hazardous and harmful use of alcohol and\/or other drugs and health status among South African patients attending HIV clinics","volume":"18","author":"Kader","year":"2014","journal-title":"AIDS Behav."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"401","DOI":"10.2147\/PPA.S55547","article-title":"Alcohol use, antiretroviral therapy adherence, and preferences regarding an alcohol-focused adherence intervention in patients with human immunodeficiency virus","volume":"8","author":"Kekwaletswe","year":"2014","journal-title":"Patient Prefer. Adherence"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1080\/09540121.2014.951306","article-title":"Understanding the experience and manifestation of depression in people living with HIV\/AIDS in South Africa","volume":"27","author":"Andersen","year":"2015","journal-title":"AIDS Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S78","DOI":"10.1080\/09540121.2014.906558","article-title":"Patterns and predictors of antiretroviral therapy use among alcohol drinkers at HIV clinics in Tshwane, South Africa","volume":"26","author":"Kekwaletswe","year":"2014","journal-title":"AIDS Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"123","DOI":"10.2989\/AJAR.2009.8.2.1.853","article-title":"The mental health of people living with HIV\/AIDS in Africa: A systematic review","volume":"8","author":"Brandt","year":"2009","journal-title":"Afr. J. AIDS Res. AJAR"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"iv27","DOI":"10.1093\/heapol\/czw169","article-title":"Interventions and approaches to integrating HIV and mental health services: A systematic review","volume":"32","author":"Chuah","year":"2017","journal-title":"Health Policy Plan."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"21585","DOI":"10.7448\/IAS.20.1.21585","article-title":"Integrating HIV and substance use services: A systematic review","volume":"20","author":"Haldane","year":"2017","journal-title":"J. Int. AIDS Soc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1093\/heapol\/czz085","article-title":"Mental health system costs, resources and constraints in South Africa: A national survey","volume":"34","author":"Docrat","year":"2019","journal-title":"Health Policy Plan."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e77","DOI":"10.1017\/S204579601900074X","article-title":"Reflections on the next ten years of research, policy and implementation in global mental health","volume":"29","author":"Lund","year":"2020","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_23","unstructured":"South African National Department of Health (2013). National Mental Health Policy Framework and Strategic Plan, 2013\u20132020."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1186\/s13063-018-2568-9","article-title":"Comparing dedicated and designated models of integrating mental health into chronic disease care: Study protocol for a cluster randomized controlled trial","volume":"19","author":"Myers","year":"2018","journal-title":"Trials"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1080\/09540121.2016.1211242","article-title":"\u201cIn this thing I have everything I need\u201d: Perceived acceptability of a brief alcohol-focused intervention for people living with HIV","volume":"29","author":"Myers","year":"2017","journal-title":"AIDS Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s13011-015-0042-1","article-title":"The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial","volume":"10","author":"Sorsdahl","year":"2015","journal-title":"Subst. Abus. Treat. Prev. Policy"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Van der Westhuizen, C., Myers, B., Malan, M., Naledi, T., Roelofse, M., Stein, D.J., Lahri, S., and Sorsdahl, K. (2019). Implementation of a screening, brief intervention and referral to treatment programme for risky substance use in South African emergency centres: A mixed methods evaluation study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0224951"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"h1258","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"Moore","year":"2015","journal-title":"BMJ"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_30","unstructured":"Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B., and Monteiro, M.G. (2001). The Alcohol Use Disorders Identification Test (AUDIT): Guidelines for Use in Primary Care, World Health Organization (WHO)."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/014662167700100306","article-title":"The CES-D scale. A self-report depression scale for research in the general population","volume":"1","author":"Radloff","year":"1977","journal-title":"Appl. Psychol. Meas."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e024277","DOI":"10.1136\/bmjopen-2018-024277","article-title":"Community health worker-delivered counselling for common mental disorders among chronic disease patients in South Africa: A feasibility study","volume":"9","author":"Myers","year":"2019","journal-title":"BMJ Open"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Gale, N.K., Heath, G., Cameron, E., Rashid, S., and Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res. Methodol., 13.","DOI":"10.1186\/1471-2288-13-117"},{"key":"ref_34","unstructured":"Lacey, A., and Luff, D. (2001). Trent Focus for Research and Development in Primary Health Care: Qualitative Data Analysis, Trent Focus Group."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.2147\/PPA.S175852","article-title":"Development of a trauma-informed substance use and sexual risk reduction intervention for young South African women","volume":"12","author":"Myers","year":"2018","journal-title":"Patient Prefer. Adherence"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.drugpo.2018.11.004","article-title":"\u201cSomeone who is in this thing that I am suffering from\u201d: The role of peers and other facilitators for task sharing substance use treatment in South African HIV care","volume":"70","author":"Magidson","year":"2019","journal-title":"Int. J. Drug Policy"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1089\/apc.2008.0022","article-title":"Coping strategies and patterns of alcohol and drug use among HIV-infected patients in the United States Southeast","volume":"22","author":"Pence","year":"2008","journal-title":"AIDS Patient Care STDS"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.2147\/PPA.S176356","article-title":"Patient preferences for the integration of mental health counseling and chronic disease care in South Africa","volume":"12","author":"Myers","year":"2018","journal-title":"Patient Prefer. Adherence"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.evalprogplan.2018.02.007","article-title":"Development of a coping intervention to improve traumatic stress and HIV care engagement among South African women with sexual trauma histories","volume":"68","author":"Sikkema","year":"2018","journal-title":"Eval. Program Plan."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1007\/s10461-017-2013-1","article-title":"Improving AIDS Care After Trauma (ImpACT): Pilot Outcomes of a Coping intervention Among HIV-Infected Women with Sexual Trauma in South Africa","volume":"22","author":"Sikkema","year":"2018","journal-title":"AIDS Behav."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e024776","DOI":"10.1136\/bmjopen-2018-024776","article-title":"A trauma-informed substance use and sexual risk reduction intervention for young South African women: A mixed-methods feasibility study","volume":"9","author":"Myers","year":"2019","journal-title":"BMJ Open"},{"key":"ref_42","unstructured":"Joint United Nations Programme on HIV\/AIDS (UNAIDS) (2015). Empower Young Women and Adolescent Girls: Fast Tracking the End of the AIDS Epidemic in Africa, UNAIDS."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"143","DOI":"10.2147\/SAR.S81535","article-title":"Benefits of peer support groups in the treatment of addiction","volume":"7","author":"Tracy","year":"2016","journal-title":"Subst. Abus. Rehabil."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.genhosppsych.2010.10.002","article-title":"Efficacy of peer support interventions for depression: A meta-analysis","volume":"33","author":"Pfeiffer","year":"2011","journal-title":"Gen Hosp Psychiatry"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1007\/s10461-011-9963-5","article-title":"Are peer interventions for HIV efficacious? A systematic review","volume":"15","author":"Simoni","year":"2011","journal-title":"AIDS Behav."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Van Ginneken, N., Tharyan, P., Lewin, S., Rao, G.N., Meera, S.M., Pian, J., Chandrashekar, S., and Patel, V. (2013). Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database Syst. Rev., CD009149.","DOI":"10.1002\/14651858.CD009149.pub2"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1146\/annurev-clinpsy-032816-045217","article-title":"Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries","volume":"13","author":"Singla","year":"2017","journal-title":"Annu. Rev. Clin. Psychol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/7\/2249\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:12:08Z","timestamp":1760173928000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/7\/2249"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,27]]},"references-count":47,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2020,4]]}},"alternative-id":["ijerph17072249"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17072249","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,27]]}}}