# Mental health challenges among adolescents and young adults with perinatally acquired HIV: Key findings from the I’mPossible program in India

## TL;DR

Adolescents and young adults with HIV in India face high rates of mental health issues, linked to stigma, family loss, and care transition challenges.

## Contribution

This study identifies key mental health risk factors and experiences among perinatally acquired HIV youth in India using mixed methods.

## Key findings

- 62.7% of participants screened positive for at least one mental health disorder.
- Loss of both parents was associated with increased anxiety risk.
- Themes like stigma, disclosure fears, and ART adherence challenges emerged as key mental health influences.

## Abstract

Adolescents and young adults with perinatally acquired HIV (APHIV) face elevated risk for common mental health disorders (CMD). To understand determinants of CMD among APHIV in India, we conducted a mixed methods study by screening for depression and anxiety among a cohort of APHIV in southern India. Between March-June 2023, we administered a cross-sectional survey to participants in the I’mPossible Fellowship, a peer-led mentorship program. We incorporated participatory research principles, wherein trained peer mentors (youth investigators) iteratively designed and administered focus group discussions and screening tools for depression (Patient Health Questionnaire-9: PHQ-9), anxiety (Generalized Anxiety Disorder-7: GAD-7), resilience (Child Youth Resilience Measure-Revised – CYRM-R), and an abbreviated HIV stigma Scale. We used multivariable regression to identify correlates of positive CMD screens and inductively analyzed focus group transcripts. Among 185 APHIV survey participants, mean age was 18.6 years (SD 3.5 years); 63.2% were male. Most (91.9%) had lost one or both parents, and 43.2% lived in child-care institutions (CCIs). Majority (90.4%) were virally suppressed (VL < 150 copies/mL). A high proportion screened positive (severity category of mild and above) for at least one CMD (62.7%), depression alone (25.9%), GAD alone (7%), or both (29.7%). Corresponding prevalence for moderate or severe categories were 18.9%, 14.6%, 9.7%, and 5.4%, respectively. Externalized stigma was high (74.6%), reinforcing disclosure concerns (81.1%). Loss of both parents was associated with increased odds of anxiety (aOR 2.10, 95% CI 1.07- 4.09). Exploration of anxiety and depression-related factors revealed themes that included uncertainty about transitioning to adult care, ART adherence challenges, and maladaptive coping mechanisms. Family support, disclosure fears, school pressures, stigma, and evolving societal attitudes shaped participants’ mental health experiences. Our findings underscore the need to prioritize integration of mental health screening and interventions across the pediatric-to-adult HIV care continuum in India.