Mental Health and Sexual Risk Behaviors Among Social Networks of Young Tanzanian Men Public Deposited

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  • March 20, 2019
Creator
  • Hill, Lauren
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
Abstract
  • Background: Young men are important targets in HIV prevention in Tanzania and throughout sub-Saharan Africa. Anxiety and depression are common among youth and may be important predictors of HIV risk behaviors. Evidence of these relationships in high-risk populations is needed, as is understanding of how normative and supportive elements of the social environment might be leveraged to buffer the risk posed by poor mental health. Methods: I conducted two studies using baseline and one-year follow-up data from 1113 sexually active male participants in an ongoing HIV and intimate partner violence prevention trial taking place among 59 social groups known as “camps” in Dar es Salaam, Tanzania. In the first study, I assessed the relationship between mental health (anxiety, depression) and sexual risk behaviors (condom use, concurrency) using multilevel modeling. In the second study, I built upon these models to test the moderating role of sexual behavior norms, camp network social cohesion, and men’s network centrality in the relationship between mental health and sexual risk behaviors. I further assessed peer behavioral influence in men’s camp friendship networks using quadratic assignment procedures. Results: Both anxiety and depression were independently associated with concurrency but only depression was independently associated with condom use. In the second study, changes in perceived descriptive norms were associated with both condom use and concurrency, perceived injunctive norms were associated with concurrency, and direct encouragement was associated with condom use. Changes in condom use norms (perceived descriptive norms and encouragement) moderated the relationship between changes in anxiety symptoms and condom use such that the negative relationship was amplified with worsening norms for condom use, and attenuated by improving norms for condom use. Network centrality and cohesion were not significantly related to sexual risk, nor did they interact with anxiety or depression in relation to sexual risk. Conclusions: The results of this dissertation indicate the importance of screening and providing treatment for depression and anxiety in high HIV-prevalence contexts, and the need to develop effective HIV prevention interventions targeting young men living with anxiety and depression. Such interventions may benefit from the combination of norms-based and mental health promotion approaches.
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  • In Copyright
Advisor
  • Pence, Brian
  • Gottfredson, Nisha
  • Go, Vivian
  • Moody, James
  • Maman, Suzanne
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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