Intersecting Vulnerabilities: Depression, Suicidality, and HIV Risk Among Young Mothers in South Africa

Many African women who are pregnant or parenting face intersecting challenges including intimate partner violence, unplanned pregnancies, and motherhood-related stresses that heighten vulnerability to poor mental health. Depression and suicidal ideation are associated with behaviors that increase HIV risk, yet limited research has explored these relationships in African contexts. This study examined associations between depressive symptoms, suicidal ideation, and sexual risk behaviors among unemployed young women aged 19-24 years in KwaZulu-Natal, South Africa. Baseline data were collected between June-October 2018 from participants who had been sexually active in the past year. Prolonged sadness (≥ 2 weeks) and suicidal ideation in the past year were measured using validated single-item indicators. The composite HIV risk outcome captured transactional sex, partners with unknown HIV/STI status, and substance-influenced sex. Poisson regression models adjusted for age, intimate partner violence, and HIV serostatus; moderation by HIV status was tested. Among 1,026 women (median age 22 years), 8.6% were living with HIV, 34% reported prolonged sadness, and 10% reported suicidal ideation. Both exposures were associated with elevated HIV risk (prolonged sadness: PRR = 1.79, 95% CI 1.41-2.27; suicidal ideation: PRR = 1.67, 95% CI 1.24-2.27). Moderation analysis showed no interaction between depressive symptoms and HIV serostatus but identified a significant interaction for suicidal ideation, with a stronger association among women living with HIV. Findings underscore the burden of depressive symptoms among young mothers and its contribution to HIV vulnerability. Integrating mental health screening and referral within antenatal, postnatal, and HIV care could improve outcomes for both women and their children.