Emotional and Behavioral Health among Adolescents Living with HIV in Seven Cities in Indonesia

Background: Adolescents everywhere face various psychosocial and behavioral challenges as they move through the developmental stages of human maturation toward adulthood. Living with HIV can introduce additional challenges to an already complex developmental process. Yet, HIV studies focusing on emotional and behavioral health among adolescents living with HIV (ALWH) are sparce along with a notable absence of culturally adapted, context-specific recommendations for such youth in low middle-income countries including Indonesia. This study investigates the emotional and behavioral health of ALWH in Indonesia as measured by self-reported emotional and behavioral problems and symptoms of depression and general anxiety. Methods: This cross-sectional study enrolled 143 ALWH ages 13-18 living with HIV in seven cities in Indonesia who have been told about their HIV serostatus. The youth were referred by local HIV nongovernment organizations in each city from February to May 2023. The youth’s self-reported emotional and behavioral health was measured through face-to-face interviews using the Strength Difficulties Questionnaire (SDQ), Patient Health Questionnaire (PHQ)-9, and Generalized Anxiety Disorder (GAD)-7. Results: Participants’ averaged 15.9 years of age. Slightly more than half were girls (55.94%). Of the 143 participants, somewhat more than half (55%) reported experiencing a high degree of emotional and behavioral problems in the past six months, and slightly less than half (45.5%) reported symptoms of moderate to severe depression and slightly more than a third (38%) reported experiencing moderate to severe general anxiety in the past two weeks. Girls reported greater emotional and behavioral problems, symptoms of depression, and general anxiety than boys. Multivariate analyses showed an association between one or more of these 3 outcomes and gender, means of HIV acquisition, perception of illness, boy/girlfriend relationships, ARV utilization, and main caregiver. Conclusions: As possibly the first research to examine the psychosocial health of ALWH in Indonesia, the study’s results point to the importance of developing and offering mental health support and culturally tailored services for ALWH. HIV programs for ALWH could include strategies that help them in identifying and adopting effective coping methods, resilience in overcoming the possible adversities of illness, and feelings of empowered in successfully confronting the challenges of living with HIV.