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

Adolescents and young adults with HIV are reported to be at high risk for common mental health disorders (CMD), but studies in India are limited. The risks may be greater among adolescents and young adults with perinatally acquired HIV (APHIV), as they face lifelong medical challenges, higher levels of stigma, and stressors related to disclosure, adherence, and transition to adult care. We screened for depression and generalized anxiety disorder (GAD) and explored psychosocial experiences among a cohort of APHIV in southern India to inform development of tailored CMD interventions. Between March-June 2023, we administered a cross-sectional survey to participants in the I’mPossible Fellowship, a peer-led mentorship program for APHIV in southern India. Survey design and administration incorporated participatory research principles, wherein trained peer mentors (youth investigators) administered 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. Subsequently we conducted focus group discussions with selected participants to explore perspectives on mental health, stigma and perceived pathways towards improved health outcomes. 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). The majority (90.4%) were virally suppressed (VL<150 copies/mL). PHQ-9 and GAD-7 scores in the severity category of mild or above were defined as positive. A high proportion screened positive for at least one CMD (62.7%), depression alone (25.9%), GAD alone (7%), or both (29.7%). 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 among APHIV revealed themes across the socioecological model (SEM) constructs 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 also shaped participants’ mental health experiences. The significant burden of positive screens for CMD among APHIV requires HIV programs in India to prioritize youth-tailored stigma-informed mental health interventions alongside strategies for successful adult care transition and long-term viral suppression.