Violence Victimisation and Mental Health Distress Among Adolescent Girls Living with HIV in Southern Africa: Does Social Protection Help?

Adolescent girls and young women (AGYW) living with HIV face heightened risks of mental distress, which may be compounded by exposure to violence and socioeconomic vulnerabilities. This study examined whether social protection moderates the relationship between violence exposure and mental distress among AGYW living with HIV in Eswatini, Lesotho, and Namibia. Using data from the Violence Against Children and Youth Surveys (VACS), we analysed 1,006 AGYW aged 15-24. Mental distress was measured using the Kessler Psychological Distress Scale (K6), with scores ≥ 5 indicating moderate-to-severe distress. Correlates included lifetime sexual, physical, or emotional violence and access to social protection from government or non-governmental programs. Findings showed that sexual (aOR = 1.84, 95% CI: 1.13-2.99, p = 0.014) and physical violence (aOR = 1.95, 95% CI: 1.18-3.23, p = 0.010) were associated with mental distress. Social protection showed no protective effect (aOR = 0.65, 95% CI: 0.41-1.03; p = 0.067) against mental distress and did not moderate the relationship between violence and distress. Predicted probabilities indicated that AGYW not exposed to violence had lower mental health distress (27.64%) compared to those exposed to all forms (77.81%). Findings suggest that integrated trauma-informed mental health and targeted social protection interventions are urgently needed for AGYW living with HIV in resource-constrained settings.