Perceptions of mental health, stigma, and hiv in botswana: a qualitative analysis of caregiver and youth dyads

To explore narratives between caregivers and their children on HIV status, mental health, and stigma in Botswana. Qualitative research was conducted using thematic analysis to explore the relationship between HIV status, mental health and stigma amongst youth and their caregivers in Botswana. Semi-structured interviews were conducted from January to February 2022 assessing attitudes towards these topics. Eligible participants were recruited from Stepping Stones International Botswana (SSI), an NGO in Mochudi, Botswana. The youth participants (ages 12-15) had variable HIV status and were considered vulnerable youth, accompanied by their caregivers to the interviews. Those younger than 12 and older than 25 without a caregiver were excluded from our sample. Preliminary caregiver narrative results show that they acknowledge mental illness, but struggle to define it. They were aware children engaged in risky behaviors like unprotected sex, but not willing to have conversations about it. Common codes used in the caregiver data analysis included insufficient interventions from a systems level, labeling mental health as “issues of young people'', parents’ personal discomfort discussing mental health, and a high level of cognitive dissonance- a distinct difference between their beliefs and actions about mental health. This was particularly distinct in conversations about caregivers’ beliefs about mental health and stigma- that they would not perpetuate bias against those with mental illness- but their actions ostracized those with mental illness from themselves. Preliminary youth narrative results show that they were better able to define mental health compared to their adult counterparts. Definitions are often within the contexts of stress and ongoing problems, recurring codes throughout the youth data. Many were not able to speak on their communication with their caregivers about these topics and other sensitive topics such as HIV. Many did not even know their HIV status indicating either a lack of communication with parents for perinatally infected youth, or youth deciding not to test themselves. Common codes among youth also include hesitancy to discuss mental health and observations of their parents’ words and actions in and around mental health. Both caregiver and youth shared a few common themes. Cognitive dissonance was a recurring code among the dyads. A common theme thus far surrounds a difficulty in defining stigma as it relates to their culture and community practices, both at the caregiver and the youth level. Children and caregivers both seem to be able to reference others who have experienced mental health issues, but rarely do they recognize it in themselves, or even in their immediate family. Findings indicate that there may be a lack of systemic, harm-reductive support to educate caregivers on having conversations about mental health. Initial findings indicate a need for education and support for both parties on mental health. It is essential to use the views of this study to aid better understanding on the mental health and HIV/AIDs related needs of the youth in Botswana and their caregivers.