Data collection tools
The data collection tool consisted of structured and standardized modules which were translated into Luganda and back translated to English by two independent bilingual psychologists. Meetings were held with the translators in order to obtain consensus. The tools included a social demographic questionnaire, The international HIV dementia Scale (IHDS) , the Mini neuropsychiatric interview (M.I.N.I plus) , a negative coping style index , a negative life events score index ,a stress score index .
The Socio-demographic questionnaire identified sex, age, marital status, highest educational attainment, religion, and employment status and various social factors such as food insecurity, distance from the HIV clinic and duration of awareness of HIV status. Clinical factors assessed included the most recent CD4 count, body mass index (BMI), probable HIV dementia and psychiatric diagnoses.
The International HIV Dementia Scale (IHDS)  scale was used for measuring probable HIV dementia. This is a bed side screening tool for HIV associated dementia. It can be used in a clinic setting and only requires 2–3 minutes to complete. This tool has been validated in South Africa and Uganda and found to have good psychometric properties in African populations with sensitivity of 88% and 80% and specificity of 50% and 55% respectively at a cut off of 10 or less [5, 8]. This tool that assesses for memory impairment, motor and psychomotor speed does not require one to be proficient in English and is brief and inexpensive. Even though it is thought not to be ideal, it is one of the best for use across cultures for screening for neuro-cognitive impairment in HIV .
The M.I.N.I. neuropsychiatric interview (MINI Plus)  is a modular DSM IV based structured interview for the diagnosis of psychiatric disorder. The psychiatric disorder modules used in this study were for major depressive disorder, suicidality, alcohol use disorders, generalized anxiety disorder and post-traumatic stress disorder.
Negative coping style index  was constructed from variables of the Mental Adjustment to Cancer Scale (MAC)  whose items had been adapted to the local HIV situation . Each of this scale’s 17 questionnaire items is scored on a 4-item likert scale 1= (definitely does not apply to me), 2= (does not apply to me), 3= (applies to me), 4= (definitely applies to me). To score all the questionnaire items so that they are all in the same direction i.e. higher scores reflecting more negative coping style required that questionnaire items (1,4,5,10,11,12, 13, 15, 16) that are cast positively be reverse scored. For instance item 1: ‘I have been doing things that I believe will improve my health e.g. changed my diet. A total score was generated so that higher scores reflected a more negative coping style. The Cronbach’s α of this scale in this study was 0.58.
Negative life events score index  was constructed from items of the adverse life events module of the European Para-suicide Interview Schedule (EPSIS I)  that has previously been modified for the Ugandan situation by Kinyanda and colleagues (2005) . For this study respondents were required to report whether they had experienced each of these events in the last 6 months. Items that were selected for inclusion in this study were those that were thought to be relevant to the HIV social situation in Uganda. The negative life events considered in this study looked at bereavement, severe illness and severe interpersonal conflict in the following significant social relationships; parent, sibling, spouse/lover and child(ren). The individual related negative life events considered in this study examined for severe sickness, interpersonal conflict, feelings of isolation and abandonment, lack of the basic requirements of food, shelter and medicine. Others included job loss, discrimination and worries about personal finances. A total score was generated to reflect the total number of life events reported. This scale had a Cronbach’s α of 0.82 in this study.
The Stress Score index  was constructed by scoring each of the reported negative life events on a 3 point likert scale where respondents were asked the question, ‘how stressful did you find the event?’ with possible responses being: 0=(not stressing/minimal stressing), 1=(moderately stressing), 2=(severely stressing). A total score was generated where high scores reflected more stress.