1
|
Grimes KEL, Ebasone PV, Dzudie A, Nash D, Pence BW, Wainberg M, Yotebieng M, Ajeh R, Parcesepe AM. Intimate partner violence, depression, hazardous alcohol use, and social support among people with HIV initiating HIV care in Cameroon. PLoS One 2024; 19:e0304114. [PMID: 38771851 DOI: 10.1371/journal.pone.0304114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/06/2024] [Indexed: 05/23/2024] Open
Abstract
Intimate partner violence (IPV) has been associated with poor mental health among people with HIV (PWH) globally. Social support may be a strategy to foster mental health among PWH. Little is known about whether the relationship between IPV and mental health differs by IPV type or level of social support. Interviews were conducted with 426 PWH initiating HIV care in Cameroon. Log binomial regression analyses were used to estimate the association between four types of IPV (controlling behavior and emotional, physical, and sexual IPV) and symptoms of depression or hazardous alcohol use, separately by IPV type and level of social support. Over half (54.8%) of respondents experienced moderate/high levels of controlling behavior, 42.0% experienced emotional IPV, 28.2% experienced physical IPV and 23.7% experienced sexual IPV. Controlling behavior was associated with greater prevalence of depressive symptoms. This relationship did not vary meaningfully by level of social support (low: aPR 2.4 [95% CI 1.2, 4.9]; high: 1.7 [95% CI 1.0, 2.7]). Emotional and physical IPV were associated with greater prevalence of depressive symptoms among those with low social support (emotional IPV: aPR 1.9 [95% CI 1.0, 3.4]; physical IPV: aPR 1.8 [95% CI 1.2, 2.8]), but not among those with high social support (emotional IPV: aPR 1.0 [95% CI 0.7, 1.6]; physical IPV: aPR 1.0 [95% CI 0.6, 1.6]). Controlling behavior, emotional IPV, and physical IPV were associated with a greater prevalence of hazardous alcohol use, with moderately larger effect estimates among those with high compared to low social support. Sexual IPV was not associated with depressive symptoms or hazardous alcohol use. Services to screen and care for people experiencing IPV are urgently needed among PWH in Cameroon. Future research to identify barriers, feasibility, acceptability, and organizational readiness to integrate IPV and mental health services into HIV care settings is needed.
Collapse
Affiliation(s)
- Kathryn E L Grimes
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States of America
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Milton Wainberg
- Department of Psychiatry, Columbia University, New York, NY, United States of America
- New York State Psychiatric Institute, New York, NY, United States of America
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| |
Collapse
|
2
|
Filiatreau LM, Ebasone PV, Dzudie A, Wainberg M, Yotebieng M, Anastos K, Parcesepe AM. Intersectional HIV- and Depression-Related Stigma Among People with HIV Entering HIV Care in Cameroon. AIDS Behav 2024:10.1007/s10461-024-04375-2. [PMID: 38767726 DOI: 10.1007/s10461-024-04375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
Mental health-related stigma is a prominent barrier to improved mental health outcomes globally and may be particularly harmful to populations with other stigmatized identities. We aimed to understand intersectional depression- and HIV-related stigma among people with HIV (PWH) entering HIV care in Cameroon. Using baseline data from a cohort of PWH entering HIV care in Cameroon between 2019 and 2020, we characterized depression- and HIV-related stigma in the population overall and by sociodemographic sub-group. We also explored substantively meaningful variation in stigma endorsement by depressive symptom severity (Patient Health Questionnaire-9 [PHQ-9]) and causal attribution of depression. Among those with elevated depressive symptoms (PHQ-9 scores > 4), we estimated the association between stigma type and depressive symptom severity using binomial regression. Among 398 participants, 49% endorsed low HIV- and depression-related stigma (N = 195), 10% endorsed high HIV- and depression-related stigma (N = 38), 29% endorsed high depression-related stigma only (N = 116), and 12% endorsed high HIV-related stigma only (N = 49). Respondents with and without heightened depressive symptoms commonly believed depressive symptoms were caused by HIV (N = 140; 32.9%). Among those with elevated depressive symptoms, the prevalence of moderate to severe symptoms was higher among those endorsing high HIV-related stigma only (prevalence ratio 1.55; 95% confidence interval: 1.01, 2.37) compared to those reporting low HIV- and depression-related stigma. HIV- and depression-related stigma are both common among PWH entering HIV care in Cameroon. The consistent association between HIV-related stigma and poor psychosocial well-being among people with HIV necessitates the urgent scale-up of evidence-based HIV-related stigma interventions specifically.
Collapse
Affiliation(s)
- Lindsey M Filiatreau
- School of Medicine, Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
3
|
Hill SE, Zhang C, Remera E, Ingabire C, Umwiza F, Munyaneza A, Muhoza B, Rwibasira G, Yotebieng M, Anastos K, Murenzi G, Ross J. Association Between Clinical Encounter Frequency and HIV-Related Stigma Among Newly-Diagnosed People Living with HIV in Rwanda. AIDS Behav 2024; 28:1390-1400. [PMID: 38112826 PMCID: PMC10947825 DOI: 10.1007/s10461-023-04226-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
HIV-related stigma in healthcare settings remains a key barrier to engaging people living with HIV (PLHIV) in care. This study investigated the association between clinical encounter frequency and HIV-related anticipated, enacted, and internalized stigma among newly-diagnosed PLHIV in Rwanda. From October 2020 to May 2022, we collected data from adult PLHIV on antiretroviral therapy (ART) in Kigali, Rwanda who were participating in a randomized, controlled trial testing early entry into differentiated care at 6 months after ART initiation. We measured anticipated HIV stigma with five-point Likert HIV Stigma Framework measures, enacted stigma with the four-point Likert HIV/AIDS Stigma Instrument, and internalized stigma with the four-point Likert HIV/AIDS Stigma Instrument. We used multivariable linear regression to test the associations between clinical encounter frequency (average inter-visit interval ≥ 50 days vs. < 50 days) and change in mean anticipated, enacted and internalized HIV stigma over the first 12 months in care. Among 93 individuals enrolled, 76 had complete data on encounter frequency and stigma measurements and were included in the present analysis. Mean internalized stigma scores of all participants decreased over the first 12 months in care. Anticipated and enacted stigma scores were low and did not change significantly over time. There was no association between encounter frequency and change in internalized stigma. In this pilot study of newly-diagnosed Rwandan PLHIV with relatively low levels of HIV-related stigma, clinical encounter frequency was not associated with change in stigma. Additional research in diverse settings and with larger samples is necessary to further explore this relationship.
Collapse
Affiliation(s)
- Sarah E Hill
- Division of General Internal Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Chenshu Zhang
- Division of General Internal Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Eric Remera
- HIV/AIDS and STIs Diseases Division, Rwanda Biomedical Center, Institute of HIV Disease Prevention and Control, Kigali, Rwanda
| | - Charles Ingabire
- Rwanda Military Hospital, Kigali, Rwanda
- Research for Development, Kigali, Rwanda
| | - Francine Umwiza
- Rwanda Military Hospital, Kigali, Rwanda
- Research for Development, Kigali, Rwanda
| | - Athanase Munyaneza
- Rwanda Military Hospital, Kigali, Rwanda
- Research for Development, Kigali, Rwanda
| | - Benjamin Muhoza
- Rwanda Military Hospital, Kigali, Rwanda
- Research for Development, Kigali, Rwanda
| | - Gallican Rwibasira
- HIV/AIDS and STIs Diseases Division, Rwanda Biomedical Center, Institute of HIV Disease Prevention and Control, Kigali, Rwanda
| | - Marcel Yotebieng
- Division of General Internal Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Kathryn Anastos
- Division of General Internal Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Gad Murenzi
- Rwanda Military Hospital, Kigali, Rwanda
- Research for Development, Kigali, Rwanda
| | - Jonathan Ross
- Division of General Internal Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| |
Collapse
|
4
|
Akoko B, Regan S, Idigbe I, Ezechi O, Pierce LJ, Musa Z, Okonkwo P, Freedberg KA, Ahonkhai AA. HIV-related stigma and psychological distress in a cohort of patients receiving antiretroviral therapy in Nigeria. AIDS Care 2024; 36:204-211. [PMID: 37229763 PMCID: PMC10674032 DOI: 10.1080/09540121.2023.2216006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
Psychological distress is increasingly recognized as a barrier to engagement in HIV care, resulting in poor HIV outcomes. HIV-related stigma is a potential driver of distress in people living with HIV (PLWH). We conducted a prospective cohort study in 288 PLWH who newly initiated ART in a Nigeria. We assessed overall stigma (range 40-160) and four stigma subtypes (personalized, disclosure, negative self-image, and public stigma) at enrollment, and assessed psychological distress at enrollment, 6, and 12-months after ART initiation. We used logistic regression to assess the relationship between stigma and 12-month psychological distress. Overall stigma was high (102.34 ± 5.65) and was higher in both unmarried patients (p < 0.01) and those who had not disclosed their HIV status to anyone at enrollment (p < 0.01). Higher overall stigma (OR: 1.05, 95% CI 1.00-1.09) and personalized stigma (OR:1.08, 95% CI 1.00-1.16) were associated with higher odds of psychological distress at 12-months. Conclusions: Overall stigma levels were high in a cohort of PLWH initiating care in Nigeria. Higher stigma was associated with psychological distress. These data support the need for integration of measures to reduce stigma and psychological distress in the care of PLWH.
Collapse
Affiliation(s)
- Bentley Akoko
- Emerging Infections Program, Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Susan Regan
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Ifeoma Idigbe
- Nigerian Institute for Medical Research, Lagos, Nigeria
| | - Oliver Ezechi
- Nigerian Institute for Medical Research, Lagos, Nigeria
| | - Leslie J. Pierce
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Zaidat Musa
- Nigerian Institute for Medical Research, Lagos, Nigeria
| | | | - Kenneth A. Freedberg
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Aima A. Ahonkhai
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| |
Collapse
|
5
|
Wang R, Zheng F, Cao G, Goldsamt LA, Shen Y, Zhang C, Yi M, Peng W, Li X. The relationship between social support and depression among HIV-positive men who have sex with men in China: the chain mediating role of psychological flexibility and hope. Front Public Health 2023; 11:1271915. [PMID: 38026353 PMCID: PMC10665023 DOI: 10.3389/fpubh.2023.1271915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction HIV and mental health problems are a global syndemic. One key issue is that the significant mental health problems among people vulnerable to acquiring or living with HIV have not been fully addressed. Access to social support has been one of the biggest challenges for HIV-positive men who have sex with men (HIV+ MSM). Lower social support has been linked to more severe depression symptoms. However, the mechanisms underlying the association between social support and depression in HIV+ MSM are unclear. Two possible mediators include hope and psychological flexibility. This study aimed to examine the relationship between social support and depression in HIV+ MSM and to explore the single mediating effects of hope and psychological flexibility and the chain mediating effect of these two variables on this relationship. Methods A convenience sample was used to recruit participants from the designated HIV/AIDS hospital in Changsha city, Hunan Province of China. A total of 290 HIV+ MSM completed questionnaires. Results Our findings showed that hope mediated the relationship between social support and depression in HIV+ MSM. Furthermore, the chain mediation model confirmed a direct negative association between social support and depression, but this relationship was largely mediated by the chain effects of hope and psychological flexibility. Conclusions Integrating hope and psychological flexibility into interventions may provide better mental health support for HIV+ MSM and improve their wellbeing and quality of life.
Collapse
Affiliation(s)
- Run Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Fang Zheng
- Department of AIDS, The First Hospital of Changsha, Changsha, Hunan, China
| | - Guiying Cao
- Department of AIDS, The First Hospital of Changsha, Changsha, Hunan, China
| | - Lloyd A. Goldsamt
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Yan Shen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Ci Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Mengyao Yi
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Wenwen Peng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| |
Collapse
|
6
|
Steffen HM, Mahanani MR, Neuhann F, Nhlema A, Kasper P, de Forest A, Chaweza T, Tweya H, Heller T, Chiwoko J, Winkler V, Phiri S. Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study. Clin Res Cardiol 2023; 112:1650-1663. [PMID: 37414923 PMCID: PMC10584708 DOI: 10.1007/s00392-023-02253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Sub-Saharan Africa is one of the regions in the world with the highest numbers of uncontrolled hypertension as well as people living with HIV/AIDS (PLHIV). However, the association between hypertension and antiretroviral therapy is controversial. METHODS Participant demographics, medical history, laboratory values, WHO clinical stage, current medication, and anthropometric data were recorded at study entry and during study visits at 1, 3, 6 months, and every 6 months thereafter until month 36. Patients who stopped or changed their antiretroviral therapy (tenofovir, lamivudine, efavirenz) were censored on that day. Office blood pressure (BP) was categorized using ≥ 2 measurements on ≥ 2 occasions during the first three visits. Factors associated with systolic and mean BP were analyzed using bivariable and multivariable multilevel linear regression. RESULTS 1,288 PLHIV (751 females, 58.3%) could be included and 832 completed the 36 months of observation. Weight gain and a higher BP level at study entry were associated with an increase in BP (p < 0.001), while female sex (p < 0.001), lower body weight at study entry (p < 0.001), and high glomerular filtration rate (p = 0.009) protected against a rise in BP. The rate of uncontrolled BP remained high (73.9% vs. 72.1%) and despite indication treatment, adjustments were realized in a minority of cases (13%). CONCLUSION Adherence to antihypertensive treatment and weight control should be addressed in patient education programs at centers caring for PLHIV in low-resources settings like Malawi. Together with intensified training of medical staff to overcome provider inertia, improved control rates of hypertension might eventually be achieved. TRIAL REGISTRATION NCT02381275.
Collapse
Affiliation(s)
- Hans-Michael Steffen
- Department of Gastroenterology and Hepatology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
- Hypertension Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | | | - Florian Neuhann
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | | | - Philipp Kasper
- Department of Gastroenterology and Hepatology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andrew de Forest
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | | | - Hannock Tweya
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | - Tom Heller
- Lighthouse Clinic, Lilongwe, Malawi
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | | | - Volker Winkler
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Sam Phiri
- Lighthouse Clinic, Lilongwe, Malawi
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Lilongwe, Malawi
| |
Collapse
|
7
|
Meyer MF, Moe CA, Galagan SR, Govere S, Gosnell BI, Moosa MY, Drain PK. Symbolic and anticipated HIV stigma are associated with mental health and education in South Africa. AIDS Care 2023; 35:1700-1707. [PMID: 37170393 DOI: 10.1080/09540121.2023.2209305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
HIV stigma continues to act as a barrier to HIV care in South Africa, necessitating further research on the intersections of socioeconomic factors and the anticipation and expression of stigma surrounding HIV. We measured the prevalence of HIV-related stigma and evaluated factors associated with symbolic and anticipated stigma in Umlazi Township, South Africa from 2013 to 2019, using a validated HIV stigma scale, before undergoing HIV testing. Among 7,724 people evaluated, 1,318 (16.9%) reported symbolic stigma and 2,396 (30.8%) anticipated HIV stigma. Prevalence of symbolic and anticipated stigma were significantly more common among both women and people living with HIV, compared to men and those who tested negative for HIV. In multivariable analyses, higher education and depressive symptoms were the strongest correlates with both symbolic stigma and anticipated stigma. Younger age, not being married, and having a partner who was not living with HIV appeared to be important correlates with anticipated stigma, but not symbolic stigma. Overall, the anticipation of experiencing stigma because of infection with HIV continues to be an important factor in the testing and management of HIV.
Collapse
Affiliation(s)
- Megan F Meyer
- School of Medicine, University of Washington, Seattle, USA
| | - Caitlin A Moe
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Sean R Galagan
- Department of Global Health, University of Washington, Seattle, USA
| | | | - Bernadett I Gosnell
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
| | - Mahomed-Yunus Moosa
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
| | - Paul K Drain
- School of Medicine, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| |
Collapse
|
8
|
Nguyen MX, Zimmer C, Latkin CA, Lancaster KE, Dowdy DW, Hutton H, Chander G, Frangakis C, Gaynes BN, Sripaipan T, Tran HV, Go VF. Validation of the combined Patient Health Questionnaire Anxiety and Depression Scale among people with HIV in Vietnam. Int J STD AIDS 2023; 34:832-840. [PMID: 37287254 DOI: 10.1177/09564624231180782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Our study aims to examine the factor structure, validity, and reliability of the combined scale Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) among people with HIV (PWH) in Vietnam. METHODS Baseline data from an alcohol-reduction intervention trial among ART clients in Thai Nguyen, Vietnam were used for this analysis (n = 1547). A score ≥10 on the PHQ-9, GAD-7 and PHQ-ADS scale was considered having clinically meaningful depression, anxiety and distress symptoms. Factor structure of the combined PHQ-ADS scale was validated using confirmatory factor analysis, and three models were tested: a one-factor, a two-factor, and a bi-factor model. Reliability and construct validity were examined. RESULTS The prevalence of clinically meaningful depression and anxiety symptoms was 7% and 2%, respectively, while 19% had distress symptoms. A bi-factor model had the best fit to the data (RMSEA = 0.048; CFI = 0.99; TLI = 0.98). The Omega index of the bi-factor model was 0.97. The scale showed good construct validity through negative associations between depression, anxiety, distress symptoms and quality of life. CONCLUSIONS Our study supports the use of a combined scale to measure general distress for PWH, which has good validity, reliability and is unidimensional enough to justify the use of a composite depression and anxiety score.
Collapse
Affiliation(s)
- Minh X Nguyen
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Catherine Zimmer
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn E Lancaster
- Department of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Teerada Sripaipan
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Ha V Tran
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Vivian F Go
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| |
Collapse
|
9
|
Li B, Liu D, Zhang Y, Xue P. Stigma and related factors among renal dialysis patients in China. Front Psychiatry 2023; 14:1175179. [PMID: 37583843 PMCID: PMC10423816 DOI: 10.3389/fpsyt.2023.1175179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
Background Stigma is an important psychological concept that is being studied in many diseases. However, there have been few studies on stigma in renal dialysis patients in China. This study aimed to investigate the level of stigma and its potential influencing factors among Chinese renal dialysis patients. Methods A cross-sectional study was conducted among renal dialysis patients in two Chinese dialysis centers between April 2022 and July 2022. Two hundred four renal kidney patients were interviewed with a questionnaire on demographic variables using the Social Impact Scale (SIS), Resilience Scale-14 (RS-14), Herth Hope Index(HHI), Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test(LOT-R), Perceived Stress Scale (PSS-4) and Fear of Progression (FoP). T-test/univariate one-way ANOVA, Pearson's R, and hierarchical linear regression analysis were used to investigate the factors that influence stigma. Results Renal dialysis patients in China experienced a moderate level of stigma (52.36 ± 8.16). Stigma was negatively correlated with resilience, hope, and perceived social support, whereas it was positively associated with perceived stress and fear of progression. However, it showed no significant relationship between optimism and stigma. Hierarchical linear regression analysis showed that hope (β = -0.318, P < 0.001), social support (β = -0.193, P < 0.01), perceived stress (β = 0.197, P < 0.01), and fear of progression (β = 199, P < 0.01) were found to be associated with stigma among the renal dialysis patients. All four variables in the model could explain 34.6% of the variance in stigma among renal dialysis patients in China. Conclusion According to this study, renal dialysis patients in China face a moderate level of stigma. Stigma was found to be negatively related to hope and social support but positively associated with perceived stress and fear of progression. Future research on the stigma of renal dialysis patients should include hope-based interventions, proper and specific social support strategies, stress management interventions, and more disease-related information.
Collapse
Affiliation(s)
| | | | | | - Pengshi Xue
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
10
|
Guta NM, Ruksi ST, Gachana Midaksa Senbata, Seid K. Predictors of perceived poor social support status of pregnant women attending antiretroviral therapy clinics in south west Ethiopia, 2021. Heliyon 2023; 9:e18282. [PMID: 37519693 PMCID: PMC10372391 DOI: 10.1016/j.heliyon.2023.e18282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
Background To improve pregnancy outcomes, a pregnant mother living with HIV/AIDS requires a high level of social and emotional support. However, women from low-income countries were subjected to low social support status despite adequate counseling and health messages to increase their social support. Therefore, this study aimed to investigate the predictors of the perceived poor social support status among pregnant women attending ART clinics in Southwest Ethiopia. Methods A hospital-based cross-sectional study with consecutive sampling was conducted to enroll 265 pregnant women on antiretroviral therapy (ART) from December 1 to 30, 2021. The data were collected using an interviewer-administered questionnaire. Epidata was used for data entry and analyzed after it was exported to a statistical package for the social sciences. Binary logistic regression was used and the level of significance was declared at P-value <0.05 using Adjusted odds ratio at 95% CI after candidate variables were identified in binary logistic regression at a P-value of <0.25. Results Finding from the study figured out that low level of poor social support is found to be 47.2%. Study revealed that income level[AOR = 5.1 95% CI [1.9,13.6]], disclosure status[AOR: 1.9 95% CI [1.1,3.3]], unwanted pregnancy [AOR = 2.3 CI; [ 1.4,3.9]], and low adherence level[AOR: 2.1 95% CI [1.1,3.1]] were strong predictors. Conclusion This study identified high levels of poor social support. Increasing access to information education and communications focusing on stigma, disclosure & refresher training that boosts the counseling skills of health care providers to enhance adherence level is strongly recommended.
Collapse
Affiliation(s)
- Nuredin Mohammed Guta
- Department of Nursing, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Sisay Tulu Ruksi
- Department of Nursing, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Gachana Midaksa Senbata
- Department of Public Health, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Kalid Seid
- Department of Nursing, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| |
Collapse
|
11
|
Mantell JE, Zech JM, Masvawure TB, Assefa T, Molla M, Block L, Duguma D, Yirsaw Z, Rabkin M. Implementing six multi-month dispensing of antiretroviral therapy in Ethiopia: perspectives of clients and healthcare workers. BMC Health Serv Res 2023; 23:563. [PMID: 37259098 DOI: 10.1186/s12913-023-09549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/14/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Multi-month dispensing (MMD) of antiretroviral therapy (ART) is an integral component of differentiated HIV service delivery for people living with HIV (PLHIV). Although many countries have scaled up ART dispensing to 3-month intervals, Ethiopia was the first African country to implement six-month dispensing (6-MMD) at scale, introducing its Appointment Spacing Model (ASM) for people doing well on ART in 2017. As of June 2021, 51.4% (n = 215,101) of PLHIV on ART aged ≥ 15 years had enrolled in ASM. Since little is known about the benefits and challenges of ASM perceived by Ethiopian clients and their healthcare workers (HCWs), we explored how the ASM was being implemented in Ethiopia's Oromia region in September 2019. METHODS Using a parallel convergent mixed-methods study design, we conducted 6 focus groups with ASM-eligible enrolled clients, 6 with ASM-eligible non-enrolled clients, and 22 in-depth interviews with HCWs. Data were audio-recorded, transcribed and translated into English. We used thematic analysis, initially coding deductively, followed by inductive coding of themes that emerged from the data, and compared the perspectives of ASM-enrolled and non-enrolled clients and their HCWs. RESULTS Participants enrolled in ASM and HCWs perceived client-level ASM benefits to include time and cost-savings, fewer work disruptions, reduced stigma due to fewer clinic visits, better medication adherence and improved overall health. Perceived health system-level benefits included improved quality of care, decongested facilities, reduced provider workloads, and improved record-keeping. Although non-enrolled participants anticipated many of the same benefits, their reasons for non-enrollment included medication storage challenges, concerns over less frequent health monitoring, and increased stress due to the large quantities of medicines dispensed. Enrolled participants and HCWs identified similar challenges, including client misunderstandings about ASM and initial ART stock-outs. CONCLUSIONS ASM with 6-MMD was perceived to have marked benefits for clients and health systems. Clients enrolled in the ASM and their HCWs had positive experiences with the model, including perceived improvements in efficiency, quality and convenience of HIV treatment services. The concerns of non-ASM enrolled participants suggest the need for enhanced client education about the model and more discreet and efficiently packaged ART and highlight that ASM is not ideal for all clients.
Collapse
Affiliation(s)
- Joanne E Mantell
- New York State Psychiatric Institute and Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Gender, Sexuality and Health Area, Columbia University Irving Medical Center, New York, New York, United States of America.
| | - Jennifer M Zech
- ICAP at Columbia University, New York, NY, United States of America
| | - Tsitsi B Masvawure
- Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, MA, United States of America
| | | | | | - Laura Block
- ICAP at Columbia University, New York, NY, United States of America
| | | | | | - Miriam Rabkin
- ICAP at Columbia University, New York, NY, United States of America
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, United States of America
| |
Collapse
|
12
|
Ma H, Hu Z, Wang Z, Ma Y, Zhai H, Li J. Development and Validation of a New Comprehensive Assessment Scale of HIV-Related Psychological Distress in China: A Methodological Study. J Assoc Nurses AIDS Care 2023; 34:292-306. [PMID: 37067998 DOI: 10.1097/jnc.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
ABSTRACT Instruments evaluating HIV-related psychological distress (HRPD) in people living with HIV may lack sensitivity to capture patients' psychological burden. We developed a comprehensive scale measuring HRPD and evaluated its psychometric properties. A mixed-method study was conducted from July 2021 to April 2022; it involved a literature review, semistructured interviews (n = 15), three rounds of panel discussions, two rounds of Delphi studies (n = 20), a pilot test (n = 20) to generate new scale items, and a cross-sectional survey (n = 659) to evaluate the psychometric properties of the HIV-related psychological distress scale. The scale contains 22 items across 4 subscales (i.e., disease-related distress, treatment adherence distress, identity distress, and disclosure distress). The confirmatory factor analysis revealed high goodness of fit (χ2/df = 2.412, comparative fit index = 0.916, incremental fit index = 0.917, and Tucker‒Lewis index = 0.902), showing that the HIV-related psychological distress scale is a reliable (Cronbach's α = 0.871 overall) and valid scale for evaluating HRPD in China and can be used to dynamically evaluate and monitor HRPD levels during patient follow-up.
Collapse
Affiliation(s)
- Haiqi Ma
- Haiqi Ma, MSN, RN, is a Graduate Student, School of Nursing, Southern Medical University, Guangzhou, Guangdong, China. Zhiguang Hu, BA, is a General Practitioner, Hongshan Street Community Health Service Center, Huangpu District, Guangzhou, Guangdong, China. Zhongqing Wang, MSN, is a Social Worker, University of Chinese Academy of Sciences Education Foundation, Beijing, China. Yue Ma, MSN, RN, is a Lecturer, School of Nursing, Southern Medical University, Guangzhou, Guangdong, China. Huimin Zhai, MSN, RN, is a Professor, School of Nursing, Southern Medical University, Guangzhou, Guangdong, China. Juan Li, MSN, RN, is a Lecturer, School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | | | | | | | | | | |
Collapse
|
13
|
Wei L, Yan H, Guo M, Tian J, Jiang Q, Zhai M, Zhu B, Yin X, Liao Y, Yu B. Perceived HIV Stigma, Depressive Symptoms, Self-esteem, and Suicidal Ideation Among People Living with HIV/AIDS in China: a Moderated Mediation Modeling Analysis. J Racial Ethn Health Disparities 2023; 10:671-679. [PMID: 35165837 PMCID: PMC8853186 DOI: 10.1007/s40615-022-01255-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/03/2022] [Accepted: 01/18/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Suicidal ideation is an important public health challenge among people living with HIV (PLWH) across the world and in China. HIV stigma, depression, and self-esteem have been associated with suicidal ideation. However, the underlying mechanisms remain not fully understood. METHODS Study data were derived from a sample of 465 PLWH in China. Suicidal ideation after HIV diagnosis was used as outcome variable. HIV stigma, depressive symptoms, and self-esteem were measured using reliable instruments and used as predictor, mediator, and moderator, respectively. Mediation and moderated mediation model were used for data analysis. RESULTS 31.6% of PLWH in China had suicidal ideation after HIV diagnosis. The association between perceived HIV stigma and suicidal ideation was partially mediated by depression (indirect effect = 0.02, 95% CI = [0.02, 0.03]) with the path from perceived HIV stigma to depressive symptoms being moderated by self-esteem (interaction effect = - 0.02, 95% CI [- 0.03, - 0.01]). CONCLUSIONS Study findings suggested a mediation mechanism of HIV stigma on suicidal ideation through depressive symptoms, and self-esteem might weaken the mediation mechanism by moderating the perceived HIV stigma-depressive symptoms pathway.
Collapse
Affiliation(s)
- Liqing Wei
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Hong Yan
- School of Public Health, Wuhan University, Wuhan, 430072, China.
| | - Menglan Guo
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Jiawei Tian
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Qingqing Jiang
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Mengxi Zhai
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Biao Zhu
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Xiaohong Yin
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Yu Liao
- School of Public Health, Wuhan University, Wuhan, 430072, China
| | - Bin Yu
- School of Public Health, Wuhan University, Wuhan, 430072, China
| |
Collapse
|
14
|
Parcesepe AM, Filiatreau LM, Gomez A, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. HIV-Related Stigma, Social Support, and Symptoms of Mental Health Disorders Among People with HIV Initiating HIV Care in Cameroon. AIDS Patient Care STDS 2023; 37:146-154. [PMID: 36802206 PMCID: PMC10024262 DOI: 10.1089/apc.2022.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
HIV-related stigma has been associated with poor mental health among people with HIV (PWH). Social support is a potentially modifiable factor that may buffer negative mental health sequelae of HIV-related stigma. Little is known about the extent to which the modifying effect of social support differs across mental health disorders. Interviews were conducted with 426 PWH in Cameroon. Log binomial regression analyses were used to estimate the association between high anticipated HIV-related stigma and low social support from family or friends and symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), and harmful alcohol use, separately. Anticipated HIV-related stigma was commonly endorsed with ∼80% endorsing at least 1 of 12 stigma-related concerns. In multivariable analyses, high anticipated HIV-related stigma was associated with greater prevalence of symptoms of depression {adjusted prevalence ratio (aPR) 1.6 [95% confidence interval (CI) 1.1-2.2]} and anxiety [aPR 2.0 (95% CI 1.4-2.9)]. Low social support was associated with greater prevalence of symptoms of depression [aPR 1.5 (95% CI 1.1-2.2)], anxiety [aPR 1.7 (95% CI 1.2-2.5)], and PTSD [aPR 1.6 (95% CI 1.0-2.4)]. However, social support did not meaningfully modify the relationship between HIV-related stigma and symptoms of any mental health disorders explored. Anticipated HIV-related stigma was commonly reported among this group of PWH initiating HIV care in Cameroon. Social concerns related to gossip or losing friends were of the greatest concern. Interventions focused on reducing stigma and strengthening support systems may be particularly beneficial and have the potential to improve the mental health of PWH in Cameroon.
Collapse
Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey M. Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amanda Gomez
- Department of Maternal and Child Health and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Milton Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Marcel Yotebieng
- Department of Medicine and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Department of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, New York, USA
| |
Collapse
|
15
|
Lifson AR, Hailemichael A, Workneh S, MacLehose RF, Horvath KJ, Hilk R, Sites A, Shenie T. Impact of Community Support Workers in Rural Ethiopia on Emotional and Psychosocial Health of Persons Living with HIV: Results of a Three-Year Randomized Community Trial. AIDS Behav 2023. [PMID: 36788166 DOI: 10.1007/s10461-023-04007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
Abstract
People living with HIV face multiple psychosocial challenges. In a large, predominantly rural Ethiopian region, 1799 HIV patients new to care were enrolled from 32 sites in a cluster randomized trial using trained community support workers with HIV to provide individual health education, counseling and social support. Participants received annual surveys through 36 months using items drawn from the Centre for Epidemiologic Studies Depression Scale-10, Medical Outcome Study Social Support Survey, and HIV/AIDS Stigma Instrument-PLWA. At 12 months (using linear mixed effects regression models controlling for enrollment site clustering), intervention participants had greater emotional/informational and tangible assistance social support scores, and lower scores assessing depression symptoms and negative self-perception due to HIV status. A significant treatment effect at 36 months was also seen on scores assessing emotional/informational social support, depression symptoms, and internalized stigma. An intervention using peer community support workers with HIV to provide individualized informational and psychological support had a positive impact on the emotional health of people living with HIV who were new to care.(ClinicalTrials.gov protocol ID: 1410S54203, May 19, 2015).
Collapse
|
16
|
Ma H, Zhu F, Zhai H, Ma Y, Liu Y, Wang S, Xu Y. Prevalence of psychological distress among people living with HIV/AIDS: a systematic review and meta-analysis. AIDS Care 2023; 35:153-164. [PMID: 35642250 DOI: 10.1080/09540121.2022.2080802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although people living with HIV/AIDS (PLWHA) are known to be vulnerable to psychological distress (PD), little is known about the prevalence of PD among PLWHA. A systematic literature search of several databases was conducted from inception to August 2021 focusing on studies reporting on PD symptoms among PLWHA. The overall prevalence estimates were pooled using a random-effects meta-analysis. Differences according to study-level characteristics were examined using stratified meta-analysis. We pooled and analyzed data from 15 studies comprising 5593 PLWHA. The prevalence rate of PD among PLWHA was 43.7% (95% Confidence Interval: 29.9-57.5%). Subgroup analyses by gender, country, CD4 count, employment status and ever attended school found no statistically significant differences in the prevalence of PD. Heterogeneity in the prevalence of PD among PLWHA was partially explained by the assessment tool. Further large-scale studies of high quality are warranted to identify risk factors of PD in PLWHA in their respective socio-cultural contexts.
Collapse
Affiliation(s)
- Haiqi Ma
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Fu Zhu
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Huimin Zhai
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Yue Ma
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Yiting Liu
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Shangjie Wang
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Ying Xu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| |
Collapse
|
17
|
Ulvund I, Dadi GB, Gutteberg A. 'I am struggling to survive' - limited living conditions increase the burden of HIV: A qualitative study. Glob Public Health 2023; 18:2280049. [PMID: 37967520 DOI: 10.1080/17441692.2023.2280049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
The human immunodeficiency virus (HIV) continues to have life-limiting health consequences for many individuals and remains a significant threat to global public health. This qualitative study explores the experiences of people living with HIV in Sidama, Ethiopia. Interviews with 19 adults recruited from an HIV outpatient clinic were conducted using a semi-structured interview guide. The analysis method used was systematic text condensation. The results reveal that an HIV diagnosis triggered strong emotions. Economic concerns, stigma, and discrimination also increased the burden of a diagnosis, which could lead to a loss of income or housing. Consequently, informants' ability to maintain a regular life and receive social and psychological support was reduced. Religious faith provided strength to informants, though they stated that some religious leaders do not support antiretroviral therapy. Understanding the everyday challenges of people living with HIV is crucial for health professionals and health programme developers working to promote health and enable people to follow their recommended course of treatment. Person-centred care is recommended. In particular, the poorest should receive attention. It is also crucial to reduce stigma and discriminatory attitudes towards people living with HIV and to motivate faith leaders to prevent HIV stigma and support antiretroviral therapy.
Collapse
Affiliation(s)
- Ingeborg Ulvund
- Faculty of Health Sciences and Social Care, Molde University College, Specialized University in Logistics, Molde, Norway
| | - Gezahegn Bekele Dadi
- School of Nursing, Hawassa University-College of Medicine & Health Science, Hawassa, Ethiopia
| | - Anne Gutteberg
- Faculty of Health Sciences and Social Care, Molde University College, Specialized University in Logistics, Molde, Norway
| |
Collapse
|
18
|
Pierce LJ, Regan S, Idigbe I, Adeola J, Musa Z, Ezechi O, Oladeji B, Gureje O, Freedberg KA, Okonkwo P, Ahonkhai AA. Psychological Distress Increases 30-Fold Among People with HIV in the First Year on ART in Nigeria-a Call for Integrated Mental Health Services. Int J Behav Med 2023; 30:38-48. [PMID: 35226343 DOI: 10.1007/s12529-022-10068-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have longitudinally assessed psychological distress among people with HIV (PWH) initiating ART in resource-limited settings. METHOD Baseline, 6-month, and 12-month psychological distress were measured in a Nigerian cohort newly initiating therapy; the relationship between baseline factors and psychological distress at 12 months was assessed; and the association between psychological distress at 12 months and care retention or immunologic failure was determined. RESULTS Among 563 patients, median age was 38 years (IQR: 33-46 years), 62% were female, and 51% were married. Psychological distress increased from 3% at baseline to 34% at 12 months. Age (aOR 1.28, 95% CI 1.06-1.56), female sex (aOR 2.89, 95% CI 1.93-4.33), lack of disclosure (aOR 4.32, 95% CI 2.48-7.51), and time on ART (6 months [aOR 6.91, 95% CI 3.14-15.18] and 12 months [aOR 32.63, 95% CI 16.54-64.36]) were associated with psychological distress while being married (OR 0.42, 95% CI 0.30-0.61) was associated with reduced odds. Tweve-month psychological distress was associated with increased risk of immunologic failure (aOR 2.22, 95% CI 1.31-3.82). CONCLUSION The risk of psychological distress increased 30-fold in the first year on therapy in PWH in Nigeria.
Collapse
|
19
|
Lifson AR, Hailemichael A, Workneh S, MacLehose RF, Horvath KJ, Hilk R, Sites A, Slater L, Shenie T. A three-year randomized community trial of community support workers in rural Ethiopia to promote retention in HIV care. AIDS Care 2022; 34:1506-1512. [PMID: 35195481 PMCID: PMC9395549 DOI: 10.1080/09540121.2022.2029819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/12/2022] [Indexed: 01/26/2023]
Abstract
Retention in care is a major challenge for global AIDS control, including sub-Saharan Africa. In a large Ethiopian region, we evaluated an intervention where HIV positive community support workers (CSWs) provided HIV health education, personal counseling and social support for HIV patients new to care. We enrolled 1,799 patients recently entering care from 32 hospitals and health centers, randomized to intervention or control sites. Dates of all clinic visits, plus deaths or transfers were abstracted from HIV medical records. Primary outcomes were gap in clinical care (>90 days from a missed clinical or drug pickup appointment) and death. For 36 months of follow-up, and for the first 12 months after enrollment, weighted risk differences [RD] between treatment arms were modest and non-significant for gap in clinical care, death or either outcome. Through 36 months, 624 of 980 controls and 469 of 819 intervention participants had gaps in clinical care (RD = -5.5%, 95% confidence interval [CI] = -17.9%, 7.0%); 79 controls and 82 intervention participants died (RD = 2.5% 95% CI = -1.7%, 6.8%). Factors including HIV stigma and a volatile political climate may have attenuated the advantages we anticipated, demonstrating how benefits of CSW interventions may depend upon psychosocial, clinical and structural factors particular to specific community settings.
Collapse
Affiliation(s)
- Alan R Lifson
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Abera Hailemichael
- Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia
| | - Sale Workneh
- Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Keith J Horvath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Rose Hilk
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Anne Sites
- Global Program, National Alliance of State and Territorial AIDS Directors, Washington, DC, USA
| | - Lucy Slater
- Global Program, National Alliance of State and Territorial AIDS Directors, Washington, DC, USA
| | - Tibebe Shenie
- Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia
| |
Collapse
|
20
|
Williams RS, Zhou Z, Cook C, Lucero R, Spencer EC, Cook RL. Does the Relationship Between HIV Stigma Subtypes and Viral Suppression Differ by Age?: A Stratified Analysis of Data from the Florida Medical Monitoring Project. AIDS Behav 2022; 27:1879-1885. [PMID: 36371749 DOI: 10.1007/s10461-022-03919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/15/2022]
Abstract
HIV-related stigma is recognized as a top barrier to achieve viral suppression in the United States, but data describing who is most affected by HIV stigma is limited. The study sought to (1) identify the relationships between HIV-related stigma and unsuppressed viral load and (2) examine whether the association between HIV stigma subtypes and unsuppressed viral load differ by age group (i.e., 18-34, 35-49, and 50+ years-old) using surveillance data from the Florida Medical Monitoring Project (n = 1195). Most participants were 50+ years-old (55%), male (71%), and Black (51%). Enacted stigma was significantly associated with unsuppressed viral loads among the 18-34-year-old age group (OR 1.68, CI 1.09-2.60). After adjusting for potential confounders, only enacted stigma was independently associated with unsuppressed viral load in the 18-34-year-old age group. Results highlight the need for targeted interventions to reduce enacted stigma among younger persons with HIV to achieve viral suppression.
Collapse
|
21
|
Muluneh AG, Merid MW, Kassa GM, Bitew DA, Ferede MG. Hotspots and determinants of women's discriminatory attitude towards people living with HIV; evidence from ethiopian demographic and health survey data. BMC Womens Health 2022; 22:420. [PMID: 36271378 PMCID: PMC9587567 DOI: 10.1186/s12905-022-01997-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Background Human Immunodeficiency Virus (HIV) is the major public health concern in Ethiopia with more profound effect on women. Discriminatory attitude towards people living with HIV (PLWH) impose a significant impact on patient outcomes and related issues. Hence, this study aimed to investigate the hotspot areas and determinant factors of women’s discriminatory attitude towards people living with HIV. Methods An in-depth secondary data analysis was conducted based on Ethiopian demographic and health survey (EDHS) 2016. A total of weighed 13,822 reproductive-age women were included in the analysis. The non-spatial analysis was conducted using Stata 16. A mixed effect multi-level logistic regression model was fitted to identify determinant factors of discriminatory attitude towards PLWH. A p-value < 0.2 and 0.05 were used as a cut-off point to declare statistical significance for the bi- and multi-variable regression models, respectively. Four separate models i.e. the null, individual, community level model, and a fourth combined model were fitted. Model comparison was done using deviance. Random effect parameters such as correlation coefficient, median odds ratio, and proportional change in variance were used to explain the variation between and within clusters. Global and local level spatial analyses were conducted using Global Moran’s index, GetisOrd Gi* statistics, and Spatial scan statistics were conducted. Results The magnitude of women’s discriminatory attitude towards PLWH was 62.66% (95%CI: 60.12, 65.10). The discriminatory attitude of women towards PLWH was spatially clustered (Moran’s index = 0.41, P < 0.01). The hotspots of discriminatory attitude towards PLWH were detected in most parts of the Tigray region; Northern, and southeast borders of the Amhara region; Addis Ababa city; Central, Southern, and western Oromiya region; and East, south, and northeastern parts of South Nations, Nationalities and Peoples Region (SNNPR). Being rural resident, and having no media exposure were positively associated while better educational statuses, better wealth index, unmarried, having comprehensive HIV knowledge, Orthodox religion fellow, and ever being tested for HIV were negatively associated with women’s discriminatory attitude towards people living with HIV. Conclusion Discriminatory attitude of women towards PLWH was high in Ethiopia. Hotspots were detected in Amhara, Oromiya, SNNPR, Tigray regions, and Addis Ababa city. Socio-demographic, socio-economic, and HIV knowledge-related factors determine the women’s discriminatory attitude towards PLWH.
Collapse
Affiliation(s)
- Atalay Goshu Muluneh
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public health, college of medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public health, college of medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Getahun Molla Kassa
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public health, college of medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Desalegn Anmut Bitew
- grid.59547.3a0000 0000 8539 4635Department of Reproductive health, Institute of Public health, College of medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Menberesibhat Getie Ferede
- grid.59547.3a0000 0000 8539 4635Departments of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
22
|
Kassaw C, Sisay D, Awulachew E, Endashaw Hareru H, Xu Y. Perceived Stigma and Its Association with Gender and Disclosure Status among People Living with HIV/AIDS and Attending Antiretroviral Therapy Clinics in Ethiopia: A Systematic Review and Meta-Analysis. AIDS Res Treat 2022; 2022:1-9. [PMID: 35846569 PMCID: PMC9287106 DOI: 10.1155/2022/3246249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background The psychological experience of being rejected, blamed, and ashamed in relation to a recognized medical disease is known as perceived stigma. It has a close connection to psychological health and therapy afterward. To the best of our knowledge, there has not been any national systematic review and meta-analysis research on this topic. Therefore, we conducted this analysis to thoroughly evaluate the pooled prevalence of perceived stigma among HIV/AIDS patients in Ethiopia who are receiving antiretroviral therapy and its relationship to gender differences and disclosure status. Method We investigated the eight databases for quantitative Ethiopian studies published in English from 2008 to 2021 that looked at the relationship between felt stigma, gender, and disclosure status. To meet the statistical requirements of a systematic review and meta-analysis analysis, the random effect model for pooled prevalence of perceived stigma, log odds ratio for associated variables, I-squared statistics for heterogeneity, and Egger's test for publication bias were implemented. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument's standard data extraction method was performed to collect the necessary data, and STATA-14 statistical software was used for analysis. Result A total of 8 cross-sectional Ethiopian studies with 3,857 participants were integrated into this systematic review and meta-analysis study. The pooled prevalence of perceived stigma among people living with HIV/AIDS and attending antiretroviral therapy in Ethiopia was OR = 50.36% (95% CI: (40.71, 60.00), I2 = 97.3%, p=0.000 ). The pooled odds ratio of being male was 0.95 (95% CI: 0.53, 1.68, I2 = 86.7%, p=0.000) and disclosure status was 0.84 (95% CI: 0.09, 7.89, I2 = 97.9%, p=0.000). Conclusion In this study, half of the participants encountered stigma. There was no statistically significant correlation between gender difference, disclosure status, and the perception of stigma. To address the mental and psychological issues of people living with HIV/AIDS, it is necessary to look into other factors that influence perceived stigma. It is recommended to screen for and treat perceived stigma with prompt examination and follow-up.
Collapse
|
23
|
Wowolo G, Cao W, Bosomtwe D, Enimil A, Tarantino N, Barker DH, Galárraga O. The Impact of Different Parental Figures of Adolescents Living With HIV: An Evaluation of Family Structures, Perceived HIV Related Stigma, and Opportunities for Social Support. Front Public Health 2022; 10:647960. [PMID: 35400055 PMCID: PMC8987121 DOI: 10.3389/fpubh.2022.647960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/17/2022] [Indexed: 12/05/2022] Open
Abstract
Although antiretroviral therapy (ART) has changed the expected health outcomes for HIV, there are still issues related to stigma, how people living with HIV are perceived, and the availability of social support. The purpose of this study was to explore the associations between family structure and psychosocial wellbeing reflected by perceived HIV stigma and social support among adolescents living with HIV in Kumasi, Ghana. This article used baseline data from two mixed methods studies that evaluated the safety and preliminary efficacy of group-based support programs for ART adherence improvement among adolescents living in Kumasi, Ghana (N = 70, aged 12–18 years). A multivariate linear regression analysis was employed to examine the associations between family structure and the outcomes of stigma and social support. The main variables for family structure were single mothers and female caregivers. We found that single motherhood was a significant determinant of stigma. When compared to other categories of caregiver types, adolescents being raised by their single mothers was associated with a 0.259 decrease in the mean internal HIV stigma score (p = 0.029). Also, for female adolescents, being raised by a female guardian (e.g., mother, aunt, grandmother, and sister) was associated with a 20.92 point increase in the overall support index (p = 0.005). This study shows that the type of parent or guardian, and their gender, influences the perceived stigma and available social support among adolescents living with HIV in Ghana. Vulnerable subgroups of adolescents living with HIV, particularly those raised up by male caregivers, should be provided with additional support.
Collapse
Affiliation(s)
- Gloria Wowolo
- Brown University School of Public Health, Providence, RI, United States
- *Correspondence: Gloria Wowolo
| | - Wangnan Cao
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Dennis Bosomtwe
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Anthony Enimil
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nicholas Tarantino
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, United States
| | - David H. Barker
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, United States
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States
| |
Collapse
|
24
|
Zhang X, Wang X, Wang H, He X, Wang X. Stigmatization and Social Support of Pregnant Women With HIV or Syphilis in Eastern China: A Mixed-Method Study. Front Public Health 2022; 10:764203. [PMID: 35359793 PMCID: PMC8961867 DOI: 10.3389/fpubh.2022.764203] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/28/2022] [Indexed: 01/10/2023] Open
Abstract
Background Stigmatization and poor social support are challenges faced by individuals living with HIV or sexually transmitted disease, which can have a profound negative impact on their healthcare. Mother-to-child transmission of either HIV or syphilis can lead to adverse maternal and fetal outcomes. The aim of this study was to investigate stigmatization and social support of pregnant women with HIV or syphilis in eastern China. Methods This was an explanatory sequential mixed-method study conducted in Zhejiang province, China in 2019. Stigmatization, social support, and the associated factors toward HIV or syphilis were evaluated using questionnaires. The social support rating scale was used to evaluate social support, where a score <25% was defined as poor social support. A logistic regression model was used to explore the association between stigmatization and poor social support. Results A total of 448 women (HIV positive, N = 93; syphilis, N = 355) were recruited in this study. Higher stigmatization was observed in pregnant women with HIV compared to those with syphilis (53.76% vs. 24.36%, p < 0.001), and poorer social support was observed in women with HIV compared with those with syphilis (40.86% vs. 19.86%, p < 0.001), with significant distributions of the total social support scores (Z = −1.976, p = 0.048) and scores on objectivity (Z = −2.036, p = 0.042) and subjectivity (Z = −2.500, p = 0.012). Similar social support among HIV or syphilis pregnant women was observed in medical healthcare facilities. In multivariable logistic model analysis, stigmatization (ORadj = 2.927; 95%CI, 1.714–4.996; p < 0.001) and ethnic minority (ORadj = 2.373; 95%CI, 1.113–5.056; p = 0.025) were negatively associated with social support. Interestingly, employment status was associated with improved social support (ORadj = 0.345; 95%CI, 0.180–0.662; p = 0.001). Conclusion Stigmatization among pregnant women with HIV or syphilis remains high. We demonstrated that stigmatization was a significant predictor of low social support in pregnant women with HIV or syphilis. The support shown in medical facilities was similar toward pregnant women with HIV or syphilis. Implementation of stigmatization eradication and social support strategies targeting pregnant women with HIV or syphilis may therefore improve the dual elimination of mother-to-child transmission service.
Collapse
Affiliation(s)
- Xiaohui Zhang
- Department of Women's Health, School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, China
| | - Xiaoyan Wang
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Wang
- Department of Obstetrics, School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, China
| | - Xinmei He
- Department of Women and Children's Health, Women and Children Health Care Hospital of Quzhou, Quzhou, China
| | - Xinyu Wang
- Department of Women's Health, School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, China
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Department of Gynecology and Obstetrics, School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, China
- *Correspondence: Xinyu Wang
| |
Collapse
|
25
|
Armoon B, Fleury MJ, Bayat AH, Fakhri Y, Higgs P, Moghaddam LF, Gonabadi-Nezhad L. HIV related stigma associated with social support, alcohol use disorders, depression, anxiety, and suicidal ideation among people living with HIV: a systematic review and meta-analysis. Int J Ment Health Syst 2022; 16:17. [PMID: 35246211 PMCID: PMC8896327 DOI: 10.1186/s13033-022-00527-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 02/17/2022] [Indexed: 12/16/2022] Open
Abstract
Background Stigma is a social phenomenon known to have a negative impact on the lives of people living with HIV (PLWH). However, defining HIV-related stigma (HRS) is difficult because of the intersection it has with structural inequalities, and cultural differences, discrimination by health care providers that measure stigma among PLWH. HIV/AIDS has been characterized as a traumatic experience and PLWH may experience stigma which can cause negative mental health disorders and experiences, including emotional distress, shame, depression, anxiety, suicidal ideation. A systematic review of the evidence on the mental disorders of PLWH is currently lacking. This study aimed to analyze the association between HRS and social support, alcohol use disorders and mental health disorders and experiences (depression, anxiety, and suicidal ideation) among PLWH. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) this study searched PubMed, Scopus, Web of sciences, PsycInfo, SciELO and Cochrane library electronic databases to identify publications between January 1992 and August 2020 that discussed social support, alcohol use disorders, mental health disorders and experiences (i.e., depression and anxiety and suicidal ideation) associated with HRS. Pooled Odds Ratios (ORs) were utilized at a 95% confidence level, and as sampling methods differed between articles pooled estimates used a random effects model. Results Twenty-two studies with 9548 participants met the eligibility criteria. No association was observed between HRS and alcohol use disorders. PLWH who had higher levels of social supports were less likely to report HRS. Participants who had been diagnosed with anxiety were 1.89 times more likely to report HRS, while those diagnosed with depression were 1.61 times more. Respondents who reported suicidal ideation also were 1.83 times more likely to report HRS. Conclusions This meta-analysis supports that HRS has a detrimental association with anxiety, depression and suicidal ideation, but social support protects again HRS in PLWH. Applying interventions which focus on the mental health disorders of PLWH may decrease HRS. Provision of social support by practitioners, combined with mental health treatment and assessments, and designing methods to identify stigma at different stages of illness are warranted.
Collapse
Affiliation(s)
- Bahram Armoon
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 33 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada.,Department of Psychiatry, McGill University, 33 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Yadollah Fakhri
- Food Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia.,Burnet Institute, Melbourne, Victoria, Australia
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Leila Gonabadi-Nezhad
- Department of Psychiatry, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| |
Collapse
|
26
|
James PB, Wardle J, Gyasi RM, Steel A, Adams J, Kabba JA, Bah AJ, Lahai M, Conteh EB. Health-related quality of life among Ebola survivors in Sierra Leone: the role of socio-demographic, health-related and psycho-social factors. Health Qual Life Outcomes 2022; 20:10. [PMID: 35033102 PMCID: PMC8761046 DOI: 10.1186/s12955-022-01916-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Evidence of how social factors affect the health-related quality of life (HRQoL) of Ebola virus disease (EVD) survivors is limited. Our study explores the association between socio-demographic, health-related and psycho-social (stigma) factors and EVD survivors' health-related quality of life (HRQoL) in Sierra Leone. Methods We conducted a nationwide cross-sectional study among 358 EVD survivors between January and August 2018. We used a multistage sampling method to recruit EVD survivors, and the RAND 36-Item Health Survey item was used to assess the HRQoL. Data were analysed using descriptive statistics and multiple linear regression. Results When comparing by each dimension in relation to their respective summary scores, role limitation physical [0.00 (50.00)] and role limitation emotional [0.00 (33.33)] were the most affected physical health and mental health domains among EVD survivors respectively. EVD survivors who were older (β = − 3.90, 95% CI − 6.47 to − 1.32, p = 0.003), had no formal education (β = − 2.80, 95% CI − 5.16 to − 0.43, p = 0.021), experienced a unit increase in the number of post-Ebola symptoms (β = − 1.08, 95% CI − 1.74 to − 0.43, p < 0.001) and experienced a unit increase in enacted stigma (β = − 2.61, 95% CI − 4.02 to − 1.20, p < 0.001) were more likely to report a decreased level of physical health. EVD survivors who experienced a unit increase in the time spent in the Ebola treatment centre (β = − 0.60, 95% CI − 0.103 to − 0.18, p = 0.006) and those who experienced a unit increase in enacted Stigma were more likely to report decreased levels of mental health (β = − 1.50, 95% CI − 2.67 to − 0.33, p = 0.012). Conclusion Sociodemographic, health-related, and psycho-social factors were significantly associated with decrease levels of HRQoL. Our findings improve our understanding of the factors that might influence the HRQoL and suggest the need for EVD survivors to be provided with a comprehensive healthcare package that caters for their physical and mental health needs.
Collapse
Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, 2480, Australia. .,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, 2480, Australia.,Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, 2007, Australia
| | - Razak M Gyasi
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, 2007, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, 2007, Australia
| | - John Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, #76 Yanta West Road, Xi'an, 710061, China
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Faculty of Basic Medical Sciences College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - Michael Lahai
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Eugene B Conteh
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| |
Collapse
|
27
|
Njejimana N, Gómez-Tatay L, Hernández-Andreu JM. HIV-AIDS Stigma in Burundi: A Qualitative Descriptive Study. Int J Environ Res Public Health 2021; 18:ijerph18179300. [PMID: 34501890 PMCID: PMC8431207 DOI: 10.3390/ijerph18179300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
HIV/AIDS stigma is a global issue and a serious problem in African countries. Although prevalence remains high in this region, no detailed study has yet been carried out to determine and characterize this problem in Burundi. Using a qualitative analysis based on an extensive series of 114 interviews, we describe the main characteristics of HIV stigma in the country. The results of our study indicate that the problem of HIV/AIDS stigma is widespread in Burundian society, as all participants in the research reported having experienced some kind of HIV stigma. The seven dimensions of stigma identified in people living with HIV/AIDS (PLWHA) in Burundi are physical violence, verbal violence, marginalization, discrimination, self-stigma, fear and insecurity, and healthcare provider stigma. These dimensions of stigma can be experienced through different manifestations, which have been characterized in this study, revealing that the problem of stigma in PLWHA is still an important issue in Burundi.
Collapse
Affiliation(s)
- Néstor Njejimana
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Lucía Gómez-Tatay
- Institute of Life Sciences, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain;
- Grupo de Medicina Molecular y Mitocondrial, Facultad de Ciencias de la Salud, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain
- Correspondence:
| | - José Miguel Hernández-Andreu
- Institute of Life Sciences, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain;
- Grupo de Medicina Molecular y Mitocondrial, Facultad de Ciencias de la Salud, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain
| |
Collapse
|
28
|
Lofgren SM, Tsui S, Atuyambe L, Ankunda L, Komuhendo R, Wamala N, Sadiq A, Kirumira P, Srishyla D, Flynn A, Pastick KA, Meya DB, Nakasujja N, Porta C. Barriers to HIV care in Uganda and implications for universal test-and-treat: a qualitative study. AIDS Care 2021; 34:597-605. [PMID: 34314261 PMCID: PMC8792098 DOI: 10.1080/09540121.2021.1946000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Achieving universal HIV test-and-treat will require targeted interventions for those with worse outcomes, including advanced HIV. We conducted qualitative, semi-structured interviews with healthcare workers (HCWs) and people living with HIV (PLWH) at 5 HIV clinics in Kampala, Uganda, to understand barriers to care. PLWH enrolled started/restarted on HIV treatment ≤3 months prior. PLWH were grouped as 1) "ART-experienced" or those restarted therapy after ≥12 months off, 2) ART naïve CD4 count <100 cells/uL "late presenters" or 3) ART naïve CD4 count >350 cells/uL "early presenters". In-depth interviews were conducted in Luganda, translated, and transcribed verbatim. Between May and August 2017, 58 PLWH and 20 HCWs were interviewed. High stigma and low social support emerged as themes among all as barriers to care. Alcohol abuse was a barrier for men. Fear of domestic violence and abandonment were barriers for women, limiting disclosure of their HIV status to their male partners. Clinic factors such as rapport with staff, distance, efficiency, and privacy impacted care. Future interventions to decrease delayed ART initiation should target stigma and social support. Assisted disclosure, contact tracing, and alcohol abuse treatment should be implemented. Strengthening client support, reducing wait times, and increasing privacy assurances would improve care-seeking behaviors.
Collapse
Affiliation(s)
- Sarah M Lofgren
- University of Minnesota, Division of Infectious Diseases and International Medicine, Department of Medicine, Minneapolis, MN, USA.,Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Sharon Tsui
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Lynn Atuyambe
- Makerere University, School of Public Health, Kampala, Uganda
| | - Leander Ankunda
- Makerere University, School of Public Health, Kampala, Uganda
| | | | - Nathan Wamala
- Makerere University, School of Public Health, Kampala, Uganda
| | - Alisat Sadiq
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Paul Kirumira
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Diksha Srishyla
- University of Minnesota, School of Public Health, Minneapolis, MN, USA
| | - Andrew Flynn
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Katelyn A Pastick
- Infectious Diseases Institute, Makerere University, Kampala, Uganda.,University of Minnesota, School of Medicine, Minneapolis, MN, USA
| | - David B Meya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Noeline Nakasujja
- Infectious Diseases Institute, Makerere University, Kampala, Uganda.,Makerere University, Department of Psychiatry, Kampala, Uganda
| | - Carolyn Porta
- University of Minnesota, School of Public Health, Minneapolis, MN, USA
| |
Collapse
|
29
|
Ross J, Murenzi G, Hill S, Remera E, Ingabire C, Umwiza F, Munyaneza A, Muhoza B, Habimana DS, Mugwaneza P, Zhang C, Yotebieng M, Anastos K. Reducing time to differentiated service delivery for newly diagnosed people living with HIV in Kigali, Rwanda: study protocol for a pilot, unblinded, randomised controlled study. BMJ Open 2021; 11:e047443. [PMID: 33895720 PMCID: PMC8074553 DOI: 10.1136/bmjopen-2020-047443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Current HIV guidelines recommend differentiated service delivery (DSD) models that allow for fewer health centre visits for clinically stable people living with HIV (PLHIV). Newly diagnosed PLHIV may require more intensive care early in their treatment course, yet frequent appointments can be burdensome to patients and health systems. Determining the optimal parameters for defining clinical stability and transitioning to less frequent appointments could decrease patient burden and health system costs. The objectives of this pilot study are to explore the feasibility and acceptability of (1) reducing the time to DSD from 12 to 6 months after antiretroviral therapy (ART) initiation,and (2) reducing the number of suppressed viral loads required to enter DSD from two to one. METHODS AND ANALYSES The present study is a pilot, unblinded trial taking place in three health facilities in Kigali, Rwanda. Current Rwandan guidelines require PLHIV to be on ART for ≥12 months with two consecutive suppressed viral loads in order to transition to less frequent appointments. We will randomise 90 participants to one of three arms: entry into DSD at 6 months after one suppressed viral load (n=30), entry into DSD at 6 months after two suppressed viral loads (n=30) or current standard of care (n=30). We will measure feasibility and acceptability of this intervention; clinical outcomes include viral suppression at 12 months (primary outcome) and appointment attendance (secondary outcome). ETHICS AND DISSEMINATION This clinical trial was approved by the institutional review board of Albert Einstein College of Medicine and by the Rwanda National Ethics Committee. Findings will be disseminated through conferences and peer-reviewed publications, as well as meetings with stakeholders. TRIAL REGISTRATION NUMBER NCT04567693.
Collapse
Affiliation(s)
- Jonathan Ross
- Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USA
- Division of General Internal Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
| | - Gad Murenzi
- Clinical Education and Research Division, Rwanda Military Hospital, Kigali, Kigali City, Rwanda
| | - Sarah Hill
- Division of General Internal Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
| | - Eric Remera
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Charles Ingabire
- Clinical Education and Research Division, Rwanda Military Hospital, Kigali, Kigali City, Rwanda
| | - Francine Umwiza
- Clinical Education and Research Division, Rwanda Military Hospital, Kigali, Kigali City, Rwanda
| | - Athanase Munyaneza
- Clinical Education and Research Division, Rwanda Military Hospital, Kigali, Kigali City, Rwanda
| | - Benjamin Muhoza
- Clinical Education and Research Division, Rwanda Military Hospital, Kigali, Kigali City, Rwanda
| | | | - Placidie Mugwaneza
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Chenshu Zhang
- Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USA
- Division of General Internal Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marcel Yotebieng
- Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USA
- Division of General Internal Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USA
- Division of General Internal Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
30
|
Turi E, Simegnew D, Fekadu G, Tolossa T, Desalegn M, Bayisa L, Mulisa D, Abajobir A. High Perceived Stigma Among People Living with HIV/AIDS in a Resource Limited Setting in Western Ethiopia: The Effect of Depression and Low Social Support. HIV AIDS (Auckl) 2021; 13:389-397. [PMID: 33833587 PMCID: PMC8021262 DOI: 10.2147/hiv.s295110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/15/2021] [Indexed: 11/23/2022]
Abstract
Background Antiretroviral therapy (ART) is only one part of a successful range of care among people living with HIV/AIDS (PLWHA). Stigma and low social support are emerging issues worsening the success of ART for PLWHA. This study thus aimed to investigate the level of perceived stigma among PLWHA. Methods An institution-based cross-sectional study was conducted in Nekemte, western Ethiopia. A multivariable logistic regression model was used to identify associations between perceived stigma and low social support, depression, and other potential predictor variables using SPSS version 24.0 and adjusted odds ratios (AORs), considering statistical significance at p<0.05. Results A total of 418 study participants were included in the study, with a response rate of 100%. About 48.6% of PLWHA had experienced perceived stigma, and more than two-fifths had poor social support. The following factors were associated with perceived stigma among PLWHA: age (18-29 years) (AOR=4.88, 95% CI:1.76-13.5), female sex (AOR=2.10, 95% CI 1.15-3.82), <12 months on ART (AOR=2.63, 95% CI 1.09-6.34), depression (AOR=1.86, 95% CI 1.08-3.19), social support (poor: AOR=3.45, 95% CI 1.65-7.23; medium: AOR=2.22, 95% CI 1.09-4.54), and non-disclosure of HIV status (AOR=2.00, 95% CI 1.11-3.59). Conclusion and Recommendation The magnitude of perceived stigma among PLWHA was high, highlighting the importance of integrating social and mental health support within standard ART for PLWHA.
Collapse
Affiliation(s)
- Ebisa Turi
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Dawit Simegnew
- Vanke School of Public Health, Tsinghua University, Beijing, People's Republic of China.,Department of Pharmacy, College of Health and Medical Sciences, Bule Hora University, Bule Hora, Ethiopia
| | - Ginenus Fekadu
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.,School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territory, Hong Kong
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Markos Desalegn
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Lami Bayisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Mulisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Amanuel Abajobir
- Maternal and Child Wellbeing Unit, African Population and Health Research Centre, Nairobi, Kenya
| |
Collapse
|
31
|
Parcesepe AM, Cordoba E, Gallis JA, Headley J, Tchatchou B, Hembling J, Soffo C, Baumgartner JN. Common mental disorders and intimate partner violence against pregnant women living with HIV in Cameroon: a cross-sectional analysis. BMC Pregnancy Childbirth 2021; 21:178. [PMID: 33663428 PMCID: PMC7934543 DOI: 10.1186/s12884-021-03673-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women living with HIV are at increased risk of poor mental health and intimate partner violence (IPV). Mental health disorders have been consistently associated with suboptimal HIV-related outcomes. Little is known about the prevalence or correlates of mental health disorders among pregnant women living with HIV in sub-Saharan Africa. METHODS This study assessed the prevalence of probable common mental disorders (CMD), i.e., depressive or anxiety disorders, and the relationship between probable CMD and recent IPV among pregnant women living with HIV in Cameroon. The sample included 230 pregnant women living with HIV aged > 18 enrolled in care at 10 HIV clinics in Cameroon. Probable CMD was assessed with the WHO Self Reporting Questionnaire (SRQ-20). Multivariable logistic regression was conducted to assess the relationship between IPV and probable CMD. RESULTS Almost half (42%) of participants had probable CMD using a 7/8 cut-off of the SRQ-20. Emotional, physical, and sexual IPV were reported by 44, 37, and 31% of respondents, respectively. In multivariable regression analyses, all forms of IPV assessed were significantly associated with greater odds of probable CMD. CONCLUSIONS Pregnant women living with HIV in Cameroon had a high prevalence of probable CMD and IPV. Screening and services to address IPV and mental health are urgently needed for this population. Integrated interventions to both prevent and screen and address IPV and probable CMD should be developed, implemented, and evaluated.
Collapse
Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC 27599 USA
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC USA
| | - Evette Cordoba
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - John A. Gallis
- Duke Global Health Institute, Duke University, Durham, NC USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC USA
| | | | | | | | | | | |
Collapse
|
32
|
Arefaynie M, Damtie Y, Kefale B, Yalew M. Predictors of Discrimination Towards People Living with HIV/AIDS Among People Aged 15–49 Years in Ethiopia: A Multilevel Analysis. HIV AIDS (Auckl) 2021; 13:283-292. [PMID: 33758550 PMCID: PMC7979683 DOI: 10.2147/hiv.s299812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Correspondence: Mastewal Arefaynie Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, EthiopiaTel +251 912867518 Email
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Yalew
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
33
|
Moges NA, Adesina OA, Okunlola MA, Berhane Y, Akinyemi JO. Psychological Distress and Its Correlates among Newly Diagnosed People Living with HIV in Northwest Ethiopia: Ordinal Logistic Regression Analyses. Infect Dis (Lond) 2021; 14:1178633721994598. [PMID: 33642865 PMCID: PMC7890707 DOI: 10.1177/1178633721994598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Although there is a high burden of HIV in sub-Saharan Africa (SSA), studies on mental health issues among people living with HIV are scarce. The study addressed the transition to "test and treat" guidelines for HIV, which makes it unique regarding its evaluation of psychological distress amongst newly initiated people living with HIV in the test and treat era. Methods We conducted a cross-sectional survey of 689 people newly diagnosed with HIV. Symptoms of psychological distress were measured using the Kessler-10 psychological distress assessment scale. Factors associated with psychological distress were captured using interviewer-administered questionnaires. Ordinal logistic regression analyses were employed to identify predictors of psychological distress. Results The magnitude of psychological distress was 58.63% (95% CI = 55.2%-62.3%). The severity of the psychological distress of which, 17.42% had severe distress. Psychological distress was observed more among female patients (β = 0.47, AOR = 1.59, 95% CI = 1.12, 2.27), patients presented with opportunistic infections (β = 0.50, AOR = 1.65, 95% CI = 1.03, 2.66) and being non-working functional status (β = 0.99, AOR = 2.70, 95% CI = 1.64, 4.45). Moreover, patients who were malnourished (β = 0.46, AOR = 1.58, 95% CI = 1.09, 2.26), having good level of knowledge on HIV prevention (β = 0.59, 95% CI = 0.55, 0.39, 0.78), presented with sexually transmitted infection (β = 0.48, AOR = 1.61, 95% CI = 1.01, 2.58), history of alcohol use (β = 0.44, AOR = 1.55, 95% CI = 1.09, 2.21), perceived stigma (β = 0.08, AOR = 1.09 95% CI = 1.04, 1.15) and treated in health centers (β = 0.55, AOR = 1.74, 95% CI = 1.25, 2.41) had higher odds of psychological distress. Conclusion The large majority of newly diagnosed HIV patients suffered from psychological distress. An increased vulnerability was observed among females, those with opportunistic and sexually transmitted infections, those having poor functional status and malnourished. Furthermore, HIV patients treated in health centers, those who had history of alcohol use and patients with high level of HIV related stigma are more negatively affected by the HIV diagnosis. Hence, all intervention strategies should target all the identified predictors.
Collapse
Affiliation(s)
- Nurilign Abebe Moges
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.,Pan African University, Life and Earth Sciences Including Health and Agriculture Institute (PAULESI), University of Ibadan, Ibadan, Nigeria
| | - Olubukola Adeponle Adesina
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
| | - Micheal A Okunlola
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
| | - Yemane Berhane
- Department of Epidemiology, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Joshua Odunayo Akinyemi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
34
|
Etowa J, Ekanem E, Ariyo O, Inoua H, Ashiri Y, Nare H, Akan Essien E, Etowa EB. Mental health experiences of African, Caribbean and Black (ACB) mothers living with HIV in the context of infant feeding. International Journal of Africa Nursing Sciences 2021; 15:100358. [DOI: 10.1016/j.ijans.2021.100358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
35
|
Tuke R, Sikorskii A, Zalwango SK, Webster KD, Ismail A, Pobee RA, Barkin JL, Boivin MJ, Giordani B, Ezeamama AE. Psychosocial Adjustment in Ugandan Children: Coping With Human Immunodeficiency Virus Exposure, Lifetime Adversity, and Importance of Social Support. New Dir Child Adolesc Dev 2020; 2020:55-75. [PMID: 32618425 DOI: 10.1002/cad.20354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cumulative lifetime adversity and social support were investigated as determinants of psychosocial adjustment (esteem, distress, hopefulness, positive outlook/future aspirations, and sense of purpose) over 12 months in 6-10-years-old HIV-infected, HIV-exposed uninfected and HIV-unexposed uninfected children from Uganda. Each determinant and psychosocial adjustment indicator was self-reported using standardized questionnaires administered at baseline, 6, and 12 months. Linear mixed effects models were used to relate time-varying lifetime adversity and social support to psychosocial adjustment over 12 months. Regardless of HIV status, higher adversity predicted lower esteem (coefficient b = -2.98, 95% confidence interval (CI): [-4.62, -1.35]) and increased distress (b =3.96, 95% CI: [1.29, 6.62]) but was not associated with hopefulness, positive outlook or sense of purpose. Low social support predicted higher distress (b =9.05, 95% CI: [7.36, 10.73]), lower positive outlook (b = -10.56, 95% CI: [-2.34, -8.79]) and low sense of purpose (b = -9.90, 95% CI: [-11.44, -8.36]) over 12 months. Pragmatic interventions that enhance coping with adversity and provide emotional/instrumental support should be tested for effectiveness in promoting resilient psychosocial adjustment trajectory in vulnerable children.
Collapse
|
36
|
Brown MJ, Serovich JM, Laschober TC, Kimberly JA, Lescano CM. Ways of coping and perceived HIV-related stigma among people living with HIV: moderation by sex and sexual orientation. PSYCHOL HEALTH MED 2019; 25:867-878. [PMID: 31631682 DOI: 10.1080/13548506.2019.1680852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Perceived HIV-related stigma continues to persist among people living with HIV and coping strategies are crucial to overall health. Coping may be associated with perceived HIV-related stigma. However, research examining differences by sex and sexual orientation is lacking. Therefore, the aims of the study were to assess the association between ways of coping and perceived HIV-related stigma, and to examine the relationship by sex and sexual orientation. Data were obtained from 346 individuals (191 men and 155 women) living with HIV. Multiple linear regression models showed that overall, distancing, and attack/escape avoidance coping were positively associated with perceived HIV-related stigma among the overall population, among men who have sex with men (MSM), and among women overall and heterosexual women. Among men overall, distancing and attack/escape avoidance coping were positively associated with perceived HIV-related stigma. Among women who have sex with women (WSW), attack/escape avoidance coping was positively associated with perceived HIV-related stigma. Effect sizes indicated small effects for overall coping and medium to large effects for distancing and attack/escape avoidance coping. Interventions focused on reducing perceived HIV-related stigma among populations living with HIV should address distancing and attack/escape avoidance strategies especially among women, regardless of sexual orientation, and MSM.
Collapse
Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, SC, USA.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina , Columbia, SC, USA.,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina , Columbia, SC, USA.,Division of Biology and Medicine, Brown University , Providence, RI, USA.,Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida , Tampa, FL, USA.,Office for the Study on Aging, Arnold School of Public Health, University of South Carolina , Columbia, SC, USA
| | - Julianne M Serovich
- College of Behavioral and Community Sciences, University of South Florida , Tampa, FL, USA
| | - Tanja C Laschober
- College of Behavioral and Community Sciences, University of South Florida , Tampa, FL, USA
| | - Judy A Kimberly
- Division of Biology and Medicine, Brown University , Providence, RI, USA
| | - Celia M Lescano
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida , Tampa, FL, USA
| |
Collapse
|
37
|
Gelaw YK, Adugna B, Tsegaye AT, Melaku T, Kefale B. Coping Strategies for Adverse Effects of Antiretroviral Therapy among Adult HIV Patients Attending University of Gondar Referral Hospital, Gondar, Northwest Ethiopia: A Cross-Sectional Study. AIDS Res Treat 2018; 2018:1879198. [PMID: 30631595 DOI: 10.1155/2018/1879198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 09/30/2018] [Accepted: 11/19/2018] [Indexed: 11/17/2022] Open
Abstract
Background Adverse effects from antiretroviral therapy (ART) have an impact on quality of life and medication adherence. There is no clear understanding of how people manage the adverse effects of ART. The individual taking medications which cause serious adverse effects may choose to stop or reduce the medications to relieve the adverse effects. Hence, this study was aimed at assessing coping strategies for adverse effects of ART among adult human immunodeficiency virus (HIV) patients. Methods A cross-sectional study was conducted at HIV clinic of University of Gondar Referral Hospital (UoGRH). A total of 394 study participants were recruited by systematic random sampling. Data were collected through interviewing patients. Data were entered to Epi-Info 3.5.4 and analyzed using SPSS-20.0. Descriptive statistics were used to summarize patient's sociodemographic data and the adverse effects of their ART regimen. Binary and multivariate logistic regressions were used to investigate the potential predictors of nonadherence coping strategies. Results The majorities of study participants were females (66%) and aged between 35 and 44 years (38.1%). The major adverse effects reported by the participants were headache (48.2%) followed by fatigability (18%) and loss of appetite (17.5%). Coping strategies used by HIV patients for adverse effect of ART were positive emotion coping strategy (91.1%), social support seeking (76.6%), taking other medications (76.6%), information seeking (48.7%), and nonadherence (35.5%). Younger age (AOR = 29.54, 95% CI = 2.49-35.25, p = 0.007), low level of education (AOR = 5.70, 95% CI = 2.16-15.05, p < 0.001), and living far from the health institution (AOR = 2.68, 95% CI = 1.29-5.57, p = 0.008) were associated with nonadherence coping strategy to relieve the adverse effects of ART. Conclusion The present study revealed that positive emotion coping was the most commonly used strategy. Age, level of education, and distance from health institution were the predictors of nonadherence coping strategy.
Collapse
|