Navigating Stigma Trajectory and Mental Health Among Young Adults Living with Perinatal HIV in New York City

Health-Related Quality of Life in Young Adults With Perinatal HIV After Transfer to Adult Health Care in the Netherlands

INTRODUCTION

Health-related quality of life (HRQoL) in adult people with HIV is lower than that of the general population. Previously, no differences were detected in HRQoL of Dutch children with perinatal HIV (PHIV) compared with norm groups. In this study, we compared HRQoL of PHIV young adults (PHIV-YA, aged 18-30 years) with 2 norm groups, the healthy Dutch YA population and YA with various chronic conditions.

METHODS

Participants received questionnaires on HRQoL, adherence, and demographics. Additional social and health care-related variables were collected from patients' medical files. We explored correlations between HRQoL and demographic characteristics. Effect sizes (ES, Hedge s 'g with confidence intervals) were calculated to quantify the difference between PHIV-YA and norm groups.

RESULTS

Of 81 participants, 53 filled out the questionnaires. Compared with the healthy Dutch YA population, PHIV-YA aged 18-30 years had significantly lower HRQoL scores in the school/work subscale. PHIV-YA aged 26-30 years had significantly lower total, physical and psychosocial HRQoL scores as well. Participants in the older age category had lower HRQoL scores throughout all subcategories as compared with the younger age group. For PHIV-YA aged 18-25 years, lower scores on the school/work subscale were correlated with substance use and being born outside the Netherlands.

CONCLUSIONS

PHIV-YA had low HRQoL scores in school/work functioning compared with the healthy Dutch YA population. The circumstances driving these outcomes are likely to be multidimensional, including HIV infection, social background, and challenges in growing up with a chronic condition.

Perceived impact of the COVID-19 pandemic and government restrictions on the lives of young adults living with HIV in Kisumu, Kenya

Young adults with HIV (YAHIV) may be particularly vulnerable to the impact of the COVID-19 pandemic. In this context, associated mitigation measures among YAHIV can adversely impact fragile social and economic systems. We examined the impact of the pandemic and related government-mandated restrictions among YAHIV in Kisumu, Kenya. Between April-May 2021, a cross-sectional survey was conducted among a convenience sample of YAHIV 18-25 years receiving HIV care in Kisumu, Kenya. The information collected included demographics, COVID-19 knowledge, protective measures, and the impact of the pandemic and related restrictions on their daily lives and well-being since the start of the pandemic (i.e., curfews, lockdowns, school/workplace closures). Responses were analyzed using descriptive statistics. Of 275 YAHIV: median age 22 years (IQR: 19-24 years); 178 (65%) female; 222 (81%) completed some secondary education or higher; 108 (39%) lived in an informal housing area. Awareness of COVID-19 was high (99%), mean knowledge score was 4.32 (SD: 0.93; range 1-5) and most reported taking protective measures. Overall, 193 (70%) reported they were affected by COVID-19 and associated restrictions. Almost half (49%) reported changes in a living situation; 24% living with different people, 11% had moved/relocated, and 5% were newly living on the street. Additionally, respondents reported increased verbal arguments (30%) and physical conflict (16%) at home with 8% reporting someone having used/threatened them with a weapon, 12% experiencing physical abuse, 7% being touched in a sexual way without permission, and 5% had forced sex. Impacts of the pandemic and related restrictions were felt across various aspects of YAHIV's lives, including disrupted living situations and increased exposure to verbal and physical conflict, including sexual violence. Interventions are needed to address the impact and potential negative long-term effects of the pandemic on YAHIV health and well-being.

A multi-informant qualitative analysis of desired features for an mHealth tool for youth living with HIV in South Carolina

OBJECTIVE

Youth living with HIV (YLHIV) in the southern United States experience poor outcomes across the HIV care continuum and are at high-risk for virologic failure. This study used a qualitative, community-engaged approach to inform the development of a tailored mobile Health (mHealth) tool for YLHIV in South Carolina (SC).

METHODS

Semistructured qualitative interviews were conducted with YLHIV in SC (n = 16) and their HIV care providers (n = 15). Focus group discussions (FGDs) were also conducted with HIV-focused community-based organization staff (n = 23). Interviews and FGDs queried desired components for a future mHealth tool tailored for YLHIV. Data were analyzed using a team-based rapid qualitative approach.

RESULTS

Across informants, key themes emerged related to medical management of HIV, including a desire for connections with medical providers, appointment and medication reminders, and accurate HIV information. In addition, informants voiced a desire for mental health resources to be integrated into the app. Connection with HIV-positive peers also emerged as a key desire from youth informants. In terms of app design, informants emphasized the need for strict privacy practices, a youth-friendly design, compensation for use, and integration with existing healthcare systems.

CONCLUSIONS

mHealth interventions developed for YLHIV should meet the mental health and social needs of YLHIV in addition to their medical needs. In addition, the highly stigmatized nature of HIV requires careful consideration when designing digital tools-youth want their privacy prioritized, but also express strong desire for social support to help cope with the isolation and stigma of this chronic health condition.

Optimizing generalized anxiety disorder screening in young adults perinatally affected by HIV: A psychometric analysis

Background

Generalized Anxiety Disorder (GAD) is prevalent among people with HIV and is associated with adverse health outcomes. This study investigates the suitability of the Generalized Anxiety Disorder Scale-7 item (GAD-7) screening tool and its 2-item (GAD-2) version for use in young adults with perinatally-acquired HIV (YAPHIV) and young adults perinatally exposed to HIV but uninfected (YAPHEU).

Methods

Data come from the 7th follow-up interview (FU7) from a longitudinal study of youth with PHIV and PHEU, first recruited when 9-16 years. The GAD-7 was administered along with a diagnostic psychiatric interview (DISC-IV). Receiver Operating Characteristic analysis assessed accuracy, sensitivity, and specificity of the GAD7 and GAD-2. Subgroup analyses considered HIV status, ethnicity, and race.

Results

At FU7, participants (n = 204) were ages 20-29; 54% female; and the majority African-American and/or Latinx. 12% met diagnostic criteria for GAD. Recommended GAD-7 (>10) and GAD-2 (>3) cut-scores showed suboptimal sensitivity (0.52 and 0.48, respectively) and high specificity (0.91 and 0.90, respectively). Lowering cut-scores (GAD-7 >6 and GAD-2 >2) improved sensitivity (0.76 and 0.80) while sacrificing specificity (0.77 and 0.78). Stratified analyses by HIV status revealed similar accuracy in YAPHIV and YAPHEU. Race/ethnicity did not significantly affect cut-scores.

Discussion

Anxiety disorders are common in YAPHIV, and efficient screening is essential. While the GAD-7 and GAD-2 show promise, recommended cut-scores may not be optimal. Lowering cut-scores may enhance sensitivity without losing clinical utility. Further research is needed to refine cut-scores based on demographic characteristics and in global contexts, ensuring effective anxiety screening in this population.

Adults with Perinatally Acquired HIV; Emerging Clinical Outcomes and Data Gaps

In resourced settings, adults living with perinatally acquired HIV are approaching the 5th decade of life. Their clinical and psychological outcomes highlight potential future issues for the much larger number of adolescents growing up with HIV in sub-Saharan Africa, and will inform the development of appropriate healthcare services. Lifelong exposure to HIV, and increasingly to antiretroviral therapy throughout growth and development, contrasts with adults acquiring HIV in later life. This review describes the clinical outcomes for adults living with perinatally acquired HIV including post transition mortality, morbidity and retention in care. Rates of viral suppression, drug resistance and immunological function are explored. Co-morbidities focus on metabolic, cardiovascular, respiratory and bone health with quality-of-life data including neurocognitive functioning and mental health. Sexual and reproductive health including vaccine-preventable disease and the prevention of onward transmission to partners and infants are considered. The data gaps and future research questions to optimise outcomes for this emerging adult cohort are highlighted.

"I am not alone with tears": embodying stigma and longing among youth living with perinatally acquired HIV in Tanzania through a collaborative arts-based approach

It is estimated that 4 million youth aged 15-24 years live with HIV globally, 85% of whom live in sub-Saharan Africa. For youth living with perinatally acquired HIV (YPHIV), stigma is frequently linked with negative health outcomes. YPHIV face distinct HIV stigma experiences across the lifespan, particularly because of the centrality of the family context in their HIV experience and the reality that they have lived with HIV since birth. Nevertheless, our understanding and measurement of stigma remains limited. One way to improve our understanding of HIV stigma for YPHIV is through in-depth exploration of embodied narratives of HIV experience. This paper is based on fieldwork that incorporated a collaborative arts-based approach with a group of six YPHIV in Tanzania. Using artwork and a theoretical framework of embodiment, this paper phenomenologically describes their narratives of HIV experience, perceptions of stigma over time and imaginations of the future. This paper highlights that collective solidarity, habitus and participants' desire to reframe others' perceptions about them and relieve the suffering of others shape the embodied experience with HIV. Moreover, this paper argues that stigma experiences for YPHIV are temporal and have changed over time with increased age, interventions and biomedical advances. Broadly, while HIV stigma continues to exist, participants report responding to stigma with agency by creating alternative solidarities and pushing boundaries of possibility, reframing others' perceptions of them and acting on dreams for better futures.

HIV and suicide risk across adolescence and young adulthood: an examination of socio-demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area

INTRODUCTION

As children become adolescents and young adults (AYA), their risk for attempting suicide increases dramatically, with chronic health conditions an important risk factor. This study examined correlates of suicidality across development in AYA living with perinatally acquired HIV (AYALPHIV) and those perinatally HIV-exposed but uninfected (AYAPHEU).

METHODS

Data come from an ongoing longitudinal New York City-based study (N = 339) with AYALPHIV and AYAPHEU interviewed every 12-18 months from 2003 to 2019 (mean enrolment age = 12 years; current mean age = 27 years). The Diagnostic Interview Schedule for Children (adolescent or young adult version) assessed psychiatric disorders and first-reported suicide attempt. Generalized estimating equations were used to examine associations between first-reported suicide attempt and socio-demographic, contextual and psychosocial correlates measured concurrently across six timepoints.

RESULTS

At enrolment, 51% of participants were female, 72% heterosexual, 60% Black and 50% Latinx. Attempted suicide was significantly higher among AYALPHIV (27%, CI 21-33%) compared to AYAPHEU (16%, CI 10-22%), with an OR of 1.74 (CI 1.04-2.92) in a model adjusting for age. For AYALPHIV, anxiety (OR 2.66, CI 1.46-4.85), mood (OR 3.62, CI 1.49-8.81) and behaviour disorders (OR 5.05, CI 2.15-11.87) and past-year arrest (OR 3.05, CI 1.26-7.4), negative life events (OR 1.27, CI 1.11-1.46), city stress (OR 2.28, CI 1.46-3.57), pregnancy (OR 2.28, CI 1.08-4.81) and HIV stigma (OR 2.46, CI 1.27-4.75) were associated with increased odds of attempted suicide, while identifying as heterosexual (OR 0.27, CI 0.14-0.52), higher personal (OR 0.45, CI 0.26-0.80) and family self-concept (OR 0.36, CI 0.22-0.57) were protective. Interactions by HIV status and age were found: substance use was more strongly associated with attempted suicide among AYAPHEU than AYALPHIV, while negative life events and higher religiosity were more strongly associated with increased odds of attempted suicide among AYA ≥ 19 versus ≤ 18 years.

CONCLUSIONS

AYALPHIV compared to AYAPHEU faced unique risks for attempted suicide as they age into adulthood, with the highest risk among AYALPHIV experiencing HIV stigma or pregnancy and the highest risk among AYAPHEU with substance use. Assessing for suicide risk and correlates with attention to ageing can inform preventive interventions tailored to meet AYALPHIV and AYAPHEU needs.

Screening for depression with the PHQ-9 in young adults affected by HIV

BACKGROUND

Major depressive disorder (MDD) is common among young adults with perinatally acquired HIV (YAPHIV), however it is often underdiagnosed and untreated. The PHQ-9 and PHQ-2 are widely used screening instruments for MDD. This study evaluates the accuracy of recommended PHQ-9 and PHQ-2 cut-scores of 10 and 3 for YAPHIV and YA who were perinatally HIV exposed but uninfected (YAPHEU).

METHODS

The PHQ-9 was administered to participants (n = 203) in a longitudinal cohort study using the DISC-IV as the gold standard for diagnosing depression. PHQ-9 and PHQ-2 sensitivity and specificity were calculated. ROC curves were constructed for the overall sample and YAPHIV and YAPHEU subsamples.

RESULTS

Almost all participants were Black and Latinx, ages 18-29. Overall, the recommended PHQ-9 cut-score of ≥10 yielded a sensitivity of 0.47 (95%CI [0.23,0.72]) and specificity of 0.86 (95%CI [0.80, 0.91]). Results indicate that PHQ-9 cut-scores of 7 and PHQ-2 cut-scores of 2 increased sensitivity to 0.76 (95%CI [0.50, 0.93]) and 0.71(95%CI [0.44,0.90]), and decreased specificity to 0.72 (95%CI [0.65, 0.79]) and 0.73 (95%CI [0.66, 0.79]) respectively. Among subsamples, existing PHQ-9 cut-scores were more accurate for MDD diagnoses in YAPHEU (N = 11) than YAPHIV(N = 6). No race/ethnicity or age differences were found.

LIMITATIONS

Participants were recruited from clinics in NYC and may not reflect all YAPHIV and YAPHEU. Without a white HIV comparison group, no conclusions could be made on the impact of race/ethnicity on optimized PHQ-9 cut-scores.

CONCLUSIONS

Using tailored cut scores for HIV-affected populations may increase identification of those experiencing or at risk for MDD. Given the need for increased depression screening in HIV care, use of optimized cut-scores could benefit at-risk populations in the US and globally.

The association between self-Esteem, stigma, and mental health among South African youth living with HIV: the need for integrated HIV care services

Treatment among pYLHIV focuses on their physical health. However, they also experience depression and anxiety, compounded by developmental challenges and the stress of managing a chronic illness. However, limited services are available to help pYLHIV manage the emotional stressors of living with a stigmatized condition. Data are from 37 caregiver-child dyads in the VUKA EKHAYA study, in Durban, South Africa. Outcomes were self-esteem and stigma. Predictors included symptoms of depression and anxiety, and HIV treatment and transmission knowledge. Outcomes and predictors were standardized (mean: 0, standard deviation: 1). Pearson correlation, bivariate and multivariate associations between predictors and outcomes were examined. Self-esteem was negatively correlated with symptoms of anxiety (r=-0.5675; p<0.001) and depression (r=-0.6836; p<0.001), suggesting higher self-concept was correlated with fewer symptoms. In multivariate analyses, increased depressive and anxiety symptoms were associated with lower self-esteem, B=0.68 and 0.57, respectively. Higher depressive and anxiety symptoms connected to more internalized stigma B=0.38 and 0.34, respectively. Conversely, HIV knowledge was not related to self-esteem or stigma. HIV treatment and transmission knowledge are not enough to reduce stigma and improve the self-esteem of pYLHIV. Integrated mental and physical health care is needed to help pYLHIV manage psychological stressors that can mitigate their emotional wellbeing.

Feasibility and acceptability of a peer youth led curriculum to improve HIV knowledge in Northern Tanzania: resilience and intervention experience from the perspective of peer leaders

BACKGROUND

Youth Living with HIV (YLWH) have reduced adherence to antiretroviral therapy (ART) and worse virologic outcomes compared to children and adults. HIV peer youth led (PYL) interventions contribute to improved retention in care and psychosocial wellbeing. The study objective was to assess the feasibility and acceptability of a PYL HIV curriculum and describe change in participants' knowledge and impact of leadership on peer leaders' lives.

METHODS

An HIV curriculum was taught during monthly Saturday adolescent HIV clinics at two clinical sites in Moshi, Tanzania (2018-2019). Youth attending clinics were ages 12 to 24 years and received the HIV curriculum during routine clinical care. Peer leaders previously participated in a mental health and life skills intervention called Sauti ya Vijana (The Voice of Youth; SYV) and were recommended for leadership by SYV facilitators and clinic staff. Peer leaders were trained and supervised weekly in curriculum delivery using a "train the trainer" model. Data were collected and analyzed using mixed methods. Fidelity checklists were used to measure adherence to the curriculum. Youth participants answered written pre- and post-knowledge questions and evaluated PYL teaching. Semi-structured interviews and the Connor Davidson Resilience scale were conducted with peer leaders before and after assuming the leadership role.

RESULTS

Peer leaders (N = 4 male; 3 female) demonstrated high fidelity (96%) to activities in each lesson and participant feedback was positive for curriculum delivery. Participants' knowledge improved in nine of ten sessions. All but one leader-who moved away before the study ended-demonstrated stable or improved resilience with a mean difference of 3.8 (SD = 7.0) from before the intervention to after assuming the leadership role. Peer leaders reported improved leadership confidence and resilience, and their perception was that the curriculum helped normalize the HIV experience for YLWH attending clinic. Nevertheless, anticipated stigma, difficulty disclosing HIV status, and teaching ability remained barriers.

CONCLUSIONS

This study demonstrated that a PYL curriculum to improve HIV knowledge integrated into routine adolescent HIV clinic in Tanzania was feasible, acceptable, and improved knowledge while also benefiting peer leaders, thus providing evidence to continue to support efforts to scale and sustain PYL interventions for YLWH.