Quality of Life of People Living with HIV in Australia: The Role of Stigma, Social Disconnection and Mental Health

The role of metacognitive beliefs in generalised anxiety disorder in men who have sex with men living with HIV in Nigeria

Men who have sex with men (MSM) living with HIV tend to experience a range of mental health issues, in particular generalised anxiety disorder (GAD), often caused and maintained by psychosocial variables including HIV stigma, discrimination, self-esteem issues, substance abuse and loneliness. This is particularly problematic in countries like Nigeria where same sex activity is illegal and can result in up to 14 years imprisonment. An important psychological variable that may contribute to the experience of GAD are metacognitive beliefs. Participants (N = 311) completed measures to examine the relationship between these variables. Results indicated that metacognition was associated with, and significantly predicted, GAD in this population. Moderation analysis showed that the effect of HIV stigma on GAD was explained by the proposed interaction with metacognition. Findings suggest that metacognition may be an important variable in explaining GAD symptoms in MSM living with HIV in Nigeria.

Exploring the dimensions of HIV-related stigma: the impact on social connectedness and quality of life

ABSTRACTAlthough the biomedical advancements in HIV treatment have improved the original prognosis of the illness, people living with HIV (PLHIV) continue to encounter psychosocial challenges that impact their quality of life (QoL), including HIV-stigma and social connectedness. The present study investigates how different types of HIV-related stigma, as per the Conceptual Model of Perceived Stigma, respectively relate to QoL in the context of social connectedness in PLHIV. A total of 213 PLHIV attending a tertiary HIV clinic in Sydney Australia, completed questionnaires assessing HIV-related stigma, social connectedness, and QoL. After controlling for illness duration, the results revealed that overall HIV-related stigma and social connectedness were predictors of reduced QoL. Specifically, negative self-image, one of the four stigma types, was associated with decreased QoL, while personalized stigma, concerns about public attitudes, and disclosure concerns were not significant predictors. Furthermore, social connectedness partially mediated the relationship between negative self-image and QoL. This study enhances understanding of the impact of various forms of HIV-related stigma in an Australian cohort, including the role of social relationships, providing novel insights for clinical interventions.

"How well do we know our patients?": Further validation of a complexity rating scale for HIV

BACKGROUND

Despite advances in the management and treatment of HIV, identifying risks for disengagement are essential to maximize positive outcomes. The current study investigated the validity of the Clinical Complexity Rating Scale for HIV (CCRS-HIV), a risk-prediction tool, by assessing agreement between patient and clinician scores of patient complexity.

METHODS

207 patients completed the patient version of the CCRS-HIV (CCRS-HIVP), and six Attending Medical Officers (AMOs) caring for those individuals completed the original clinician version (CCRS-HIVC). Kappa statistics, sensitivity and specificity were used to assess patient-clinician agreement.

RESULTS

Patient-clinician agreement was highest for problematic crystal methamphetamine use (86%), polypharmacy (84%) and other physical health concerns (67%). Cut-offs of 40 and 45 for the total CCRS-HIV score were identified as most appropriate, with high sensitivity (79.31% and 76.0% respectively).

CONCLUSIONS

Overall agreement between the clinician and patient complexity scores was high. These findings provide further evidence of the validity of the scale. The study demonstrates that the unique role of AMOs at the center contributes to them knowing their patients well, allowing them to manage and refer when required for interdisciplinary care which likely contributes to their ongoing engagement in care and may account for the high level of agreement.

Prevalence of HIV-related stigma manifestations and their contributing factors among people living with HIV in Sweden - a nationwide study

BACKGROUND

With access to  antiretroviral therapy (ART) HIV infection is a chronic manageable condition and non-sexually transmissible. Yet, many people living with HIV still testify about experiencing HIV-related stigma and discrimination. It is well-documented that HIV-related stigma and discrimination continue to be critical barriers to prevention, treatment, care and quality of life. From an individual stigma-reduction intervention perspective, it is essential to identify individual and interpersonal factors associated with HIV-related stigma manifestations. To address this issue and to expand the literature, the aim of this study was to assess the prevalence of HIV-related stigma manifestations and their associated factors among a diverse sample of people living with HIV in Sweden.

METHOD

Data from 1 096 participants were derived from a nationally representative, anonymous cross-sectional survey "Living with HIV in Sweden". HIV-related stigma manifestations were assessed using the validated Swedish 12-item HIV Stigma Scale encompassing four HIV-related stigma manifestations: personalised stigma, concerns with public attitudes towards people living with HIV, concerns with sharing HIV status, and internalized stigma. Variables potentially associated with the HIV-related stigma manifestations were divided into four categories: demographic characteristics, clinical HIV factors, distress and ART adherence, and available emotional HIV-related support. Four multivariable hierarchical linear regression analyses were employed to explore the associations between multiple contributors and HIV-related stigma manifestations.

RESULTS

The most dominating stigma feature was anticipation of HIV-related stigma. It was manifested in high scores on concerns with sharing HIV status reported by 78% of the participants and high scores on concerns about public attitudes towards people living with HIV reported by 54% of the participants. High scores on personalised stigma and internalized stigma were reported by around one third of the participants respectively. Between 23 and 31% of the variance of the four reported HIV-related stigma manifestations were explained mainly by the same pattern of associated factors including female gender, shorter time since HIV diagnosis, feelings of hopelessness, non-sharing HIV status, and lack of available emotional HIV-related support.

CONCLUSION

The most dominating stigma feature was anticipation of stigma. Female gender, shorter time since HIV diagnosis, feelings of hopelessness, non-sharing HIV status, and lack of available emotional HIV-related support constituted potential vulnerability factors of the four HIV-related stigma manifestations. Our findings highlight the vital necessity to support people living with HIV to increase their resilience to stigma in its different forms. Exploring associated factors of HIV-related stigma manifestations may give an indication of what circumstances may increase the risk of stigma burden and factors amenable to targeted interventions. As individual stigma-reductions interventions cannot be performed isolated from HIV-related stigma and discrimination in society, a key challenge is to intensify anti-stigma interventions also on the societal level.

An Analysis of Post-Traumatic Stress Disorder and Quality of Life Among Adults Living with HIV in Western Uganda

Background

HIV/AIDS remains a significant global public health issue, profoundly impacting infected individuals. Living with HIV involves complex mental health dynamics, with post-traumatic stress disorder (PTSD) being a prevalent challenge. This study aims to examine the correlation between PTSD and quality of life among HIV-positive individuals in western Uganda.

Material and Methods

Conducted between May and July 2023, this facility-based cross-sectional study surveyed 439 participants from four HIV clinics in southwestern Uganda. Data were collected through interviewer-administered questionnaires, analyzed using descriptive statistics, simple linear regression, and multiple linear regression (p<0.05).

Results

Respondents had a mean age of 40.6 years, with 68.3% female, 54.9% married, and 55.1% lacking formal education. The reported PTSD prevalence among HIV-positive individuals was 33.7%, significantly correlating with reduced overall quality of life (β = -4.52; p<0.001). The social quality of life had the highest mean score of 14.24 (±3.45) while the environmental quality of life had the lowest mean score 11.89 (±2.68).

Conclusion

Our study reveals a concerning prevalence of PTSD, affecting 1 in 3 individuals, emphasizing the pressing need for comprehensive mental health support within HIV care settings. We observed a significant negative impact of PTSD on overall quality of life, particularly in physical and social aspects. Integrating mental health screening into routine HIV care is crucial, using validated tools like the PSTD Checklist Civilian Version, alongside training for healthcare providers to recognize PTSD symptoms in the context of HIV diagnosis and treatment.

Associations Between Internalized and Anticipated HIV Stigma and Depression Symptoms Among People Living with HIV in China: A four-wave Longitudinal Model

Previous research has documented that HIV-related stigma (e.g., internalized and anticipated stigma) is detrimental to the mental health of people living with HIV (PLWH). However, longitudinal data on the bidirectional relationship between HIV-related stigma and depression symptoms are limited. The purpose of this study was to examine the bidirectional association among internalized and anticipated HIV stigma and depression symptoms among Chinese PLWH. A four-wave longitudinal design (6 months intervals) was employed among 1,111 Chinese PLWH (Mage = 38.58, SD = 9.16, age range: 18-60 years; 64.1% men). The bidirectional model was examined using a random-intercept cross-lagged panel model (RI-CLPM), which evaluated the within- and between-person effects of study variables. At the within-person level, results indicated that depression symptoms at T2 mediated the linkage between internalized HIV stigma at T1 and anticipated HIV stigma at T3, and that anticipated HIV stigma at both T2 and T3 mediated the relationship between depression symptoms at the previous time point and internalized HIV stigma at the subsequent time point. Furthermore, a bidirectional association was found between anticipated HIV stigma and depression symptoms across four waves. At the between-person level, internalized and anticipated HIV stigma were significantly associated with depression symptoms. This study highlights the complex interplay between different forms of HIV-related stigma and mental health problems among PLWH and underscores the importance of considering the bidirectional relationship between the development of psychopathology and stigmatization process in clinical practice.

How does a chronic wound change a patient's social life? A European survey on social support and social participation

Chronic wounds can severely limit patient's social life. This cross-sectional study investigated quantitatively social support of patients with chronic wounds, its association with health-related quality of life as well as qualitatively changes in social participation of these patients. Overall, 263 patients from seven countries participated. The most frequent wound class was leg ulcer (49.2%). Results revealed generally high levels of social support (mean global score: 5.5) as measured with the Multidimensional Scale of Perceived Social Support. However, individuals differed considerably (range 1.0-7.0). All dimensions of social support differed by patients' family and living situations (p < 0.001 to p = 0.040) and were positively correlated with generic health-related quality of life (r = 0.136-0.172). Having children, living with others and being in a relationship were significant predictors of having higher global social support. Patients reported great support from family members. Many participants reported no changes in relationships with friends. Wound care managers took an important role and provided additional emotional support. Patients reported a range of discontinued activities. Despite the high overall level of social support, inter-individual differences should be acknowledged. The importance of family carers should be acknowledged to be able to reduce caregiver burden and to ensure high-qualitative wound care.

Quality of life among people living with HIV aged 50 years and over in Australia: Identifying opportunities to support better ageing

OBJECTIVES

Improved life expectancy has led to an ageing population of people living with HIV in most countries. Research on ageing among people living with HIV has predominantly focused on physical and health-related quality of life rather than multidimensional quality of life. We measured quality of life among older people living with HIV in Australia and identified opportunities to guide the development and implementation of appropriate interventions.

METHODS

In a national health and wellbeing survey of Australian people living with HIV, participants aged ≥50 years completed additional questions relevant to ageing. Quality of life was measured using PozQoL, a validated multidimensional instrument assessing quality of life among people living with HIV (range 1-5). Exploratory bivariate analyses aimed to identify sociodemographic characteristics associated with quality of life. Adjusted linear regressions aimed to assess changes in PozQoL score associated with recent experiences (last 12 months) of four exposures: food insecurity, HIV-related stigma, isolation from the HIV community, and difficulties accessing non-HIV health services.

RESULTS

Among 319 older people living with HIV, the mean PozQol score was 3.30 (95% confidence interval [CI] 3.20-3.39). In bivariate analyses, PozQol scores were significantly higher among participants who were older (p = 0.006), had higher educational attainment (p = 0.009), were in a relationship (p = 0.005), were employed (p = 0.005), and had a higher income (p = 0.001). In adjusted regression models, PozQoL scores were lower among participants who reported recent experiences of food insecurity (β -0.49; 95% CI -0.74 to -0.24), stigma (β -0.53; 95% CI -0.73 to -0.33), isolation from the HIV community (β -0.49; 95% CI -0.70 to -0.29), and difficulties accessing non-HIV health services (β -0.50; 95% CI -0.71 to -0.30).

CONCLUSIONS

Overall, older people living with HIV in this study had a moderate quality of life. Our findings suggest that HIV services should integrate programmes to support economic security and foster connections within the HIV community and across health services.