The Mental Health of People Living with HIV in China, 1998-2014: A Systematic Review

The longitudinal change of depressive symptoms among people living with HIV in Guangdong Province, China: A network analysis

BACKGROUND

Depression may change over time among people living with HIV (PLHIV). This study aimed to understand longitudinal change of depression among PLHIV in China, and the impact of change in depression on mortality.

METHODS

A cohort study was conducted to collect data on depressive symptoms among PLHIV at baseline and one-year follow-up in Guangdong Province from May 2018 to June 2019 and continued to follow up until June 2023. Generalized estimating equations were used to explore factors associated with depression. Network analysis was used to explore the interrelations between specific depressive symptoms at baseline and one-year follow-up.

RESULTS

30.9 % of 792 participants had a pattern of remission at one-year follow-up, 6.3 % had persistent depression at both baseline and one-year follow-up, and 5.9 % had new-onset depression at one-year follow-up. 46 (5.8 %) participants died. High levels of education, HIV-related symptoms, high levels of HIV-related stigma, and low social cohesion were longitudinally associated with a higher risk of depression. Network analysis revealed that "Depressed mood" and "Sadness" had high centrality in both the baseline and follow-up networks, with "Fearful" being the most increased central node at follow-up compared to baseline. Cox regression after propensity score weighting showed that the groups with new-onset and persistent depression had a higher risk of mortality than the non-depressed group.

CONCLUSION

More attention should be paid to individuals with high levels of education and those with HIV-related symptoms. Interventions targeting symptoms with increased centrality nodes, reducing HIV-related stigma and improving social cohesion may also help to reduce depression among PLHIV.

Self-reported sleep disturbances among people living with HIV in China: A Systematic Review and Meta-Analysis

OBJECTIVE

People living with HIV (PLWH) commonly face a range of health issues, among which sleep disturbances are common and are related to adverse health outcomes. This review aims to assess the pooled prevalence of sleep disturbances among PLWH in China through a comprehensive and quantitative meta-analysis.

METHODS

We conducted comprehensive searches of Chinese databases and international databases from their inception to December 23, 2023. The random effects model was used to calculate the pooled prevalence estimates with a 95% confidence interval.

RESULTS

This meta-analysis included 20 studies involving 12,256 Chinese PLWH, 5,542 PLWH of whom experienced sleep disturbances. The pooled prevalence was 46% (95% CI: 42-51%). Subgroup analysis revealed that the prevalence of sleep disturbances was influenced by the mental status of depression (Q = 4.21, p < .001) and anxiety (Q = 4.76, p < .001), receiving support from family and friends (Q = 6.63, p < .001), treatment with Efavirenz (Q = 37.53, p = .007), studies using different instruments (Q = 42.69, p < .001) and those using different cutoff values of PSQI (Q = 48.29, p < .001). Meta-regression analysis revealed that the covariates, including mean age, female proportion, publication year, and quality score, were not significant moderators of heterogeneity (p > .05).

CONCLUSIONS

Chinese PLWH experience a significant burden of sleep disturbances. Early screening and comprehensive interventions targeting sleep disturbances in this population should be prioritized to improve their overall well-being and quality of life.

The effect of depression on antiretroviral drug non-adherence among women living with HIV in Gondar health facilities, northwest Ethiopia: a prospective cohort study

Background

Globally, depression has been recognized as one of the risk factors for poorer outcomes in human immunodeficiency virus (HIV)- affected populations including women living with HIV (WLWHIV). Additionally, depression continues to be a barrier to antiretroviral therapy (ART) adherence. In African countries, including Ethiopia, depression often goes undetected and untreated for extended periods, leading to prolonged health outcomes. Factors such as the lack of awareness about depression and its impact on ART adherence contribute to its poor management. Understanding depression's role in ART is crucial for generating evidence to improve individuals' functionality and treatment outcomes. This study aimed to examine the effects of depression on ART non-adherence among WLWHIV in Ethiopia.

Methods

A prospective cohort study was conducted with data collected from 627 study participants who were on stable ART regimens at baseline, 3 months, and 6 months. Depression, the primary exposure variable, was measured using the Patient Health Questionnaire (PHQ-9). Antiretroviral adherence, the dependent variable, was assessed using the Simplified Medication Adherence Questionnaire (SMAQ). Generalized estimating equations (GEEs) were used to examine the association between HIV- related stigma, social support, depression, and ART non-adherence.

Results

The response rates of the study participants in the 2nd and 3rd phases were 99.7% and 94.4%, respectively, with a mean age of 42.27 years (SD ± 10.51). Depressed WLWHIV had a 2.19 times higher incidence of ART non-adherence compared to non-depressed WLWHIV. In panel data analysis, depression, poor social support, and HIV- related stigma were positively associated with ART non-adherence, with adjusted odds ratios of 1.97 [95% confidence interval (CI) (1.35, 2.87)], 2.15 [95% CI (1.05, 4.38)], and 1.56, [95% CI (1.09, 2.25)] respectively.

Conclusion

Depression, poor social support, and HIV- related stigma in women living with HIV were associated with ART non-adherence. Addressing these modifiable barriers could significantly enhance ART adherence in these populations.

Pathogenesis of HIV-associated depression: contributing factors and underlying mechanisms

Cumulative evidence indicates that compared to HIV negative individuals, people living with HIV (PLWH) have a higher likelihood of developing depression, anxiety, and cognitive disorders. Depression, which is known to be a persistent and overwhelming feeling of sadness accompanied by a loss of interest in usual activities, is one of the most common mental illnesses encountered during HIV infection. Experts believe that several factors such as neuroinflammation, life stressors, lack of sleep, poor nutritional state, opportunistic infections and comorbidities, and HIV medications are contributing factors favoring the development of depression in PLWH. However, the fundamental mechanisms which underlie the involvement of these factors in the emergence of depression in the context of HIV remain poorly explored. Past researches describing the role of one or two of the preceding factors do exist; however, very few articles tackle this important topic while considering the several different putative causative factors comprehensively in the particular context of HIV infection. Herein, we elaborate on the factors currently understood to be responsible for the development of depression, and discuss the particular fundamental mechanisms whereby each factor may result in the outcome of depression. We believe that the understanding of these factors and of their underlying mechanisms is essential for the development of future therapeutic interventions to alleviate the burden of depression commonly seen in PLWH, and therefore facilitate the development of strategies to improve their overall quality of life.

Mental Health Symptoms Between Developed and Developing Regions for People Living With HIV in China: A Network Analysis of 40 Psychological Symptom Scales

BACKGROUND

People living with HIV (PLWH) frequently encounter mental health symptoms. Yet, a notable gap exists regarding the divergence in core mental health symptoms among PLWH across developed and developing regions. This study aims to explore the differences in mental health symptom networks among PLWH in both developed and developing regions.

METHODS

A multicenter cross-sectional study was conducted in China from April 2022 to April 2023. Six designated HIV hospitals enrolled 2436 participants, including 1430 PLWH from developed regions and 1006 PLWH from developing regions. The study assessed 40 mental health symptoms across six dimensions: somatization symptoms, negative affect, cognitive processes, cognitive function, interpersonal communication, and social adaptation among PLWH.

RESULTS

The diverse developed regions exhibited varying mental health symptoms among PLWH, particularly concerning their core symptoms. In the developed regions of China, PLWH predominantly experience core symptoms centered around "Sadness," "Anger," and "Distress." In contrast, PLWH from developing regions tends to manifest core symptoms such as "Inability to integrate into society," "Difficulty in managing daily work and study," and "Hostility."

CONCLUSIONS

The regional variation in mental health symptoms among PLWH underscores the disparities in their circumstances. This insight is crucial for crafting tailored intervention strategies for urban PLWH. In developed regions, psychological interventions such as catharsis and empathy are integral to clinical practice, while in less developed regions, family support interventions are paramount, given the limited social interactions available to PLWH.

REPORTING METHOD

This study was reported according to the STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

[ART adherence and its association with depression, anxiety and stress]

Background

Stress, anxiety, and depression are associated with low adherence to antiretroviral therapy (ART) in HIV patients, but there are no reports of this association in southeastern Mexico.

Objective

To describe the frequency of adherence to ART and its association with depression, anxiety, and stress.

Material and methods

A cross-sectional study was conducted. 442 HIV-positive outpatients treated at General Hospital Number 1 in Tapachula, Chiapas, in the period August-December 2022 were analyzed. Adherence to ART was assessed with the Simplified Medication Adherence Questionnaire (SMAQ) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) was applied. To assess the association between variables, adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated using a multivariate logistic regression model. Cases with ART adherence between 95% and 100% were compared with those with ART adherence below 95%.

Results

Of the total 442 HIV-positive subjects, 344 had ART adherence between 95% and 100%, and 98 had ART adherence below 95%. The frequencies of depression, anxiety, and stress were 33%, 13.3%, and 8.8%, respectively. Associations were observed between ART adherence below 95% and anxiety, depression, and stress.

Conclusions

Since low ART adherence was associated with depression, anxiety, and stress among HIV-positive patients, early mental health interventions may help improve therapeutic adherence.

Coping strategies for depression among HIV-positive women in Gondar town health facilities, Northwest, Ethiopia: A cross-sectional study

BACKGROUND

Most women living with HIV in low- and middle-income countries remain undiagnosed and untreated for depression. Even though depression has an adverse effect on treatment outcome and disease progression, less attention is given. The progression of depression is influenced by coping mechanism. The aim of this study was to identify the coping strategies used by depressed women living with HIV in Gondar town health facilities, north west, Ethiopia.

METHODS

Health institution based cross-sectional study was conducted in Gondar town health facilities, in north-western Ethiopia. All women living with HIV (n = 1043) were screened for depression symptoms using the validated Patient Health Questionnaire, 9 item version (PHQ-9). Those who scored ten or more, "moderate depression among women living with HIV," (n = 435) were included in this study. The BRIEF Coping with Problem Experienced (COPE-28) scale was used to assess coping strategies. Construct validity of the brief COPE was evaluated using confirmatory factor analysis with AMOS 23 software. Linear regression model was fitted and beta coefficients were used to interpret the significant factors for coping strategies at p- values < 0.05 with 95% confidence interval.

RESULTS

Dysfunctional coping strategy was more widely practiced than emotional focused or problem focused coping strategies. From the emotional coping strategy, spiritual believes and praying coping were the most frequently used coping strategies in the study group. Time taken to initiate antiretroviral therapy (ART) less than 5 years and the increment of viral load were significantly associated with dysfunctional coping strategy. Having 1-2 children and fear of COVID-19 were the significant factors for problem focused coping strategy. An increment in emotion focused coping was associated with food insecurity. Social support and distance from health institutions 5 km or more were found to have a positive association with problem and emotion-focused coping strategies. Conversely, time taken to initiate antiretroviral therapy (ART) 5 years and more negatively correlated with both problem and emotion-focused coping mechanisms.

CONCLUSION

The study revealed that all coping strategies were utilized by depressed women living with HIV (WLWHIV). Strengthening spiritual coping styles proved beneficial in reducing depression among these individuals. It is recommended that depressed WLWHIV practice problem and emotion-focused coping strategies. Additionally, social support enhances both problem and emotion-focused coping approaches. Factors contributing to dysfunctional coping included having started ART less than five years ago and high viral load levels. Therefore, providing holistic support for depressed WLWHIV is essential to improve their mental health.

HIV self-management and associated factors among people living with HIV in Hunan, China: a nine-year longitudinal study

Self-management refers to the behaviors and strategies individuals employ to manage their health conditions. For people living with HIV (PLWH), it encompasses medication adherence, health monitoring, symptom management, lifestyle maintenance and seeking emotional support. While previous studies on the factors influencing self-management in PLWH are predominantly cross-sectional, longitudinal studies are scarce. This nine-year longitudinal study aimed to investigate the trajectories of psychosocial characteristics in PLWH and their effects on self-management. A total of 265 PLWH were assessed for psychosocial factors, including stigma, depression, anxiety, and social support, at baseline and at one-, five- and nine-year follow-ups. Self-management was evaluated at the nine-year follow-up. Psychosocial trajectories were identified using latent growth trajectory models (LGMM), and associations with self-management were analyzed via multiple linear regression. The majority of participants exhibited a low-level decline in depression (79.6%) and rising social support (54.3%). The high-level decline depression group demonstrated the lowest self-management scores (b = -4.67, 95% CI: -8.166 to -1.175). Multivariate analysis revealed significant associations between self-management and exercise (b = 5.360, 95% CI: 3.934-6.786), depressive symptoms (b = -0.168, 95% CI: -0.305 to -0.031) and social support (b = 0.182, 95% CI: 0.101-0.264). These findings emphasize the need for continuous monitoring and targeted interventions to improve self-management in PLWH.

Intrinsic Association Between Death Anxiety and Depression Among Men Living with HIV/AIDS in China: A Network Analysis

Background

With the increasing popularity of ARVs, physical symptoms of people living with HIV/AIDS (PLWHA) have been effectively improved. Improving mental health and quality of life has gradually become the focus of attention in the treatment. The aim of this study is to explore the association between death anxiety and depression in men living with HIV/AIDS (MLWHA) from the perspective of network analysis.

Methods

This study recruited 701 MLWHA in Jilin Province, China. Participants were asked to complete a questionnaire. The average age of the participants was 37.4 years old. Among them, there were 54 heterosexual participants, 494 homosexual participants, 139 bisexual participants, and 14 asexual/other participants. Network analysis was used to identify central symptoms, key bridge symptoms, and the strongest edge among symptoms in the death anxiety and depression network.

Results

In this study, 18.1% of MLWHA may suffer from severe depression. The severity of depression in homosexual MLWHA was severer than in heterosexuals. Death anxiety was severer among unmarried and married/cohabiting MLWHA compared to divorced/separated/widowed MLWHA. This study found that item DAS10 (The topic of post death is very confusing to me) was the most central symptom. The edge DAS2 - PHQ9 (Rarely think of death - Suicide ideation) was the strongest edge between death anxiety and depression. Item DAS2 (Rarely think of death) was the strongest bridge symptom.

Conclusion

Psychological symptoms such as distress over the topic of death, thoughts of death, and suicidal ideation play an important influential and connecting role in the death anxiety-depression network among MLWHA. Implementing appropriate interventions for these symptoms-such as popularizing correct knowledge of death and providing more psychological counseling services for this group-can effectively reduce the co-occurrence of death anxiety and depression, thereby improving the mental health of MLWHA.

Limited Impact of Cannabidiol on Health-related Quality of Life of People With Long-term Controlled HIV: A Double-blind, Randomized, Controlled Trial

Background

People with HIV (PWH) with undetectable HIV viral load still have an impaired health-related quality of life (HRQoL). Cannabidiol (CBD) is a nonintoxicating cannabis-derived cannabinoid that holds promise for the treatment of many ailments. In the present study, we tested whether oral CBD-rich medication could significantly improve PWH's HRQoL.

Methods

Eighty participants with undetectable HIV viral load were randomized to either a placebo or full-spectrum CBD (1 mg/kg twice a day) arm for 12 weeks plus a 4-week follow-up period. HRQoL was assessed at baseline, week 12, and week 16 using the 36-Item Short Form Health Survey questionnaire (SF-36). Primary outcomes were physical and mental component summary scores; secondary outcomes were the 8 SF-36 subscale scores. Treatment effects on outcomes were estimated using generalized estimating equations.

Results

We found no effect of CBD intake on the summary score for either component. However, CBD intake was associated with a higher physical functioning score at week 12 only (regression coefficient [95% confidence interval], 7.72 [0.55-14.89]; P = .035). No significant main effect of CBD intake on the other HRQoL subscale scores was observed. Furthermore, there was no difference in self-reported adverse effects between the 2 arms.

Conclusions

Twice-daily CBD full-spectrum oil at 1 mg/kg had no major effect on virologically suppressed PWH's HRQoL but had a positive effect on physical functioning. Further randomized controlled trials including PWH with lower baseline HRQoL are needed to confirm this finding.

Mental health disparities in people living with human immunodeficiency virus: A cross-sectional study on physician-patient concordance and treatment regimens

BACKGROUND

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) can profoundly affect the mental health of the people living with HIV (PLWH), with higher rates of anxiety, depression, and sleep disturbances. The disparities in neuropsychological problems evaluated by physicians and self-assessed by patients are still unknown.

METHODS

A total of 5000 PLWH and 500 physicians from 167 hospitals were enrolled in this cross-sectional study from September 2022 to February 2023. 4-Item Patient Health Questionnaire (PHQ-4) was used for the evaluation of depressive issues and anxiety issues by PLWH. Each physician assessed 10 PLWH under their care for the presence of depressive or anxiety issues. The primary outcomes of this study are the concordance rates on the depressive issues and anxiety issues evaluation between physicians and PLWH. The Cohen's kappa test was used to assess the agreement between physicians and PLWH.

RESULTS

The concordance rate for the evaluation of depressive issues is 73.84% (95% confidence interval [CI]: 72.60-75.04%), and it is significantly different from the expected rate of 80% (P <0.001). Similarly, the concordance rate for the evaluation of anxiety issues is 71.74% (95% CI: 70.47-72.97%), which is significantly different from the expected rate of 80% as per the null hypothesis (P <0.001). The overestimation rate by physicians on depressive issues is 12.20% (95% CI: 11.32-13.14%), and for anxiety issues is 12.76% (95% CI: 11.86-13.71%). The mismatch rate for depressive issues is 26.16% (95% CI: 24.96-27.40%), and for anxiety issues is 28.26% (95% CI: 27.02-29.53%). The underestimation rate by physicians on depressive issues is 13.96% (95% CI: 13.03-14.95%), and for anxiety issues is 15.50% (95% CI: 14.52-16.53%). For the treatment regiments, PLWH sustained on innovative treatment regimen (IR) related to a lower prevalence of depressive issues (odds ratio [OR] = 0.71, 95% CI: 0.59-0.87, P = 0.003) and a lower prevalence of anxiety issues (OR = 0.63, 95% CI: 0.52-0.76, P <0.001). PLWH switch from conventional treatment regimen (CR) to IR also related to a lower prevalence of depressive issues (OR = 0.79, 95% CI: 0.64-0.98) and a lower prevalence of anxiety issues (OR = 0.81, 95% CI: 0.67-0.99).

CONCLUSION

Nearly one in three PLWH had their condition misjudged by their physicians. The findings underscore the need for improved communication and standardized assessment protocols in the care of PLWH, especially during the acute phase of HIV infection.

Brief Report: Depression, Substance Use, and Factors Associated With Sexual Risk Behaviors Among Adults Living With HIV in the Asia-Pacific Region

Background

Mental health and substance use disorders are common among people living with HIV and are associated with high-risk sexual behaviors, such as unprotected sex and multiple sexual partners, but Asia-Pacific data are limited.

Methods

Adult PLHIV in care at five Asia-Pacific HIV clinics were enrolled at routine clinic visits between July 2019 and June 2020. Depression, substance use, sexual practice and socio-demographic data were collected using PHQ-9, ASSIST, and a study-specific questionnaire. Clinical data were accessed from medical records. Risk factors for medium- to high-risk sexual practices, defined based on total scores from the sexual practice questionnaire assessing number of sexual partners and condom use, were analyzed using logistic regression. Moderate to severe depression was defined as a PHQ-9 score >9, and moderate- to high-risk substance use as an ASSIST score ≥11 for alcohol or ≥4 for other substances.

Results

Among 723 participants, median age was 38 years, 89% were male, 99% were on ART and 37% had medium- to high-risk sexual practices. Medium- to high-risk sexual practices were more common among those ≤30 years old, unemployed, and HIV status disclosed, and were more likely in participants with moderate to severe depression (aOR 2.09, 95%CI 1.17-3.74) compared to none to minimal depression, and moderate- to high-risk substance use (aOR 1.73, 95%CI 1.23-2.44) compared to those without.

Conclusions

Further integration of comprehensive sexual risk reduction strategies, mental health services and substance use harm reduction within HIV clinical settings in the region is needed.

Investigating the Moderating Effect of HIV Status Disclosure on the Link Between Discrimination Experience and Psychological Distress Among People Living with HIV in Japan Infected Through Sexual Contact

BACKGROUND

There is a scarcity of research on the potential impact of disclosing HIV status to friends and family in moderating the adverse effects of discrimination on the mental health of people living with HIV (PLWH). This study assessed the experiences of discrimination and HIV status disclosure among PLWH in Japan, and evaluated their potential associations with psychological distress.

METHOD

Data were derived from a nationwide cross-sectional survey of PLWH conducted in Japan between 2019 and 2020. The interaction effects of HIV-related discrimination and HIV status disclosure on the psychological distress were examined using logistic and linear regression analyses.

RESULTS

The median age of the 804 respondents was 46 years old. Most respondents were male and 85.4% (687/804) identified as homosexuals or bisexuals. A total of 12.7% (102/804) of the respondents reported that they had recently experienced discrimination because of their HIV status. Experience of HIV-related discrimination was independently associated with high psychological distress (adjusted OR 2.02; 95% CI, 1.15-3.57), and HIV status disclosure to friends partially weakened the association between discrimination and the level of psychological distress (regression coefficient -3.115; p = 0.004).

CONCLUSION

While measures that aim to end discrimination remain vital, increasing the opportunities of PLWH to communicate with friends they feel comfortable disclosing their HIV status may also be helpful in protecting their mental health.

Systematic review and meta-analysis on the effect of depression on ART adherence among women living with HIV

BACKGROUND

Depression is a very common psychiatric disorder in worldwide. Globally, Human Immunodeficiency Virus (HIV) is highly prevalent among women, and are disproportionately affected by depression. Antiretroviral Therapy (ART) adherence which could highly be affected by depression is yet to be explored effectively. Depression affects overall poor HIV clinical outcomes, socioeconomic and social interactions. However, it is not well understood specifically how depression affects ART adherence in women living with HIV (WLWHIV). Investigating the effects of depression on ART adherence is critical in order to develop nuanced new evidence to address non-adherence in WLWHIV.

OBJECTIVE

To conduct a meta-analysis on the correlation between depression and adherence to antiretroviral therapy among women living with HIV in the globe.

METHOD

Using population, exposed and outcome approach, we searched Scopus, PubMed, EMBASE, Cochrane Library, Psych info, Web of science and google scholar for cohort and cross-sectional studies globally. The search strategy was structured comprising terms associated with antiretroviral therapy and adherence, women living with HIV and depression. We evaluated the paper quality, using the Newcastle-Ottawa Scales (NOS). The fixed effect model was used to analysis the effect of depression on ART adherence.

RESULT

A total of 8 articles comprise 6474 participants were included in this study. There were controversial findings related to the effect of depression to ART adherence. Among three cross-sectional study, one article demonstrating, depression was associated with ART adherence. Of the five cohort studies, four cohort studies reported association. The overall pooled estimated effect of depression on ART adherence was 1.02 [RR = 1.015 with 95% CI (1.004, 1.026)] with a p-value of 0.005.

CONCLUSION AND RECOMMENDATION

Depression was the risk factor for ART adherence among women living with HIV. It is therefore, necessary for clinician to note this and perform screening for ART adherence.

TRIAL REGISTRATION

The review protocol was developed with prospero registration: CRD42023415935.

Is Abstinence from Alcohol and Smoking Associated with Less Anxiety and Depressive Symptoms Among People with HIV?

Achieving abstinence from alcohol, tobacco, or both may improve mental health, but is understudied in people with HIV (PWH). The St PETER HIV randomized clinical trial compared varenicline, cytisine, and nicotine replacement therapy on alcohol and smoking behavior among 400 PWH in Russia. The primary exposure was thirty-day point prevalence abstinence (PPA) from (1) alcohol, (2) smoking, (3) both, or (4) neither and was assessed at 1, 3, 6 and 12-months as were the study outcomes of anxiety (GAD-7) and depressive (CES-D) symptoms. The primary aim was to examine the association between smoking and/or alcohol abstinence and subsequent symptoms of depression and anxiety. Primary analysis used repeated measures generalized linear modeling to relate PPA with mental health scores across time. In secondary analyses, Kruskal-Wallis tests related PPA with mental health scores at each timepoint. Primary analyses did not identify significant differences in anxiety or depressive symptoms between exposure groups over time. Secondary analyses found CES-D scores across PPA categories were similar at 1-month (11, 10, 11, 11) and 6-months (10, 10, 11, 11) but differed at 3-months (9, 11, 10, 12; p = 0.035) and 12-months (10, 6, 11, 10; p = 0.019). GAD-7 scores did not vary across PPA categories at any time point. While abstinence was associated with fewer depressive symptoms at times, findings were not consistent during follow-up, perhaps reflecting intermittent relapse. PWH with polysubstance use and mental health comorbidity are complex, and larger samples with sustained abstinence would further elucidate effects of abstinence on mental health.

The impact of cash incentives on mental health among adults initiating antiretroviral therapy in Tanzania

Mental illness is prevalent among people living with HIV (PLHIV) and hinders engagement in HIV care. While financial incentives are effective at improving mental health and retention in care, the specific effect of such incentives on the mental health of PLHIV lacks quantifiable evidence. We evaluated the impact of a three-arm randomized controlled trial of a financial incentive program on the mental health of adult antiretroviral therapy (ART) initiates in Tanzania. Participants were randomized 1:1:1 into one of two cash incentive (combined; provided monthly conditional on clinic attendance) or the control arm. We measured the prevalence of emotional distress, depression, and anxiety via a difference-in-differences model which quantifies changes in the outcomes by arm over time. Baseline prevalence of emotional distress, depression, and anxiety among the 530 participants (346 intervention, 184 control) was 23.8%, 26.6%, and 19.8%, respectively. The prevalence of these outcomes decreased substantially over the study period; additional benefit of the cash incentives was not detected. In conclusion, poor mental health was common although the prevalence declined rapidly during the first six months on ART. The cash incentives did not increase these improvements, however they may have indirect benefit by motivating early linkage to and retention in care.Clinical Trial Number: NCT03341556.

Association between psychological discomforts and sleep quality among people living with HIV/AIDS

BACKGROUND

Psychological discomfort and sleep problems are considered separate disorders. Due to the high prevalence of both disorders among people living with HIV (PLWH), this study was designed to evaluate how those challenges are present among PLWH.

METHOD

A cross-sectional study was conducted using data from a national survey of 1185 confirmed PLWH from 15 provinces in Iran from April to August 2019. Psychological discomfort and sleep quality were assessed using standardized versions of related Persian questionnaires. Logistic regression was used to assess the association between psychological discomfort and sleep quality in PLWH.

RESULTS

The overall prevalence of poor sleep quality, depression, anxiety, and stress was 47.71%, 50.95%, 44.26%, and 41.77%, respectively. The results of multivariate-adjusted logistic regression showed that each psychological discomfort covariate increased the odds of poor sleep quality. Depression by adjusting for anxiety and stress, anxiety by adjusting for depression and stress, and stress by adjusting for depression and anxiety all increased the odds of poor sleep quality.

CONCLUSION

A high prevalence of psychological discomfort was observed in PLWH. Depression, anxiety, and stress were strongly associated with sleep quality. PLWH needed more attention and social support in order to reduce sleep and psychological issues.

The impact of anxiety, depression, and social support on the relationship between HIV-related stigma and mental health-related quality of life among Chinese patients: a cross-sectional, moderate-mediation study

BACKGROUND/OBJECTIVE

People living with HIV (PLWH) are prone to mental health problems and evidence indicates that HIV-related stigma can negatively impact mental health-related quality of life. This study explored potential mechanisms between HIV-related stigma and mental health-related quality of life, specifically whether anxiety or depression mediates, and whether social support moderates, the relationship.

METHOD

A total of 1197 Chinese PLWH participated in the study. The Berger HIV Stigma Scale, the Hospital Anxiety and Depression Scale (HADS), the 12-item Brief Health Survey (SF-12), and the Multidimensional Scale of Perceived Social Support (MSPSS) were employed.

RESULTS

HIV-related stigma was negatively associated with mental health-related quality of life. Anxiety and depression partially mediated the relationship between HIV-related stigma and mental health-related quality of life; social support played a moderating role.

CONCLUSIONS

The mental health-related quality of life in PLWH was shown to be indirectly affected by HIV-related stigma through anxiety and depression in China. The negative impact of HIV-related stigma decreased with increased social support.

Genomic Factors and Therapeutic Approaches in HIV-Associated Neurocognitive Disorders: A Comprehensive Review

HIV-associated neurocognitive disorders (HANDs) still persist despite improved life expectancy, reduced viral loads, and decreased infection severity. The number of patients affected by HANDs ranges from (30 to 50) % of HIV-infected individuals. The pathological mechanisms contributing to HANDs and the most serious manifestation of the disease, HIV-associated dementia (HAD), are not yet well understood. Evidence suggests that these mechanisms are likely multifactorial, producing neurocognitive complications involving disorders such as neurogenesis, autophagy, neuroinflammation, and mitochondrial dysfunction. Over the years, multiple pharmacological approaches with specific mechanisms of action acting upon distinct targets have been approved. Although these therapies are effective in reducing viral loading to undetectable levels, they also present some disadvantages such as common side effects, the need for administration with a very high frequency, and the possibility of drug resistance. Genetic studies on HANDs provide insights into the biological pathways and mechanisms that contribute to cognitive impairment in people living with HIV-1. Furthermore, they also help identify genetic variants that increase susceptibility to HANDs and can be used to tailor treatment approaches for HIV-1 patients. Identification of the genetic markers associated with disease progression can help clinicians predict which individuals require more aggressive management and by understanding the genetic basis of the disorder, it will be possible to develop targeted therapies to mitigate cognitive impairment. The main goal of this review is to provide details on the epidemiological data currently available and to summarise the genetic (specifically, the genetic makeup of the immune system), transcriptomic, and epigenetic studies available on HANDs to date. In addition, we address the potential pharmacological therapeutic strategies currently being investigated. This will provide valuable information that can guide clinical care, drug development, and our overall understanding of these diseases.

Exploration of adaptation process and experience among the HIV/AIDS patients based on the comprehensive task-based adaptation model

OBJECTIVES

Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) confront multiple difficulties during the disease adaptation process. Based on the comprehensive task-based adaptation model, this study aims to explore the process and experience of adapting to living with HIV among HIV/AIDS patients and to provide evidence for promoting the adaptation of this population.

METHODS

With the design of the phenomenon study, we purposefully recruited 43 HIV/AIDS patients and conducted semi-structural interviews. The qualitative data was analyzed by Van Manen method.

RESULTS

There were 1 307 significant quotes and 6 themes with 14 sub-themes. "The shadow comes along with the sunshine" was proposed to describe the process of adapting to life with HIV. Another 5 themes emerged to represent the tasks as follows: the direction of the mental anchor, the management of physical tasks, social network and support, the occupational dilemma and benefits, and the consideration of the future.

CONCLUSIONS

The adapting process possesses both common and personalized characteristics. Future intervention development should address the integrality and interaction of the adaptation tasks, contributing to the positive adaptation outcomes of HIV/AIDS patients.

Treatment persistence of bictegravir/emtricitabine/tenofovir alafenamide and efavirenz + lamivudine + tenofovir disoproxil among HIV-1 patients newly starting treatment in Hunan Province in China

BACKGROUND

Though bictegravir/emtricitabine/tenofovir (BIC/FTC/TAF) have been regulatory approved and included in the National Reimbursement Drug List in China, due to the affordability concern, generic version of efavirenz + lamivudine + tenofovir (EFV + 3TC + TDF) is still recommended as the first-line therapy in the clinical guideline and widely used in clinical practice. The aim of the study is to assess the persistence with first-line BIC/TAF/TAF and EFV + 3TC + TDF in newly treated HIV-1 patients in the real-world setting in Hunan Province in China.

METHODS

A retrospective analysis of the medical records of HIV patients initiating first-line antiretroviral therapy in the First Hospital of Changsha in January 1st, 2021-July 31st, 2022 was conducted. Persistence was assessed as the number of days on the therapy from the index until treatment discontinuation or end of data availability. Kaplan-Meier Curves and Cox Proportional Hazard models were used to evaluate the discontinuation rates. Subgroup analysis was performed excluding BIC/FTC/TAF patients with treatment discontinuation due to economic reason, and EFV + 3TC + TDF patients with a viral load > 500,000 copies/mL.

RESULTS

A total of 310 eligible patients were included in the study, with 244 and 66 patients in the BIC/FTC/TAF group and EFV + 3TC + TDF group, respectively. Compared with EFV + 3TC + TDF patients, BIC/FTC/TAF patients were older, more living in the capital city currently, and had significantly higher total cholesterol and low-density level (all p < 0.05). No significant difference was shown in the time to discontinuation between BIC/FTC/TAF patients and EFV + 3TC + TDF patients. After excluding BIC/FTC/TAF patients with treatment discontinuation due to economic reason, EFV + 3TC + TDF group were shown to have a significantly higher risk of discontinuation than BIC/FTC/TAF group (hazard ratio [HR] = 11.1, 95% confidence interval [CI] = 1.3-93.2). After further removing the EFV + 3TC + TDF patients with a viral load > 500,000 copies/mL, the analysis showed similar results (HR = 10.1, 95% CI = 1.2-84.1). 79.4% of the EFV + 3TC + TDF patients discontinued treatment due to clinical reasons, while 83.3% of the BIC/FTC/TAF patients discontinued treatment due to economic reasons.

CONCLUSIONS

Compared with BIC/FTC/TAF, EFV + TDF + 3TC patients were significantly more likely to discontinue the first-line treatment in Hunan Province in China.

The impact of the COVID-19 pandemic on mental health, associated factors and coping strategies in people living with HIV: a scoping review

INTRODUCTION

The COVID-19 pandemic and associated measures implemented by authorities have created additional stressors and increased the risk of psychological illnesses among people living with HIV (PLWH). Yet, there is no collective evidence on the mental health status of this population during the global pandemic and associated factors. This scoping review aimed to synthesize the evidence in the current literature related to the mental health outcomes and challenges faced by PLWH during the COVID-19 pandemic, identify the associated factors with psychological distress and summarize various coping strategies to ease these psychological distresses used by this population.

METHODS

We conducted a scoping review following the PRISMA-ScR guideline and a literature search in four electronic databases in August 2022. Three reviewers independently screened all the search records and extracted the data from studies that met the inclusion criteria. Factors associated with worsened mental health outcomes were synthesized according to the socio-ecological framework.

RESULTS

Among 1100 research records, 45 articles met the eligibility criteria and were included in the final review and data extraction, most of which were quantitative analyses. PLWH reported high rates of mental health problems during the pandemic. Multi-level factors were associated with increased psychological distress, including substance use, antiretroviral adherence, social support, financial hardship and economic vulnerability during the pandemic. PLWH used social media as a coping strategy to foster social support to deal with growing mental distress. Increased mental health illnesses were associated with increased substance use, it was also found associated with suboptimal medication adherence and antiretroviral therapy (ART) care engagement.

DISCUSSION

PLWH experienced high rates of mental health illnesses, such as depression during the global COVID-19 pandemic. There is an urgent need to provide comprehensive HIV treatment and mental health services as the pandemic continues to evolve.

CONCLUSIONS

The review summarized how the mental health of PLWH was affected during the COVID-19 pandemic. Future work in the implementation of effective interventions to promote mental health in this population is needed, not only to ensure their quality of life but also to help them maintain ART adherence and healthcare during more unprecedented times.

Unraveling the central and bridge psychological symptoms of people living with HIV: A network analysis

Background

People living with HIV (PLWH) experience multiple psychological symptoms. Few studies have provided information on central and bridge psychological symptoms among PLWH. This information has implications for improving the efficiency and efficacy of psychological interventions. Our study aimed to identify the central and bridge psychological symptoms of PLWH and to explore the interconnectedness among symptoms and clusters.

Methods

Our study used data from the HIV-related Symptoms Monitoring Survey, a multisite, cross-sectional study conducted during 2017-2021. We used R to visualize the network of 16 symptoms and analyzed the centrality and predictability indices of the network. We further analyzed the bridge symptoms among the three symptom clusters.

Results

A total of 3,985 participants were included in the analysis. The results suggested that sadness had the highest strength (r S = 9.69) and predictability (70.7%) compared to other symptoms. Based on the values of bridge strength, feeling unsafe (r bs = 0.94), uncontrollable worry (r bs = 0.82), and self-abasement (r bs = 0.81) were identified as bridge symptoms. We also found a strong correlation between sadness and self-abasement (r = 0.753) and self-loathing and self-blame (r = 0.744).

Conclusion

We found that sadness was the central psychological symptom of PLWH, indicating that sadness was the center of the psychological symptom network from a mechanistic perspective and could be a target for intervention. Deactivating bridge symptoms, including "feeling unsafe," "self-abasement," and "uncontrollable worry," could be more effective in preventing symptom activation from spreading (e.g., one symptom activating another).

Exploring core mental health symptoms among persons living with HIV: A network analysis

CONTEXT

Persons living with HIV (PLWH) commonly experience mental health symptoms. However, little is known about the core mental health symptoms and their relationships.

OBJECTIVE

This study aimed to evaluate the prevalence of various mental health symptoms and to explore their relationships in symptom networks among PLWH.

METHODS

From April to July 2022, we recruited 518 participants through convenience sampling in Beijing, China, for this cross-sectional study. Forty mental health symptoms, including six dimensions (somatization symptoms, negative affect, cognitive function, interpersonal communication, cognitive processes, and social adaptation), were assessed through paper-based or online questionnaires. Network analysis was performed in Python 3.6.0 to explore the core mental health symptoms and describe the relationships among symptoms and clusters.

RESULTS

Of the 40 mental health symptoms, the most common symptoms were fatigue (71.2%), trouble remembering things (65.6%), and uncertainty about the future (64.0%). In the single symptom network, sadness was the most central symptom across the three centrality indices (r_S = 0.59, r_C = 0.61, r_B = 0.06), followed by feeling discouraged about the future (r_S = 0.51, r_C = 0.57, r_B = 0.04) and feelings of worthlessness (r_S = 0.54, r_C = 0.53, r_B = 0.05). In the symptom cluster network, negative affect was the most central symptom cluster across the three centrality indices (r_S = 1, r_C = 1, r_B = 0.43).

CONCLUSION

Our study provides a new perspective on the role of each mental health symptom among PLWH. To alleviate the mental health symptoms of PLWH to the greatest extent possible and comprehensively improve their mental health, we suggest that psychological professionals pay more attention to pessimistic mood and cognitive processes in PLWH. Interventions that apply positive psychology skills and cognitive behavioral therapy may be necessary components for the mental health care of PLWH.

Age and Mental Health Symptoms Among Chinese Persons With HIV: The Mediating and Moderating Role of Perceived Discrimination

ABSTRACT

The association between age and mental health symptoms among persons with HIV (PWH) is inconsistent, and little is known about the mediators and moderators of this association. This study aimed to examine the association between age and mental health symptoms, as well as the mediators and moderators of perceived discrimination. Data were from 1,304 PWH who completed a cross-sectional survey in five areas of China. Multiple linear regressions showed that younger age was significantly associated with more severe mental health symptoms and that perceived discrimination moderated this relationship. The Sobel test showed that perceived discrimination also mediated the association between age and mental health symptoms. Our study indicates that perceived discrimination shapes the association between age and mental health symptoms among PWH and highlights the importance of designing age-tailored mental health intervention strategies for perceived discrimination among young PWH. Interventions addressing discrimination are necessary to help improve mental health, especially for young PWH.

Prevalence of suicide ideation among HIV/AIDS patients in China: A systematic review and meta-analysis

Objective

A systematic review and meta-analysis was performed to evaluate the prevalence of suicide ideation among HIV/AIDS patients in China.

Methods

Systematic search of CNKI, Wanfang, China biology medicine database, Weipu, EMBASE, Web of science and PubMed for studies related to the suicide ideation of HIV/AIDS patients. The incidence of suicide ideation of HIV / AIDS patients in China was investigated by meta-analysis.

Results

A total of 16 studies were included (n = 6,174). The incidence of suicidal ideation in HIV/AIDS patients was 30.6% (95%CI: 21.4-39.9%). The results of subgroup analysis showed that the incidence of suicidal ideation in male was 36.1%, which was higher than that in female (32.8%), homosexual patients (39.7%) higher than heterosexual patients (27.1%), 2013-2021 survey (35.2%) higher than 2003-2012 survey (26.5%), the unmarried patients (39.6%) were higher than the married patients (34.5%), the patients diagnosed >1 year (28.4%) were higher than the patients diagnosed <1 year (27.6%), and the depression patients (34.3%) were higher than patients without depression (20.5%) and CD4 cell counts ≤200 cells/ul group (20.6%) were higher than those in >400 cells/ul group (19.8%).

Conclusion

The incidence of suicide ideation in HIV/AIDS patients in China is relatively high.

Prevalence and Risks of Depression and Substance Use Among Adults Living with HIV in the Asia-Pacific Region

Despite the mental health and substance use burden among people living with HIV (PLHIV) in the Asia-Pacific, data on their associations with HIV clinical outcomes are limited. This cross-sectional study of PLHIV at five sites assessed depression and substance use using PHQ-9 and ASSIST. Among 864 participants, 88% were male, median age was 39 years, 97% were on ART, 67% had an HIV viral load available and < 1000 copies/mL, 19% had moderate-to-severe depressive symptoms, and 80% had ever used at least one substance. Younger age, lower income, and suboptimal ART adherence were associated with moderate-to-severe depressive symptoms. Moderate-to-high risk substance use, found in 62% of users, was associated with younger age, being male, previous stressors, and suboptimal adherence. Our findings highlight the need for improved access to mental health and substance use services in HIV clinical settings.

Depressive symptoms, HIV disclosure, and HIV-related stigma among migrant workers living with HIV in Chiang Mai, Thailand

Currently migrant workers living with HIV (MWLHIV) in Thailand have access to antiretroviral treatment. We determined the frequency of depressive symptoms, HIV disclosure, and HIV-related stigma in this population. The cross-sectional study was conducted at 12 HIV clinics in community hospitals in Chiang Mai, Thailand. Data were collected from MWLHIV through face-to-face interviews. A 9-item Patient Health Questionnaire-9 (PHQ-9) and a Thai-validated HIV/AIDS stigma scales were used. A total of 316 MWLHIV participated; their median age was 39 years and 65% were female. Sixty (19%) had depressive symptoms, with higher frequency of depression in females (22.4% vs.12.6%, respectively; p = .033). The overall HIV disclosure rate was 69.9%. Females were more likely than males to disclose HIV status to someone outside the clinic (72.2% vs. 65.8%, respectively; p = .234). The most prevalent type of HIV-related stigma was internalized, followed by felt stigma. Enacted stigma had the lowest prevalence. Multiple linear regression revealed that being female (β = 0.125, p = .029), enacted stigma (β = 0.152, p = .011) and felt stigma (β = 0.248, p < .001) were significantly associated with depressive scores. To ensure favorable HIV treatment outcomes, individual counseling, psychosocial support, and mental health screening should be integrated into HIV services.

Gender differences in suicidal ideation, suicide attempts, and suicide death among people living with HIV : A systematic review and meta‐analysis

OBJECTIVE

Although excess mortality, especially suicide, is a critical trait in people living with HIV, consensus about gender differences in these areas is lacking. We conducted meta-analyses to examine gender differences in suicidal ideation, suicide attempts, and suicide death among people living with HIV.

METHODS

We systematically searched PubMed and Web of Science for studies written in English. In this review, suicide among people living with HIV includes suicide death, suicidal ideation, and suicide attempts. Studies reporting the suicide prevalence among males and females living with HIV were eligible for inclusion in our review. Odds ratios (ORs) and 95% confidence intervals (CIs) served as the effect size index. Fixed-effects or random-effects meta-analyses were chosen based on the size of the heterogeneity.

RESULTS

A total of 27 studies comprising 801 017 participants from 11 countries were included in the meta-analysis. The overall prevalence of suicidal ideation was 18.0% (95% CI 13.3%-22.8%) in males and 20.8% (95% CI 16.4%-25.1%) in females, and there was a statistically significant higher risk of suicidal ideation in females living with HIV (OR 1.30; 95% CI 1.09-1.56; p < 0.05). The overall prevalence of suicide attempts was 16.8% (95% CI 9.0%-24.5%) in males and 24.7% (95% CI 12.4%-37.1%) in females, and there was a statistically significant higher risk of suicide attempts in females living with HIV (OR 1.34; 95% CI 1.02-1.75; p < 0.05). The pooled prevalence of suicide death was 1.2% (95% CI 0.5%-1.9%) among males and 0.2% (95% CI 0.1%-0.3%) among females, and the risk of suicide death between genders was not statistically significant (OR 0.78; 95% CI 0.50-1.24; p = 0.298).

CONCLUSIONS

There were gender differences in suicidal ideation and suicide attempts among people living with HIV. Females living with HIV were more likely to experience suicidal ideation and make suicide attempts, but there were no statistically significant gender differences in suicide death. Appropriate initiatives to optimize the recognition, treatment, and management suicide behaviours of males and females living with HIV may narrow this gender gap.

Prevalence of stressful life events and associations with symptoms of depression, anxiety, and post-traumatic stress disorder among people entering care for HIV in Cameroon

BACKGROUND

Exposure to stressors increases the risk of mental health disorders. People living with HIV (PLWH) are particularly affected by poor mental health which can contribute to adverse HIV treatment outcomes.

METHODS

We estimated the prevalence of recent stressful life events (modified Life Events Survey) among a cohort of PLWH entering HIV care at three public health care facilities in Cameroon and quantified the association of seven types of stressful life events with symptoms of depression (Patient Health Questionnaire-9 scores>9), anxiety (General Anxiety Disorder-7 scores>9), and PTSD (PTSD Checklist for DSM-5 scores>30) using separate log-binomial regression models.

RESULTS

Of 426 PLWH enrolling in care, a majority were women (59%), in relationships (58%), and aged 21 to 39 years (58%). Recent death of a family member (39%) and severe illness of a family member (34%) were the most commonly reported stressful life events. In multivariable analyses, more stressful life event types, a negative relationship change, death or illness of a friend/family member, experience of violence, work-related difficulties, and feeling unsafe in one's neighborhood were independently associated with at least one of the mental health outcomes assessed. The greatest magnitude of association was observed between work-related difficulties and PTSD (adjusted prevalence ratio: 3.1; 95% confidence interval: 2.0-4.8).

LIMITATIONS

Given the design of our study, findings are subject to recall and social desirability bias.

CONCLUSIONS

Stressful life events were common among this population of PLWH entering care in Cameroon. Evidence-based interventions that improve coping, stress management, and mental health are needed.

Trends in the psychosocial and mental health of HIV-positive women in China from 2015 to 2020: Results from two cross-sectional surveys

Background

The human immunodeficiency virus (HIV) continues to be one of the major public health challenges in the world. Despite the advancement in medication and changes in views towards HIV in Chinese society, little is known about the changes in the psychosocial and mental health of HIV‐positive women in recent years.

Objectives

The present study examined the change in depression, anxiety, stigma, relationship with the child, intimacy with a partner, and social support from family, friends, and health professionals, for HIV‐positive women in China from 2015 to 2020.

Methods

Two cross‐sectional surveys were conducted in 2015 and 2020, and 429 and 382 HIV‐positive women were recruited from the Women's Health Department in Yunnan and Guangxi, China between November 2015 to May 2016, and November 2019 to January 2020, respectively.

Results

After controlling for significant sociodemographic variables, participants recruited in 2019–2020 had significantly lower levels of depression and anxiety and higher scores on emotional and tangible support from friends. On the other hand, they had lower scores in intimacy with partners and emotional and tangible support from family. No significant changes were found in stigma, relationship with the child, and support from health professionals.

Conclusion

Results provide important information on the changes in psychosocial and mental health, which offer insights into the design of interventions to promote psychosocial and mental health among HIV‐positive women in China.

Patient or Public Contribution

HIV‐positive women contributed to the data of this study. Health care professionals were involved in the discussion of the methods and results.

Relationships of Illness Perceptions with Depression and Anxiety in People Who Live with HIV/AIDS in a High-prevalence Ethnic Autonomous Region of Sichuan, China

Poor mental health challenges outcomes and treatment of people living with HIV/AIDS (PLWHA) and may be related to illness perceptions. To investigate if depression and anxiety were associated with illness perceptions, we drew a random sample of 729 PLWHA from 13 administrative units in Liangshan Prefecture, Sichuan, China. Among the PLWHA surveyed, 222 and 175 had probable anxiety or depression. In mixed-effects logistic regression, negative illness perceptions were associated with increased odds of anxiety/depression. In linear mixed-effects quantile regression, the relationship of more negative illness perceptions with more severe and frequent symptoms of anxiety/depression grew stronger in the upper quantiles of the GAD-7 and PHQ-9 distributions, well beyond scale cut-offs for probable clinical relevance. We hypothesize that negative illness perceptions of HIV/AIDS and severity of depression and anxiety symptoms may mutually reinforce each other. Illness perceptions are a promising intervention target for improving the mental health of PLWHA.

Factors Related to Smoking and Perceptions of a Behavioral Counseling and Messenger Service-Delivered Smoking Cessation Intervention for People with HIV in China: A Qualitative Study (Preprint)

Background

China, where half of the adult male population smoke tobacco, has one of the highest global burdens of smoking. Smoking rates are even higher among people with HIV. People with HIV can be affected by smoking in multiple ways, including more severe HIV-related symptoms and worse antiretroviral therapy treatment outcomes. However, smoking cessation services targeted for people with HIV are not routinely integrated into HIV care in China. Given the widespread mobile phone ownership, an exploration of factors related to smoking among people with HIV in China who smoke could inform the design and implementation of mobile smoking cessation interventions that target the needs of this vulnerable population.

Objective

This study aims to explore the perspectives of smoking, barriers and facilitators to quitting, and perceptions related to a smoking cessation intervention delivered through behavioral counseling sessions and brief daily messenger service (WeChat)–delivered messages.

Methods

We recruited people with HIV from the People’s 4th Hospital of Nanning, Guangxi, China, and conducted semistructured face-to-face interviews. All interviews were audio-recorded, transcribed verbatim in Chinese, and translated into English for data analysis. We conducted a thematic analysis using a codebook, which was guided by a team-based consensus approach to identify 5 main themes. We also explored themes according to the demographic groups.

Results

A total of 24 participants were enrolled in the study. The mean age was 37.2 (SD=13.5) years. The participants had lived with HIV for a mean of 2.4 years. The majority were male (18/24, 75%) and lived in urban or metropolitan settings (19/24, 79%). We identified five main themes: variable knowledge of the harms of smoking, both related and unrelated to HIV; willpower perceived as the primary quitting strategy; a duality of the effect of social factors on quitting; perceptions about optimal features of the smoking cessation intervention (eg, messages should be brief and most frequent during the first few weeks); and the largely negative impact of their HIV diagnosis on smoking behaviors. In addition, some themes differed according to participant demographic characteristics such as age, sex, and education level.

Conclusions

We identified barriers to and facilitators of smoking cessation among people with HIV in China by conducting semistructured qualitative interviews. Owing to the adverse impact of smoking on HIV outcomes, targeting cessation interventions to the unique needs and preferences of people with HIV in China may be needed to increase the effectiveness of future interventions. A pilot clinical trial will be conducted in the future to evaluate this behavioral counseling and brief daily messenger service (WeChat)–delivered messages approach among people with HIV who smoke in China.

Comparison of Psycho-Social Factors Associated With Suicidal Ideation and Suicide Attempts Among People Living With HIV in Central West China

Background

Previous studies have described the correlation of suicidal ideation (SI) or suicide attempts (SA) in people living with HIV (PLWH), whereas few studies compare the correlation between SI and SA in PLWH. Understanding specific risk factors for SI and SA among PLWH will help with developing tailored and effective suicide prevention strategies among this high-risk group.

Methods

A cross-sectional study was conducted from December 2020 to April 2021 in Baoji municipality, Shaanxi Province. The PLWH registered with the Baoji Municipal Center for Disease Control and Prevention (CDC) were recruited and interviewed. Questionnaires and interviews for this study consisted of socio-demographic variables, mental health history, and psychosocial characteristics. The HIV-related clinical features were obtained from CDC medical records. The PLWH included were divided into three groups, i.e., those with a history of suicide attempts (SA group), those with suicidal ideation only (SI group), and those without any suicidal behavior (NSB group). Multinomial logistic regression was used for three-way comparisons among these three groups of PLWH.

Results

In total, 995 PLWH were interviewed. The prevalence of probable depression, probable anxiety, SI, and SA in PLWH after being diagnosed as HIV+ was 18.6%, 13.5%, 26.7%, and 3.2%, respectively. Compared with the NSB group, the SI or SA groups were more likely to report probable depression [adjusted odds ratio (AOR) = 2.43, 4.44, respectively], probable anxiety (AOR = 2.80, 5.62, respectively), and high HIV-related stigma (AOR = 2.05, 2.65, respectively). The SI group was more likely to experience high HIV-related stress (AOR = 1.91) and lower quality of life (AOR = 0.56) than the NSB group. Social support and HIV-related clinical features were not associated with SI or SA in this sample. The SA group did not differ from the SI group on any of the psychosocial or HIV-related clinical features.

Conclusions

Mental health problems are serious in community residents identified with having an HIV infection in a Central West China municipality. It is important to deliver low-cost and effective psychological services tailored for PLWH that are focused on reducing mental health problems. Future studies should utilize sensitive screening measures and further clarify factors potentially associated with the transition from SI to SA in PLWH.

Lebanese People Living with HIV: Psychiatric Co-morbidities and Psycho-Social Environment

Data are lacking on the psychiatric and psycho-social profiles of Middle-Eastern people living with HIV (PLHIV). Our study aimed to establish the prevalence and correlates of mental illness in a sample of Lebanese PLHIV, and to delineate their socio-cultural reality. PLHIV, either attending a private ID clinic or a non-governmental organization, were interviewed. A total of 94 patients were included. Sixty-nine (73.4%) were found to have at least one psychiatric disorder. Only nine participants were currently receiving psychotropic medications. The most common diagnosis was major depression, occurring in half of the subjects. Homosexual or bisexual orientation predicted the presence of a current depression (p = 0.024), and ART status was negatively associated with current depression (p = 0.028). The rate of psychiatric disorders is clearly higher than that of the general population. PLHIV with a homosexual or bisexual orientation face a double stigma, perhaps making them more vulnerable to depression. Our findings need to be replicated in larger studies with more representative samples.

Associations between antiretroviral therapy-related experiences and mental health status among people living with HIV in China: a prospective observational cohort study

BACKGROUND

Mental health problems (e.g., depression and anxiety) are among the most commonly reported comorbidities of HIV. Antiretroviral therapy (ART) coverage has increased sharply. The purposes of this prospective cohort study were to investigate the ART-related experiences and whether they were associated with mental health problems among a sample of people living with HIV undergoing ART in China.

METHODS

The participants were 400 people living with HIV who had started ART for the first time in Guangzhou city. They were followed-up 1-year after ART initiation. Probable depression and moderate/severe anxiety were measured at baseline and Month 12, while experiences related to ART (e.g., side effects and regained self-confidence) were measured at Month 6. Univariate and multivariate logistic regressions were used to explore the associations between baseline characteristics, ART-related experiences and mental health status.

RESULTS

Among the 300 participants (75.0%) who completed all three surveys, a significant decline in prevalence of probable depression (23.0% at baseline vs. 14.0% at Month 12, P = 0.002) and moderate/severe anxiety (14.7% at baseline vs. 8.7% at Month 12, P = 0.023) was observed during the follow-up period. After adjustment for mental health status and potential confounders at baseline, a number of ART-related experiences at Month 6 were associated with probable depression and/or moderate/severe anxiety measured at Month 12. Improved physical health, relationships with sexual partners, and self-confidence were associated with decreased mental health issues, while the side effects of ART, AIDS-related symptoms, and inconvenience in daily life due to ART use were associated with increased mental health issues.

CONCLUSIONS

ART-related experiences were associated with mental health problems, tailored mental health promotion interventions targeting these experiences are needed.

Mental health symptoms and inflammatory markers among HIV infected patients in Tanzania

Background

HIV and mental disorders are predicted to be the leading causes of illness worldwide by the year 2030. HIV-infected patients are at increased risk of developing mental disorders which are significantly associated with negative clinical outcomes and propagation of new HIV infections. There is little evidence that links inflammation to development of mental disorders among HIV patients. Therefore, the main objective of this study was to evaluate if mental health symptoms were associated with biomarkers of inflammation in HIV infected subjects.

Methods

A cross-sectional study was conducted in Dar es Salam, Tanzania from March to May 2018. Standardized tools were used to collect data based on the World Health Organisation's (WHO) stepwise approach for non-communicable diseases (NCD) surveillance. A total of 407 HIV+ patients on antiretroviral therapy were recruited. The WHO stepwise approach for NCD surveillance was used to collect data together with anthropometric measurements. Mental health symptoms were determined based on self-reported thoughts of helplessness, suicide ideation, depression, despair, discouragement, and feelings of isolation. Enzyme-linked immunosorbent assay was used to test for inflammatory markers:- C-reactive protein (CRP), Iinterleukin-6 (IL-6), interleukin-18 (IL-18), soluble tumour necrosis factor receptor-I (sTNFR-I), and soluble tumour necrosis factor receptor-II (sTNFR-II). Bivariate and multi-variate analysis was conducted to examine the association between biomarkers and mental health symptoms.

Results

The prevalence of self-reported mental health symptoms was 42% (n = 169). Participants with self-reported symptoms of mental health had elevated CRP, were less likely to walk or use a bicycle for at least 10 minutes, were less likely to participate in moderate-intensity sports or fitness activities, and had poor adherence to HIV treatment (p < 0.005). CRP remained significant in the sex adjusted, age-sex adjusted, and age-sex-moderate exercise adjusted models. In the fully adjusted logistic regression model, self-reported mental health symptoms were significantly associated with a higher quartile of elevated CRP (OR 4.4; 95% CI 1.3–5.9) and sTNFR-II (OR 2.6; 95% CI 1.4–6.6) and the third quartile of IL-18 (OR 5.1;95% CI 1.5–17.5) as compared with those reporting no mental health symptoms. The significance of sTNFR-II and IL-18 in the fully adjusted model is confounded by viral load suppression rates at the sixth month.

Conclusion

High CRP and sTNFR II were important contributors to the prevalence of mental health symptoms. This study is among the minimal studies that have examined mental health issues in HIV, and therefore, the findings may offer significant knowledge despite the potential reverse causality. Regardless of the nature of these associations, efforts should be directed toward screening, referral, and follow-up of HIV patients who are at-risk for mental health disorders.

Alterations in the Kynurenine Pathway of Tryptophan Metabolism Are Associated With Depression in People Living With HIV

BACKGROUND

People living with HIV have increased risk of depression compared with uninfected controls. The determinants of this association are unclear. Alterations in kynurenine (Kyn) metabolism have been associated with depression in uninfected individuals, but whether they are involved in the development of depression in the context of HIV infection is unknown.

METHODS

A total of 909 people living with HIV were recruited from the Copenhagen Comorbidity in HIV infection study. Information regarding demographics and depression was obtained from questionnaires. HIV-related variables and use of antidepressant medication were collected from patient records. Logistic regression models before and after adjustment for confounders were used to test our hypotheses.

RESULTS

The prevalence of depression was 11%. Among traditional risk factors, only being unmarried was associated with greater odds of depression. Higher levels of quinolinic-to-kynurenic acid ratio (P = 0.018) and higher concentrations of quinolinic acid (P = 0.048) were found in individuals with depression than in those without. After adjusting for confounders, high levels of quinolinic-to-kynurenic acid ratio and high concentrations of quinolinic acid remained associated with depression [adjusted odds ratio 1.61 (1.01; 2.59) and adjusted odds ratio 1.68 (1.02; 2.77), respectively].

CONCLUSIONS

The results from this study suggest that alterations in the kynurenine pathway of tryptophan metabolism are associated with the presence of depression in the context of HIV infection.

Measuring and explaining inequality of continuous care for people living with HIV receiving antiretroviral therapy in Kunming, China

Background

In the context of scaling up free antiretroviral therapy (ART), healthcare equality is essential for people living with HIV. We aimed to assess socioeconomic-related inequalities in uptake of continuous care for people living with HIV receiving ART, including retention in care in the last six months, routine toxicity monitoring, adequate immunological and virological monitoring, and uptake of mental health assessment in the last 12 months. We also determined the contributions of socioeconomic factors to the degree of inequalities.

Methods

A hospital-based cross-sectional survey was conducted among consecutive clients visiting an HIV treatment center in Kunming, China in 2019. Participants were 702 people living with HIV aged ≥18 years (median age: 41.0 years, 69.4% male) who had been on ART for 1–5 years. Socioeconomic-related inequality and its contributing factors were assessed by a normalized concentration index (CI_n) with a decomposition approach.

Results

The uptake of mental health assessment was low (15%) but significantly higher among the rich (CI_n 0.1337, 95% CI: 0.0140, 0.2534). Retention in care, toxicity, and immunological monitoring were over 80% but non-significant in favor of the rich (CI_n: 0.0117, 0.0315, 0.0736, respectively). The uptake of adequate virological monitoring was 15% and higher among the poor (CI_n = -0.0308). Socioeconomic status positively contributed to inequalities of all care indicators, with the highest contribution for mental health assessment (124.9%) and lowest for virological monitoring (2.7%).

Conclusions

These findings suggest virological monitoring and mental health assessment be given more attention in long-term HIV care. Policies allocating need-oriented resources geared toward improving equality of continuous care should be developed.

The Development of a Personalized Symptom Management Mobile Health Application for Persons Living with HIV in China

Persons living with HIV (PLWH) continuously experience symptom burdens. Their symptom prevalence and severity are also quite different. Mobile health (mHealth) applications (apps) offer exceptional opportunities for using personalized interventions when and where PLWH are needed. This study aimed to demonstrate the development process of the symptom management (SM) app and the structure and content of it. Our research team systematically searched for evidence-based resources and summarized up-to-date evidence for symptom management and health education. Our multidisciplinary research team that included physicians, nurses, software engineers, and nursing professors, evaluated the structure and content of the drafted app. Both quantitative data and qualitative results were collected at a group discussion meeting. Quantitative data were scores of sufficient evidence, situational suitability, practicability, cost-effectiveness, and understandability (ranged from one to four) for 119 items of the app contents, including the health tracking module, the self-assessment module, coping strategies for 18 symptoms (80 items), medication management, complementary therapy, diet management, exercise, relaxation techniques, and the obtaining support module. The SM app was comprised of eight modules and provided several personalized symptom management functions, including assessing symptoms and receiving different symptom management strategies, tracking health indicators, and communicating with medical staff. The SM app was a promising and flexible tool for HIV symptom management. It provided PLWH with personalized symptom management strategies and facilitated the case management for medical staff. Future studies are needed to further test the app's usability among PLWH users and its effects on symptom management.

Spatial analysis and risk factors of suicide among people living with HIV/AIDS who committed suicide

Poor mental health may confer worse health outcomes among people living with HIV/AIDS (PLWH). Suicidal behaviors are symptoms of a depressive episode. The goal was to explore characteristics for spatial distribution and risk factors for suicide among PLWH. This study was conducted in Mainland China with the annual newly reported data of PLWH from 2013 to 2018. We compared the spatial distribution differences between the HIV epidemic and suicide mortality and analyzed the global and local spatial analysis of suicide. Further, we explored the possible risk factors of suicide in PLWH by multivariate regression and a decision tree model. High suicide mortality regions in PLWH in China were inconsistent with that of the high prevalence of PLWH, which showed that there was distribution discordance between the HIV epidemic and suicide mortality. Multivariate regression showed that the possible risk factors of PLWH who committed suicide were younger age, with Han nationality, single, having a higher educational level, and homosexual infection route. The decision tree model showed that age was the primary factor. In conclusion, there was a discordance between HIV prevalence and suicide mortality; lower HIV prevalence regions might have higher mortality due to suicide. Concern is merited amongst PLWH with poor mental health.

Integration of mental health services into HIV healthcare facilities among Thai adolescents and young adults living with HIV

Introduction

To assess the burden of depression, anxiety and suicidality; and to determine the impact of integrated mental health and HIV services on treatment outcomes among Thai adolescents and young adults living with HIV (AYHIV).

Methods

A multicentre prospective cohort study was conducted among AYHIV (15 to 25 years), and age‐ and sex‐matched HIV‐uninfected adolescents and young adults (HUAY). The Patient Health Questionnaire 9‐item (PHQ‐9) and Generalized Anxiety Disorder 7‐item scales (GAD‐7) were used as screening tools for depressive and anxiety symptoms respectively. History of lifetime and recent suicidal ideations/attempts were ascertained. Elevated mental health screening scores were defined as having either significant depressive symptoms (PHQ‐9 ≥9), significant anxiety symptoms (GAD‐7 ≥10) or suicidality (lifetime; and recent [within two weeks]). Participants meeting these criteria were referred to psychiatrists for confirmatory diagnosis and mental health services. Follow‐up assessment with PHQ‐9 and GAD‐7 was performed one year after psychiatric referral.

Results

From February to April 2018, 150 AYHIV and 150 HUAY were enrolled, median age was 19.0 (IQR:16.8 to 21.8) years and 56% lived in urban areas. Among AYHIV, 73% had HIV RNA <50 copies/mL, and median CD4 count was 580 (IQR:376 to 744) cells/mm³. At enrolment, 31 AYHIV (21%; 95%CI:14% to 28%) had elevated mental health screening scores; 17 (11%) significant depressive symptoms, 11 (7%) significant anxiety symptoms and 21 (14%) suicidality. Seven AYHIV (5%) had all three co‐existing conditions. These prevalences were not substantially different from HUAY. Urban living increased risk, whereas older age decreased risk of elevated mental health screening scores (p < 0.05). All AYHIV with elevated mental health screening scores were referred to study psychiatrists, and 19 (13%; 95%CI: 8% to 19%) had psychiatrist‐confirmed mental health disorders (MHDs), including adjustment disorder (n = 5), major depression (n = 4), anxiety disorders (n = 2), post‐traumatic stress disorder (n = 1) and mixed MHDs (n = 4). One year after psychiatric referral, 42% of AYHIV who received mental health services demonstrated an absence of significant mental health symptoms from the reassessments, and 26% had an improved score.

Conclusions

With the significant burden of MHDs among AYHIV, an integration of mental health services, including mental health screenings, and psychiatric consultation and referral, is critically needed and should be scaled up in HIV healthcare facilities.

Sleep satisfaction and cognitive complaints in Chinese middle-aged and older persons living with HIV: the mediating role of anxiety and fatigue

Middle-aged and older persons living with HIV (PLWH) suffer from sleep distress and cognitive disorders due to HIV infection and aging. We aim to explore the relationship between sleep satisfaction and cognitive complaints, and the mediating role of anxiety and fatigue in this relationship among middle-aged and older PLWH. We used data from a multicenter cross-sectional study in China (Shanghai, Kunming, Nanning, Hengyang, and Changning) conducted in 2017. The data analysis included 435 PLWH aged 45 years and over. Multiple linear regression models showed that worse sleep satisfaction was significantly associated with lower cognitive complaints after controlling for anxiety, fatigue, demographic variables, and clinical variables (β = -0.246, p < 0.01). Both anxiety and fatigue were significant partial mediators in the relationship between sleep satisfaction and cognitive complaints. The serial multiple mediation models of sleep satisfaction-anxiety (M1)-fatigue (M2)-cognitive complaints were supported and the alternative model of sleep satisfaction-fatigue (M2)-anxiety (M1)-cognitive complaints were both supported. Our study indicates that it is important to improve sleep quality to promote cognitive function among Chinese middle-aged and older PLWH. Prevention and treatment programs for sleep satisfaction and cognitive function should include the assessment and reduction of fatigue and anxiety.

Exploring the Relationship Between Anxiety, Depression, and Sleep Disturbance Among HIV Patients in China From a Network Perspective

Background: Mental disorder of people living with HIV (PLWH) has become a common and increasing worldwide public health concern. We aimed to explore the relationship between anxiety, depression, and sleep disturbance for PLWH from a network perspective. Methods: The network model featured 28 symptoms on the Hospital Anxiety and Depression scale questionnaire and Pittsburgh Sleep Quality Index questionnaire in a sample of 4,091 HIV-infected persons. Node predictability and strength were computed to assess the importance of items. We estimated and compared 20 different networks based on subpopulations such as males and females to analyze similarities and differences in network structure, connections, and symptoms. Results: Several consistent patterns and interesting differences emerged across subgroups. Pertaining to the connections, some symptoms such as S12-S13 ("sleepy"-"without enthusiasm") shown a strong positive relationship, indicating that feeling sleepy was a good predictor of lacking enthusiasm, and vice versa. While other symptoms, such as A3-D3 ("worried"-"cheerful"), were negatively related in all networks, revealing that nodes A3 and D3 were bridge symptoms between anxiety and depression. Across all subgroups, the most central symptom was A7 "panic" and S2 "awake", which had the greatest potential to affect an individual's mental state. While S3 "bathroom" and S5 "cough or snore" shown consistent lower node importance, which would be of limited therapeutic use. Conclusions: Mental conditions of PLWH varied considerably among subgroups, inspiring psychiatrists and clinicians that personalized invention to a particular subgroup was essential and might be more effective during treatment than adopting the same therapeutic schedule.

Effects of Nurse-Delivered Cognitive Behavioral Intervention on Depression and Anxiety for Persons Living With HIV in China: A Clinical Controlled Trial

ABSTRACT

Depression and anxiety, which may influence antiretroviral therapy (ART) medication adherence, are prevalent among persons living with HIV (PLWH) in China. This parallel two-arm clinical controlled trial aimed to examine the effects of a nurse-delivered cognitive behavioral intervention (CBI) on depression, anxiety, and ART medication adherence in Chinese PLWH. Using in-person and online recruitment, 140 PLWH ages 18 years and older who were undergoing ART and had a Patient Health Questionnaire-4 score of ≥2 were assigned to the 10-week-long CBI group or the routine follow-up group according to their preference. Outcomes were measured at baseline, postintervention, and 6-month follow-up. Results showed significant intervention effects on depression maintained until the 6-month follow-up. Although anxiety and ART medication adherence did not show robust effects between conditions, amelioration trends for these outcomes were also found. Our study demonstrated that the nurse-delivered CBI could help Chinese PLWH ameliorate depression.

Neuropsychiatric Adverse Events During 12 Months of Treatment With Efavirenz in Treatment-Naïve HIV-Infected Patients in China: A Prospective Cohort Study

Background: Efavirenz (EFV) is widely used in antiretroviral therapy (ART), but the incidence and risk factors of neuropsychiatric adverse events (NPAEs) after EFV treatment have rarely been studied in Chinese ART naïve patients. Methods: This prospective cohort study assessed HIV-infected patients initiating antiretroviral treatment with EFV to determine prevalence of and factors associated with NPAEs over a 12-month follow-up period using the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI). Results: A total of 546 patients were enrolled. Prevalence of anxiety, depression, and sleep disturbances at baseline were 30.4, 22.7, and 68.1%, respectively. Six patients discontinued treatment due to drug related NPAEs. Treatment was associated with improvements in HADS-A, HADS-D, and PSQI scores over the 12-month follow-up, and the frequencies of patients with anxiety, depression, and sleep disturbances significantly decreased after 12 months. Abnormal baseline HADS-A, HADS-D, and PSQI scores and other factors, including high school education or lower income, unemployment, divorce, and WHO III/IV stages, were associated with severe neuropsychiatric disorders over the 12 months. Conclusions: These findings suggested EFV discontinuation due to NAPEs was low, and the HADS-A, HADS-D, and PSQI scores after 12 months of EFV treatment were associated with several risk factors. The clinicians should keep in mind and routinely screen for the risk factors associated with neuropsychiatric disorders in HIV-infected patients.

Cognitive behavioral therapy for persons living with HIV in China: A randomized pilot trial

BACKGROUND

Chinese persons living with HIV (PLWH) suffer from prevalent mental health issues. We aimed to develop a tailored cognitive behavioral therapy (CBT), test its feasibility, acceptability, and preliminary effects (depression, anxiety, and medication adherence) for Chinese PLWH.

METHODS

Twenty PLWH were assigned randomly. Intervention participants learned skills in CBT and relaxation training in a tailored group-based weekly 10-session project. Each session lasted for two hours and was delivered by nurses and volunteers. Control participants only received laboratory tests and free antiretroviral therapy (ART) medication. Feasibility and acceptability were descriptively summarized. Depression, anxiety, and ART medication adherence data were collected at the baseline (T0), after the intervention (T1) and after 6 months of follow-up (T2).

RESULTS

The average CBT attendance rate for all sessions was 60%. No participants in the intervention group dropped out of the study. All participants in the intervention group agreed that they could benefit from the CBT. Participants in the intervention group showed a greater improvement in anxiety and self-reported ART medication adherence than those in the control group at T1. However, no preliminary intervention effect was found at T2.

LIMITATIONS

The small sample size leads to a lack of representativeness in the study sample. We excluded participants with severe comorbidities, which may lead to an underestimate of the intervention effect of CBT among Chinese PLWH.

CONCLUSIONS

CBT is feasible and acceptable, demonstrating promising preliminary effects on anxiety and ART medication adherence among Chinese PLWH. Additional research is needed to test the effectiveness of this approach.

Negative attitudes toward aging mediated the association between HIV status and depression among older people in mainland china

BACKGROUND

In China, people living with HIV (PLWH) are aging. The study compared prevalence of probable depression between older PLWH and their HIV-negative counterparts, and tested the hypothesis that the between-group difference in depressive symptoms would be mediated by attitudes toward aging.

METHODS

With informed consent, a cross-sectional survey was conducted via anonymous face-to-face interviews to 337 and 363 HIV-positive and HIV-negative people aged ≥50, respectively, in Yongzhou City, Hunan, China from December 2017 to August 2018. Depression was measured by the Center for Epidemiologic Studies Depression (CES-D) scale. Attitudes toward aging were measured by the Attitudes to Aging Questionnaire (subdomains: psychosocial loss, physical change, psychological growth). Bootstrapping analyses were performed to test the mediation hypothesis.

RESULTS

The prevalence of probable depression (CES-D ≥ 16) was significantly higher in the HIV-positive group than the HIV-negative group (44.8% versus 20.4%). The HIV-positive participants presented more negative attitudes toward aging (in psychosocial loss and physical change) than their HIV-negative counterparts. Negative attitudes toward aging were associated with more depressive symptoms. Overall attitudes toward aging (effect size=41.3%) and the subdomains of psychosocial loss (effect size=38.5%) and physical change (effect size=16.3%) partially mediated the association between HIV status and depressive symptoms, respectively.

LIMITATIONS

The cross-sectional design limited the ability of causal inference. Selection bias, information bias, and confounding bias might exist.

CONCLUSIONS

Older PLWH might be more depressed than their HIV-negative counterparts in mainland China, partially because they possessed more negative attitudes toward aging. Interventions for depression may include components of improving attitudes toward aging.

Resilience, self-esteem, self-efficacy, social support, depression and ART adherence among people living with HIV in Sichuan, China

ABSTRACTAIDS has had physical, psychological and social consequences on People living with HIV (PLWH) with the result that the challenges and adversity they face have significantly increased. Resilience helps individuals cope with these adversities and difficulties. For PLWH to face increased challenges and setbacks created by AIDS, they are required to have resilience. This paper presents research carried out in China aiming to examine the relationships among resilience, self-esteem, self-efficacy, social support, depression and antiretroviral therapy (ART) adherence in PLWH. A cross-sectional study using a convenience sample was conducted and 223 PLWH were recruited from 2 hospitals and 1 Center of Disease Control in Sichuan, China, from May to August 2018. The present research found that resilience was positively affected by self-esteem, self-efficacy and social support, and negatively predicted depression and positively predicted ART adherence. Resilience plays a mediating role between influential factors (self-esteem, self-efficacy and social support) and adaptive outcomes (depression and ART adherence). It suggests that resilience should be considered as a factor in intervention designed to reduce PLWH's depression and improve ART adherence. Improving self-esteem, self-efficacy and social support could enhance resilience.