Center for Community Health, Semel Institute, University of California, Los Angeles, CA, USA. firstname.lastname@example.org
BACKGROUND People living with HIV/AIDS (PLWHA) in Thailand face tremendous challenges, including HIV-related stigma, lack of social support, and mental health issues such as depression. This study aims to examine complex relationships among demographics, HIV-related stigma, and social support and their impact on depression among PLWHA in Thailand. METHODS This study uses data collected in northern and northeastern Thailand. A total of 408 PLWHA were recruited and interviewed in 2007. HIV-related stigma was measured by two subscales:"Internalized Shame" and "Perceived Stigma." Based on correlation analyses, hierarchical multiple regression models were used to examine the predictors of depression, social support, and HIV-related stigma, controlling for demographic characteristics. RESULTS Correlational analysis revealed that depression was significantly associated with both dimensions of stigma: internalized shame and perceived stigma. Self-reported emotional social support was negatively associated with depression. We found that internalized shame and emotional social support were significant predictors of depression after controlling for gender, age, income, and education. CONCLUSIONS HIV-related stigma has a negative impact on psychological wellbeing of PLWHA in Thailand, and emotional social support remains a protective factor against depression. Intervention developers and clinicians working with PLWHA may find it useful to incorporate the association between stigma and depression into their programs and treatments, and to address social support as a protective effect for the mental health of PLWHA.
M Tanvir Hasan, Samir Ranjan Nath, Nabilah S Khan, Owasim Akram, Tony Michael Gomes, Sabina F Rashid
James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka 1212, Bangladesh. email@example.com
Internalized stigma among people living with HIV/AIDS (PLHA) is prevalent in Bangladesh. A better understanding of the effects of stigma on PLHA is required to reduce this and to minimize its harmful effects. This study employed a quantitative approach by conducting a survey with an aim to know the prevalence of internalized stigma and to identify the factors associated with internalized stigma among a sample of 238 PLHA (male=152 and female=86) in Bangladesh. The findings suggest that there is a significant difference between groups with the low- and the high-internalized HIV/AIDS stigma in terms of both age and gender. The prevalence of internalized stigma varied according to the poverty status of PLHA. An exploratory factor analysis (EFA) found 10 of 15 items loaded highly on the three factors labelled self-acceptance, self-exclusion, and social withdrawal. About 68% of the PLHA felt ashamed, and 54% felt guilty because of their HIV status. More than half (87.5% male and 19.8% female) of the PLHA blamed themselves for their HIV status while many of them (38.2% male and 8.1% female) felt that they should be punished. The male PLHA more frequently chose to withdraw themselves from family and social gatherings compared to the female PLHA. They also experienced a higher level of internalized stigma compared to the female PLHA. The results suggest that the prevalence of internalized stigma is high in Bangladesh, and much needs to be done by different organizations working for and with the PLHA to reduce internalized stigma among this vulnerable group.
BMC Public Health. 2012 ;12 :244 22452846
Anxiety and depression amongst patients enrolled in a public sector antiretroviral treatment programme in South Africa: a cross-sectional study.
Centre for Development Support, University of the Free State, Bloemfontein, South Africa. firstname.lastname@example.org
BACKGROUND HIV/AIDS and depression are projected to be the two leading causes of disability by 2030. HIV/AIDS and anxiety/depression are interlinked. People suffering from depression may be more likely to engage in risky sexual behaviour, and therefore at greater risk of contracting HIV. An HIV + diagnosis may trigger symptoms of anxiety and depression, which may in turn result in risky sexual behaviour and the spread of HIV. This study explores correlates of anxiety and depression in patients enrolled in a public sector ART programme in South Africa. METHODS Interviews were conducted with 716 patients initiating ART at twelve public health care facilities in the Free State. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). An 8+ cut-off was used to identify possible cases of anxiety and depression. Multivariate logistic regression analysis, using STATA Version 11, was performed to identify correlates of anxiety and depression. RESULTS The prevalence of symptoms of respectively anxiety and depression amongst this study population in the Free State was 30.6% and 25.4%. The multivariate logistic regression analyses identified five correlates of symptoms of anxiety and depression. Disruptive side effects (OR = 3.62, CI 1.95-6.74) and avoidant coping (OR = 1.42, CI 1.22-1.65) were associated with a greater number of symptoms of anxiety. Stigma was associated with an increase in symptoms of anxiety (OR = 1.14, CI 1.07-1.21) and of depression (OR = 1.13, CI 1.06-1.20), while being a widow (OR = 0.30, CI 0.13-0.69) and participating in a support group (OR = 0.21, CI 0.05-0.99) were associated with decreased symptoms of depression. CONCLUSIONS The findings from the study provide valuable insights into the psychosocial aspects of the Free State public-sector ART programme. Combined with the literature on the intricate link between mental health problems and treatment outcomes our results emphasise firstly, the necessity that resources be allocated for both screening and treating mental health problems and, secondly, the need for interventions that will encourage support-group participation, address ART side effects, reduce maladaptive coping styles, and minimise the stigma associated with symptoms of anxiety and/or depression.
Sexual transmission behaviors and serodiscordant partnerships among HIV-positive men who have sex with men in Asia.
Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. email@example.com
We described sexual transmission behaviors and serodiscordant partnerships among an online sample of HIV-positive men who have sex with men (N = 416) in Asia. High rates of unprotected anal intercourse (74.8%), serodiscordant partnerships (68.5%), and unprotected sex within serodiscordant partnerships (∼60.0%) were reported. Increased number of partners, meeting partners on the Internet, drug use before sex, and not knowing one's viral load were associated with unprotected anal intercourse. Efforts to develop and scale up biomedical and behavioral interventions for HIV-positive men who have sex with men in Asia are needed.
Renata Karina Reis, Vanderley José Haas, Claudia Benedita dos Santos, Sheila Araujo Teles, Marli Teresinha Gimenez Galvão, Elucir Gir
Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Development, SP, Brazil. firstname.lastname@example.org
This is a cross-sectional study conducted with 228 people living with HIV/AIDS in a municipality in the State of São Paulo during 2007 and 2008. The aims of this study were to investigate the intensity of the depressive symptoms in individuals with HIV/AIDS treated at two referral units in Ribeirão Preto, Brazil, and to compare the quality of life with the different degrees of intensity of the depressive symptoms in these individuals, according to gender. Data were collected through individual interviews, using the Beck Depression Inventory and HIV/AIDS Targeted Quality of Life (HATQoL). A total of 63 (27.6%) patients with symptoms of depression (mild, moderate and severe) were detected. The women presented more severe symptoms of intensity of depression than men. Individuals with depressive symptoms presented lower scores of quality of life than individuals without these symptoms, with statistically significant differences between the means/medians in most domains of the HATQoL. Healthcare professionals should offer integral care for people with HIV/AIDS, emphasizing the depressive symptoms.
Psychological and social correlates of HIV status disclosure: the significance of stigma visibility.
Sarah E Stutterheim, Arjan E R Bos, John B Pryor, Ronald Brands, Maartje Liebregts, Herman P Schaalma
School of Psychology, Open University of the Netherlands, Heerlen, The Netherlands. email@example.com
HIV-related stigma, psychological distress, self-esteem, and social support were investigated in a sample comprising people who have concealed their HIV status to all but a selected few (limited disclosers), people who could conceal but chose to be open (full disclosers), and people who had visible symptoms that made concealing difficult (visibly stigmatized). The visibly stigmatized and full disclosers reported significantly more stigma experiences than limited disclosers, but only the visibly stigmatized reported more psychological distress, lower self-esteem, and less social support than limited disclosers. This suggests that having a visible stigma is more detrimental than having a concealable stigma. Differences in psychological distress and self-esteem between the visibly stigmatized and full disclosers were mediated by social support while differences between the visibly stigmatized and limited disclosers were mediated by both social support and stigma. These findings suggest that social support buffers psychological distress in people with HIV.
AIDS Behav. 2012 May ;16 (4):911-9 21861194
Size, composition, and strength of ties of personal social support networks among adult people living with HIV/AIDS in Henan and Beijing, China.
Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Haidian District, Beijing, People's Republic of China. firstname.lastname@example.org
To characterize the level of personal support available to people living with HIV/AIDS (PLWHA) in Henan and Beijing, China, face-to-face interviews were conducted to collect information on network size, composition, and strength of ties. The number of people as sources of support for participants in Henan varied from 1 to 13 and 1 to 16 in Beijing. In Henan, family members were more likely to provide support than non-relatives and they provided support more frequently; in Beijing non-relatives were more likely to provide support than family members. Family members were closer to PLWHA than non-relatives in both sites, but the closest type of relative and non-relative supporters were different between Henan and Beijing. PLWHA in Henan and Beijing receive considerable social support, but there is still opportunity for additional social support. Efforts should be made to mobilize civil society to provide support for PLWHA in China.
UCLA Semel Institute for Neuroscience and Human Behavior, Center for Community Health, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA 90024, USA. email@example.com
This study makes an effort to go beyond traditional analytical models to explore the complex and interactive nature of family processes. A total of 79 families affected by HIV in China participated in the study (79 persons living with HIV [PLH] and 79 seronegative family members), with in-person interviews conducted in 2009. A higher level of depressive symptoms was reported by PLH participants than their family members. Negative associations between depressive symptoms and social support and family relations were observed for both PLH and their family members. Results from actor-partner interdependence models indicate that the depressive symptoms of PLH and their family members were positively correlated when either the family relations measure or the social support measure was included in the model. Results highlight the link between family experience and individual well-being, with implications for designing and implementing interventions for families impacted by HIV.
AIDS Care. 2011 Jun ;23 (6):680-5 21360358
The prevalence and predictors of stigma amongst people living with HIV/AIDS in the Western Province.
Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa. firstname.lastname@example.org
The aim of the present study was determine the extent to which internalized and enacted stigma is experienced by people living with HIV/AIDS and to establish correlates of such experiences. A convenience sample of 400 HIV-positive participants was selected from three health clinics in the Cape Town area. Respondents' experiences of internalized and enacted stigma were investigated using the HIV/AIDS Stigma Instrument - PLWA (HASI-P). Overall, 28% of respondents endorsed more than one item addressing internalized stigma and 8% endorsed more than one item on any of the four subscales measuring enacted stigma. Male respondents (OR = 0.52, CI = 0.92-0.99), younger respondents (OR = 0.52, CI = 0.29-0.94), and those respondents who had been living with HIV longer were less likely to experience internalized stigma. More educated respondents (OR = 1.19, CI = 1.02-1.39) experienced more internalized stigma than those with less education No demographic characteristics predicted enacted stigma in this particular population. There are a number of possible reasons for low reports of HIV-related stigma, including having access to treatment and not disclosing HIV status.
Department of Community Health and Psychiatry, The University of the West Indies, Kingston 7, Jamaica, West Indies. email@example.com
BMC Res Notes. 2010 ;3 :249 20920360
Department of Epidemiology, Jimma University, Jimma, Ethiopia. firstname.lastname@example.org.
BACKGROUND The synergy between tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection on perceived stigma is not well studied. The objective of this study was to assess the effect of TB/HIV co-infection on perceived stigma in selected hospitals of Oromiya region, Ethiopia. A cross sectional study was conducted from February to April, 2009 in Adama, Nekemet and Jimma Specialized hospitals. Data were collected by trained HIV counselors. A structured questionnaire which consisted of socio-demographic variables, clinical information, perceived stigma, and depression was used to collect the data FINDINGS A total of 591 participants were included in the study of whom 124 (20.9%) were co-infected with TB/HIV. The stigma items were highly reliable (Cronbach's alpha = 0.93) and had strong inter dimension correlation. Respondents who were co-infected with TB and HIV were more likely to have perceived stigma compared to non-co-infected HIV patients,[OR = 1.4,(95% CI: 1.2, 2.0)]. Non-literate individuals [OR = 1.9,(95% CI: 1.2, 3.0)] and females [OR = 1.6,(95% CI: 1.2, 2.3)] had also more perceived stigma. CONCLUSIONS TB/HIV co-infected patients, non-literate individuals and females were more likely to have high perceived stigma. Behavioral Change Communication should focus on these segments of the population to rectify the high perceived stigma.
Other papers by authors:
Mary Jane Rotheram-Borus, Judith A Stein, Chuleeporn Jiraphongsa, Siwaporn Khumtong, Sung-Jae Lee, Li Li
University of California, Los Angeles, CA, USA.
Family and social relationships are important structural supports in Thailand that are likely to influence the health and mental health of persons living with HIV (PLH). Structural equation modeling examined these relationships among 409 PLH in two communities in Thailand. Latent variables were constructed for most outcomes and mediators, with adherence to antiretroviral (ARV) therapy, depression, and disclosure represented by single-item indicators. All models controlled for gender, age, and education. Disclosure was significantly and positively associated with ARV adherence, and to both family functioning and social support. Family functioning and social support were significantly related to the PLH's self-perceptions of health and mental health, as well as being significantly correlated with each other. Better family functioning was significantly associated with better quality of life, better perceived health, fewer symptoms of depression, and greater ARV adherence. Social support was significantly associated with better quality of life and fewer depressive symptoms. These results highlight the important role that an organized and structured family life and social support network can play in encouraging better health outcomes among PLH.
AIDS Behav. 2012 Jul ;16 (5):1276-85 22038079
Efficacy of an intervention for families living with HIV in Thailand: a randomized controlled trial.
Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA. email@example.com
This study evaluates the efficacy of an intervention for persons living with HIV (PLH) and their family members in Thailand. A randomized controlled trial of 813 PLH and family members was carried out at four district hospitals in Thailand. Participants completed Computer Assisted Personal Interview assessments at baseline, 6, 12, 18, and 24 months. The primary outcome was quality of life (QoL); other measures included depressive symptoms and family functioning. Relative to the standard care condition, the intervention group reported significantly improved QoL at 6 months (P = 0.0014). When the intervention efficacy was stratified by baseline depressive symptoms (low vs. high), intervention efficacy was observed only among those with low depressive symptoms. Study findings suggest that the intervention was more efficacious for participants with less depressive symptoms and better family functioning. Extensive interventions may be optimal for those who have the capacity to learn the tools and skills.
Center for HIV Identification, Prevention, and Treatment Services, AIDS Institute, University of California, Los Angeles, Los Angeles, CA USA.
Family-based interventions are efficacious for human immunodeficiency virus (HIV) detection, prevention, and care, but they are not broadly diffused. Understanding intervention adaptation and translation processes can support evidence-based intervention (EBI) diffusion processes. This paper provides a narrative review of a series of EBI for families affected by HIV (FAH) that were adapted across five randomized controlled trials in the US, Thailand, and South Africa over 15 years. The FAH interventions targeted parents living with HIV and their children or caregiver supports. Parents with HIV were primarily mothers infected through sexual transmission. The EBIs for FAH are reviewed with attention to commonalities and variations in risk environments and intervention features. Frameworks for common and robust intervention functions, principles, practice elements, and delivery processes are utilized to highlight commonalities and adaptations for each location, time period, and intervention delivery settings. Health care, housing, food, and financial security vary dramatically in each risk environment. Yet, all FAH face common health, mental health, transmission, and relationship challenges. The EBIs efficaciously addressed these common challenges and were adapted across contexts with fidelity to robust intervention principles, processes, factors, and practices. Intervention adaptation teams have a series of structural decision points: mainstreaming HIV with other local health priorities or not; selecting an optimal delivery site (clinics, homes, community centers); and how to translate intervention protocols to local contexts and cultures. Replication of interventions with fidelity must occur at the level of standardized functions and robust principles, processes, and practices, not manualized protocols. Adopting a continuous quality improvement paradigm will enhance rapid and global diffusion of EBI for FAH.
Center for Community Health, Semel Institute, University of California, Los Angeles, California 90024, USA. firstname.lastname@example.org
The importance of antiretroviral therapy adherence for patients living with HIV/AIDS has been well documented. Despite this critical need, many do not follow prescribed regimens. To examine the barriers that lead to non-adherence, we used cross-sectional survey data from a randomized controlled intervention trial in northern and north-eastern Thailand. Of the 507 patients that were enrolled in the trial, we analyzed 386 patients on antiretroviral therapy in order to examine the barriers to adherence. In addition to demographic characteristics, depressive symptoms, physical health, access to care, social support, and internalized shame, HIV disclosure and family communication were examined. The correlation analysis revealed that adherence is significantly associated with internalized shame, access to care, depressive symptoms, and family communication. Based on the multiple logistic regression analysis, depressive symptoms, access to care, HIV disclosure, and family communication were significant predictors of adherence. Having depressive symptoms remains a significant barrier to adherence, while access to care, HIV disclosure, and family communication play important positive roles. Our findings underscore the critical importance of addressing these various challenges that can influence adherence to antiretroviral therapy.
Research Epidemiologist, University of California, Semel Institute Center for Community Health, Los Angeles, California, USA.
Caregivers of people living with HIV (PLH) in Thailand face tremendous caregiver burden. This study examines complex ways in which caregivers' mental health affects their levels of caregiver burden. This study uses data from 409 caregivers of PLH in northern and north-eastern Thailand. Multiple regression models were used to examine the predictors of caregiver burden. Depression was significantly associated with caregiver burden (P < 0.0001) and being HIV positive (P = 0.015). Inverse associations were observed between depression and quality of life (P < 0.0001) and caregiver burden and quality of life (P = 0.004). Social support had direct positive association with caregiver's quality of life (P < 0.0001). Our findings underscore the complex relationship between caregiver burden, depression and HIV-status. Interventions that address the caregiver burden are urgently needed.
Li Li, Zunyou Wu, Mary Jane Rotheram-Borus, Jihui Guan, Yueping Yin, Roger Detels, Sheng Wu, Sung-Jae Lee, Haijun Cao, Chunqing Lin, Keming Rou, Zhendong Liu
Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA. email@example.com
Entertainment venues in China are associated with risky sexual behavior. Most previous studies related to entertainment venues in China have focused on sex workers and commercial sex, but this study addressed sexual health in a sample of the general urban population. A randomly selected sample of market vendors (n = 4,510) from an eastern city was recruited and assessed to examine relationships between entertainment venue visits and sexual risk. Both behavioral (self-reports of unprotected sex) and biomedical (STD test results) measures were used. About 18% of the sample (26.8% of men and 9% of women) reported visiting entertainment venues in the past 30 days. Those who visited entertainment venues were more likely to be male, younger, single, with higher education, and to have more discretionary income. For both men and women, visiting entertainment venues was a significant predictor for unprotected sex and STD infection. Gender differences were observed in predicting unprotected sex and STD infections. Entertainment venues could be potential sites for place-based intervention programs and outreach for the general population.
Li Li, Zunyou Wu, Sheng Wu, Sung-Jae Lee, Mary Jane Rotheram-Borus, Roger Detels, Manhong Jia, Stephanie Sun
Center for Community Health, Department of Psychiatry, Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA 90024, USA. LiLiLiLi@ucla.edu
Health-care providers in China are facing an exponential increase in HIV testing and HIV-positive patients. A total of 1101 service providers were recruited to examine attitudes toward people living with HIV/AIDS (PLWHA) in China. Logistic regression models were used to assess factors associated with providers' attitudes toward mandatory HIV testing. Providers were most likely to endorse mandatory HIV testing for patients with high-risk behaviour and for all patients before surgery. Over 43% of providers endorsed mandatory testing for anyone admitted to hospital. Controlling for demographics, multivariate analyses indicated that providers with higher perceived risk of HIV infection at work, higher general prejudicial attitudes toward PLWHA, and previous contact with HIV patients were more likely to endorse mandatory HIV testing for anyone admitted to hospital. Results underscore the importance of implementing universal precautions in health-care settings and call attention to social and ethical issues associated with HIV/AIDS control and treatment in China.
a Semel Institute Center for Community Health , University of California , Los Angeles , California , USA.
Although the impact of HIV falls on both partners of a married couple, the burden of stress may not be necessarily shared evenly. The researchers in this study examined the relations among HIV status, gender, and depressive symptoms among 152 married or cohabitating couples living with HIV in the northern and northeastern regions of Thailand. Depressive symptoms were assessed using a 15-item depressive symptom screening test that was developed and used previously in Thailand. Among the 152 couples, 59% were couples in which both members were people living with HIV (seroconcordant; both people living with HIV couples), 28% had only female members with HIV (serodiscordant; females living with HIV couples), and 13% had only male members with HIV (serodiscordant; males living with HIV couples). The prevalence of depressive symptoms between seroconcordant and serodiscordant groups was similar. However, females living with HIV reported significantly higher levels of depressive symptoms, regardless of their partners' HIV status. Future prevention programs focusing on serodiscordant couples should be planned to target HIV risk, as well as emphasis on mental health, with a particular focus on women's increased susceptibility to negative mental health outcomes.
Resiliency and survival skills among newly homeless adolescents: Implications for future interventions.
University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Center for Community Health, Los Angeles, CA.
Recent studies on homeless adolescents suggest that the profiles of homeless adolescents are heterogeneous, and that certain clusters of homeless adolescents demonstrated resiliency and positive coping strategies. This study examined the relationship between HIV-related risk factors and resiliency (survival skills) of homeless adolescents over a 2-year period. Those who did not engage in unprotected sex reported significantly higher survival skills scores. Similarly, those who were monogamous during the study period reported significantly higher survival skills scores. However, there was a significant decline in survival skills scores after 6 months, regardless of the HIV-related risk factors. Findings from this study point to the urgent need to identify and target resilient adolescents early on to provide interventions to facilitate the transition to stable living situations before their resiliency deteriorates.
AIDS Behav. 2012 Jul ;16 (5):1265-75 22020758
Mary Jane Rotheram-Borus, Eric Rice, W Scott Comulada, Karin Best, Carla Elia, Katherine Peters, Li Li, Sara Green, Ena Valladares
Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California Los Angeles, 10920 Wilshire Blvd., Ste. 350, Los Angeles, CA 90024, USA. CCHPublications@mednet.ucla.edu
We evaluate the efficacy of a family-based intervention over time among HIV-affected families. Mothers living with HIV (MLH; n = 339) in Los Angeles and their school-aged children were randomized to either an intervention or control condition and followed for 18 months. MLH and their children in the intervention received 16 cognitive-behavioral, small-group sessions designed to help them maintain physical and mental health, parent while ill, address HIV-related stressors, and reduce HIV-transmission behaviors. At recruitment, MLH reported few problem behaviors related to physical health, mental health, or sexual or drug transmission acts. Compared to MLH in the control condition, intervention MLH were significantly more likely to monitor their own CD4 cell counts and their children were more likely to decrease alcohol and drug use. Most MLH and their children had relatively healthy family relationships. Family-based HIV interventions should be limited to MLH who are experiencing substantial problems.
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Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok, Thailand. firstname.lastname@example.org
OBJECTIVE To assess the quality of life and factors related to quality of life among people living with HIV/AIDS in Bangkok, Thailand. MATERIAL AND METHOD A cross-sectional survey research was conducted among 138 people aged over 18 years living with HIV/AIDS in Bangkok. The sample was selected by purposive sampling from HIV infected persons who attended the HIV clinic at the hospitals in Bangkok. Data were collected by self-administered questionnaires from June to July 2010 and analyzed by frequency, percentage, mean, standard deviation, Chi-square test and Pearson Product Moment Correlation Coefficient. RESULTS The finding revealed that of the people living with HIV/AIDS, 67.4% reported a moderate level with respect to quality of life and 32.6% reported a good level concerning the quality of life. Factors related to quality of life were age, education level, monthly income, self-esteem,family relationships and social support (p < 0.05). CONCLUSION All of the people living with HIV/AIDS reported having a moderate to good quality of life. From research results, responsible organizations should establish activities to promote self-esteem, family relationships and social support for people living with HIV/AIDS to enhance the quality of life of infected persons. Increasing public awareness to better understand basic needs such as family relationships and social support and providing HIV/AIDS education to the community were deemed important.
Centre for Global Health, University of Dublin Trinity College, Dublin Ireland.
BACKGROUND Availability of antiretroviral therapies has transformed AIDS into a manageable chronic condition and improved well-being among people living with HIV/AIDS (PHA) in developed countries. In developing countries however, such transformations are yet to occur due to socio-economic, systemic and environmental constraint. This study examined the impact of social, economic, psychological and environmental factors on health and wellbeing among PHA living in southwest Nigeria. METHODS Using qualitative participatory methodology, 50 HIV positive people, 8 health personnel and 32 care providers were interviewed to explore how care and social support affect wellbeing among PHA in view of constraints to accessing antiretroviral drugs. Analysis of data used the grounded theory (GT) approach to identify themes, which are considered crucial to the wellbeing of PHA. RESULTS The findings highlight several factors, apart from antiretroviral drugs, that impact the wellbeing of PHA in southwest Nigeria. These include concerns about deteriorating physical health, family and children's welfare, pervasive stigma, financial pressures and systemic failures relating to care among others. We describe how psychosocial and social support structures can considerably contribute to improving health outcomes among them because of how they affect the functioning of immune system, self-care activities and other illness behaviours. CONCLUSION We recommend that interventions should address the psychosocial, socio-economic and other systemic issues that negatively influence the wellbeing of PHA and governments need to strengthen the policy environment that empowers PHA support groups.
Department of Human Development and Psychology, Regent University College of Science and Technology, Accra, Ghana.
OBJECTIVE The current study sought to investigate the association between age, gender, social support and the psychological wellbeing of people living with HIV and AIDS (PLHA) in Ghana. METHOD Cross-sectional data containing information on demographics, social support and psychological well-being (stress, depression, and anxiety), were collected from 107 men and women living with HIV/AIDS. To explore age group differences, participants were stratified by age (< 39 vs. 40+ years). Three anonymous self-administered questionnaires were used, namely the demographic data questionnaire, Sources of Social Support Scale, and the Depression Anxiety Stress Scale (DASS- 42). RESULTS Correlation analysis revealed that social support was negatively associated with depression, stress and anxiety. Compared with males living with HIV, women reported higher levels of stress, depression and anxiety. Female gender and low social support were significant predictors of depression and stress after controlling for selected independent variables. Older participants experienced higher levels of stress than their younger counterparts. CONCLUSION Public health personnel and AIDS professionals may consider further interventions to promote psychological health in HIV/AIDS-positive individuals. More attention should be paid to the social environment of individuals diagnosed with HIV as the quality of social relationships may be particularly important for successful psychological adaptation to HIV.
Gerontologist. 2012 Oct 3;: 23034470
The Physical and Mental Health of Lesbian, Gay Male, and Bisexual (LGB) Older Adults: The Role of Key Health Indicators and Risk and Protective Factors.
Karen I Fredriksen-Goldsen, Charles A Emlet, Hyun-Jun Kim, Anna Muraco, Elena A Erosheva, Jayn Goldsen, Charles P Hoy-Ellis
*Address correspondence to Karen I. Fredriksen-Goldsen, School of Social Work, University of Washington, Seattle, WA 98105. E-mail: email@example.com.
PURPOSE: Based on resilience theory, this paper investigates the influence of key health indicators and risk and protective factors on health outcomes (including general health, disability, and depression) among lesbian, gay male, and bisexual (LGB) older adults. DESIGN AND METHODS: A cross-sectional survey was conducted with LGB older adults, aged 50 and older (N = 2,439). Logistic regressions were conducted to examine the contributions of key health indicators (access to health care and health behaviors), risk factors (lifetime victimization, internalized stigma, and sexual identity concealment), and protective factors (social support and social network size) to health outcomes, when controlling for background characteristics. RESULTS: The findings revealed that lifetime victimization, financial barriers to health care, obesity, and limited physical activity independently and significantly accounted for poor general health, disability, and depression among LGB older adults. Internalized stigma was also a significant predictor of disability and depression. Social support and social network size served as protective factors, decreasing the odds of poor general health, disability, and depression. Some distinct differences by gender and sexual orientation were also observed. IMPLICATIONS: High levels of poor general health, disability, and depression among LGB older adults are of major concern. These findings highlight the important role of key risk and protective factors, which significantly influences health outcomes among LGB older adults. Tailored interventions must be developed to address the distinct health issues facing this historically disadvantaged population.
Perceived Family Support and Depression among People Living with HIV/AIDS in the Kathmandu Valley, Nepal.
Sadhana Shrestha, Krishna C Poudel, Kalpana Poudel-Tandukar, Jun Kobayashi, Basu Dev Pandey, Junko Yasuoka, Keiko Otsuka, Masamine Jimba
Background: Depression is emerging as a highly prevalent psychiatric condition among people living with HIV/AIDS (PLWHA). Perceived family support (PFS) buffers depression among chronic disease patients. However, a similar relationship among PLWHA is unexplored. Objective: To examine the relationship between PFS and depression among PLWHA in the Kathmandu Valley, Nepal. METHODS: In this cross-sectional study, depression was measured by Beck Depression Inventory Ia. Perceived family support was measured by Nepali Family Support and Difficulties Scale. The status of depression was compared between 208 PLWHA and 208 HIV-negative participants. The relationship between PFS and depression was examined only among PLWHA. RESULTS: Among each of the 208 participants, the number of depressed PLWHA (n = 61,29.3%) was higher than that of HIV-negative participants (n = 13,6.2%; P <.001). Perceived family support had a negative association with depression in PLWHA (adjusted odds ratio [AOR]= 0.20, 95% confidence interval [CI]= 0.08-0.53). CONCLUSION: In Nepal, PLWHA display a higher level of depression than HIV-negative people, and a lower level of PFS is associated with depression among PLWHA. Improved family support might be helpful in reducing depression among Nepalese PLWHA.
Social support mediates the relationship between HIV stigma and depression/quality of life among people living with HIV in Beijing, China.
Department of Global Health.
Stigma towards people living with HIV is pervasive in China and related to poor service utilization, psychosocial distress and diminished quality of life (QOL). In an effort to identify mechanisms to reduce HIV stigma and its negative consequences, we examined whether social support mediates the relation between enacted stigma and both depressive symptoms and QOL among 120 HIV outpatients in Beijing, China. Generally, perceived social support was associated with less stigma, less depressive symptomatology and better QOL. Using multivariable regression models, we found that social support was a full mediator of the impact of stigma on both depressive symptomatology and QOL. The findings suggest social support may be an important target of interventions to reduce the impact of stigma on poor psychosocial health outcomes.
AIDS Care. 2012 Jul 27;: 22835331
Perceived discrimination, social support, and perceived stress among people living with HIV/AIDS in China.
Xiaoyou Su, Joseph T F Lau, Winnie W S Mak, Lin Chen, K C Choi, Junmin Song, Yan Zhang, Guanglu Zhao, Tiejian Feng, Xi Chen, Chuliang Liu, Jun Liu, De Liu, Jinquan Cheng
a Division of Health Improvement, School of Public Health and Primary Care , The Chinese University of Hong Kong , Beijing , China.
Abstract Perceived stress among people living with HIV/AIDS (PLWH) was associated with severe mental health problems and risk behaviors. Discrimination toward PLWH in China is prevalent. Both perceived discrimination and social supports are determinants of the stress level among PLWH. Psychological support services for PLWH in China are scarce. It is unknown whether social support is a buffer between the perceived discrimination and perceived stress. With written consent, this study surveyed 258 PLWH recruited from multiple sources in two cities in China. Instruments were validated in previous or the present study, including the perceived stress scale for PLWH (PSSHIV), the perceived social support scale (PSSS), and the perceived discrimination scale for PLWH (PDSHIV). Pearson correlations and multiple regression models were fit. PDSHIV was associated with the Overall Scale and all subscales of PSSHIV, whilst lower socioeconomic status in general and lower scores of PSSS were associated with various subscales of PSSHIV. The interaction item (PSSS×PSDHIV) was nonsignificant in modeling PSSHIV, hence no significant moderating effect was detected. Whilst perceived discrimination is a major source of stress and social support can reduce stress among PLWH in China, improved social support cannot buffer the stressful consequences due to perceived discrimination. The results highlight the importance to reduce discrimination toward PLWH and the difficulty to alleviate its negative consequences. It is warranted to improve mental health among PLWH in China and it is still important to foster social support among PLWH as it has direct effects on perceived stress.
AIDS. 2012 Jul 31;26 Suppl 1 :S65-75 22781178
Cancer and the 'other' noncommunicable chronic diseases in older people living with HIV/AIDS in resource-limited settings: a challenge to success.
aDepartment of Global Health and Social Medicine, Harvard Medical School bPartners in Health cJSI Research and Training Institute, Boston, Massachusetts, USA dDepartment of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, School of Medicine, Dar es Salaam, Tanzania.
OBJECTIVE : There is considerable research around the morbidity and mortality related to noncommunicable diseases (NCDs), particularly cardiovascular disease and diabetes, among people living with HIV/AIDS (PLWHA) in resource-richer settings. Less is known about the burden and appropriate management of NCDs, particularly 'other' NCDs including cancer, renal, pulmonary, neurocognitive and mental health conditions, among older PLWHA in resource-limited settings (RLSs). We undertook a literature review of these other NCDs to explore what is currently known about them and identify areas of further research. METHODS : Systematic literature review of published manuscripts and selected conference abstracts and reports. RESULTS : Although there is growing recognition of the importance of these NCDs among the aging population of PLWHA in RLSs, significant gaps remain in understanding the epidemiology and risk factors among older PLWHA in these settings. Even more concerning is the limited available evidence for effective and feasible approaches to prevention, screening and treatment of these conditions. The burden of these NCDs is related to both the aging of the population of PLWHA and an increased risk due to HIV infection, other comorbidities associated with HIV infection or transmission risk and underlying risk factors in the general community. Results from resource-richer settings and RLSs highlight malignancies, neurocognitive and mental health as well as renal disease as the most significant challenges currently and likely to increase in the future. CONCLUSION : Although some lessons can be taken from the growing experience with NCDs in older PLWHA in resource-richer settings, additional research is needed to better understand their risk and impact and identify optimal models of care to effectively address this challenge in the areas where the majority of older PLWHA will be receiving care.
J Int AIDS Soc. 2012 ;15 (2):17421 22713256
Between a rock and a hard place: stigma and the desire to have children among people living with HIV in northern Uganda.
Centre for International Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia. firstname.lastname@example.org
BACKGROUND HIV-related stigma, among other factors, has been shown to have an impact on the desire to have children among people living with HIV (PLHIV). Our objective was to explore the experiences of HIV-related stigma among PLHIV in post-conflict northern Uganda, a region of high HIV prevalence, high infant and child mortality and low contraception use, and to describe how stigma affected the desires of PLHIV to have children in the future. METHODS Semi-structured interviews were conducted with 26 PLHIV in Gulu district, northern Uganda. The interviews, conducted in Luo, the local language, were audio recorded, transcribed and then translated into English. Thematic data analysis was undertaken using NVivo8 and was underpinned by the "Conceptual Model of HIV/AIDS Stigma". RESULTS HIV-related stigma continues to affect the quality of life of PLHIV in Gulu district, northern Uganda, and also influences PLHIV's desire to have children. PLHIV in northern Uganda continue to experience stigma in various forms, including internal stigma and verbal abuse from community members. While many PLHIV desire to have children and are strongly influenced by several factors including societal and cultural obligations, stigma and discrimination also affect this desire. Several dimensions of stigma, such as types of stigma (received, internal and associated stigma), stigmatizing behaviours (abusing and desertion) and agents of stigmatization (families, communities and health systems), either directly, or indirectly, enhanced or reduced PLHIV's desire to have more children. CONCLUSIONS The social-cultural context within which PLHIV continue to desire to have children must be better understood by all health professionals who hope to improve the quality of PLHIV's lives. By delineating the stigma process, the paper proposes interventions for reducing stigmatization of PLHIV in northern Uganda in order to improve the quality of life and health outcomes for PLHIV and their children.
Home and community based care program assessment for people living with HIV/AIDS in Arba Minch, Southern Ethiopia.
ABSTRACT: BACKGROUND: People Living with HIV/AIDS (PLWHA) require significant care and support; however, most care needs are still unmet. To our knowledge, no studies have described the activities and challenges of care services in Ethiopia. Our objective was to assess the status, shortcomings and prospects of care and support services provided to PLWHA in the town of Arba Minch, Ethiopia, and surrounding areas.. METHODS: A cross-sectional quantitative study combined with qualitative methods was conducted in Southern Ethiopia among 226 randomly selected PLWHAs and 10 service providers who were purposively selected. Data was collected using a pre-tested structured interview questionnaire and in-depth interview guideline. Quantitative data was analyzed using SPSS windows based statistical software while qualitative data was analyzed manually using thematic framework analysis. RESULTS:- A total of 226 PLWHAs were interviewed. Socio-economic support (material and income generating activities) was being received by 108 (47.8%) of the respondents, counseling services (e.g. psychological support) were being received 128(56.6%), 144 (63.7%) alleviation of stigma and discrimination as human right and legal support for study participants. Inadequate external financial support, lack of proper referral systems between different care providers were among the reasons identified for the low quality and redundancy of care and support activities. Nonetheless, many opportunities and prospects, including easily accessible care receivers (PLWHA), good political and societal will were also implicated. CONCLUSION:- Care and support services provided to PLWHAs in the study area are by far lower in terms of coverage and quantity. Strategies for improvement could be facilitated given the observed political will, social support and access to care givers. KEYWORDS: Community, Home-Based, Palliative Care, PLWHA, Ethiopia.