Anxiety symptoms and felt stigma among young people living with perinatally or behaviourally-acquired HIV in Ukraine: A cross-sectional survey

Abstract

BackgroundUkraine has the second largest European HIV epidemic. This study aimed to describe stigma, demographic and social factors and their association with anxiety among perinatally and behaviourally-HIV-infected (PHIV; BHIV) young people in Kiev and Odessa.Methods104 PHIV and 100 BHIV young people aged 13–25 years completed a confidential tablet-based survey. Survey tools included the Hospital Anxiety and Depression Scale (HADS) (anxiety sub-scale scores of 8–10 indicating mild and ≥11 moderate/severe symptoms in last 7 days), Rosenberg Self-Esteem Scale (RSES) and HIV Stigma Scale (HSS) (short version, composite of disclosure, negative self-image and public attitudes sub-scales). Unadjusted Poisson regression models were fitted to explore factors associated with moderate/severe anxiety symptoms.ResultsPHIV and BHIV young people were of median age 15.5 [IQR 13.9–17.1] and 23.0 [21.0–24.3] years, having registered for HIV care a median 12.3 [10.3–14.4] and 0.9 [0.2–2.4] years previously; 97% (97/100) and 66% (65/99) respectively were on ART. Overall 43% (95%CI 36–50%) reported any and 13% (95%CI 9–19%) moderate/severe anxiety symptoms, with no difference by HIV acquisition mode (p = 0.405) or gender (p = 0.700). 42% (75/180) reported history of an emotional health problem for which they had not been referred/attended for care. Moderate/severe anxiety symptoms were associated with HIV-related stigma (prevalence ratio (PR) 1.24 95%CI 1.14–1.34 per HSS unit increase), lower self-esteem (PR 0.83 95%CI 0.78–0.90 per RSES point increase), CD4 ≤350 cells/mm3 (PR 2.29 95%CI 1.06–4.97), having no-one at home who knew the respondent’s HIV status (PR 9.15 95%CI 3.40–24.66 vs all know) and, among BHIV, less stable living situation (PR 6.83 95%CI 1.99–23.48 for ≥2 vs no home moves in last 3 years) and history of drug use (PR 4.65 95%CI 1.83–11.85).ConclusionsResults indicated unmet need for psychosocial support. Further work is needed to explore strategies for mental health support, particularly around disclosure, self-esteem and stigma.

Prevalence, risk and protective indicators of common mental disorders among young people living with HIV compared to their uninfected peers from the Kenyan coast: a cross-sectional study

“…Perceived HIV-related stigma was significantly associated with higher odds of depressive symptoms, anxiety symptoms and their co-occurrence in this study. Other studies also report similar findings [ 14 , 20 , 23 ]. For a young person, stigma due to living with HIV may decrease their perceived level of social support in the community, which in turn, may increase mental ill-health symptoms.…”

“…Even so, the male sex has been reported as a predictor of higher depressive scores in YLWH by a study conducted in England [21]. HIVrelated stigma among YLWH appears an important psychosocial risk indicator for elevated CMDs from recent African-based reports [14,20,22], a finding also observed elsewhere [23]. Other identified psychosocial risk indicators for elevated CMDs among YLWH, but with little or no consensus from past studies, include an experience of negative or stressful life events [24], poor adherence to cART [5,20], HIV clinic inaccessibility [15] and disclosure of HIV status [25].…”

“…Similarly, several HIV-related clinical factors have been investigated as risk indicators for elevated CMDs among YLWH but with little or no consensus. These include low cluster of differentiation-4 cell count [ 23 ], presence of HIV opportunistic infections [ 20 ], cART regimen particularly efavirenz use [ 26 ], duration on cART [ 9 ] and its side effects [ 22 ]. The role of HIV status (being positive or not) in increasing the risk for CMDS among YLWH also remains unclear as studies report mixed findings [ 21 , 27 , 28 ].…”

Depression and associated factors among HIV-positive youths attending antiretroviral therapy clinics in Jimma town, southwest Ethiopia

“…Exposure to psychosocial stress, developmental, and hormonal factors will increase depression in youths but not in adults [43]. Additionally, this finding is higher than the study among HIV-positive youths in England (16%) [44], Ukraine (13%) [45], Thailand (15%) [16], Malawi (18.9%) [20], and Nigeria (20%) [21]. The difference may be attributable to the use of different psychometric scales, study settings, and also applying different exclusion criteria.…”

Stigma and quality of co‐located care for HIV‐positive people in addiction treatment in Ukraine: a cross‐sectional study

“…HIV‐related stigma has been linked to numerous poor health outcomes: negative effects on mental health [3‐5]; unhealthy alcohol use [3,6,7]; poor antiretroviral treatment (ART) adherence [3,8]; and lower overall quality of life [3,9]. In addition to HIV‐related stigma, key populations are also affected by stigma relating to people with other identities and behaviours, such as people who use substances [10], people engaged in sex work [11], sexual minorities [12] and people under 25 years of age [13].…”