HIV-related enacted stigma and increase frequency of depressive symptoms among Thai and Cambodian adolescents and young adults with perinatal HIV

Abstract

HIV-related enacted stigma and social problems may increase risk for depression and/or behavioral problems among adolescents and young adults with perinatal HIV(AYA-PHIV), yet few studies have explored stigma in AYA-PHIV residing in low-to-middle income regions, including Southeast Asia. We assessed HIV-related enacted stigma and social problems in AYA-PHIV who participated in the RESILIENCE study (clinicaltrials.gov identification: U19AI53741) in Thailand and Cambodia using specific questions during structured in-person interviews. Depression was measured by the Child Depression Inventory for children <15 years, or the Center for Epidemiologic Studies Depression Scales for youth ≥15 years); behavioral problems were measured by the Child Behavior Checklist (CBCL-caregiver report). Among 195 AYA-PHIV (median age 16.9 years), 25.6% reported a lifetime experience of enacted stigma, while 10.8% experienced social problems due to HIV infection. The frequency of depressive symptoms was nearly two-fold higher among AYA-PHIV with compared to those without HIV-related enacted stigma (34.7% vs. 16.0%, p = 0.005). Caregiver-reported behavioral problems were detected in 14.6% of all AYA-PHIV, with no differences between those with and without HIV-related enacted stigma. Low household income and caregiver mental health problems were independent risk factors for depressive symptoms; HIV-related enacted stigma was also associated with increased risk, warranting targeted services to support AYA-PHIV.

Alcohol use, suicidality and virologic non‐suppression among young adults with perinatally acquired HIV in Thailand: a cross‐sectional study

“…4) The Patient Health Questionnaire for Adolescents (PHQ-A, validated Thai version) was used to assess depressive symptoms in the past 2 weeks, with questions on suicidality in the past month and over a lifetime. Depressive symptoms were classified by score as mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19) and severe (20)(21)(22)(23)(24)(25)(26)(27). A PHQ-A score ≥10 was considered to represent significant depression [22,23].…”

“…A PHQ-A score ≥10 was considered to represent significant depression [22,23]. 5) The Generalized Anxiety Disorder 7-item test (GAD-7, validated Thai version) was used to assess anxiety symptoms, classified by scores as minimal (1-4), mild (5-9), moderate (10)(11)(12)(13)(14) and severe (15)(16)(17)(18)(19)(20)(21). Scores ≥10 were considered significant [24].…”

“…YA‐PHIV additionally have had to face multiple challenges that extended beyond maintaining their physical health, including HIV‐related stigma [ 12 ] and familial and economic insecurities [ 13 ]. The combination of poorer health and social instability has led some YA‐PHIV to fall behind in their formal education [ 14 , 15 ], which could negatively impact their ability to function as independent adults in society.…”

Assessing the Validity of the Social Impact Scale Among a Longitudinal Cohort of Adolescents and Young Adults Living With Perinatally Acquired HIV

“…These development changes, coupled with the various types of HIV-related stigma experienced by AYA (including structural, internalized, perceived, experienced, and anticipated stigma), make HIV-related stigma among AYA a multidimensional determinant of health outcomes; appropriate measurement tools are needed to accurately assess the potentially critical causal factor. [38][39][40][41] A systematic review of quantitative measures used to assess stigma among pediatric populations (ie, the Perceived Public Stigma Against Children Affected by HIV, Brief HIV Stigma by Association Scale), and especially the global prominence of variations (ie, shorter versions or the full version) of the HIV Stigma Scale, 42 found that few of the existing HIV-related stigma scales were validated for use among individuals aged 18 years or younger, with only some using psychometric techniques to validate measures with target populations. 42 Despite its high use among pediatric populations, the original HIV Stigma Scale, which includes 40 items across 4 subscales-personalized stigma, disclosure, self-image, and public attitudes-was originally validated among adults living with HIV in the United States; few studies both adapt and validate this scale for use among younger populations.…”

“…These development changes, coupled with the various types of HIV-related stigma experienced by AYA (including structural, internalized, perceived, experienced, and anticipated stigma), make HIV-related stigma among AYA a multidimensional determinant of health outcomes; appropriate measurement tools are needed to accurately assess the potentially critical causal factor. 38–41…”