Mental Health and Perceived Access to Care among People Who Inject Drugs in Athens, Greece

Abstract

Poor mental health among human immunodeficiency virus (HIV)-positive people who inject drugs (PWID) may contribute to stigma, and together they act as barriers to medical care. This analysis aims to examine factors associated with the mental health of PWID and their network contacts, and the association of poor mental health with the experience of HIV-related stigmatizing events, with HIV-related social support, and with perceived access to care. Data were collected during the Transmission Reduction Intervention Project (TRIP) conducted in Athens, Greece (2013–2015). PWID (n = 292; n = 122 HIV-positive) were interviewed both at baseline and follow-up. Items of depression, anxiety, and general positive affect subscales of the Mental Health Inventory were used to explore the psychological distress and well-being of participants at follow-up. Items of the Access to Care Scale were used to evaluate perceived access to medical care at baseline and follow-up. Linear regression showed that unemployment was positively related to depression (β = 1.49, p = 0.019), while injecting drug use was a risk factor for a low general positive affect score (β = −3.21, p = 0.015). Poor mental health was not linked to HIV-related stigma or social support. Positive perception of access to care was associated in multivariable analyses with low depression (β = −0.22, p = 0.049). The perceived access to care score improved from baseline to follow-up (p = 0.019) and HIV-positive participants had a higher score than HIV-negative participants. Future interventions should include targets to improve the mental well-being of participants, reduce psychosocial distress, and minimize perceived barriers to accessing medical care.

Methods for Assessing Spillover in Network-Based Studies of HIV/AIDS Prevention among People Who Use Drugs

“…These contacts were then recruited and asked to identify, in turn, their sexual and drug-use partners, who were also recruited, and their connections to other individuals in the study were ascertained. If any of these partners were identified as recently infected with HIV, then their contacts and the contacts of their contacts (i.e., two waves of contact tracing) would be recruited as well, and their contacts were ascertained [ 146 ]. In addition, longer-term HIV-infected individuals (long-term control seeds) were also recruited, and their network contacts were traced based on the same procedure described above.…”

“…Moreover, the TRIP staff, using a combination of approaches to improve case management (information and instrumental support, multiple reminders, multiple and consistent efforts to overcome administrative obstacles), was achieved to connect almost 87% of the recently HIV-infected PWID participants into care; 77% of those began antiretroviral treatment, and eventually 89% had very low viral load levels [ 147 ]. The data analyses also showed that the behavioral patterns reported by the participants at the follow-up interview of TRIP were much safer than those reported at the start of the project [ 148 ], while the project was not associated with any adverse events in terms of the mental health of the participants or any TRIP-related stigmatizing experiences [ 146 , 149 ]. Instead, there was some evidence that HIV-related support increased significantly over the course of the project [ 149 ].…”