Mental health and well-being of older adults living with HIV in sub-Saharan Africa: a systematic review

Mwangala, Patrick N.; Mabrouk, Adam; Wagner, Ryan G.; Newton, Charles R.; Abubakar, Amina

doi:10.1136/bmjopen-2021-052810

Cited by 24 publications

(27 citation statements)

References 76 publications

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“…Despite previous studies reporting how HIV affects the lives of WLHIV, to date, there have been no published systematic reviews which specifically address and examine research-based evidence around the psychological and social impacts HIV have on WLHIV and their families in LMICs in Asia and globally [ 24 , 25 , 26 , 27 ]. This review provides a better understanding of HIV impact on WLHIV and their families and how HIV impact influences their lives.…”

Section: Introductionmentioning

confidence: 99%

Psychological and Social Impact of HIV on Women Living with HIV and Their Families in Low- and Middle-Income Asian Countries: A Systematic Search and Critical Review

Fauk

Mwanri

Hawke

et al. 2022

IJERPH

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Human Immunodeficiency Virus (HIV) infection adds a significant burden to women in Low- and Middle-Income Countries (LMICs), often leading to severe detrimental impact, not only on themselves, but also on their families and communities. Given that more than half of all people living with HIV globally are females (53%), this review seeks to understand the psychological and social impact of HIV infection on Women Living with HIV (WLHIV) and their families in LMICs in Asia, and the interrelationships between one impact and another. A systematic review was conducted to find literature using the following databases: Medline, PsycINFO, CINAL, Emcare, Scopus and ProQuest. Research articles included in this review were selected based on the following inclusion criteria: conducted in LMICs in Asia, published in English language between 1 January 2004 and 31 December 2021, had full text available, involved WLHIV (married and unmarried) and explored the psychological and social impacts of HIV on these women and their families. Critical appraisal tools developed by Joanna Briggs Institute (JBI) were used to assess the methodological quality of the studies, and thematic narrative synthesis was used to analyse the findings. A total of 17 articles met the inclusion criteria. The review showed that HIV has a range of negative psychological consequences on WLHIV, such as stress, fear, worry, anxiety and depression, as well as social impacts on the women and their families, including stigma, discrimination and family separation. The findings indicate the need for targeted interventions—specific to WLHIV—that address the psychological challenges, stigma and discrimination these women and their families face. These interventions should also incorporate education and sustainable support structures for WLHIV and their families.

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Section: Introductionmentioning

confidence: 99%

Psychological and Social Impact of HIV on Women Living with HIV and Their Families in Low- and Middle-Income Asian Countries: A Systematic Search and Critical Review

Fauk

Mwanri

Hawke

et al. 2022

IJERPH

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“…Research findings, mainly from HICs, indicate that OALWH present with an average of three comorbid conditions in addition to HIV, including medical diseases (e.g., diabetes, hypertension), mental health problems (e.g., depression, anxiety, substance use) and social challenges (e.g., stigma, loneliness, and lack of social support) (6)(7)(8)(9). Depression is exceptionally high among OALWH, up to five times greater than in HIV uninfected older adults (10).…”

Section: Introductionmentioning

confidence: 99%

Navigating life with HIV as an older adult on the Kenyan coast: perceived health challenges seen through the biopsychosocial model

Mwangala

Wagner

Newton

et al. 2022

Preprint

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Background : Kenya, like many sub-Saharan African countries (SSA), is experiencing a rise in the number of HIV infected adults aged at least 50 years (recognized as older adults living with HIV [OALWH]). This trend has created a subgroup of vulnerable older adults demanding a prompt response in research, policy, and practice to address their complex and transitioning needs. Unfortunately, little is known about the health and wellbeing of these adults in Kenya. As such, we explore the experiences of OALWH and key stakeholders at the coast of Kenya to understand the health challenges facing the OALWH. Material and methods : We utilized the biopsychosocial model to explore views from 34 OALWH and 22 stakeholders (11 health care providers and 11 primary caregivers) on the physical, mental, and psychosocial health challenges of ageing with HIV in Kilifi County, Kenya, between October and December 2019. Data were drawn from semi-structured in-depth interviews, which were audio-recorded and transcribed. A framework approach was used to synthesize the data. Results : Symptoms of common mental disorders (e.g. stress, worry, thinking too much), comorbidities (especially ulcers/hyperacidity, hypertension, visual and memory difficulties), somatic symptoms (especially pain/body aches, fatigue, and sleep problems), financial difficulties, stigma, and discrimination were viewed as common across the participants. Suicidal ideation and substance use problems (especially ' mnazi ' – the local palm wine and 'ugoro' – snuff) were also raised. There was an overlap of perceived risk factors across the three health domains, such as family conflicts, poverty, lack of social support, stigma, and the presence of comorbid health complaints. Conclusion : Our findings provide a preliminary understanding of challenges, using the biopsychosocial model, facing OALWH in a low-literacy Kenyan setting. We found that OALWH at the Kenyan coast are at risk of multiple physical, mental, and psychosocial challenges, likely affecting their HIV treatment and overall health. Before programmes can have any lasting impact on these adults, improved access to basic needs, including food, financial support, and caregiving, and a reduction of stigma and discrimination must be addressed. Future research should quantify the burden of these challenges and examine the resources available to these adults before piloting and testing feasible interventions.

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“…In Kenya, the increasing population of OALWH [5] is experiencing an elevated incidence of chronic age-related conditions [6], all potentially resulting in an increase of CMDs. The prevalence of depression among OALWH in SSA ranges from 6% to 59% [7] compared to 26% among their HIVnegative peers [8]. Outside SSA, estimates of depression among OALWH range from 19% to 45% in Asia [9,10], 39% to 90% in the United States [11,12], 16% to 35% in Latin America and the Caribbean [13], and 28% in Europe [14].…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of depression among OALWH in SSA ranges from 6% to 59% [ 7 ] compared to 26% among their HIV‐negative peers [ 8 ]. Outside SSA, estimates of depression among OALWH range from 19% to 45% in Asia [ 9 , 10 ], 39% to 90% in the United States [ 11 , 12 ], 16% to 35% in Latin America and the Caribbean [ 13 ], and 28% in Europe [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and factors associated with mild depressive and anxiety symptoms in older adults living with HIV from the Kenyan coast

et al. 2022

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Introduction Empirical research on the burden and determinants of common mental disorders (CMDs), especially depression and anxiety, among older adults living with HIV (OALWH) in sub‐Saharan Africa is inadequate. To bridge the gap in Kenya we: (1) determined the prevalence of CMDs among OALWH on routine HIV care compared to HIV‐negative peers; (2) investigated HIV status as an independent predictor of CMDs in older adults; and (3) investigated CMD determinants. Methods In a cross‐sectional study conducted between 2020 and 2021, the prevalence of CMDs and associated determinants were investigated at the Kenyan coast among 440 adults aged ≥50 years (257 OALWH). The Patient Health Questionnaire and Generalized Anxiety Disorder scale were administered alongside measures capturing biopsychosocial information. Logistic regression was used to examine the correlates of CMDs. Results No significant differences were found in the prevalence of mild depressive symptoms, 23.8% versus 18.2% (p = 0.16) and mild anxiety symptoms, 11.7% versus 7.2% (p = 0.12) among OALWH compared to HIV‐negative peers, respectively. HIV status was not independently predictive of CMDs. Among OALWH, higher perceived HIV‐related stigma, ageism, increasing household HIV burden, loneliness, increasing functional disability, sleeping difficulties, chronic fatigue and advanced age (>70 years) were associated with elevated CMDs. Among HIV‐negative older adults, loneliness, increased medication burden and sleeping difficulties were associated with elevated depressive symptoms. Easier access to HIV care was the only factor associated with lower CMDs among OALWH. Conclusions On the Kenyan coast, the burden of moderate and severe CMDs among older adults is low; however, both OALWH and their HIV‐negative peers have a similar relatively high burden of mild depressive and anxiety symptoms. Our results also suggest that determinants of CMDs among OALWH in this setting are predominantly psychosocial factors. These results highlight the need for psychosocial interventions (at the family, community and clinical levels) to mitigate the risks of mild CMDs as they are known to be potentially debilitating.

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Mental health and well-being of older adults living with HIV in sub-Saharan Africa: a systematic review

Cited by 24 publications

References 76 publications

Psychological and Social Impact of HIV on Women Living with HIV and Their Families in Low- and Middle-Income Asian Countries: A Systematic Search and Critical Review

Psychological and Social Impact of HIV on Women Living with HIV and Their Families in Low- and Middle-Income Asian Countries: A Systematic Search and Critical Review

Navigating life with HIV as an older adult on the Kenyan coast: perceived health challenges seen through the biopsychosocial model

Prevalence and factors associated with mild depressive and anxiety symptoms in older adults living with HIV from the Kenyan coast

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