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Zeng C, Li L, Hong YA, Zhang H, Babbitt AW, Liu C, Li L, Qiao J, Guo Y, Cai W. A structural equation model of perceived and internalized stigma, depression, and suicidal status among people living with HIV/AIDS. BMC Public Health 2018; 18:138. [PMID: 29334959 PMCID: PMC5769512 DOI: 10.1186/s12889-018-5053-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 01/10/2018] [Indexed: 12/03/2022] Open
Abstract
Background Previous studies have shown positive association between HIV-related stigma and depression, suicidal ideation, and suicidal attempt among people living with HIV/AIDS (PLWH). But few studies have examined the mechanisms among HIV-related stigma, depression, and suicidal status (suicidal ideation and/or suicidal attempt) in PLWH. The current study examined the relationships among perceived and internalized stigma (PIS), depression, and suicidal status among PLWH in Guangzhou, China using structural equation modeling. Methods Cross-sectional study by convenience sampling was conducted and 411 PLWH were recruited from the Number Eight People’s Hospital from March to June, 2013 in Guangzhou, China. Participants were interviewed on their PIS, depressive symptoms, suicidal status, and socio-demographic characteristics. PLWH who had had suicidal ideation and suicidal attempts since HIV diagnosis were considered to be suicidal. Structural equation model was performed to examine the direct and indirect associations of PIS and suicidal status. Indicators to evaluate goodness of fit of the structural equation model included Chi-square Statistic, Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA), Standardized Root Mean Square Residual (SRMR), and Weighted Root Mean Square Residual (WRMR). Results More than one-third (38.4%) of the PLWH had depressive symptoms and 32.4% reported suicidal ideation and/or attempt since HIV diagnosis. The global model showed good model fit (Chi-square value = 34.42, CFI = 0.98, RMSEA = 0.03, WRMR = 0.73). Structural equation model revealed that direct pathway of PIS on suicidal status was significant (standardized pathway coefficient = 0.21), and indirect pathway of PIS on suicidal status via depression was also significant (standardized pathway coefficient = 0.24). There was a partial mediating effect of depression in the association between PIS and suicidal status. Conclusions Our findings suggest that PIS is associated with increased depression and the likelihood of suicidal status. Depression is in turn positively associated with suicidal status and plays a mediating role between PIS and suicidal status. Therefore, to reduce suicidal ideation and attempt in PLWH, targeted interventions to reduce PIS and improve mental health status of PLWH are warranted.
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Affiliation(s)
- Chengbo Zeng
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Linghua Li
- Department of Infectious Disease, Guangzhou Number Eight People's Hospital, #627 Dongfeng Road, Guangzhou, 510080, China
| | - Yan Alicia Hong
- Department of Health Promotion and Community Health Sciences, School of Public Health, Health Science Center, Texas A&M University, College Station, TX, 77843, USA
| | - Hanxi Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Andrew Walker Babbitt
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Cong Liu
- Department of Infectious Disease, Guangzhou Number Eight People's Hospital, #627 Dongfeng Road, Guangzhou, 510080, China
| | - Lixia Li
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, #283 Jianghai Street, Guangzhou, 510220, China
| | - Jiaying Qiao
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Yan Guo
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080, China. .,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China. .,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China.
| | - Weiping Cai
- Department of Infectious Disease, Guangzhou Number Eight People's Hospital, #627 Dongfeng Road, Guangzhou, 510080, China.
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Lau JTF, Gu J, Tsui HY, Chen H, Wang Z, Cao W. Anticipated suicidal ideation among female injecting drug users who are sex workers of negative or unknown HIV status in China. Women Health 2017; 58:774-789. [PMID: 29261438 DOI: 10.1080/03630242.2017.1353571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In China, female injection drug users who are also sex workers (IDUFSW) have a high prevalence of HIV and low prevalence of HIV testing. They are concerned about HIV infection and may be subjected to the risk of suicidal ideation if they become infected, due to stress and discrimination. During 2005-2006, we recruited 199 IDUFSW who self-reported negative/unknown HIV sero-status in Dazhou, Sichuan, China, to investigate the prevalence of and factors associated with suicidal ideation if they became HIV positive. Among the participants, 40.7% responded affirmatively to the question "Whether you would commit suicide if you were infected with HIV in the future?" In multivariate analyses, hatred toward oneself, perception of dying within 2-3 years, perceived nonavailability of HIV-related treatment, inability to cope with HIV-related trauma, and inclination to leave one's family if one contracted HIV were significant factors related to anticipated suicidal ideation under the hypothetical situation of HIV infection. The odds ratios (OR) ranged from 2.38 to 10.36 (p < .05). These findings can facilitate the planning of primary suicidal prevention services targeting high-risk, non-HIV-positive IDUFSW. Such programs may enhance psychosocial support, empowerment, cultivation of positive coping strategies, and perceived accessibility to treatment, and be integrated with HIV testing.
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Affiliation(s)
- Joseph T F Lau
- a Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China.,b Centre for Medical Anthropology and Behavioral Health , Sun Yat-sen University , Guangzhou, China
| | - Jing Gu
- c Department of Medical Statistics and Epidemiology, School of Public Health , Sun Yat-sen University , Guangzhou, China.,d Sun Yat-sen Global Health Institute , Sun Yat-sen University , Guangzhou, China
| | - Hi Yi Tsui
- a Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China
| | - Hongyao Chen
- e Department of HIV/AIDS Prevention , Dazhou Center for Disease Control and Prevention , Dazhou , China
| | - Zixin Wang
- a Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China
| | - Wangnan Cao
- a Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China
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The infection staging and profile of genotypic distribution and drug resistance mutation among the human immunodeficiency virus-1 infected blood donors from five Chinese blood centers, 2012-2014. PLoS One 2017. [PMID: 28622345 PMCID: PMC5473534 DOI: 10.1371/journal.pone.0179328] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The increasing complexity and diversity of the human immunodeficiency virus-1 (HIV-1) infections challenge the disease control and anti-retrovirus treatment in China. The infection stages and molecular characteristics of HIV-1 from infected Chinese blood donors were examined to shed light on the HIV genotype distribution and the status of drug resistance mutations (DRMs) in the changing HIV epidemic in China. Western blot (WB) confirmed HIV-1 positive plasma samples were collected from blood donors at five Chinese blood centers from April 16, 2012, through June 30, 2014. The HIV infection stages were determined using the Lag-avidity assay. HIV Pol regions including whole protease and partial reverse transcriptase (RT) were amplified and sequenced to establish the profile of genotype distribution and drug resistance mutations (DRMs). Viral loads were determined using the ROCHE COBAS system. Of the 259 HIV-1 positive samples tested by the Lag-avidity assay, 23.6% (61/259) were identified as recent infections. A total of 205 amplified sequences displayed the following genotype distributions: circulating recombinant form (CRF) 07_BC (61.5%), CRF08_BC (8.3%), CRF01_AE (20%), B (6.3%), and 01B (3.9%). There was no significant difference in genotype distribution between recent and long-term infections. 31 DRMs were identified from 27 samples including four protease inhibitors (PIs) accessory DRMs, two PIs major DRMs (M46I), two nucleoside RT inhibitors DRMs (K219R and K70Q), and 23 nonnucleoside RT inhibitors DRMs. 27 samples had DRMs, yielding a drug resistance prevalence of 13.2% (27/205). Our findings provide important information for developing strategies for comprehensive HIV control and improving anti-retroviral treatment in China.
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Lau JTF, Wang Z, Kim Y, Li J, Gu J, Mo PKH, Wang X. Low sustainability, poor governance, and other challenges encountered by grassroots non-governmental organizations targeting HIV prevention for men who have sex with men in China - a nation-wide study. AIDS Care 2017; 29:1480-1490. [PMID: 28271717 DOI: 10.1080/09540121.2017.1300630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Grassroots non-governmental organizations (NGOs) played pivotal roles in HIV prevention among men who have sex with men (MSM) in China. Their governance and sustainability issues were under-studied. This nation-wide study surveyed leaders of 202 of the HIV related NGOs in China.58.4% of the leaders believed that their NGO would last for ≤5 years; which was negatively associated with perceived good relationship with CDC. 65.3% mentioned ≥3 non-sustainability issues; associated factors included perceived inadequacies in prevention skills, management skills, policy support, technical support, operational support, and CDC's support; a reverse association was found for frequent collaboration with organizations in China. 30.6% of the leaders mentioned ≥7 governance issues; a stepwise model found a positive association with having no office and negative associations with number of full-time staff and core volunteers. These problems would severely limit the effectiveness of HIV prevention among MSM. Related improvements and support are warranted.
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Affiliation(s)
- Joseph T F Lau
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China.,b Shenzhen Research Institute, The Chinese University of Hong Kong , Shenzhen , China.,c Centre for Medical Anthropology and Behavioral Health , Sun Yat-sen University , Guangzhou , China
| | - Zixin Wang
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China.,b Shenzhen Research Institute, The Chinese University of Hong Kong , Shenzhen , China
| | - Yoona Kim
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China
| | - Jinghua Li
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China
| | - Jing Gu
- d School of Public Health , Sun Yat-sen University , Guangzhou , China
| | - Phoenix K H Mo
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China
| | - Xiaodong Wang
- e Chengdu Tongle Health Consulting Service Center , Chengdu , China
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Li J, Mo PKH, Wu AMS, Lau JTF. Roles of Self-Stigma, Social Support, and Positive and Negative Affects as Determinants of Depressive Symptoms Among HIV Infected Men who have Sex with Men in China. AIDS Behav 2017; 21:261-273. [PMID: 26896120 DOI: 10.1007/s10461-016-1321-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Poor mental health was prevalent among HIV positive men who have sex with men (HIVMSM), and a tremendous burden extents on their families and society. The present study investigated the prevalence of depression and its relationship with social support, HIV self-stigma, positive affect and negative affect among 321 HIVMSM in Chengdu, China. The study was conducted during July 2013 through October 2013. Findings showed that 55.8 % of the participants had mild to severe depression. The results of structural equation modeling showed that social support and positive affect were negatively associated with depression, while HIV self-stigma and negative affect were positively associated with depression. Social support, positive affect, and negative affect mediated the association between HIV self-stigma and depression. The hypothesized model had a satisfactory fit. Interventions improving mental health among this population are warranted.
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Affiliation(s)
- Jinghua Li
- Division of Behavioral Health and Health Promotion, The School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Phoenix K H Mo
- Division of Behavioral Health and Health Promotion, The School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Anise M S Wu
- Department of Psychology, University of Macau, Macau, China
| | - Joseph T F Lau
- Division of Behavioral Health and Health Promotion, The School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China.
- Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou, China.
- Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Carpiniello B, Pinna F. The Reciprocal Relationship between Suicidality and Stigma. Front Psychiatry 2017; 8:35. [PMID: 28337154 PMCID: PMC5340774 DOI: 10.3389/fpsyt.2017.00035] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/22/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Although suicidality is frequently the cause of stigma, it is conversely true that stigma may be the cause of suicidality. The present paper focuses on the complex relationships that exist between suicidal behavior and stigmatizing attitudes. METHODS A narrative review of the topic will be presented on the basis of the relevant literature collected from an electronic search of PubMed, ISI Web of Knowledge, and Scopus databases, using stigma, public stigma, structural stigma, perceived stigma, self-stigma, suicide, attempted suicide, and suicidality as key words. RESULTS A negative perception is frequently held of suicidal people, labeling them as weak and unable to cope with their problems, or selfish. Individuals who have attempted suicide are subject to similar processes of stigmatization and "social distancing"; insurance policies include an exclusion clause against death by suicide. Subjects with a direct personal experience of depression or suicide strongly endorse a feeling of self-stigma; those who have attempted suicide are often ashamed and embarrassed by their behavior and tend to hide the occurrence as much as possible. Similar processes are observed among family members of subjects who have committed suicide or made a suicide attempt, with a higher perceived stigma present in those bereaved by suicide. Perceived or internalized stigma produced by mental or physical disorders, or through belonging to a minority group, may represent a significant risk factor for suicide, being severely distressing, reducing self-esteem and acting as a barrier in help-seeking behaviors. CONCLUSION With the aim of preventing suicide, greater efforts should be made to combat the persisting stigmatizing attitudes displayed toward mental disorders and suicide itself. Indeed, the role of stigma as a risk factor for suicide should further motivate and spur more concerted efforts to combat public stigma and support those suffering from perceived or internalized stigma. Experts and scientific societies should form an alliance with the media in an effort to promote a marked change in the societal perception of mental health issues and suicide. As stigma may result in severe consequences, specialist care and psychological interventions should be provided to populations submitted to stigma.
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Affiliation(s)
- Bernardo Carpiniello
- Department of Medical Sciences and Public Health, University of Cagliari and Psychiatric Clinic, University Hospital , Cagliari , Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari and Psychiatric Clinic, University Hospital , Cagliari , Italy
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Stahlman S, Grosso A, Ketende S, Pitche V, Kouanda S, Ceesay N, Ouedraogo HG, Ky-Zerbo O, Lougue M, Diouf D, Anato S, Tchalla J, Baral S. Suicidal ideation among MSM in three West African countries: Associations with stigma and social capital. Int J Soc Psychiatry 2016; 62:522-31. [PMID: 27515832 DOI: 10.1177/0020764016663969] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Suicidal ideation is understudied among men who have sex with men (MSM) across Sub-Saharan Africa. AIMS This study aimed to explore social capital and sexual behavior stigma associated with suicidal ideation among MSM in the West African nations of The Gambia, Burkina Faso and Togo. METHODS Participants were recruited using respondent-driven sampling and snowball sampling across multiple cities (n = 1555) from July 2011 to August 2013. During a single study visit, participants completed a survey. Logistic regression models were used to assess bivariate and multivariable associations with suicidal ideation. RESULTS The prevalence of lifetime suicidal ideation was 13% overall and ranged 6%-17% across study sites. After adjusting for potential confounders, MSM who reported stigma as a result of having sex with men were more likely to report suicidal ideation. Physical and sexual violence was strongly associated with suicidal ideation, including being physically harmed (adjusted odds ratio (aOR) = 2.94, 95% confidence interval (CI) = 1.91, 4.52), tortured (aOR = 3.86, 95% CI = 2.17, 6.86) and raped (aOR = 3.07, 95% CI = 2.05, 4.60). In contrast, increasing social participation with the broader community was associated with decreased report of suicidal ideation (aOR = 0.91, 95% CI = 0.85, 0.99). CONCLUSION Sexual behavior stigma should be addressed to improve mental health among MSM in Western Sub-Saharan Africa.
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Affiliation(s)
- Shauna Stahlman
- Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ashley Grosso
- Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sosthenes Ketende
- Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vincent Pitche
- Conseil National de Lutte contre le SIDA-Togo (National AIDS Council), Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | | | - Henri G Ouedraogo
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Odette Ky-Zerbo
- Programme d'Appui au Monde Associatif et Communautaire (PAMAC), Ouagadougou, Burkina Faso
| | - Marcel Lougue
- Programme d'Appui au Monde Associatif et Communautaire (PAMAC), Ouagadougou, Burkina Faso
| | | | | | | | - Stefan Baral
- Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Mu H, Li Y, Liu L, Na J, Yu L, Bi X, An X, Gu Y, Zhou Y, Li S, Zhang R, Jiang C, Pan G. Prevalence and risk factors for lifetime suicide ideation, plan and attempt in Chinese men who have sex with men. BMC Psychiatry 2016; 16:117. [PMID: 27129468 PMCID: PMC4850688 DOI: 10.1186/s12888-016-0830-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/25/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To describe the level and risk factors for suicidal behaviors in Chinese men who have sex with men (MSM). METHODS A total of 807 MSM were recruited using a respondent-driven sampling method from Anshan, Benxi, Dandong, and Shenyang cities in northeastern China. RESULTS Chinese MSM had lifetime prevalences of suicide ideation (18.3%), plan (8.7%) and attempt (4.6%) that were about 2.8, 5.8 and 5.8 times greater than that of male adults in the general population of China. The MSM with any psychiatric disorders were 4-7 times more likely to think about, plan or attempt suicide than those MSM with no disorder, and there was a clear relationship between the number of comorbid disorders and suicidal behaviors. Multiple regression analysis showed that major depression, bipolar disorder, dysthymia and alcohol use disorder significantly increased the risk for suicide ideation, but not for suicide attempt. Drug dependence disorder, panic disorder and generalized anxiety disorder significantly increased the risk for suicide attempt, but not for suicide ideation. More advanced education reduced the risk of suicidal behaviors, sexual orientations revealed to or discovered by family members or friends significantly increased risk of these suicidal behaviors. CONCLUSIONS Chinese MSM have significantly increased risk for suicidal behaviors, mental disorders and their comorbidities could be the largest risk factors for the elevated suicidal behaviors in Chinese MSM. Reducing the family and social stigma and rejection of homosexual behavior and early detection and effective treatment of psychiatric disorders and their comorbidities in MSM may help to decrease suicidal behaviors of Chinese MSM.
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Affiliation(s)
- Huijuan Mu
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Yanxia Li
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Li Liu
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Jun Na
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Liya Yu
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Xuejuan Bi
- Anshan Municipal Center for Disease Control and Prevention, Anshan, P.R. China
| | - Xiaoxia An
- Benxi Municipal Center for Disease Control and Prevention, Benxi, P.R. China
| | - Yuan Gu
- Shenyang Municipal Center for Disease Control and Prevention, Shenyang, P.R. China
| | - Yan Zhou
- Dandong Municipal Center for Disease Control and Prevention, Dandong, P.R. China
| | - Shuang Li
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Rui Zhang
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005 P.R. China
| | - Chao Jiang
- Department of Psychiatry, Dalian Medical University, Dalian, P.R. China
| | - Guowei Pan
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Sayang Road 242, Heping District, Shenyang, 110005, P.R. China.
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Niu L, Qiu Y, Luo D, Chen X, Wang M, Pakenham KI, Zhang X, Huang Z, Xiao S. Cross-Culture Validation of the HIV/AIDS Stress Scale: The Development of a Revised Chinese Version. PLoS One 2016; 11:e0152990. [PMID: 27043134 PMCID: PMC4820124 DOI: 10.1371/journal.pone.0152990] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/22/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Being HIV-infected is a stressful experience for many individuals. To assess HIV-related stress in the Chinese context, a measure with satisfied psychometric properties is yet underdeveloped. This study aimed to examine the psychometric characteristics of a simplified Chinese version of the HIV/AIDS Stress Scale (SS-HIV) among people living with HIV/AIDS in central China. METHOD A total of 667 people living with HIV (92% were male) were recruited from March 1st 2014 to August 31th 2015 by consecutive sampling. A standard questionnaire package containing the Chinese HIV/AIDS Stress Scale (CSS-HIV), the Chinese Patient Health Questionnaire-9 (PHQ-9), and the Chinese Generalized Anxiety Disorder Scale (GAD-7) were administered to all participants, and 38 of the participants were selected randomly to be re-tested in four weeks after the initial testing. RESULTS Our data supported that a revised 17-item CSS-HIV had adequate psychometric properties. It consisted of 3 factors: emotional stress (6 items), social stress (6 items) and instrumental stress (5 items). The overall Cronbach's α was 0.906, and the test-retest reliability coefficient was 0.832. The revised CSS-HIV was significantly correlated with the number of HIV-related symptoms, as well as scores on the PHQ-9 and GAD-7, indicating acceptable concurrent validity. CONCLUSION The 17-item Chinese version of the SS-HIV has potential research and clinical utility in identifying important stressors among the Chinese HIV-infected population and in understanding the effects of stress on adjustment to HIV.
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Affiliation(s)
- Lu Niu
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan, China
| | - Yangyang Qiu
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan, China
| | - Dan Luo
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan, China
| | - Xi Chen
- Hunan provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Min Wang
- The First Hospital of Changsha, Changsha, Hunan, China
| | | | - Xixing Zhang
- Changsha Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Zhulin Huang
- Changsha Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan, China
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Li J, Mo PKH, Kahler CW, Lau JTF, Du M, Dai Y, Shen H. Prevalence and associated factors of depressive and anxiety symptoms among HIV-infected men who have sex with men in China. AIDS Care 2015; 28:465-70. [PMID: 26689341 DOI: 10.1080/09540121.2015.1118430] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
HIV-positive men who have sex with men (HIVMSM) face severe stigma and high levels of stressors, and have high prevalence of mental health problems (e.g., depression and anxiety). Very few studies explored the role of positive psychological factors on mental health problems among HIVMSM. The present study investigated the prevalence of two mental health problems (anxiety and depression), and their associated protective (gratitude) and risk (enacted HIV-related stigma, and perceived stress) factors among HIVMSM in China. A cross-sectional survey was conducted among 321 HIVMSM in Chengdu, China, by using a structured questionnaire. Over half (55.8%) of the participants showed probable mild to severe depression (as assessed by the Center of Epidemiologic Studies Depression scale); 53.3% showed probable anxiety (as assessed by the General Anxiety Disorder scale). Adjusted logistic regression models revealed that gratitude (adjusted odds ratio (ORa = 0.90, 95% confidence intervals (95% CI) = 0.86-0.94) was found to be protective, whilst perceived stress (ORa = 1.17, 95% CI = 1.12-1.22) and enacted stigma (ORa = 7.72, 95% CI = 2.27-26.25) were risk factors of depression. Gratitude (ORa = 0.95, 95% CI = 0.91-0.99) was also found to be protective whilst perceived stress (ORa = 1.19, 95% CI = 1.14-1.24) was a risk factor of anxiety. Gratitude did not moderate the associations found between related factors and poor mental health. It is warranted to promote mental health among HIVMSM, as depression/anxiety was highly prevalent. Such interventions should consider enhancement of gratitude, reduction of stress, and removal of enacted stigma as potential strategies, as such factors were significantly associated with depression/anxiety among HIVMSM.
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Affiliation(s)
- Jinghua Li
- a Division of Behavioral Health and Health Promotion, The School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Shatin , Hong Kong
| | - Phoenix K H Mo
- a Division of Behavioral Health and Health Promotion, The School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Shatin , Hong Kong.,b The Chinese University of Hong Kong Shenzhen Research Institute , Shenzhen , People's republic of China
| | - Christopher W Kahler
- c Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA
| | - Joseph T F Lau
- a Division of Behavioral Health and Health Promotion, The School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Shatin , Hong Kong.,b The Chinese University of Hong Kong Shenzhen Research Institute , Shenzhen , People's republic of China.,d Centre for Medical Anthropology and Behavioral Health , Sun Yat-sen University , Guangzhou , People's republic of China
| | - Mengran Du
- e West China School of Public Health, Sichuan University , People's republic of China
| | - Yingxue Dai
- f Chengdu Center for Disease Control and Prevention , Sichuan , People's republic of China
| | - Hanyang Shen
- g School of Public Health , Drexel University , Philadelphia , USA
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Liu Y, Ruan Y, Vermund SH, Osborn CY, Wu P, Jia Y, Shao Y, Qian HZ. Predictors of antiretroviral therapy initiation: a cross-sectional study among Chinese HIV-infected men who have sex with men. BMC Infect Dis 2015; 15:570. [PMID: 26714889 PMCID: PMC4696158 DOI: 10.1186/s12879-015-1309-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 12/03/2015] [Indexed: 11/16/2022] Open
Abstract
Background Early antiretroviral therapy (ART) initiation is crucial to achieve HIV viral suppression and reduce transmission. HIV-infected Chinese men who have sex with men (MSM) were less likely to initiate ART than other HIV-infected individuals. We assessed predictors of ART initiation among Chinese MSM. Methods In 2010–2011, a cross-sectional study was conducted among MSM in Beijing, China. We examined ART initiation within the subgroup who were diagnosed with HIV infection prior to participation in the survey. Logistic regression models were fitted to evaluate socio-demographic and behavioral factors associated with ART initiation. The eligibility criterion in the 2010/2011 national HIV treatment guidelines was CD4 cell count <350 cells/μL or World Health Organization (WHO) clinical stage III/IV. Results Of 238 eligible HIV-infected participants, the median duration of HIV infection was 15 months (range: 31 days-12 years); 62 (26.1 %) had initiated ART. Among 103 men with CD4 counts <350 cells/μL, 38 (36.9 %) initiated ART. Being married to a woman (adjusted odd ratios [aOR]: 2.50; 95 % confidence interval [CI]: 1.07-5.87), longer duration of HIV infection (aOR: 10.71; 95 % CI: 3.66-31.32), and syphilis co-infection (aOR: 2.58; 95 % CI: 1.04-6.37) were associated with a higher likelihood of ART initiation. Of 135 men with CD4 count ≥350 cells/μL, 24 (18 %) initiated ART. Being married to a woman (aOR: 4.21; 95 % CI: 1.60-11.06), longer duration of HIV infection (aOR: 22.4; 95 % CI: 2.79-180), older age (aOR: 1.26; 95 % CI: 1.1-1.44), Beijing Hukou (aOR: 4.93; 95 % CI: 1.25-19.33), presence of AIDS-like clinical symptoms (aOR: 3.97; 95 % CI: 1.32-14.0), and history of sexually transmitted infections (aOR: 4.93; 95 % CI: 1.25-19.43) were associated with ART initiation. Compared with men who did not initiated ART, those with ART were more likely to receive counseling on benefits of ART (96.8 % vs. 66.4 %, P = 0 < 0.01), HIV stigma coping strategy (75.8 % vs. 65.9 %, P = 0.04), mental health (66.1 % vs. 52.9 %, P = 0.02), and substance use (46.7 % vs. 36.6 %, P = 0.04). Conclusions We documented low rates of ART initiation among Chinese MSM. Policy changes for expanding ART eligibility and interventions to improve the continuum of HIV care are in progress in China. Impact evaluations can help assess continuing barriers to ART initiation among MSM.
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Affiliation(s)
- Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. .,Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Chandra Y Osborn
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. .,Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Pingsheng Wu
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. .,Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Yujiang Jia
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. .,Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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Lee HJ, Moneyham L, Kang HS, Kim KS. Peer supporter experiences of home visits for people with HIV infection. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2015; 7:233-9. [PMID: 26445560 PMCID: PMC4590551 DOI: 10.2147/hiv.s89436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose This study’s purpose was to explore the experiences of peer supporters regarding their work in a home visit program for people with HIV infection. Patients and methods A qualitative descriptive study was conducted using focus groups. Participants were 12 HIV-positive peer supporters conducting home visits with people living with HIV/AIDS in South Korea. Thematic analysis was used to analyze the data. Results Six major themes emerged: feeling a sense of belonging; concern about financial support; facing HIV-related stigma and fear of disclosure; reaching out and acting as a bridge of hope; feeling burnout; and need for quality education. The study findings indicate that although peer supporters experience several positive aspects in the role, such as feelings of belonging, they also experience issues that make it difficult to be successful in the role, including the position’s instability, work-related stress, and concerns about the quality of their continuing education. Conclusion The findings suggest that to maintain a stable and effective peer supporter program, such positions require financial support, training in how to prevent and manage stress associated with the role, and a well-developed program of education and training.
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Affiliation(s)
- Han Ju Lee
- Department of Nursing, Sangmyung University, Cheonan-si, Chungcheongnam-do, South Korea
| | - Linda Moneyham
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hee Sun Kang
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Kyung Sun Kim
- Gyeonggi Branch, Korean Alliance to Defeat AIDS, Anyang, Gyeonggi-do, South Korea
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