Post-traumatic Stress Disorder Symptoms Among People Living with HIV/AIDS in Rural China

The Relationship Between Forgiveness and Health Outcomes Among People Living with HIV: A Cross-Sectional Study in France

Research to date has shown that HIV infection is a highly stressful experience for individuals, and one of the key adaptive resources after such painful experiences may be forgiveness. The aim of the present study was to examine the associations between dispositional forgiveness (assessed using Mullet's Forgivingness Questionnaire and Toussaint's Forgiveness Scale), perceived stress (single-item measure of stress symptoms), health perception (EuroQol visual analogue version of the scale) and life satisfaction (Satisfaction With Life Scale) in people living with HIV (PLWH) in France. Paper surveys were completed by 222 PLWH aged 18-78 (57% male). Multiple regression analysis revealed that sensitivity to circumstances, unconditional forgiveness, self-forgiveness, and forgiveness of others were significant predictors of health and happiness. Mediation analysis showed that these relationships are completely mediated by perceived stress. The present findings suggest that forgiveness and perceived stress may be important variables for healing in PLWH. Interventions designed to improve forgiveness and self-forgiveness may result in improved health and life satisfaction in PLWH.

Psychological pathways to HIV-related posttraumatic stress disorder symptoms among people living with HIV in China: the mediating role of rumination

The occurrence of HIV-related posttraumatic stress disorder (PTSD) compromises the physical and mental health of people living with HIV (PLWH). This study examined the psychological pathways of HIV-related PTSD symptoms considering the influence of rumination in PLWH of China. A cross-sectional survey was conducted in Changsha, China. The data were collected using the PTSD Checklist-Civilian Version, the Ruminative Response Scale, the Multidimensional Scale of Perceived Social Support, and measures of sociodemographic and HIV-related clinic characteristics. A total of 602 PLWH were surveyed. The average score of HIV-related PTSD symptoms was (34.54 ± 13.58). The mediation model showed that perceived social stigma and physical health exhibited direct associations with PTSD symptoms (β = 0.093, -0.145, respectively), while the direct relations of family support, friend support and significant others support to PTSD symptoms were not significant. Rumination mediated the effect of perceived social stigma (β = 0.077), physical health (β = -0.150), family support (β = -0.144) and friend support (β = -0.105) on PTSD symptoms. The study findings underscore the importance of routinely assessing PTSD for PLWH, and developing trauma-focused interventions that alleviate HIV-related PTSD symptoms and reduce rumination while improving social support and physical health and reducing social stigma.

Health related quality of life of HIV-positive women on ART follow-up in north Shewa zone public hospitals, central Ethiopia: Evidence from a cross-sectional study

Background

Evidence revealed that there is a statistically significant gender difference in Health-related quality of life (HRQoL) among HIV-positive people on Antiretroviral therapy (ART). Consequently, HIV-positive women have low scores in all HRQoL domains than men. Despite this fact, previous studies in Ethiopia focused on general HIV-positive people and paid less attention to HIV-positive women. Therefore, this study was intended to measure HRQoL and associated factors among HIV-positive women on ART follow-up in north Shewa zone public hospitals, central Ethiopia.

Methods

An institution-based cross-sectional study was conducted from February 01-April 30, 2022. Four hundred twenty-six women on ART were included using a systematic random sampling technique. Face-to-face interviews and medical record reviews were used to collect data. Both bivariable and multiple linear regressions were computed to identify the factors associated with HRQoL. A p-value <0.05 was used to assert statistically significant variables in multiple linear regression analysis.

Results

The overall mean (SD) score of the HRQoL was 11.84 (2.44). And, 44.7% [95% CI: 40.3, 49.5] of the women have poor HRQoL. In multiple linear regression analysis, factors like depression (β = -0.35), Post-Traumatic Stress Disorder (PTSD) (β = -0.16), age (β = -0.07), rural residence (β = -0.52), and bedridden functional status (β = -1.02) were inversely associated with HRQoL. Oppositely, good treatment adherence (β = 0.46) was positively associated with overall HRQoL, keeping other factors constant.

Conclusion

This study reveals a high magnitude of poor HRQoL among HIV-positive women. Therefore, as HRQoL domains are comprehensive indicators of living status, healthcare service providers should be dedicated to screening and supporting HIV-positive women with poor HRQoL. Additionally, healthcare providers should also pay special attention to routine PTSD screening and management for HIV-positive women due to its detrimental effect on HRQoL.

Stigma Affects the Health-Related Quality of Life of People Living with HIV by Activating Posttraumatic Stress Symptoms

Stigma is a strong concern in the effort to manage the impact of many chronic diseases on patients and affects the quality of life (QoL) of patients, but little is understood regarding how this happens. We explored the perspective that stigma reduces health-related QoL (HRQoL) by evoking the traumatic experiences associated with HIV diagnosis. Outpatients (n = 250) receiving HIV-related care were recruited from 2 hospitals in the southeastern region of Nigeria. Participants completed measures of stigma, posttraumatic stress symptoms, and HRQoL. Mediation analyses were conducted using Hayes PROCESS Macro for SPSS. Result showed that stigma was negatively associated with HRQoL; patients who reported more traumatic symptoms also reported poorer HRQoL. Traumatic stress symptoms mediated the path between stigma and all the dimensions of HRQoL. Findings suggest that recognizing and addressing trauma symptoms are important in the management of PLWH. Perhaps addressing trauma would reduce the impact of stigma on HRQoL.

Factors associated with COVID-19 pandemic induced post-traumatic stress symptoms among adults living with and without HIV in Nigeria: a cross-sectional study

BACKGROUND

Nigeria is a country with high risk for traumatic incidences, now aggravated by the COVID-19 pandemic. This study aimed to identify differences in COVID-19 related post-traumatic stress symptoms (PTSS) among people living and not living with HIV; to assess whether PTSS were associated with COVID-19 pandemic-related anger, loneliness, social isolation, and social support; and to determine the association between PTSS and use of COVID-19 prevention strategies.

METHODS

The data of the 3761 respondents for this analysis was extracted from a cross-sectional online survey that collected information about mental health and wellness from a convenience sample of adults, 18 years and above, in Nigeria from July to December 2020. Information was collected on the study's dependent variable (PTSS), independent variables (self-reported COVID-19, HIV status, use of COVID-19 prevention strategies, perception of social isolation, access to emotional support, feelings of anger and loneliness), and potential confounder (age, sex at birth, employment status). A binary logistic regression model tested the associations between independent and dependent variables.

RESULTS

Nearly half (47.5%) of the respondents had PTSS. People who had symptoms but were not tested (AOR = 2.20), felt socially isolated (AOR = 1.16), angry (AOR = 2.64), or lonely (AOR = 2.19) had significantly greater odds of reporting PTSS (p < 0.001). People living with HIV (AOR = 0.39), those who wore masks (AOR = 0.62) and those who had emotional support (AOR = 0.63), had lower odds of reporting PTSS (p < .05).

CONCLUSION

The present study identified some multifaceted relationships between post-traumatic stress, HIV status, facemask use, anger, loneliness, social isolation, and access to emotional support during this protracted COVID-19 pandemic. These findings have implications for the future health of those affected, particularly for individuals living in Nigeria. Public health education should be incorporated in programs targeting prevention and prompt diagnosis and treatment for post-traumatic stress disorder at the community level.

Adherence to antiretroviral therapy mediates the link between posttraumatic stress disorder symptoms and health-related quality of life

Human immunodeficiency virus is one of the trauma-inducing chronic illnesses with attendant-negative impact on health-related quality of life. Substantial literature exists on the association of posttraumatic stress disorder symptoms and health-related quality of life among people living with human immunodeficiency virus, but little is known about the pathways explaining this link. This study therefore examined the mediating role of adherence to antiretroviral therapy in the association between posttraumatic stress disorder symptoms and health-related quality of life among people living with human immunodeficiency virus. Nine hundred and sixty-nine people living with human immunodeficiency virus in Nigeria who were on antiretroviral therapy completed measures of posttraumatic stress disorder symptoms, adherence to antiretroviral therapy, and health-related quality of life. Hayes PROCESS macro for SPSS was used to analyse the data. Adherence to antiretroviral therapy mediated the association between posttraumatic stress disorder symptoms and health-related quality of life in the relationship and treatment impact domains, implying that poor adherence to antiretroviral therapy is a pathway through which posttraumatic stress disorder symptoms exert negative influence on health-related quality of life of people living with human immunodeficiency virus. Interventions aimed at reducing the impact of posttraumatic stress disorder symptoms on quality of life of people living with human immunodeficiency virus should focus on improving clients’ level of adherence to antiretroviral therapy treatment.

The Prevalence of Post-Traumatic Stress Disorder among People Living with HIV/AIDS: a Systematic Review and Meta-Analysis

Numerous studies have reported that the prevalence estimates of post-traumatic stress disorder (PTSD) might be substantially high among people with HIV/AIDS (PLWHA) when compared to the general population. However, there are no previous systematic reviews and meta-analysis studies that reported the pooled prevalence of PTSD among PLWHA. To fill this gap in research, this study aims to analyze data from observational studies concerning the prevalence of PTSD among PLWHA and formulate a recommendation for future research and clinical practice. Three electronic databases (PubMed, EMBASE, and SCOPUS) were searched to identify relevant studies that reported the prevalence of PTSD among PLWHA. A comprehensive meta-analysis software was used to conduct the meta-analysis. Subgroup and sensitivity analysis was conducted the I² test was utilized to evaluate heterogeneity. Publication bias was assessed by using Egger's test and visual inspection of the symmetry in funnel plots. Nineteen-studies with 9094 participants were included in this systematic review and meta-analysis. The pooled prevalence estimate of PTSD among PLWHA was found to be 32.67% (95% CI; 25.29-41.01). The prevalence of PTSD was 25.17% (95% CI; 19.72-31.55) for studies that used diagnostic instrument to assess PTSD and it was 34.68% (95% CI; 25.42-45.26) for studies that used screening instruments. Furthermore, the prevalence of PTSD among PLWHA was comparable between high-income (31.19%) and low, and middle-income countries (34.87%). We also found that the pooled prevalence of PTSD was remarkably higher for moderate and low-quality studies (42.64%) than for high-quality studies (24.84%). The prevalence of PTSD among PLWHA in the current study showed a significant variation by the location of the studies, the instruments used to measure PTSD as well as the quality of the included studies. The present review demonstrated that the prevalence estimates of PTSD among PLWHA (32.67%) was notably high and requires clinical attention. The estimated prevalence of PTSD was found to be comparable between high income and low, and middle-income countries. In addition, we found that the prevalence of PTSD was notably lower when measured by the diagnostic instrument than the screening instrument, although the variation was not statistically significant. Early screening and treatment of PTSD among PLWHA is needed to alleviate suffering.

Negative attitudes toward aging mediated the association between HIV status and depression among older people in mainland china

BACKGROUND

In China, people living with HIV (PLWH) are aging. The study compared prevalence of probable depression between older PLWH and their HIV-negative counterparts, and tested the hypothesis that the between-group difference in depressive symptoms would be mediated by attitudes toward aging.

METHODS

With informed consent, a cross-sectional survey was conducted via anonymous face-to-face interviews to 337 and 363 HIV-positive and HIV-negative people aged ≥50, respectively, in Yongzhou City, Hunan, China from December 2017 to August 2018. Depression was measured by the Center for Epidemiologic Studies Depression (CES-D) scale. Attitudes toward aging were measured by the Attitudes to Aging Questionnaire (subdomains: psychosocial loss, physical change, psychological growth). Bootstrapping analyses were performed to test the mediation hypothesis.

RESULTS

The prevalence of probable depression (CES-D ≥ 16) was significantly higher in the HIV-positive group than the HIV-negative group (44.8% versus 20.4%). The HIV-positive participants presented more negative attitudes toward aging (in psychosocial loss and physical change) than their HIV-negative counterparts. Negative attitudes toward aging were associated with more depressive symptoms. Overall attitudes toward aging (effect size=41.3%) and the subdomains of psychosocial loss (effect size=38.5%) and physical change (effect size=16.3%) partially mediated the association between HIV status and depressive symptoms, respectively.

LIMITATIONS

The cross-sectional design limited the ability of causal inference. Selection bias, information bias, and confounding bias might exist.

CONCLUSIONS

Older PLWH might be more depressed than their HIV-negative counterparts in mainland China, partially because they possessed more negative attitudes toward aging. Interventions for depression may include components of improving attitudes toward aging.

Post-Traumatic Stress Disorder and its Correlates Among People Living with HIV in Southern Ethiopia, an Institutionally Based Cross-Sectional Study

Post-traumatic stress disorder is a common psychiatric problem more highly prevalent among HIV infected individuals than the general population. This study aims to assess the probable prevalence of post-traumatic stress disorder and associated factors among individuals living with HIV in Hawassa, Ethiopia, 2018. An institution based cross-sectional study was employed. A total of 205 HIV positive individuals who attend follow-up sessions at HIV clinics were recruited for the study through systematic sampling techniques. The presence of probable post-traumatic stress disorder was assessed by using the post-traumatic stress disorder checklist -5. The potential traumatic life events and any stressful events that occurred in participants' lives were assessed by the life event checklist for DSM-5 (LEC-5). The mean age of the respondents was 32.33 years (SD ±8.67). Prevalence of post-traumatic stress disorder (PTSD) was 46.3%. Being female [AOR = 1.27, (95% CI: 1.01, 3.98)], poor social support [AOR = 1.71, (95% CI: 1.08, 4.45)], poor medication adherence [AOR = 3.87, (95% CI: 1.75, 6.79)], current alcohol use [AOR = 2.34, (95% CI: 1.32, 5.16)], HIV/TB coinfection [AOR = 1.23, (95% CI: 1.09, 6.84)] and having negative life events [AOR = 1.76, (95% CI: 1.41, 6.98)] had statistically significant association with probable post-traumatic stress disorder. The prevalence of post-traumatic stress disorder among HIV positive individuals was high. The researchers highly recommend the integration of psychiatric services to HIV clinics and develop guidelines to screen and treat PTSD among HIV patients. Further research on risk factors of PTSD and longitudinal studies should be conducted to strengthen and broaden the current findings.

Global estimate of the prevalence of post-traumatic stress disorder among adults living with HIV: a systematic review and meta-analysis

OBJECTIVES

Although people living with HIV (PLWH) have been disproportionately affected by post-traumatic stress disorder (PTSD), the global prevalence of PTSD among PLWH is unknown. This study aimed to systematically review the prevalence of PTSD among PLWH worldwide and explore variation in prevalence across sociodemographic and methodological factors.

DESIGN

A meta-analysis using a random-effects model was conducted to pool the prevalence estimated from individual studies, and subgroup analyses were used to analyse heterogeneities.

SETTING, PARTICIPANTS AND MEASURES

Observational studies providing PTSD prevalence data in an adult HIV population were searched from January 2000 to November 2019. Measurements were not restricted, although the definition of PTSD had to align with the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases diagnostic criteria.

RESULTS

A total of 38 articles were included among 2406 records identified initially. The estimated global prevalence of PTSD in PLWH was 28% (95% CI 24% to 33%). Significant heterogeneity was detected in the proportion of PLWH who reported PTSD across studies, which was partially explained by geographic area, population group, measurement and sampling method (p<0.05).

CONCLUSION

PTSD among PLWH is common worldwide. This review highlights that PTSD should be routinely screened for and that more effective prevention strategies and treatment packages targeting PTSD are needed in PLWH.

Genome Sequence of a Novel HIV-1 Circulating Recombinant Form (CRF103_01B) Identified from Hebei Province, China

We reported a novel HIV-1 circulating recombinant form (CRF) among three epidemiologically unlinked patients through men having sex with men in Hebei Province, China. It was named CRF103_01B (this is temporary as we have not received the CRF number from HIV databases). A near full-length genome phylogenetic tree showed that CRF103_01B was generated by three B (Western origin) segments and CRF01_AE that was described as cluster 5 lineage of CRF01_AE (CRF01-5). The emergence of CRF103_01B increased the complexity of the HIV-1 epidemic in China.

Posttraumatic Stress Disorder and Nonadherence to Treatment in People Living With HIV: A Systematic Review and Meta-analysis

BACKGROUND

Posttraumatic stress disorder (PTSD) is a commonly reported and serious complication among people living with HIV (PLWH). PTSD may significantly increase unintentional non-adherence to antiretroviral therapy. In this systematic review and meta-analysis, we aimed to pool the observational studies exploring the association between PTSD and medication adherence among PLWH.

METHODS

Comprehensive searches were conducted in PubMed/Medline, Web of Science, PsycINFO, Google Scholar, and ProQuest to identify relevant articles and dissertations. A random effects meta-analysis with inverse variance weighting was used to summarize the odds ratio (OR) across studies. Meta-regression and subgroup analyses were also carried out to assess the moderation effects for potential factors.

RESULTS

By synthesizing 12 studies comprising 2489 participants, the pooled odd ratio of non-adherence to antiretroviral therapy was 1.19 (95% confidential interval (CI), 1.03-1.37, p = 0.02). No significant publication bias was detected by Egger's test (Intercept = 0.842, p = 0.284). Factors moderating the association were mean age of participants, depression adjustment, and depression (all p < 0.05).

CONCLUSIONS

This meta-analysis supports that PTSD is related to adherence in PLWH. The hypothesized mechanisms (avoidant behavior and cognitive impairment) underlying this association need further investigation. Overall, this study highlights that clinicians should thoughtfully integrate timely mental health intervention into routine care.