Getting to Zero: Targeting Psychiatric Comorbidities as Drivers of the HIV/AIDS Epidemic

Provider perspectives on screening and treatment for opioid use disorder and mental health in HIV care: A qualitative study

BACKGROUND

HIV, opioid use disorder (OUD), and mental health challenges share multiple syndemic risk factors. Each can be effectively treated with routine outpatient appointments, medication management, and psychosocial support, leading implementers to consider integrated screening and treatment for OUD and mental health in HIV care. Provider perspectives are crucial to understanding barriers and strategies for treatment integration.

METHODS

We conducted in-depth qualitative interviews with 21 HIV treatment providers and social services providers (12 individual interviews and 1 group interview with 9 participants) to understand the current landscape, goals, and priorities for integrated OUD, mental health, and HIV care. Providers were purposively recruited from known clinics in Mecklenburg County, North Carolina, U.S.A. Data were analyzed using applied thematic analysis in the NVivo 12 software program and evaluated for inter-coder agreement.

RESULTS

Participants viewed substance use and mental health challenges as prominent barriers to engagement in HIV care. However, few organizations have integrated structured screening for substance use and mental health into their standard of care. Even fewer screen for opioid use. Although medication assisted treatment (MAT) is effective for mitigating OUD, providers struggle to connect patients with MAT due to limited referral options, social barriers such as housing and food insecurity, overburdened staff, stigma, and lack of provider training. Providers believed there would be clear benefit to integrating OUD and mental health treatment in HIV care but lacked resources for implementation.

CONCLUSIONS

Integration of screening and treatment for substance use and mental health in HIV care could mitigate many current barriers to treatment for all three conditions. Efforts are needed to train HIV providers to provide MAT, expand resources, and implement best practices.

The Association Between Social and Spatial Closeness With PrEP Conversations Among Latino Men Who Have Sex With Men

BACKGROUND

US Latino men who have sex with men (LMSM) are a group at highest risk for HIV. One driver of HIV among LMSM is inadequate access to pre-exposure prophylaxis (PrEP) information. The social network theory of homophily suggests that sharing similar sociodemographic factors could influence PrEP conversations within networks. This study aimed to determine how the effects of homophily across sociodemographic, immigration, cultural, and PrEP-related factors are associated with PrEP-related communication.

SETTING

This study was conducted in Miami-Dade County, FL.

METHODS

Data collected between August 2018 and October 2019 included 10 sociocentric friendship groups of 13 LMSM (N = 130). Participants were recruited using respondent-driven sampling by a community-based organization in Miami. We used the multiple regression quadratic assignment procedure to identify the effects of homophily and relationship characteristics on PrEP-related conversations using R software.

RESULTS

More frequent PrEP-related conversations were associated with dyadic friendships characterized by homophily on knowledge of PrEP effectiveness, heterophily on depressive symptom severity, home addresses proximity, friend closeness, and interaction frequency. Past PrEP-related conversation frequency also increased based on heterophily on the Latino cultural value of familism (ie, emotional support to family). Racial homophily, heterophily on severity of depressive symptoms, home addresses proximity, friendship closeness, and frequency of interactions increased likelihood to encourage a friend to use PrEP.

DISCUSSION

Social and spatial closeness and homophily play a role in PrEP-related conversations. Information from social networks contextualized in geographic settings can be elucidated to contribute toward the design of novel opportunities to end HIV.

HIV/AIDS stigma and psychological well-being after 40 years of HIV/AIDS: a systematic review and meta-analysis

Background

In June 2021, 40 years have passed since the first cases of HIV infection were detected. Nonetheless, people living with HIV (PLWH) still suffer from intense HIV-related distress and trauma, which is nowadays mostly linked to the still-existing stigmatization of PLWH.

Objectives

The aim of this systematic review and meta-analysis was to examine the association between HIV/AIDS stigma and psychological well-being among PLWH. We also explored whether this association varies as a function of sociodemographic and clinical characteristics as well as study publication year and stigma measurement.

Method

A structured literature search was performed on Web of Science, Scopus, PsyARTICLES, MedLine, ProQuest, and Google Scholar databases. The inclusion criteria were quantitative, peer-reviewed articles published in English between 1996 and 2020.

Results

After selection, 64 articles were accepted for further analysis (N = 25,294 participants). The random-effects pooled estimate revealed an overall negative and medium-strength association between stigma and well-being (r = -.31, 95% CI [-.35; -.26]). The participants' age modified this effect with a stronger association for older PLWH. Other sociodemographic and clinical variables as well as publication year and stigma measurement did not explain the variation in association between stigma and well-being across studies.

Conclusions

The present meta-analysis and systematic review not only showed an expected negative relationship between stigma and well-being but also revealed a substantial heterogeneity between studies that suggests a strong role of context of a given study. This finding calls for more advanced theoretical and analytical models to identify protective and vulnerability factors to effectively address them in clinical practice and interventions.

Daily emotional inertia and long-term subjective well-being among people living with HIV

OBJECTIVE

The aim of this study was to verify if subjective well-being (SWB) modifies the autoregressive effect of daily emotions and if this emotional inertia predicts long-term changes in SWB among people living with HIV (PLWH).

METHODS

The 131 participants had medically confirmed diagnoses of HIV and were undergoing antiretroviral therapy. They assessed their SWB (satisfaction with life, negative affect, positive affect) twice with an interval of one year. They also took part in a five-day online diary study six months from their baseline SWB assessment and reported their daily negative and positive emotions.

RESULTS

Results showed that baseline SWB did not modify the emotional carryover effect from one to another. Additionally, after control for baseline SWB, emotional inertia did not predict SWB one year later. However, such an effect was noted for the mean values of daily reported emotions, indicating their unique predictive power over SWB itself.

CONCLUSIONS

This may suggest that emotional inertia does not necessarily provide better information than more straightforward measures of affective functioning.

Inertia, innovation, and cross-lagged effects in negative affect and rumination: daily diary study among people living with HIV

OBJECTIVE

The aim of this study was to examine individual differences in the day-by-day relationship between negative affect (NA) and rumination in terms of their inertia, innovation, and cross-lagged effects among people living with HIV (PLWH).

METHODS

The participants were 217 PLWH with confirmed diagnoses of HIV and undergoing antiretroviral treatment. They assessed their NA and rumination for five consecutive days each evening via an online survey.

RESULTS

Results showed that inertia in NA is negatively related to inertia in rumination. Both innovations were unrelated. However, the individuals with relatively higher overall NA were also more reactive to external factors and/or had more variability in their daily lives, to which they respond with NA. Finally, the autoregressive effects were revealed to be important for spillover effects in a direction that is coherent with a given inertia. Thus, the direction of the cascade between daily NA and rumination depends on the area of major regulatory weakness.

CONCLUSION

The results support the view that intensity, inertia, and innovation are distinct dimensions in spite of the common assumption that higher overall intensity of emotions and coping should be strongly related or even synonymous to their perseveration.

Affective Well-Being, Rumination, and Positive Reappraisal among People Living with HIV: A Measurement-Burst Diary Study

Background

Changes of affective well‐being are usually analysed either as longitudinal processes or as daily fluctuations. We used a three‐burst diary study to combine these perspectives.

Method

The participants were 211 patients with a diagnosis of HIV infection. In three bursts with 6‐month intervals, they completed an online diary for five consecutive days, which gives 15 days of measurements. They evaluate affective well‐being (positive and negative affect), stress associated with a central hassle, and coping (rumination and positive reappraisal).

Results

Higher daily stress coupled with higher rumination was related to lower well‐being. For positive reappraisal, the picture was more complex. First, its interaction with daily stress had an effect on negative, but not on positive, affect. Second, this effect was significant only at the first burst.

Conclusions

These results suggest a stable debilitating effect of daily rumination, but a limited and diminishing beneficial effect of daily positive reappraisal among people living with HIV. As such, they do not confirm the view that positive reappraisal sustains affective well‐being during chronic health conditions. This may inform stress management interventions for PLWH, which are now increasingly taking the form of mobile applications, adapted to the daily lives of patients in their natural environment.

Medical comorbid diagnoses among adult psychiatric inpatients

OBJECTIVE

Shortened life expectancy of people with mental disorders has been attributed to medical comorbidities, yet these conditions remain under-recognized and under-treated. This study characterizes the medical demands placed on inpatient psychiatric units to help guide medical assessment and management practices in these settings.

METHODS

Medicaid claims records and clinician data were linked with hospital and regional data for individuals with a principal diagnosis of any mental disorder admitted to psychiatric inpatient units in New York State from 2012 to 2013. A modified Elixhauser Comorbidity Index (ECI) score was calculated for each unique individual (n = 14,458). Adjusted odds ratios (AORs) of having a medical comorbidity were calculated using logistic regression analyses.

RESULTS

74.9% of psychiatric inpatients had at least one medical comorbidity, including 57.5% of people ages 18-24. Higher rates of medical comorbidity were associated with older age, female gender, non-schizophrenia diagnoses, and engagement in care prior to hospitalization. Patients with medical comorbidities had lower odds (AOR 0.54; 99% CI 0.35-0.83) of being treated in hospitals with 100 or more total beds compared to smaller hospitals.

CONCLUSIONS

A high prevalence of common medical diagnoses among psychiatric inpatients underscores the importance of adequate detection and medical treatment of medical comorbidities in psychiatric inpatient settings.

Trajectories of Health-Related Quality of Life and Perceived Social Support Among People Living With HIV Undergoing Antiretroviral Treatment: Does Gender Matter?

The study examined the trajectories of health-related quality of life (HRQoL) and perceived social support (PSS) among people living with HIV (PLWH), with a special focus on gender differences. The participants included 252 PLWH (18% female) undergoing antiretroviral therapy. HRQoL (WHO Quality of Life-BREF; WHOQOL Group, 1998) and PSS (Berlin Social Support Scales; Schulz and Schwarzer, 2003) were measured three times at six-month intervals. Using a univariate approach, three trajectories of HRQoL and four trajectories of PSS were identified. Gender and relationship status were significant covariates for PSS only, with overrepresentation of single women in the increasing trajectory. The dual trajectory approach revealed a match in the decrease of HRQoL and PSS, but only for 31% of the sample. In fact, decreasing PSS co-occurred with increasing as well as stable HRQoL. There was no significant gender effect in this regard. Although a clear correspondence for decreasing trajectories exists, the findings also highlight a discrepancy between HRQoL and PSS changes that are unrelated to gender.