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

Empowering Women Living with HIV/AIDS in Vietnam: A Hybrid Online-Offline Intervention to Combat Stigma

Women living with HIV/AIDS (WLHA) encounter numerous challenges, such as stigma and gender disparities, that hinder their access to care, especially in patriarchal societies like Vietnam. We developed a hybrid intervention with online and offline (in-person) components to empower WLHA in Vietnam. The intervention was pilot tested with 91 WLHA in Hanoi. During baseline and 4-month, study investigators delivered two in-person sessions, one Zoom session, and 15 weeks of Zalo (social media platform) discussions to enhance positive coping strategies, treatment utilization and adherence, and engagement of support from family and peers. The participants continued their Zalo discussions from 4-month to 6-month without investigators' involvement. Intervention outcomes, including active coping and perceived barriers to care, were evaluated at baseline, 4-, and 6-month surveys. Mixed-effects regression models showed that the participants' active coping significantly increased from baseline (50.5 ± 9.4) to 4-month (53.8 ± 6.2; p = 0.0001), although there was a slight decrease at 6-month (52.8 ± 7.2), the change from 4-month to 6-month was not significantly significant (p = 0.3256). There was a significant reduction in participants' perceived barriers to care, from 19.8 ± 5.2 at baseline to 17.4 ± 5.2 at 4-month (p < 0.0001), which remained stable at 17.8 ± 4.3 at 6-month (p < 0.0001 compared to baseline). This intervention presents a promising model to empower WLHA in Vietnam and potentially in similar global contexts. Future interventions could benefit from leveraging natural peer leaders and adopting a more person-centered approach to meet WLHA's varying needs.

Intersectionality of HIV Stigma with Female Identity: An Investigation among Women Living with HIV/AIDS in Vietnam

Women living with HIV/AIDS (WLHA) in Vietnam encounter challenges stemming from HIV-related stigma and gender disparities. This study delves into the intersectionality of HIV-related stigma and gender disparities as perceived by WLHA. A cross-sectional survey was conducted among 91 WLHA in Hanoi, Vietnam. Two sets of identically worded scales were used to measure awareness, agreement, and application of stigma towards people living with HIV/AIDS (PLHA) and WLHA. A larger difference between stigma scores towards WLHA and that of PLHA represents a higher level of female-specific stigma. Univariate analyses and multiple regressions were conducted to identify demographic and psycho-social factors associated with the gendered differences in stigma measures. Multiple linear regression showed that WLHA who were currently married were more likely to apply stigma concepts to themselves due to gender identity (adjusted beta coefficient (aBeta Coef) = 0.223). Psychological capital was negatively associated with awareness of stigma towards female identity (aBeta Coef = -0.261). A higher perceived norm in women's equity and power was associated with less self-application of female-specific stigma (aBeta Coef = -0.294). Our findings underscore the importance of addressing psychological well-being and promoting gender equity norms as essential components in the efforts to reduce female-specific HIV-related stigma in WLHA.

A qualitative exploration of the impact of the COVID-19 pandemic on gender-based violence against women living with HIV or tuberculosis in Timor Leste

Violence against women or gender-based violence (GBV) is a significant public health issue facing women and girls in different settings. It is reported to have worsened globally during the COVID-19 pandemic. Despite the impact of the COVID-19 pandemic on increased violence against women in general, which has been reported in many settings globally, there is a paucity of evidence of its impact on violence against highly vulnerable women living with HIV or tuberculosis (TB). Using a qualitative design, this study aimed to explore the views and experiences of women living with HIV (n = 19) or TB (n = 23) in Timor Leste regarding the GBV they faced during the COVID-19 pandemic. They were recruited using the snowballing sampling technique. Data were collected using one-on-one, in-depth interviews and focus group discussions. The five steps of qualitative data analysis suggested in Ritchie and Spencer's analysis framework were employed to guide the analysis of the findings. Findings indicated that women in this study experienced intensified physical, verbal, sexual and psychological violence by their partners, spouses, in-laws, and parents or other family members during the COVID-19 pandemic. Several prominent risk factors that worsened violence against women during the pandemic were (i) HIV or TB-positive status, (ii) traditional gender roles or responsibilities and expectations, (iii) economic and financial difficulties reflected in the loss of jobs and incomes due to the pandemic, and (iv) individual factors such as jealousy and increased alcohol drinking developed during the lockdowns. The women's experience of GBV during the pandemic also led to various negative psychological impacts. The findings underscore the urgent need for multifaceted interventions to address GBV, which should encompass challenging traditional gender norms, addressing economic inequalities, and targeting individual-level risk factors. The findings also indicate the need for the development of robust monitoring and evaluation systems to assess the effectiveness of policies and interventions addressing GBV where the results can inform future improvement. The findings also indicate the need to include GBV in the protocol or guidelines for HIV and TB management. Future large-scale quantitative studies to capture the magnitude and specific drivers of GBV against women living with HIV and TB during the pandemic are recommended.

HIV self-management perceptions and experiences of students at one university in South Africa

BACKGROUND

 The public health concern posed by HIV in South Africa is significant, particularly among young adults aged 15-34 years. Within this age range, university students present a unique demographic, concurrently managing their HIV condition and academic pursuits, thus raising concerns about HIV management within university environments. Research into the experiences of South African university students living with HIV is relatively sparse.

OBJECTIVES

 The study aimed to explore the HIV self-management perceptions and experiences of South African university students.

METHOD

 The study employed a qualitative research approach grounded in the constructivist paradigm. Data were collected through semi-structured interviews with eight (8) students living with HIV at a university in the Western Cape area in 2021. Data were analysed through thematic analysis. All ethical principles were adhered to, and trustworthiness was ensured.

RESULTS

 Findings revealed that students utilised various strategies to manage their HIV condition, inclusive of maintaining a positive mindset, and adopting a healthy diet. They encountered obstacles such as experiencing HIV-related stigma, which frequently resulted in elevated stress levels. The potential role of peer support groups was also underscored, with students expressing a desire to participate in such groups to maintain their mental health.

CONCLUSION

 Living with HIV is a challenging experience for university students, but self-management of the condition makes life easier for them.Contribution: These findings contribute to the understanding of HIV self-management perceptions and experiences of university students, and can inform the development of a comprehensive supportive structure that addresses their needs.

Empowering people living with HIV (PLHIV): unveiling care gaps and identifying opportunities for improving care for PLHIV in Singapore and Hong Kong

INTRODUCTION

This study explored the behaviours of people living with HIV in Singapore and Hong Kong in terms of achieving and maintaining their physical and psychological wellbeing in relation to HIV, to identify the challenges and support needed in HIV care.

METHODS

This qualitative study involved 90-minute interviews among Singapore and Hong Kong people living with HIV aged ≥18 years to explore health-related quality of life perceptions and gaps in patient empowerment in HIV care during February-May 2022. The COM-B (C: Capability; O: Opportunity; M: Motivation; B: Behaviour) framework was used during data analysis to identify behaviour facilitators and barriers for people living with HIV to achieve and maintain their wellbeing. Detailed accounts of respondents' experience of living with and managing HIV, that is what worked well, unmet needs and perceived significance of wellbeing indicators, were analysed qualitatively via a combination of inductive content and deductive frameworks.

RESULTS

A total of 30 and 28 respondents were recruited from Singapore (SG) and Hong Kong (HK), respectively. Most respondents were aged 20-49 years (SG: 83.3%; HK: 64.3%), males (SG: 96.7%; HK: 92.9%), men who have sex with men (SG: 93.3%; HK: 71.4%), had university or higher education (SG: 73.3%; HK: 50.0%) and were fully employed (SG: 73.3%; HK: 57.1%). In both Singapore and Hong Kong, physical health was considered a key focus of overall wellbeing, albeit attention to long-term health associated with cardiovascular and renal health was less salient. The impact of symptoms, side effects of treatment, mood and sleep were among the top wellbeing indicators of importance. Respondents felt that insufficient information was provided by physicians, citing consultation time and resource constraints impeding further expression of concerns to their physicians during consultation. Respondents prioritized functional wellness and delegated psychosocial health to supportive care professionals, patient groups, families and/or friends.

CONCLUSIONS

There is a need in Singapore and Hong Kong to empower people living with HIV to establish better communications with their physicians and be more involved in their treatment journey and equally prioritize their psychosocial wellbeing.

Can social support mediate stigma and perceived stress in people live with human immunodeficiency virus?

Stigma has heavily impacted People Living with HIV (PLWH). Limited studies report on how social support affects HIV-related stigma and perceived stress, especially in Myanmar. During first seven months of 2020, a random sample of 248 eligible PLWH were contacted from a private, closed Facebook group with more than 18,000 Myanmar people, where 90% of the members were PLWH. Variables collected included demographics data, perceived stress, social support, and HIV stigma. After controlling for the effects of demographic variables, the path from HIV stigma to perceived stress (direct effect β = 0.40) and though the mediation of social support was significant (indirect effect β = 0.014). However, the mediating effect of social support was non-significant between HIV stigma and perceived stress. This exploratory study shows that social support did not have the expected effect of decreasing perceived stress in PLWH in Myanmar. Interventions to reduce HIV stigma to decrease perceived stress should consider other strategies, e.g., spirituality-based practice, to reduce perceived stress in Myanmar PLWH.

Adherence to option B + antiretroviral therapy and associated factors in pregnant and breastfeeding women in Sub-Saharan Africa: a systematic review and meta-analysis

BACKGROUND

To assess the adherence to option B + antiretroviral therapy (ART) and associated factors in pregnant and breastfeeding women in Sub-Saharan Africa (SSA).

METHODS

We conducted a comprehensive search from 01st January 2012 to 03rd October 2022, across four databases: PubMed, Scopus, Proquest Central, and Index Medicus Africain, to identify studies focused on pregnant and/or breastfeeding women living with HIV and receiving option B+ ART in SSA. Studies reporting adherence data were included in the meta-analysis. Were excluded studies published before 01st January 2012, grey literature, systematic reviews, and meta-analysis studies. Articles selection and data extraction were performed independently by two reviewers. We evaluated pooled adherence and pooled association between various factors and adherence using a random-effects model.

RESULTS

Overall, 42 studies involving 15,158 participants across 15 countries contributed to the meta-analysis. The overall pooled adherence was 72.3% (95% CI: 68.2-76.1%). Having high education level (pooled odds ratio (OR): 2.25; 95% CI: 1.57-3.21), living in urban area (pooled OR: 1.75; 95% CI: 1.10-2.81), disclosing status to a family/partner (pooled OR: 1.74; 95% CI: 1.27-2.40), having a support system (pooled OR: 3.19; 95% CI: 1.89-5.36), receiving counseling (pooled OR: 3.97; 95% CI: 2.96-5.34), initiating ART at early clinical HIV stage (pooled OR: 2.22; 95% CI: 1.08-4.56), and having good knowledge on PMTCT/HIV (pooled OR: 2.71; 95% CI: 1.40-5.25) were factors significantly associated with adherence to option B + ART.

CONCLUSIONS

Despite the implementation of option B+ ART, the level of adherence among pregnant and breastfeeding women in SSA falls short of meeting the critical thresholds for viral load suppression as outlined in the 95-95-95 objectives set for 2025. These objectives are integral for achieving HIV elimination, and in turn, preventing HIV mother-to-child transmission. To bridge this gap, urgent tailored interventions based on individual and structural factors are essential to enhance adherence within these subgroups of women. This targeted approach is crucial in striving towards the HIV elimination target in SSA.

Uncovering the forgotten story of the impact of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome on economic growth in Ghana: A gender analysis

Aside from being a health issue, Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) has an economic impact on Africa and Ghana in particular. Despite this, fewer empirical studies have examined the effect of the disease on economic growth from a gender point of view. This study aims to investigate the impact of the HIV/AIDS epidemic on economic growth in Ghana. The paper uses time series data spanning 1990-2018 to estimate the impact of HIV/AIDS from a gender perspective. The Cobb-Douglas aggregate function and the Granger Causality test were used to examine the determinant of growth and the direction of causality, respectively. The study's finding shows a unidirectional feedback causality running from HIV/AIDS to economic growth. Controlling for varieties of factors, the study found that HIV/AIDS has a negative significant impact on economic growth in both the short and long-run periods in Ghana. From the gender perspective, the impact of HIV/AIDS on growth was higher in the case of males when compared to females.

Community stigma and discrimination against the incidence of HIV and AIDS

The problem of human immunodeficiency virus (HIV) /acquired immunodeficiency syndrome (AIDS) is increasingly complex, including not only health-related concerns problems but also rampant stigma and discrimination, further exacerbating the health and social conditions of the affected individuals. This study aimed to examine the triggers of stigma and discrimination among individuals with HIV/AIDS in Wakatobi, Southeast Sulawesi. We employed a quasi-qualitative design with a case study approach involving data reduction, presentation, and drawing conclusions. Triggers of stigma and discrimination experienced by individuals living with HIV/AIDS encompassed a range of factors. Stigma was rooted in various causes, including fear, perceptions of unattractiveness, anxiety, associations with the disease, and lack of confidentiality. Discrimination, on the other hand, was caused by disappointment, feelings of insecurity, diminished self-esteem, and factors like competition and exploitation. The forms of stigma for people living with HIV/AIDS were public stigma, self-stigma, verbal discrimination, and avoidance. Meanwhile, the impact of stigma and discrimination on individuals living with HIV and AIDS is substantial. They encounter difficulties in finding help, restoring their lives, and discrimination. Stigmatizing attitudes and discriminatory acts of people living with HIV/AIDS worsen the quality of life of people living with HIV/AIDS, which can potentially cause new infections. Therefore, the government should undertake extensive educational initiatives regarding HIV and AIDS. By enhancing public knowledge and awareness, society can work towards eradicating stigma and discrimination from social interactions.

Understanding the quality of life of people living with HIV in rural and urban areas in Indonesia

Human Immunodeficiency Virus (HIV) is a major global public health issue that affects the quality of life (QoL) of people living with HIV (PLHIV) globally and in Indonesia. As a part of a large-scale qualitative study investigating HIV risk factors and impacts on PLHIV and facilitators of and barriers to their access to HIV care services in Yogyakarta and Belu, Indonesia, this paper describes their in-depth views and experiences of the influence of HIV on their QoL. Ninety-two participants were recruited using the snowball sampling technique. Data were collected using in-depth interviews. In addition, the World Health Organisation Quality of Life questionnaire (WHOQOL-HIV BREF) was also distributed to each of them to fill out prior to the interviews. Chi-Square analysis was used to analyse data from the survey and a framework analysis was applied to guide qualitative data analysis. The findings reported several factors affecting the QoL of the participants. These included (i) environmental factors, such as living in rural areas, the unavailability of HIV care services and public transport, and long-distance travel to healthcare facilities; (ii) personal beliefs associated with HIV; (iii) sexual and social relationships and their influence of the QoL of participants; and (iv) level of independence and physical health condition following HIV diagnosis. The findings indicate the need for intervention programs that address the availability and accessibility of HIV care services to PLHIV within rural communities and support various physical, psychological, and financial needs of PLHIV. These can be implemented by providing supplements and nutritious food, HIV counselling and door-to-door/community-based ART service delivery to PLHIV, which may increase their engagement in and adherence to the treatment and improve their physical and psychological condition and QoL.

Understanding coping strategies of mothers living with HIV who care for children living with HIV: a qualitative study in Indonesia

HIV infection and its sequelae continue to be a significant challenge among women and their families in developing countries despite the progress that has been made in the prevention and treatment of HIV. This paper describes the strategies employed by mothers with HIV to cope with the various challenges experienced following their own and their children's HIV diagnosis. This paper uses previously unpublished data collected for a study that sought to explore the mental health challenges and coping strategies of mothers living with HIV (MLHIV) (n = 23) who have children living with HIV (CLHIV). Data collection was conducted using in-depth interviews, and participants were recruited using the snowball sampling technique. The concept of meaning-making was used to guide the conceptualisation, analysis, and discussion of the findings. Our analysis showed that meaning-making such as the awareness of how important mothers were to their children/CLHIV and families and religious meaning were used by participants to cope with HIV-related and mental health challenges they faced. The meaning of mother-child relationship which was supported and maintained through the provision of time, attention and fulfillment of CLHIV's needs were also coping strategies employed by these women. Additional coping strategies used were to link their CLHIV to groups and activities of CLHIV. The connections made through these links enabled their children to know other CLHIV, build relationships, and share experiences. These findings are useful evidence that can inform policies and practices and indicate the need for the development of intervention programs that address the needs of MLHIV and their families to cope with HIV-related challenges of their children. Future large-scale studies involving MLHIV who have CLHIV are recommended to have a comprehensive understanding of strategies they employ to cope with HIV-related challenging circumstances and mental health issues that they continue to face.

“A frightening experience, especially at our age”: Examining the neglect and abuse of older persons in HIV prevention and care programs

Background

As the global population ages and the HIV pandemic matures, a growing number of older persons aged ≥50 years are becoming increasingly vulnerable to acquiring HIV. Unfortunately, older persons are often neglected and left out of sexual health programs and services. This study explored the experiences of older persons living with and without HIV in accessing prevention and care services and how those experiences translate into the neglect and abuse of older persons. The study also explored older people's perspectives on community responses to HIV in older people.

Methods

This qualitative analysis used data from 37 individuals who participated in focus group discussions conducted in 2017/2018 across two communities in Durban, South Africa. Using an interview guide and thematic content analysis, salient themes regarding attitudes to HIV in older persons and factors of access to HIV prevention and cares services for older persons were analyzed.

Results

The study participant's mean age was 59.6 years. Major themes emerging from the data included factors impacting HIV prevention and transmission in older people; community responses to HIV contributing to the abuse of older people, and structural drivers of abuse in older people living with HIV (OPLHIV). Knowledge about HIV and how to protect themselves from HIV was limited among participants. Older persons were frightened to acquire HIV at an older age as they feared judgment and discrimination for getting HIV at that age. OPLHIV reported frequently experiencing community stigma and poor staff attitudes and practices at health facilities, such as a triage health delivery system that fueled community stigma. Participants also experienced neglect, verbal and emotional abuse at healthcare facilities.

Conclusion

Although there were no reports of physical and sexual abuse of older persons in this study, this study shows that despite decades of HIV programs in the country, HIV-related stigma, discrimination, and disrespect of older persons remain pervasive in the community and at health facilities. As an increasing number of people age and live longer with HIV, the neglect and outright abuse of older persons need urgent policy and program interventions.

Global trends in depression among patients living with HIV: A bibliometric analysis

Background

Human immunodeficiency virus (HIV) related depression has seriously affected the quality of life and treatment outcomes of patients living with HIV (PLWH), which has become a hot topic in recent years. This study aims to discover the main keywords, predict frontier topics, and give meaningful suggestions for researchers by bibliometric analysis.

Methods

Publications between 1999 and 2022 on depression in HIV/AIDS were searched in the Web of Science core collection. Microsoft Excel 2010 and VOSviewer were utilized to key contributors (e.g., authors, journals, institutions, and countries). VOSviewer and CiteSpace were used to analyze the knowledge evolution, collaborative maps, hot topics, and keywords trends in this field.

Results

In total, 8,190 publications were included in the final analysis. From 1999 to 2021, the number of published articles roughly presents a steadily increasing trend. The United States, South Africa, and the United Kingdom were three key contributing countries/regions to this field. University Calif San Francisco (United States), University Calif Los Angeles (United States), and Johns Hopkins University (United States) were three key contributing institutions. Safren, Steven A. was the most productive and highest cited author. AIDS Care was the top prolific journal. Antiretroviral therapy and adherence, men has sex with men, mental health, substance abuse, stigma, and Sub-Saharan Africa were the central topics regarding the depression-related research in HIV/AIDS.

Conclusion

This bibliometric analysis reported the publication trend, major contributing countries/regions, institutions, authors, journals and mapped the knowledge network of depression-related research on HIV/AIDS. In this field, topics such as “adherence,” “mental health,” “substance abuse,” “stigma,” “men who have sex with men” and “South Africa” have attracted considerable attention.

'I am struggling to survive' - limited living conditions increase the burden of HIV: A qualitative study

The human immunodeficiency virus (HIV) continues to have life-limiting health consequences for many individuals and remains a significant threat to global public health. This qualitative study explores the experiences of people living with HIV in Sidama, Ethiopia. Interviews with 19 adults recruited from an HIV outpatient clinic were conducted using a semi-structured interview guide. The analysis method used was systematic text condensation. The results reveal that an HIV diagnosis triggered strong emotions. Economic concerns, stigma, and discrimination also increased the burden of a diagnosis, which could lead to a loss of income or housing. Consequently, informants' ability to maintain a regular life and receive social and psychological support was reduced. Religious faith provided strength to informants, though they stated that some religious leaders do not support antiretroviral therapy. Understanding the everyday challenges of people living with HIV is crucial for health professionals and health programme developers working to promote health and enable people to follow their recommended course of treatment. Person-centred care is recommended. In particular, the poorest should receive attention. It is also crucial to reduce stigma and discriminatory attitudes towards people living with HIV and to motivate faith leaders to prevent HIV stigma and support antiretroviral therapy.

Stigma and Discrimination of HIV/AIDs Recipients of Care in Western Uganda: Experiences and Roles of Expert Clients

Purpose

Stigma and discrimination (SAD) remains a major challenge facing HIV/AIDs management in most countries of sub-Saharan Africa. Expert clients can potentially play a role in the fight against SAD. Our study explored the experiences and the role of expert clients in reducing SAD among people living with HIV/AIDs enrolled on care in health facilities in Western Uganda.

Participants and Materials

We conducted a phenomenological qualitative study among (12) twelve purposively selected expert clients at four health facilities in Sheema district, Western Uganda. In-depth interviews were conducted using an interview guide. Data were transcribed verbatim, translated to English, manually coded and analysed manually by thematic content.

Results

Four themes emerged describing the experiences of expert clients in reducing HIV/AIDs SAD; 1) Feeling of inner satisfaction, 2) Challenging work environment, 3) Acquisition of skills and 4) Disclosure dilemma. The roles of expert clients in reducing HIV-related SAD included 1) Facilitating status disclosure, 2) Identifying and helping clients with stigma/discrimination, 3) Linking patients to the health care system and 4) Promotion of positive living.

Conclusion

Expert clients had numerous experiences and play a key role in the fight against SAD. Expert clients should be included as one of the stakeholders in the efforts to reduce or eradicate SAD in the management of HIV/AIDs.

Personal experiences following acquiring HIV infection while volunteering in Phase I/II HIV vaccine trials: A qualitative study from Tanzania

BACKGROUND

Participation in HIV vaccine trials is an essential step towards development of an effective preventive vaccine. A Phase I/II HIV vaccine trial enrolls volunteers at low risk of acquiring HIV infection, however a few may still become infected. Understanding the experiences of volunteers who acquired HIV infection while participating in such trials is essential for future research. Here, we describe experiences of HIV infected volunteers in Phase I/II HIV vaccine trials conducted in urban Tanzania.

MATERIALS AND METHODS

We used a case study design. In-depth interviews were conducted with four participants who became HIV infected during long follow-up visits after completion of vaccination schedules in a Phase I/II trial. Between 3 and 8 years after HIV positive diagnosis, each participant was interviewed at three time points within a two-year interval so as to allow for accumulation of experiences and cross-checking the emerging constructs. Data was analyzed using a qualitative data analysis framework.

RESULTS

Analysis revealed that participation in HIV vaccine trials involves balancing controversies and the spirit of informed decision. The participants declared that they did not acquire HIV from the experimental vaccine. Disclosure of HIV status within the family was gender specific. Men were hesitant to disclose their HIV status to their sexual partners fearing for the consequences. Women's attempt to disclose their HIV status yielded negative reactions from the sexual partners. The acquired knowledge from the HIV vaccine research enabled the participants to cope with the uncertainties and their health status.

CONCLUSIONS

The knowledge acquired during the Phase I/II HIV vaccine trial appears to be an essential resource to cope with uncertainties post research. The HIV vaccine trial implementers need to understand the challenges the volunteers may confront after the trial while coping with their health status. Longitudinal studies are essential to trace the effects of uncertainties to the individual participants.

HIV-related challenges and women's self-response: A qualitative study with women living with HIV in Indonesia

HIV infection is a major public health concern, with a range of negative impacts on People Living with HIV (PLHIV). A qualitative study in Yogyakarta, Indonesia, using in-depth interviews with 26 Women Living with HIV (WLHIV) was conducted to understand HIV risk factors and impact and their access to HIV care services. This paper describes the self-response of WLHIV towards negative HIV-related experiences facing them and adds to the existing literature which tends to focus on HIV impact only, as opposed to strategies that many WLHIV have used to empower and educate themselves and their family/community. Participants were recruited using the snowball sampling technique. Data analysis was guided by a qualitative data analysis framework. Our study highlighted that WLHIV experienced psychological challenges, stigma and discrimination. However, they demonstrated remarkable self-response and capacity in pursuing effective strategies and support to protect themselves, and educating themselves and others around them to rebuild trust and regain respect and acceptance. Our findings indicate that the needs of WLHIV should be addressed through policy and practice to help them cope with HIV-related psychological and social challenges effectively. Family and community members seem to play an important role in those negative challenges against WLHIV, thus there is also a need for HIV education programs for family and community members to enhance their HIV-health literacy and acceptance of PLHIV.

Mental Health Challenges and the Associated Factors in Women Living with HIV Who Have Children Living with HIV in Indonesia: A Qualitative Study

Women living with HIV (WLHIV) are vulnerable to various mental health challenges. However, there is a paucity of studies globally and in the Indonesian context that have specifically explored mental health challenges among mothers living with HIV who also have children living with HIV (CLHIV). This qualitative study explored mental health challenges and the associated factors in mothers living with HIV who have CLHIV in Yogyakarta, Indonesia. In-depth interviews were employed to collect data from the participants (N = 23) who were recruited using the snowball sampling technique. A qualitative data analysis framework was used to guide the analysis of the findings. The findings showed that the mothers experienced a range of mental health issues due to their own, and their child’s diagnoses of stress, depression, anxiety, fear, sadness, and guilt. Lack of knowledge about HIV, fear of death, shame, not knowing whom to talk with and what to do after their own HIV diagnosis, and the HIV diagnosis of their children were factors that challenged their mental health. Difficulties in dealing with daily life or social activities of their CLHIV, dilemmas in addressing questions and complaints of their CLHIV about HIV treatment, and concerns about the health condition of their CLHIV and how their children cope with any potential negative social impacts also impacted the mothers’ mental health. Social factors such as unsympathetic expressions from friends towards them and their CLHIV and negatively worded religious-related advice from parents and relatives also contributed to their poor mental health. Our findings indicate the need for intervention programs that support mothers living with HIV and their CLHIV. Future large-scale studies involving mothers living with HIV who have CLHIV in Indonesia and other settings globally are needed to obtain a comprehensive understanding of mental health challenges and the associated factors they face.

Stigma, coping strategies, and their impact on treatment and health outcomes among young men living with HIV in Vietnam: A qualitative study

BACKGROUND

Stigma affects persons living with HIV in myriad ways, including mental health, adherence to antiretroviral therapy, and retention in care, and may manifest at inter- and intra-personal levels. Youth are particularly vulnerable; those in vulnerable groups may experience multiple stigmas. In Vietnam, new HIV infections are rising among men in young age groups. To better understand the facets of stigma experienced by young men living with HIV in Vietnam, we conducted a qualitative study with youth and clinicians.

METHODS

We conducted in-depth interviews with ten youth and two clinicians in Hanoi, querying experiences of inter- and intra-personal stigma, coping strategies, and disclosure. As a framework for further research, we developed a conceptual model based on our findings and the published evidence base which portrays interactions among HIV-related stigma, coping strategies, and ART adherence, care engagement, and health outcomes.

RESULTS

Common themes that emerged from interviews with youth included extensive internalized/self-stigma and perceived stigma, yet limited experienced interpersonal stigma due to non-disclosure and avoidant coping strategies. Within different types of relationships or contexts, youth used different strategies. Non-disclosure with family, friends, and workplaces/school, and avoidance of romantic relationships and health care were common. Mental health and social support appeared to be mediating factors between coping strategies and health outcomes.

CONCLUSIONS

Validation of this model of mechanisms of the impact of stigma for youth will require further research with larger samples. In the meantime, public campaigns to increase public awareness related to HIV should be implemented in Vietnam. Critical support for youth and their mental health should involve approaches tailored to the individual, taking into account context and personal capacity, including adequate time to prepare psychologically for disclosure. Some strategies for safe and effective disclosure are suggested.