AIDS-related stigma and mental disorders among people living with HIV: a cross-sectional study in Cambodia

Siyan Yi, Pheak Chhoun, Samedy Suong, Kouland Thin, Carinne Brody, Sovannary Tuot, Siyan Yi, Pheak Chhoun, Samedy Suong, Kouland Thin, Carinne Brody, Sovannary Tuot

Abstract

Background: AIDS-related stigma and mental disorders are the most common conditions in people living with HIV (PLHIV). We therefore conducted this study to examine the association of AIDS-related stigma and discrimination with mental disorders among PLHIV in Cambodia.

Methods: A two-stage cluster sampling method was used to select 1,003 adult PLHIV from six provinces. The People Living with HIV Stigma Index was used to measure stigma and discrimination, and a short version of general health questionnaire (GHQ-12) was used to measure mental disorders. Multivariate logistic regression analysis was conducted.

Results: The reported experiences of discrimination in communities in the past 12 months ranged from 0.8% for reports of being denied health services to 42.3% for being aware of being gossiped about. Internal stigma was also common ranging from 2.8% for avoiding going to a local clinic and/or hospital to 59.6% for deciding not to have (more) children. The proportions of PLHIV who reported fear of stigma and discrimination ranged from 13.9% for fear of being physically assaulted to 34.5% for fear of being gossiped about. The mean score of GHQ-12 was 3.2 (SD = 2.4). After controlling for several potential confounders, higher levels of mental disorders (GHQ-12≥ 4) remained significantly associated with higher levels of experiences of stigma and discrimination in family and communities (AOR = 1.9, 95% CI = 1.4-2.6), higher levels of internal stigma (AOR = 1.7, 95% CI = 1.2-2.3), and higher levels of fear of stigma and discrimination in family and communities (AOR = 1.5, 95% CI = 1.1-2.2).

Conclusions: AIDS-related stigma and discrimination among PLHIV in Cambodia are common and may have potential impacts on their mental health conditions. These findings indicate a need for community-based interventions to reduce stigma and discrimination in the general public and to help PLHIV to cope with this situation.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Grossman CI, Stangl AL. Global action to reduce HIV stigma and discrimination. J Int AIDS Soc. 2013; 16 (Suppl. 2): 18881 10.7448/IAS.16.3.18881
    1. Sidibé M, Goosby EP. Global action to reduce HIV stigma and discrimination. J Int AIDS Soc. 2013; 16 (Suppl. 2): 18893 10.7448/IAS.16.3.18893
    1. Steward WT, Bharat S, Ramakrishna J, Heylen E, Ekstrand ML. Stigma is associated with delays in seeking care among HIV-infected people in India. J Int Assoc Provid AIDS Care. 2013; 12: 103–109. 10.1177/1545109711432315
    1. Turan JM, Bukusi EA, Onono M, Holzemer WL, Miller S. HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS study. AIDS Behav. 2011; 15: 1111–1120. 10.1007/s10461-010-9798-5
    1. Nachega JB, Morroni C, Zuniga JM, Sherer R, Beyrer C. HIV-related stigma, isolation, discrimination, and serostatus disclosure: a global survey of 2035 HIV-infected adults. J Int Assoc Physicians AIDS Care. 2012; 11: 172–178. 10.1177/1545109712436723
    1. Tsai AC, Bangsberg DR, Kegeles SM, Katz IT, Haberer JE, Muzoora C et al. Internalized stigma, social distance, and disclosure of HIV sero-positivity in rural Uganda. Ann Behav Med. 2013; 46: 285–294. 10.1007/s12160-013-9514-6
    1. Naar-King S, Bradford J, Coleman S, Green-Jones M, Cabral H. Retention in care of persons newly diagnosed with HIV: outcomes of the outreach initiative. AIDS Patient Care STDS. 2007; 21 (Suppl. 1): S40–48.
    1. Katz IT, Ryu AE, Onuegbu AG, Psaros C, Weiser SD. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013; 16 (Suppl. 2): 18640 10.7448/IAS.16.3.18640
    1. Rao D, Kekwaletswe TC, Hosek S, Martinez J, Rodriguez F. Stigma and social barriers to medication adherence with urban youth living with HIV. AIDS Care. 2007; 19: 28–33.
    1. Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial/ethnic HIV disparities: moving toward resilience. Am Psychol. 2013; 68: 225–236. 10.1037/a0032705
    1. Logie C, James L, Tharao W, Loutfy M. Associations between HIV-related stigma, racial discrimination, gender discrimination, and depression among HIV-positive African, Caribbean, and Black women in Ontario, Canada. AIDS Patient Care STDS. 2013; 27: 114–122. 10.1089/apc.2012.0296
    1. Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Longitudinal relationships between antiretroviral treatment adherence and discrimination due to HIV sero-status, race, and sexual orientation among African-American men with HIV. Ann Behav Med. 2010; 40: 184–190. 10.1007/s12160-010-9200-x
    1. Chibanda D, Benjamin L, Weiss HA, Abas M. Mental, neurological, and substance use disorders in people living with HIV/AIDS in low- and middle-income countries. J Acquir Immune Defic Syndr. 2014. 67 (Suppl. 1): S54–67. 10.1097/QAI.0000000000000258
    1. Adewaya AO, Afolabi MO, Ola BA, Ogundele OA, Ajibare AO, Oladipo BF. Psychiatric disorders among the HIV-positive population in Nigeria: A control study. J Psychosom Res. 2007; 63: 203–206.
    1. Akena D, Musisi S, Joska J, Stein DJ. The association between aids related stigma and major depressive disorder among HIV-positive individuals in Uganda. PLoS One. 2012; 7: e48671 10.1371/journal.pone.0048671
    1. Kaharuza FM, Bunnell R, Moss S, Purcell DW, Bikaako- Kafura W. Depression and CD4 cell count among person with HIV infection in Uganda. AIDS Behav. 2006; 10: S105–111.
    1. Kinyanda E, Hoskins S, Nakku J, Nawaz S, Patel V. Prevalence and risk factors of major depressive disorder in HIV/AIDS as seen in semi-urban Entebbe district, Uganda. BMC Psychiatry. 2011; 11: 205 10.1186/1471-244X-11-205
    1. Myer L, Smit J, Roux LL, Parker S, Stein DJ. Common mental disorders among HIV- infected individuals in South Africa: Prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care STDs. 2008; 22: 147–158. 10.1089/apc.2007.0102
    1. Nakasujja N, Skolasky RL, Musisi S, Allebeck P, Robertson K. Depression symptoms and cognitive function among individuals with advanced HIV infection initiating HAART in Uganda. BMC Psychiatry. 2010; 10: 44 10.1186/1471-244X-10-44
    1. Olley BO, Seedat S, Stein DJ. Persistence of psychiatric disorders in a cohort of HIV/AIDS patients in South Africa. A 6-month follow- up study. J Psychosom Res. 2006; 61: 479–484.
    1. Petrushkin A, Boardman J, Ovuga E. Psychiatric disorders in HIV- positive individuals in urban Uganda. Psychiatr Bull. 2005; 29: 455–458.
    1. Freeman M, Nkomo N, Kafaar Z, Kelley K. Mental disorder in people living with HIV/AIDS in South Africa. S Afr J Psych. 2008; 38: 480–500.
    1. Mogga S, Prince M, Alem A, Kebede D, Stewart R, Glozier N, et al. Outcome of major depression in Ethiopia: Population-based study. Br J Psychiatry. 2006; 189: 241–246.
    1. Nakimuli-Mpungu E, Munyaneza G. Depression, alcohol abuse, and disclosure of HIV serostatus among rural HIV-positive individuals in western Uganda. Neurobehav HIV Med. 2011; 3: 19–25.
    1. Horberg MA, Silverberg MJ, Hurley LB, Towner WJ, Klein DB, Bersoff-Matcha S, et al. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr. 2008; 47: 384–390.
    1. Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: A system review. AIDS Behav. 2012; 16: 2119–2143. 10.1007/s10461-012-0212-3
    1. Treisman G, Angelino A. Interrelation between psychiatric disorders and the prevention and treatment of HIV infection. Clin Infect Dis. 2007; 45: S313–317. 10.1086/522556
    1. Joska JA, Obayemi A Jr., Cararra H, Sorsdahl K. Severe mental illness and retention in anti-retroviral care: A retrospective study. AIDS Behav. 2014; 18: 1492–1500. 10.1007/s10461-014-0709-z
    1. Pence BW. The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS. J Antimicrob Chemother. 2009; 63: 636–640. 10.1093/jac/dkp006
    1. Bouhnik AD, Pre´au M, Vincent E, Carrieri MP, Gallais H, Lepeu G, et al. Depression and clinical progression in HIV-infected drug users treated with highly active antiretroviral therapy. Antivir Ther. 2005; 10: 53–61.
    1. Cruess DG, Douglas SD, Petitto JM, Have TT, Gettes D, Dubé B, et al. Association of Resolution of Major Depression With Increased Natural Killer Cell Activity Among HIV-Seropositive Women. Am J Psychiatry. 2005; 162: 2125–2130.
    1. Cook JA, Grey D, Burke J, Cohen MH, Gurtman AC. Depressive symptoms and AIDS-related mortality among a multisite cohort of HIV-positive women. Am J Public Health. 2004; 94: 1133–1140.
    1. Yu XN, Lau JT, Mak WW, Cheng YM, Lv YH. Risk and protective factors in association with mental health problems among people living with HIV who were former plasma/blood donors in rural China. AIDS Care. 2009; 21: 645–654. 10.1080/09540120802459770
    1. Su X, Lau JT, Mak WW, Chen L, Choi KC. Perceived discrimination, social support, and perceived stress among people living with HIV/AIDS in China. AIDS Care. 2013; 25: 239–248. 10.1080/09540121.2012.701713
    1. Freeman M, Nkomo N, Kafaar Z, Kelley K. Factors associated with prevalence of mental disorder in people living with HIV/AIDS in South Africa. AIDS Care. 2007; 19: 1201–1209.
    1. Olley BO, Seedat S, Nel DG, Stein DJ. Predictors of major depression in recently diagnosed patients with HIV/AIDS in South Africa. AIDS Patient Care STDs. 2004; 18: 481–487.
    1. Bjelland I, Krokstad S, Mykletun A, Dahl AA, Tell GS, Tambs K. Does a higher educational level protect against anxiety and depression? The HUNT study. Soc Sci Med. 2008; 66: 1334–1345. 10.1016/j.socscimed.2007.12.019
    1. Steward WT, Herek GM, Ramakrishna J, Bharat S, Chandy S. HIV-related stigma: adapting a theoretical framework for use in India. Soc Sci Med. 2008; 67: 1225–1235. 10.1016/j.socscimed.2008.05.032
    1. Steward WT, Chandy S, Singh G, Panicker ST, Osmand TA. Depression is not an inevitable outcome of disclosure avoidance: HIV stigma and mental health in a cohort of HIV-infected individuals from Southern India. Psychol Health Med. 2011; 16: 74–85. 10.1080/13548506.2010.521568
    1. Simbayi LC, Kalichman S, Strebel A, Cloete A, Henda N. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Soc Sci Med. 2007; 64: 1823–1831.
    1. Bogart LM, Wagner GJ, Galvan FH, Landrine H, Klein DJ. Perceived discrimination and mental health symptoms among black men with HIV. Cultur Divers Ethnic Minor Psychol. 2011; 1: 295–302. 10.1037/a0024056
    1. Fields EL, Bogart LM, Galvan FH, Wagner GJ, Klein DJ. Association of discrimination-related trauma with sexual risk among HIV-positive African American men who have sex with men. Am J Public Health. 2013; 103: 875–880. 10.2105/AJPH.2012.300951
    1. Yi S, Chhoun P, Brant S, Kita K, Tuot S. The Sustainable Action against HIV and AIDS in Communities (SAHACOM): End-of-project evaluation. Phnom Penh, Cambodia: KHANA; 2014.
    1. Sopheab H, Tuot S. Mid-term review of the Sustainable Action against HIV and AIDS in Communities (SAHACOM) program. Phnom Penh, Cambodia: KHANA; 2013.
    1. National Institute of Public Health, National Institute of Statistics, and ORC Macro. Cambodia Demographic and Health Survey 2010. Phnom Penh, Cambodia and Calverton, Maryland, USA; 2010.
    1. Goldberg DP. The detection of psychiatric illness by questionnaire: A technique for identification and assessment of non-psychotic psychiatric illness London, New York: Oxford University Press; 1972.
    1. Kim YJ, Cho MJ, Park S, Hong JP, Sohn JH. The 12-item general health questionnaire as an effective mental health screening tool for general Korean adult population. Psychiatry Investig. 2013; 10: 352–358. 10.4306/pi.2013.10.4.352
    1. Zulkefly NS, Baharudin R. Using the 12-item General Health Questionnaire (GHQ-12) to assess the psychological health of Malaysian college students. Glob J Health Sci. 2010; 2: 73–80.
    1. Goldberg DP, Williams P. A user’s guide to the General Health Questionnaire Winsor UK: NFER-Nelson; 1988.
    1. Goldberg DP, Oldehinkel T, Ormel J. Why GHQ threshold varies from one place to another. Psychol Med. 1998; 28: 915–921.
    1. International Parenthood Federation (IPF), Global Network of People Living with HIV (GNP+), International Community of Women Living with HIV (ICW), UNAIDS. The People Living with HIV Stigma Index: an index to measure the stigma and discrimination experienced by people living with HIV London: International Parenthood Federation; 2008.
    1. dos Santos MML, Kruger P, Mellors SE, Wolvaardt G, van der Ryst E. An exploratory survey measuring stigma and discrimination experienced by people living with HIV/AIDS in South Africa: the People Living with HIV Stigma Index. BMC Public Health. 2014; 14: 80 10.1186/1471-2458-14-80
    1. Stangl AL, Grossman CI. Global action to reduce HIV stigma and discrimination. J Int AIDS Soc. 2012; 16: 2.
    1. Valdiserri RO. HIV/AIDS stigma: an impediment to public health. Am J Public Health. 2012; 92: 341–342.
    1. UNAIDS–Joint United Nations Programme on HIV/AIDS. People Living with HIV Stigma Index: Asia Pacific Regional Analysis. Geneva, Switzerland: UNAIDS; 2011.
    1. Wang B, Li X, Barnett D, Zhao G, Zhao J. Risk and protective factors for depression symptoms among children affected by HIV/AIDS in rural China: A structural equation modeling analysis. Soc Sci Med. 2012; 74: 1435–1443. 10.1016/j.socscimed.2012.01.007
    1. Lia L, Leea SJ, Thammawijay P, Jiraphongs C, Rotheram-Borusa MJ. Stigma, social support, and depression among people living with HIV in Thailand. AIDS Care. 2009; 21: 1007–1013. 10.1080/09540120802614358
    1. Jackson JS, Knight KM. Race and self-regulatory health behaviors: The role of the stress response and the HPA axis in physical and mental health disparities In: Schaie KW, Carstensen LL, editors. Social structure, aging and self-regulation in the elderly. Springer; New York; 2006.
    1. Williams DR, Mohammed SA. Discrimination and racial disparities in health: Evidence and needed research. J Behav Med. 2009; 32: 20–47. 10.1007/s10865-008-9185-0
    1. Pascoe EA, Smart Richman L. Perceived discrimination and health: A meta-analytic review. Psychol Bull. 2009; 135: 531–554. 10.1037/a0016059
    1. Hatzenbuehler ML, Nolen-Hoeksema S, Dovidio J. How does stigma “get under the skin”? The mediating role of emotion regulation. Psychol Sci. 2009; 20: 1282–1289. 10.1111/j.1467-9280.2009.02441.x
    1. Stangl A, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002–2013: How far have we come? J Int AIDS Soc. 2013; 16 (suppl. 2): 18734 10.7448/IAS.16.3.18734

Source: PubMed

3
Abonneren