Association between internalized stigma and depression among HIV-positive persons entering into care in Southern India

Abstract

BackgroundIn India, which has the third largest HIV epidemic in the world, depression and HIV–related stigma may contribute to high rates of poor HIV–related outcomes such as loss to care and lack of virologic suppression.MethodsWe analyzed data from a large HIV treatment center in southern India to estimate the burden of depressive symptoms and internalized stigma among Indian people living with HIV (PLHIV) entering into HIV care and to test the hypothesis that probable depression was associated with internalized stigma. We fitted modified Poisson regression models, adjusted for sociodemographic variables, with probable depression (PHQ–9 score ≥10 or recent suicidal thoughts) as the outcome variable and the Internalized AIDS–Related Stigma Scale (IARSS) score as the explanatory variable.Findings521 persons (304 men and 217 women) entering into HIV care between January 2015 and May 2016 were included in the analyses. The prevalence of probable depression was 10% and the mean IARSS score was 2.4 (out of 6), with 82% of participants endorsing at least one item on the IARSS. There was a nearly two times higher risk of probable depression for every additional point on the IARSS score (Adjusted Risk Ratio: 1.83; 95% confidence interval, 1.56–2.14).ConclusionsDepression and internalized stigma are highly correlated among PLHIV entering into HIV care in southern India and may provide targets for policymakers seeking to improve HIV–related outcomes in India.

Stigma, Social Support, Illicit Drug Use, and Other Predictors of Anxiety and Depression Among HIV/AIDS Patients in Pakistan: A Cross-Sectional Study

“…HIV-related stigma was evaluated by a six-item instrument, Internalized AIDS-Related Stigma Scale (IARSS) ( 35 ). The internalized stigma is a significant predictor of health outcomes ( 14 , 36 ). IARSS is an internationally validated tool and has been translated into many other languages and is a brief tool compared to other community tools, such as the Berger stigma scale ( 37 , 38 ).…”

“…Due to limited education of health professionals about determinants of mental health in HIV patients, poor understanding among HIV patients, and lack of advice on clinical issues in HIV clinics, the impact of mental health concerns on HIV patients has sometimes been overlooked in resource-constrained settings ( 11 , 12 ). As a result, PLWHA are more likely to exhibit anxious and depressive symptoms, affecting illness-related stigma, reducing personal satisfaction, increasing mortality, reducing drug adherence, and impairing their ability to resist illness ( 13 , 14 ).…”

El papel de la educación para la salud en la prevención del VIH/sida: una aproximación desde la educación para el desarrollo en Centroamérica

“…-Los estereotipos asociados tradicionalmente al VIH/sida continúan jugando un importante papel en la justificación, el desarrollo y el mantenimiento de la estigmatización hacia las personas seropositivas (Cobos-Sanchiz et al, 2013;Cobos-Sanchiz et al, 2014). Este hecho se configura en un grave problema que se manifiesta incluso en el acceso de las personas que viven con VIH a los servicios de salud, el cual, tal como han recogido también Bermúdez-Román, Bran-Piedrahita, Palacios-Moya y Posada-Zapata ( 2015) en investigaciones desarrolladas en otros contextos de América Latina, puede estar asociado a riesgos de carácter psicosocial (Chan et al, 2017) e incluso limitar la efectividad de las acciones para la reducción de casos (Bermúdez-Román, Bran-Piedrahita, Palacios-Moya y Posada-Zapata, 2016). -La homosexualidad como tabú y lacra social ligada al VIH/sida, especialmente en el ámbito laboral, sigue siendo un importante reto pendiente (Cobos-Sanchiz et al, 2013).…”

Depression, social support, and stigma as predictors of quality of life over time: results from an Asha-based HIV/AIDS intervention in India

“…Cross-sectional work has described social support as a mediator of depression (Hou et al, 2014) and vice versa (Jia et al, 2004;Simoni, Frick, Lockhart, & Liebovitz, 2002). Previous research has linked internalized stigma and depression in HIV populations in Southern India (Chan et al, 2017;Steward et al, 2011). Moreover, also in HIV-positive individuals in India, depression and stigma were highly correlated and depression predicted lower QOL (Charles et al, 2012).…”