Attitudes of Indian HIV Clinicians Toward Depression in People Living with HIV

Abstract

BACKGROUND Depression in people living with HIV (PLHIV) is highly prevalent and associated with increased morbidity and mortality. In India, where access to mental health specialists is limited, little is known about the attitude of HIV clinicians towards depression in PLHIV. METHODS We administered a questionnaire to HIV clinicians attending the 2015 Chennai Anti Retroviral Therapy symposium that assessed respondents’ level of agreement with 29 statements regarding the etiology, importance, and management of depression and whether they felt capable and willing to manage depression in PLHIV. RESULTS The 69 respondents were from nine Indian states. Most respondents agreed that depression in PLHIV is a serious problem (91%) and associated with poorer HIV-related outcomes (62-81%). Although most respondents (76%) reported feeling comfortable discussing mental health problems with PLHIV, almost half (48%) admitted that lack of knowledge and training about mental health issues hindered the diagnosis and treatment of depression in PLHIV. With few exceptions, there were no significant differences in responses by gender, urban/rural practice location, or government vs. private practice. CONCLUSIONS Indian HIV clinicians believe that depression in PLHIV is important and are willing to manage depression in the HIV primary care setting. These findings suggest that HIV clinicians require further training to deliver evidence-based interventions to treat PLHIV with depression.

A scoping review of the role of HIV-related stigma and discrimination in noncommunicable disease care

“…Three studies examined the role of HIV-stigma in NCD diagnosis and treatment, and all focused on identifying and managing depression [ 45 , 49 , 50 ]. One small qualitative study examined the adaptation of an effective depression screening tool for low-income African Americans living with HIV.…”

“…While this study included only seven providers and staff with training in medicine and social work, it found that HIV stigma interferes with clinical efforts to identify individuals struggling with depression [ 49 ]. In a cross-sectional study in India with health providers, when asked about their attitudes towards PLHIV with depression, 62% of respondents were either neutral or agreed with the statement “depression is a sign of personal weakness,” and 53% of respondents felt that it was difficult to work with depressed PLHIV [ 50 ]. A cross-sectional study on barriers to mental health treatment among veterans living with HIV in the United States found that among those with positive Patient Health Questionnaire-2 screens, participants who reported experiencing HIV stigma were more likely to be in treatment (χ2 = 4.22, P = .04) compared to those who did not report HIV stigma.…”

“…NCDs may carry their own stigma. Seven articles discussed stigma related to cervical cancer [ 40 , 41 , 48 , 52 ], depression [ 49 , 50 ], and diabetes and hypertension [ 53 ] alongside HIV-related stigma. For example, Rosser et al (2015 and 2016) presented analyses from different timepoints in their evaluation of a cervical cancer screening intervention, measuring both cervical cancer-related and HIV-related anticipated stigma (e.g., fear of being treated badly by health workers or becoming a social outcast should others find out they had cervical cancer).…”

“…A qualitative study of attitudes and beliefs around cervical cancer found that cervical cancer is highly stigmatized in Zambia, not only because of its anatomic location, dire natural course, and connections to socially condemned behaviors, but also because of its association with HIV [ 48 ]. In light of both the stigma attached to HIV and widespread stigmatizing views of depression among non-psychiatric clinicians, Chan et al conducted a cross-sectional survey that measured the intersection of depression and HIV-related stigma among HIV-care providers by measuring stigmatizing attitudes toward PLHIV with depression [ 50 ]. In this sense, Chan et al measured compounded depression and HIV stigma, without separately measuring either HIV stigma or depression stigma.…”

“…The studies identified in this literature review, while few in number, provide some useful insights. In particular, findings suggest that fear of disclosure, internalized shame and embarrassment, and negative past experiences with or perceptions of health care providers as stigmatizing all negatively influence engagement with NCD care for PLHIV [ 46 , 47 , 50 , 51 , 53 , 56 ]. As well, we found stigma, both related to HIV and to certain NCDs, may affect engagement in NCD care for all patients in need of services regardless of HIV status.…”