Challenges facing HIV-positive persons who use drugs and their families in Vietnam

Abstract

It is hypothesized that persons who use drugs (PWUD) in Vietnam who are also HIV-positive may face additional challenges in psychosocial outcomes, and these challenges may extend to their family members. In this study, we examined depressive symptoms, stigma, social support, and caregiver burden of HIV-positive PWUD and their family members, compared to the outcomes of HIV-negative PWUD and their family members. Baseline, 3-month, and 6-month assessment data were gathered from 83 PWUD and 83 family members recruited from four communes in Phú Tho Province, Vietnam. For PWUD, although we observed a general decline in overall stigma over time for both groups, HIV-positive PWUD consistently reported significantly higher overall stigma for all three periods. Depressive symptoms among family members in both groups declined over time; however, family members of HIV-positive PWUD reported higher depressive symptoms across all three periods. In addition, family members of HIV-positive PWUD reported lower levels of tangible support across all three periods. Caregiver burden among family members of HIV-positive PWUD increased significantly over time, whereas the reported burden among family members of HIV-negative PWUD remained relatively unchanged. The findings highlight the need for future interventions for PWUD and family members, with targeted and culturally specific strategies to focus on the importance of addressing additional stigma experienced by PWUD who are HIV-positive. Such challenges may have direct negative impact on their family members’ depressive symptoms, tangible support and caregiver burden.

Factors related to the perceived stigmatization of people living with HIV

“…Although most participants in this study were heterosexual, which can be justified by the stimulus to early sexuality and the possibility of paid sex (26) , homosexuals are the ones who are strongly stigmatized and linked to large manifestations of exclusion and blamed for HIV infection (22,27) ; this is similar to what happens with drug users, being labelled and socially excluded (6,18,22,27) . We found that interruption of ART was not predominant in this study.…”

“…A stigma is considered a defect or a label that defines others, diminishing them through negative stereotypes, discriminatory and prejudiced labels (1,(3)(4) . Thus, in addition to the clinical changes that HIV can bring to people's lives, the stigma can also cause serious social and psychological damage due to feelings of inferiority (1,(4)(5) , which significantly increase anxiety, loneliness, depression and the desire to die, reducing self-esteem and self-confidence, which lead to social and sexual isolation of people living with HIV (4,6) . It is estimated that 36.9 million people live with HIV worldwide (2) .…”

“…Despite this significant number, a decrease in social impacts of HIV have been observed in many regions of the world (8) since 2004, including in Brazil, with a 42% decrease in AIDSrelated deaths (2) . Despite epidemiological indicators pointing to a reduction in the number of cases of the disease in the country and in other regions, its stigma is still seen as a major barrier for infection control (6) . In fact, in addition to causing financial deficits due to the risk of employees being fired (4)(5) , the disease can also interfere with affective and social relationships due to feelings of guilt and shame which leads to the isolation of these individuals (1,(4)(5)9) , affecting adherence to clinical and antiretroviral follow-up by many HIV positive persons (1) .…”

Estigmatização de pessoas que vivem com HIV/aids e sua relação com suporte social e qualidade de vida

“…A falsa associação de que a doença estava restrita a um grupo específico de pessoas favoreceu a disseminação viral para indivíduos que pensavam estar protegidos, sendo esta causa apontada como favorável para a expansão do vírus da imunodeficiência humana (HIV) (SOUZA et al, 2012), em especial para grupos sociais mais vulneráveis (GALVÃO et al, 2013;LEE et al, 2015).…”

“…Assim, a infecção do HIV pode alcançar a todos os grupos, sendo considerado um problema de saúde pública no Brasil e no mundo, e de grandes proporções (GRANGEIRO; CASTANHEIRA; NEMES, 2015), uma vez que, além de poder de disseminação que ultrapassa os limites da dimensão biomédica, é uma patologia clínica incurável, a qual fere os indivíduos em suas áreas psicológicas e sociais, marcando-os por rótulos, como seres condenados por transgredir as regras da sociedade, podendo ainda levá-los à morte (ISHIKAWA et al, 2011;LEE et al, 2015). (BRASIL, 2015).…”