The Burden of Anxiety During the COVID-19 Pandemic Among People Living with HIV (PLHIV) in Pune, India

Abstract

Introduction: There is a dearth of data on anxiety related to the COVID-19 pandemic from people living with HIV (PLHIV). This is a cause of concern as anxiety is associated with antiretroviral therapy (ART) nonadherence. Globally, India has the third largest population of PLHIV and third highest number of COVID-19 cases which are rapidly increasing. Therefore, it is crucial to understand the burden of anxiety and its sources among Asian Indian PLHIV during this pandemic.Methods: We used data from a telephonically delivered assessment among PLHIV engaged in care at a tertiary healthcare associated antiretroviral therapy (ART) center in Pune, India. Assessments were conducted between April 21 and May 28, 2020, one month into the government mandated lockdown. GAD-7 was used to assess for anxiety over two-preceding weeks. Significant sociodemographic and clinical differences between groups (GAD-7<10 and GAD-7≥10) were assessed using Fisher’s exact and Wilcoxson rank sum tests, for categorical and continuous variables, respectively. Thematic analysis was employed to analyze an open-ended question that asked about the most pressing cause(s) of concern. Results: Of 167 PLHIV contacted, median age was 44 years (IQR:40 – 50), 60% (n=100) were cisgender women and 81% (n=135) had a monthly family income<200 USD. Thirty-eight percent (n=64) had prior history of tuberculosis and 27% (n=45) were living with another comorbidity. A fourth (25%, n=41) had GAD-7 scores indicative of generalized anxiety. PLHIV who had fewer remaining doses of ART had significantly higher GAD-7 scores compared to those that had more doses (p=0.05). Thematic analysis indicated that concerns were both health related and unrelated, and stated temporally. Present concerns were often also projected as future concerns. Conclusions: In a group of socioeconomically disadvantaged PLHIV, a fourth were found to have anxiety, that appeared to be influenced by concerns about ART availability. Furthermore, the persistence of sources of anxiety and therefore an increase in anxiety for these PLHIV is anticipated as the pandemic worsens in India. We recommend the regular utilization of short screening tools for anxiety to monitor and triage PLHIV as an extension of current HIV-services.

Sexual health (excluding reproductive health, intimate partner violence and gender-based violence) and COVID-19: a scoping review

“…Fifteen studies evaluated mental health outcomes. [81][82][83][84][85] Most (67%) were cross-sectional observational quantitative studies detailing the mental health impact of the pandemic on SGM.…”

“…Five studies detailed PLHIV. [81][82][83][84][85] A cross-sectional observational quantitative study conducted in Turkey found a relationship between generalised anxiety levels and COVID-19-related anxiety among clinical patients with HIV. 85 A US-based study found that the decision to social distance was associated with COVID-19-related stigma and fears.…”

Prevalence of anxiety during the COVID-19 pandemic in patients diagnosed with subglottic stenosis

“…Other cohorts of patients with pre-existing conditions have similarly demonstrated disproportionately high mental health burdens. Marbaniang et al reported that patients with HIV experienced a significantly higher mental burden during the pandemic than non-immunosuppressed patients [22] . These findings support the premise of the study that respondents are aware of the increased risk that their diagnoses pose in developing illness from the COVID-19 virus.…”