Prevalence and sociodemographic determinants of public stigma towards people with HIV and its impact on HIV testing uptake: A cross-sectional study in 64 low- and middle-income countries

Background: HIV stigma and discrimination are drivers of adverse HIV outcomes because they deter individuals from engaging in the HIV care continuum. We estimate the prevalence of public stigma towards people with HIV, investigate individuals' sociodemographic determinants for reporting stigmatizing attitudes, and test the impact of HIV stigma on HIV testing uptake. Methods: This was an observational study based on an analysis of cross-sectional surveys from 64 low- and middle-income countries. We used nationally representative survey data for the population aged 15–49 years from 2015 to 2021, which was the latest available data. HIV public stigma was measured using an index of two questions about attitudes towards people with HIV. First, prevalence estimates of HIV stigma were calculated by country, across countries, and by sociodemographic characteristics. Second, country fixed-effects multivariable logistic regression models were fit to assess sociodemographic determinants of holding stigmatizing attitudes towards people with HIV. Additional logistic regression models assessed country-level income and HIV prevalence as determinants of stigma and assessed the role of HIV public stigma as a driver of testing uptake. Results: A total of 1 172 841 participants were included in the study. HIV stigma was prevalent in all countries, ranging from 12.87% in Rwanda to 90.58% in Samoa. There was an inverse dose–response association between HIV stigma and educational level, wealth quintile, and age group, whereby higher levels of each were associated with lower odds of holding stigmatized attitudes towards people with HIV. The odds of stigmatized attitudes were lower among men and individuals with adequate knowledge of HIV. HIV stigma was lower in countries with greater gross domestic product per capita and HIV prevalence. Holding stigmatized attitudes towards people with HIV was associated with lower testing uptake, including having ever tested or having tested in the last year. Conclusion: HIV stigma is present to a highly varying degree in all countries studied, so different approaches to reducing stigma towards people with HIV are required across settings. Action to eliminate HIV stigma is crucial if we are to progress towards ending HIV because holding stigmatized attitudes towards people with HIV was associated with reduced testin

Health-Related Quality of Life in People with Advanced HIV Disease, from 1996 to 2021: Systematic Review and Meta-analysis

The purpose of the study was to assess the effects of advanced HIV disease (AHD) on health-related quality of life (HRQoL) in PLHIV, the changes in HRQoL outcomes over the last 25 years, and the differences between countries according to level of economic development. We conducted a systematic review and meta-analysis. The search was conducted in PubMed and Web of Science using the terms: “health-related quality of life”, “HQRoL”, “HIV”, “AIDS”, “advanced HIV disease” and “low CD4 cells”. Studies inclusion criteria were: adult population; initiated after 1996 and published before July 2021; clinical trials, cross-sectional, cohort, and case–control studies; studies analyzing the relationship between AHD and HRQoL; English or Spanish language. Standardized mean differences (d+) were calculated to estimate the effect size for the meta-analyses. Summary statistics were calculated using a random-effects model, and analyses of effect moderators, using mixed-effects models. The meta-analysis included 38 studies. The results indicated that HRQoL is worse in patients with AHD compared to those without. The main HRQoL domains affected were overall health perception and concern and physical and functional health and symptoms. We found a moderate impact for age and gender on some HRQoL domains. There were no differences in relation to socioeconomic inequities, country of residence, or time period analyzed. In conclusion, advanced HIV disease has a negative impact on health and well-being in PLHIV. Our results show that despite all the advances in antiretroviral treatments over the last 25 years, AHD persists as a source of extreme vulnerability, regardless of where PLHIV live.El objetivo del estudio fue evaluar los efectos de la enfermedad avanzada de sida (EAS) en la calidad de vida relacionada con la salud (CVRS) en personas que viven con el VIH (PVVIH), los cambios experimentados en la CVRS en los últimos 25 años y las diferencias entre países. Realizamos una revisión sistemática y metaanálisis. La búsqueda se llevó a cabo en PubMed y Web of Science utilizando los términos: “calidad de vida relacionada con la salud”, “CVRS”, “VIH”, “SIDA”, “enfermedad avanzada por VIH” y “células CD4 bajas”. Los criterios de inclusión de los estudios fueron: población adulta; iniciado después de 1996 y publicado antes de julio de 2021; ensayos clínicos, estudios transversales, de cohorte y de casos y controles; estudios que analizan la relación entre EAS y CVRS; idioma inglés o español. Se calcularon diferencias de medias estandarizadas (d+) para estimar el tamaño del efecto para los metaanálisis. Los efectos promedios se calcularon utilizando un modelo de efectos aleatorios, y el análisis de moderadores utilizando modelos de efectos mixtos. El metaanálisis incluyó 38 estudios. Los resultados indicaron que la CVRS es peor en pacientes con EAS en comparación con aquellos sin EAS. Los principales dominios de CVRS afectados son la percepción de salud general y su preocupación, y la función física y de salud y los síntomas asociados. Encontramos un impacto moderado por edad y género en algunos dominios de CVRS. No encontramos diferencias en cuanto a las desigualdades socioeconómicas, país de residencia o período de tiempo analizado. En conclusión, la enfermedad avanzada por VIH tiene un impacto negativo en la salud y el bienestar en las personas con VIH. Nuestros resultados muestran que, a pesar de todos los avances en los tratamientos antirretrovirales en los últimos 25 años, el EAS persiste como una fuente de extrema vulnerabilidad, independientemente de dónde vivan las personas con VIH.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature

Pasado y futuro de la infección por VIH. Un documento basado en la opinión de expertos

[EN] HIV infection is now almost 40 years old. In this time, along with the catastrophe and tragedy that it has entailed, it has also represented the capacity of modern society to take on a challenge of this magnitude and to transform an almost uniformly lethal disease into a chronic illness, compatible with a practically normal personal and relationship life. This anniversary seemed an ideal moment to pause and reflect on the future of HIV infection, the challenges that remain to be addressed and the prospects for the immediate future. This reflection has to go beyond merely technical approaches, by specialized professionals, to also address social and ethical aspects. For this reason, the Health Sciences Foundation convened a group of experts in different aspects of this disease to discuss a series of questions that seemed pertinent to all those present. Each question was presented by one of the participants and discussed by the group. The document we offer is the result of this reflection.[ES] La infección por VIH cumple ahora casi 40 años de existencia. En este tiempo, junto a la catástrofe y la tragedia que ha supuesto, ha representado también la capacidad de la sociedad moderna de asumir un reto de esta magnitud y de transformar, gracias al tratamiento antirretroviral, una enfermedad mayoritariamente letal en una enfermedad crónica, compatible con una vida personal y de relación prácticamente normales. Este aniversario parecía un momento idóneo para pararse a reflexionar sobre el futuro de la infección VIH, los retos que todavía quedan por abordar y las perspectivas para el inmediato futuro. Esa reflexión tiene que ir más allá de planteamientos meramente técnicos, de profesionales especializados, para abordar aspectos sociales y éticos. Por este motivo, la Fundación de Ciencias de la Salud convocó a un grupo de expertos en distintos aspectos de esta infección para discutir una serie de preguntas que parecieron pertinentes a todos los convocados. Cada pregunta era expuesta por uno de los participantes y discutida por el grupo. El documento que ofrecemos es el resultado de esa reflexión.For transparency purposes, we would like to inform you that GSK has contributed to the funding of this publicationPeer reviewe

Impact of Advanced HIV Disease on Quality of Life and Mortality in the Era of Combined Antiretroviral Treatment

Currently, AIDS or severe immunodeficiency remains as a challenge for people with HIV (PWHIV) and healthcare providers. Our purpose was to analyze the impact of advanced HIV disease (AHD) on mortality, life expectancy and health-related quality of life (HRQoL). We reviewed cohort studies and meta-analyses conducted in middle- and high-income countries. To analyze HRQoL, we selected studies that reported overall health and/or physical/mental health scores on a validated HRQoL instrument. AIDS diagnosis supposes a higher risk of mortality during the first six months, remaining higher for 48 months. It has been reported that cancer and cardiovascular disease persist as frequent causes of mortality in PWHIV, especially those with previous or current AHD. PWHIV who initiate combination antiretroviral therapy (cART) with CD4 < 200 cells/µL have significantly lower estimated life expectancy than those with higher counts. AHD is associated with lower HRQoL, and a worse physical health or mental health status. AIDS and non-AIDS defining events are significant predictors of a lower HRQoL, especially physical health status. AHD survivors are in risk of mortality and serious comorbidities, needing special clinical attention and preventive programs for associated comorbidities. Their specific needs should be reflected in HIV guidelines

Desarrollo de un nuevo cuestionario para medir las estrategias que las personas con VIH usan para afrontar el estigma y la discriminación

Este estudio tiene como objetivo elaborar un cuestionario para medir las estrategias que las personas con VIH usan para afrontar el estigma. Se partió para su desarrollo del modelo de Compas et al. (2001) sobre el estrés y su afrontamiento. Para ello, en primer lugar, y con la finalidad de obtener evidencias de validez de contenido, se realizó un estudio cualitativo. Este estudio, se realizaron 40 entrevistas en profundidad a personas con VIH para conocer que estrategias usaban estas personas para afrontar el estigma y la discriminación. A partir de las categorías halladas en el análisis del contenido de las entrevistas, se diseñaron los ítems de la escala. Se seleccionaron los más relevantes por un grupo de jueces expertos. En segundo lugar, se llevó a cabo un estudio cuantitativo de carácter correlacional ex post-facto en el que se realizó una primera aproximación a la estructura factorial del cuestionario. En este estudio participaron 557 personas con VIH. Los resultados de esta investigación han mostrado que las personas con VIH utilizan una variedad de estrategias de afrontamiento tanto de Control Primario, como Secundario y de Evitación. Conocerlas abre la puerta al diseño de intervenciones para capacitar a las personas con VIH para afrontar el estigma y la discriminación

Psicothema

Resumen tomado de la publicaciónDiscriminación percibida sutil y manifiesta y bienestar en personas lesbianas y gais en España: el papel del apoyo social. Antecedentes: la situación de las personas lesbianas y gais (LG) en España ha mejorado mucho en las últimas décadas. Sin embargo, el prejuicio y la discriminación todavía están presentes en la sociedad española. El presente estudio persigue tres objetivos principales: 1) analizar hasta qué punto las personas LG perciben la existencia de discriminación manifiesta y sutil; 2) explorar la relación existente entre la discriminación percibida y el bienestar psicológico y subjetivo de las personas LG; y 3) analizar el papel mediador que el apoyo social puede jugar a la hora de reducir la influencia negativa de la discriminación percibida en el bienestar. Método: la muestra incluía 237 mujeres lesbianas y 232 hombres gais. Resultados: los resultados muestran que la discriminación sutil percibida es mayor que la manifiesta y que además dicha discriminación sutil, comparada con la manifiesta, tiene efectos más negativos en el bienestar de las personas LG. Los resultados muestran que el apoyo social contribuye a aliviar los efectos negativos de la discriminación en el bienestar. Conclusiones: estos resultados son relevantes y pueden contribuir a diseñar intervenciones para mejorar el bienestar de las personas LG.Universidad de Oviedo. Biblioteca de Psicología; Plaza Feijoo, s/n.; 33003 Oviedo; Tel. +34985104146; Fax +34985104126; [email protected]

A Spanish Study on Psychological Predictors of Quality of Life in People with HIV

In Spain little research has focused on assessment of health indicators, both physical and psychological, in people living with HIV. The aim of this study is to evaluate a set of different indicators that allow us to identify psychological factors that may be influencing the quality of life of these people. The sample consist of 744 people infected with HIV aged between from 18 to 82 years (M = 43.04; SD = 9.43). Results show that factors such as self-esteem and leading a healthy lifestyle act as protectors in both, physical and mental health. On the other hand, financial problems, body disfigurement, and depressive mood could have harmful effects on both, physical and mental health. The structural model reveals depressed mood as the factor with greatest influence upon mental health, which in turn can be largely explained by factors such as the stress generated by HIV and personal autonomy. This work has allowed us to identify the vulnerability and protective factors that play a significant role in the physical and mental HRQOL of persons with HIV, providing guidelines for design and implementation of psychological intervention programs aimed to improve HRQOL in this population.En España son escasos los trabajos que evalúan los indicadores de salud, tanto física como psicológica, en las personas que viven con VIH. El objetivo del trabajo es valorar diferentes indicadores, que nos permitan conocer los factores psicológicos que influyen en la calidad de vida de las personas con VIH. Se contó con la participación de 744 personas con HIV con edades de entre 18 y 82 años (M = 43.04; DT = 9.43). Los resultados muestran que factores como la autoestima y el mantenimiento de hábitos de vida saludables actúan como protectores en la salud física y mental. Por otro lado, los problemas económicos, la desfiguración corporal y el ánimo depresivo podrían vulnerar ambos indicadores de salud. En el modelo estructural encontramos que el ánimo depresivo aparece como el factor que más peso tiene sobre la salud mental, muy influido a su vez por el estrés que genera el VIH y la autonomía personal. Este trabajo ha permitido identificar los factores de vulnerabilidad y protección que resultan relevantes para la CVRS física y mental de las personas con VIH, proporcionando directrices para el diseño y la ejecución de programas de intervención psicológica dirigidos a mejorar la CVRS de esta población.This research has been made possible thanks to funding from a FIPSE Spain (Fundación para la Investigación y Prevención del Sida en España , Project: 36-0743/09)

Field Psychometric Testing of the Instrument for Assessment of Psychological Predictors of Well-Being and Quality of Life in People with HIV or AIDS

The Screenphiv, a screening measure for psychological issues related to HIV, was psychometrically tested in a study involving 744 HIV-infected people in Spain. Participants ages 18–82 (M = 43.04, 72 % men, 28 % women) completed an assessment protocol that included the Screenphiv and the MOS-HIV. A trained interviewer also collected relevant illness-related clinical data and socio-demographics from the participants. A confirmatory factor analysis was used to evaluate the goodness of fit of the Screenphiv’s theoretical model and confirmed six first-order factors and two second-order factors [RMSEA (IC 90 %) = 0.07 (0.07–0.08)]. No floor or ceiling effects were observed for the scores. Cronbach’s alphas were acceptable for all of the factors (from 0.65 to 0.92). Criterion-related validity also achieved; Screenphiv scores were related to socio-demographic and clinical variables and MOS-HIV summary scores. The Screenphiv is a reliable and valid measure, ready to use in research and clinical settings in Spain.El Screenphiv, una herramienta de cribado de indicadores psicológicos relacionados al VIH, fue evaluado psicométricamente en un estudio con 744 personas con VIH en España. Los participantes con edades entre 18 y 82 años (M = 43.04, 72 % hombres, 28 % mujeres) completaron un protocolo de evaluación que incluía el Screenphiv y el MOS-HIV. Un investigador entrenado también recogió datos clínicos y sociodemográficos. El Análisis Factorial Confirmatorio permitió evaluar la bondad de ajuste de la estructura teórica del Screenphiv y confirmó la presencia de seis factores de primer orden y dos de segundo orden [RMSEA (IC90 %) = 0.07 (0.07-0.08)]. No se observaron efectos suelo o techo en las puntuaciones del cuestionario. El alfa de Cronbach fue aceptable para todos los factores (de 0.65 a 0.92). Evidencias de validez relacionadas a criterio fueron establecidas. Las puntuaciones del Screenphiv se relacionaron con variables sociodemográficas y clínicas y con las puntuaciones sumario del MOS-HIV. El Screenphiv es una medida fiable y con evidencias de validez, que está disponible para usar en investigaciones y entornos clínicos en España.This work has been supported by a grant from FIPSE (Fundación para la Investigación y Prevención del Sida en España, Grant 36-0743/09

Development of a New Instrument for the Assessment of Psychological predictors of well-being and quality of life in people with HIV or AIDS

This study aims to develop an instrument for the assessment of psychological predictors of well-being and quality of life (QoL) in people living with HIV. A four- step procedure was followed to achieve this objective. A literature review, focus group in different regions of Spain and content analysis generated a preliminary pool of 96 items. Interjudgement ratings over the items and a cogni- tive debriefing interview were performed to delete or review items (one omitted and 15 reviewed). The psy- chometric properties of the instrument were assessed in a sample of 84 HIV ? . Pilot testing allowed a new wave of depuration process by empirical criteria (30 items omitted). A final pool of 63 items covering 23 facets ( a from 0.53 to 0.95) of psychological predictors remained. Exploratory factorial analysis (GLS) assessing the underlying structure of the questionnaire showed a six-factor model explaining 56.5 of variance. Empirical exploratory structure revealed evidence of goodness of fit ( v 2 = 113.110, gl = 130, p [ 0.05; RMSEA = 0.017; RMSEA IC90 % 0.000– 0.057). This study presents the first instrument able to screen key psychological variables expected to be related to adjustment, well-being and QoL in people with HIV

Outcome of an HIV education program for primary care providers: Screening and late diagnosis rates

DRIVE 03, OPTtest WP5 and FOCO Study Groups.[Background] Late HIV diagnosis remains one of the challenges in combating the epidemic. Primary care providers play an important role in screening for HIV infection. Our study aims to evaluate the relationship between knowledge and barriers to HIV testing and screening outcomes. The impact of an education program for primary care providers, towards improving HIV testing and late diagnosis rates, is also assessed.[Methods] A self-administered questionnaire that was developed within the framework of the European project OptTEST was used to examine HIV knowledge and barriers to HIV testing scores before and after being involved in an HIV education program. A quasi-experimental design with pre- and post-intervention measures was performed to investigate its impact. We performed multivariable logistic regression analysis to assess the relationship between variables for the HIV testing offer.[Results] A total of 20 primary care centers and 454 primary care staff were included. Baseline OptTEST results showed that more knowledgeable staff offered an HIV test more frequently (OR 1.07; CI 95% 1.01–1.13; p = 0.027) and had lower barrier scores (OR 0.89; CI 95% 0.77–0.95; p = 0.005). Nurses had lower scores in knowledge-related items (OR 0.28; CI 95% 0.17–0.46; p<0.001), but higher scores in barrier-related items than physicians (OR 3.28; CI 95% 2.01–5.46; p<0.001). Specific centers with more knowledgeable staff members had a significant association with a greater level of new HIV diagnosis rates (OR 1.61; CI 95% 1.04–2.49; p = 0.032). After the intervention, we found that 12 out of 14 individual questions showed improved scores. In the 6 months after the training program, we similarly found a higher HIV testing rate (OR 1.19; CI 1.02–1.42; p = 0.036).[Conclusions] This study highlights the association between knowledge and barriers to HIV testing, including HIV testing rates. It shows that it is possible to modify knowledge and reduce perceived barriers through educational programs, subsequently improving HIV screening outcomes.This study was supported by two competitive Grants: GILEAD FELLOWSHIP 2015, 2016/0056 and the Ministerio de Sanidad, Seguridad Social e Igualdad Projects codes: PI16/00551; EC11-144, co-financed by the European Development Regional Fund ‘‘A way to achieve Europe’’ (ERDF) and partially funded by the RD12/0017/0017 project as part of the Plan Nacional R + D + I and cofinanced by ISCIII- Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER), and also partially supported by unrestrictional grants from Janssen Cilag supporting FOCO project developed by the Spanish AIDS Interdisciplinary Society (SEISIDA), VIIF and Gilead supporting DRIVE 01, 02 and DRIVE 03 through IRYCIS.Peer reviewe