HIV-infected individuals with high coping self-efficacy are less likely to report depressive symptoms: a cross-sectional study from Denmark.

ObjectivesHaving effective ways to cope helps HIV-infected individuals maintain good psychological and physical well-being. This study investigated the relationship between coping self-efficacy levels, as determined by the Coping Self-Efficacy Scale (CSE), HIV status disclosure, and depression in a Danish cohort.MethodsIn 2008, the CSE was administered to 304 HIV-infected individuals to measure their confidence in their ability to cope with HIV infection. HIV status disclosure was assessed on a three-point scale: living openly with the disease, partly openly, or secretly. The Beck Depression Inventory (BDI) was used to assess depression prevalence and severity.ResultsThe CSE score was significantly related to depression (Spearman's rho = -0.71; the test of H0: BDI and coping, probability >t=0.0001). There was a significant relationship between higher CSE scores and living openly with HIV. The risk of depression was four times higher in HIV-infected individuals who did not disclose their HIV status (i.e. who lived 'secretly'; odds ratio = 4.1) than in individuals who lived openly.ConclusionThose with low CSE scores were more likely to report living secretly with HIV and to be depressed. Disclosing HIV may constitute a social stressor, and a lack of coping self-efficacy may increase the likelihood of non-disclosure and depression. Interventions that enhance self-efficacy may help in managing the demands of daily life with HIV, increase disclosure, and reduce depression

HIV-infected individuals with high coping self-efficacy are less likely to report depressive symptoms: a cross-sectional study from Denmark.

ObjectivesHaving effective ways to cope helps HIV-infected individuals maintain good psychological and physical well-being. This study investigated the relationship between coping self-efficacy levels, as determined by the Coping Self-Efficacy Scale (CSE), HIV status disclosure, and depression in a Danish cohort.MethodsIn 2008, the CSE was administered to 304 HIV-infected individuals to measure their confidence in their ability to cope with HIV infection. HIV status disclosure was assessed on a three-point scale: living openly with the disease, partly openly, or secretly. The Beck Depression Inventory (BDI) was used to assess depression prevalence and severity.ResultsThe CSE score was significantly related to depression (Spearman's rho = -0.71; the test of H0: BDI and coping, probability >t=0.0001). There was a significant relationship between higher CSE scores and living openly with HIV. The risk of depression was four times higher in HIV-infected individuals who did not disclose their HIV status (i.e. who lived 'secretly'; odds ratio = 4.1) than in individuals who lived openly.ConclusionThose with low CSE scores were more likely to report living secretly with HIV and to be depressed. Disclosing HIV may constitute a social stressor, and a lack of coping self-efficacy may increase the likelihood of non-disclosure and depression. Interventions that enhance self-efficacy may help in managing the demands of daily life with HIV, increase disclosure, and reduce depression

The Impact of a Holistic Intervention on Self-Efficacy and Risk of Depression in HIV-Infected Individuals in Denmark

Introduction: Human immunodeficiency virus (HIV) infection is a stressful disease,and depression is frequently experienced by HIV-infected individuals. The aim of this pilot study was to investigate whether a holistic intervention could improve coping self-efficacy strategies and have a positive impact on the mental health of HIV-infected individuals 12 months posterior to the intervention.Method: From January 2010–January 2011, a total of 30 HIV-infected individuals at the Department of Infectious Diseases at Aarhus University Hospital, Denmark were included in the study. The intervention was a group intervention and was facilitated by an educated coach. It was organized as a three day residential course as well as 6 single day follows up events spread out over 6 months.The main outcome measures were coping self-efficacy (self-efficacy as defined as the belief in one’s ability to perform a specific behavior) and depression. The intervention was evaluated 12 months after the end of the intervention.Results: Twenty individuals completed the intervention. Coping self-efficacy and psychological health improved overall, and there was a significant decrease in depression (p=0·0017). The qualitative interview results supported the questionnaire results,displaying changes in bodily sensation, in awareness, in understanding and insight, in behaviour and in actions as well as the development of new competences. The individuals felt more in balance (e.g. emotional stability), and this feeling of being more competent in terms of managing the disease was maintained at the 12-month follow-up.Conclusion: These results will be useful for developing effective interventions that help individuals manage the acute and chronic stress of living with HIV and increase coping self-efficacy, thereby preventing depression. These results merit further investigation in a randomized controlled trial.</p

Perceptions of quality of life among Ugandan patients living with HIV: a qualitative study.

BACKGROUND: Ugandans have endured the HIV epidemic for three decades. Now, with the availability of antiretroviral therapy (ART) and early diagnosis, those living with HIV can live longer and can enjoy the same life expectancy as the rest of the Ugandan population. This emerging trend necessitates the assessment of quality of life, alongside other patient outcomes, of those undergoing therapy, alongside other patient outcomes. While major strides have been made in developing measures of quality of life in the developed world, there remains a paucity of evidence from resource-limited settings. This challenge is further complicated by the contentious definition of quality of life, which is highly subjective and varies between individuals. In this paper, we aim to identify the determinants of quality of life for people living with HIV in a Ugandan context to contribute to the chronic care model for persons living with HIV/AIDS. METHODS: Twenty HIV-positive participants took part in in-depth interviews at an urban clinic, with follow-ups at three and six months. Ten patients were on ART and ten not on ART. All interviews were transcribed and translated for analysis. Data were analysed manually using the framework approach to content analysis. RESULTS: Individuals reported on four aspects of quality of life: liveability of the environment, utility of life, life ability of a person and appreciation of life. Respondents described multiple expectations and expressed hope for their future. However, many still suffered from stigma, fears of disclosure and poverty, which negatively affected their quality of life. CONCLUSIONS: Individuals living with HIV receiving treatment or in care experienced an improved quality of life in this setting, although the situation for many remains precarious

‘Everyone has a secret they keep close to their hearts’: challenges faced by adolescents living with HIV infection at the Kenyan coast

Abstract: Background: The upsurge in the uptake of antiretroviral therapy (ART) has led to a significant increase in the survival of vertically acquired HIV infected children, many of whom are currently living into adolescence and early adulthood. However little if anything is known of the lived experiences and the challenges faced by HIV positive adolescents in the African context. We set out to investigate psychosocial challenges faced by HIV infected adolescents on the Kenyan coast. Methods: A total of 44 participants (12 HIV-infected adolescents, 7 HIV uninfected adolescents, and 25 key informants) took part in this qualitative study, using individually administered in-depth interviews. A framework approach was used to analyze the data using NVIVO software. Results: We observed that the challenges faced by adolescents in rural Kenya could be placed into six major themes: poverty, poor mental and physical health, the lack of a school system that is responsive to their needs, challenges in how to disclose to peers and family members, high levels of stigma in its various forms, and challenges of medical adherence leading to the need for close monitoring. Conclusion: In this African community, vertically acquired HIV-infected adolescents face a complex set of social, economic and medical challenges. Our study points to the urgent need to develop multisectorial intervention support programmes to fully address these challenges

HIV/AIDS, Obesity and stigma: a new era for non-discrimination law?

This aim of this paper was to explore commonalities between HIV/AIDS related conditions, obesity and other disabling impairments as health-related barriers that limit opportunity and advancement in society and the workplace. Taking a number of examples from original fieldwork and European Union and United Kingdom law, we posit that ‘disability discrimination’ under European Union law remains an indefinite, imprecise and incomplete area that requires greater alignment with the social model of disability. The principle attributes of societal discrimination towards people living with HIV and obese people are that these conditions are perceived to be primarily or in some instances, solely caused by controllable factors related often to behaviours and lifestyle choices. Strong beliefs that these conditions are controllable, is perceived as a justification and in some instances encouragement for the creation of stigma and discriminative behaviours that are unjust and uninformed. The structure of the paper is as follows. First, this paper postulates how and why stigma exists towards both individuals with disabilities and also obese individuals and people living with HIV; second, reviews the legal framework on disability discrimination in both United Kingdom and European Union courts that are directly relevant to the concepts of obesity and HIV-AIDS; third, presents critical thoughts as to the extent to which emerging decisions of the Court of Justice of the European Union concerning obesity and HIV-AIDS accord with the social model of disability; and fourth, offers an analysis of the implications of the United Kingdom and European framework and suggests possible interventions in this area