Social inequality impacts upon mental health, with the less educated more likely to have psychological problems but less likely to seek treatment

Mental health is a key policy issue across Europe. Lucia Fiestas Navarrete, Mahlet Atakilt Woldetsadik and Antoine Flahault take a comprehensive look at the roles education and gender play in mental health problems in 15 European countries. They note that individuals with lower levels of education are more likely to experience psychological problems, but are also less likely to seek treatment by consulting a psychologist or taking medication. The fact that education may function as a proxy for socio-economic status suggests that socially determined inequalities have an impact on mental health outcomes

Stigma gets in my way: Factors affecting client-provider communication regarding child bearing among people living with HIV in Uganda

The study explored client-provider communication about childbearing and safer conception among HIV clients in Uganda.Introduction Many HIV-affected couples living in sub-Saharan Africa desire to have children, but few quantitative studies have examined support for their childbearing needs. Our study explored client-provider communication about childbearing and safer conception among HIV clients in Uganda. Methods 400 Ugandan HIV clients in committed relationships and with intentions to conceive were surveyed. Knowledge, attitudes and practices related to childbearing, and use of safer conception methods were assessed, including communication with providers about childbearing needs, the correlates of which were examined with bivariate statistics and logistic multivariate analysis. Results 75% of the sample was female; 61% were on antiretroviral therapy; and 61% had HIV-negative or unknown status partners. Nearly all (98%) reported the desire to discuss childbearing intentions with their HIV provider; however, only 44% reported such discussions, the minority (28%) of which was initiated by the provider. Issues discussed with HIV providers included: HIV transmission risk to partner (30%), HIV transmission risk to child (30%), and how to prevent transmission to the child (27%); only 8% discussed safer conception methods. Regression analysis showed that those who had communicated with providers about childbearing were more likely to have been diagnosed with HIV for a longer period [OR (95% CI) = 1.09 (1.03, 1.15)], while greater internalized childbearing stigma was associated with lower odds of this communication [OR (95% CI) = 0.70 (0.49, 0.99)], after controlling for all bivariate correlates and basic demographics. Conclusions Communication between HIV clients and providers about childbearing needs is poor and associated with stigma. Innovations to mitigate stigma among clients as well as training to improve health worker communication and skills related to safer conception counseling is needed

Logistic regression of correlates of having discussed childbearing intentions with HIV provider(s).

<p>Logistic regression of correlates of having discussed childbearing intentions with HIV provider(s).</p

Correlates of communication with HIV provider(s) about childbearing intentions.

<p>Correlates of communication with HIV provider(s) about childbearing intentions.</p