Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
AIDS and Behavior
Published in: AIDS and Behavior 5/2018

01-05-2018 | Original Paper

Depressive Symptoms, Disclosure, HIV-Related Stigma, and Coping Following HIV Testing Among Outpatients in Uganda: A Daily Process Analysis

Authors: Susan M. Kiene, Meredith Dove, Rhoda K. Wanyenze

Published in: AIDS and Behavior | Issue 5/2018

Login to get access

Abstract

As efforts to end the HIV epidemic accelerate there is emphasis on reaching those living with undiagnosed HIV infection. Newly diagnosed individuals face a number of psychosocial challenges, yet we know little about depressive symptoms in the weeks immediately following diagnosis and how disclosure, coping, and other factors may affect short and longer-term depressive symptoms. Purposively sampled Ugandan outpatients completed structured interviews immediately prior to testing for HIV, daily for 28 days after receiving their test results, and at 3 and 6 months post-test. The sample included a total of 244 participants: 20 who tested HIV positive at baseline and who provided 342 daily data points, and 224 who tested HIV negative at baseline and who provided 4388 daily data points. We used linear mixed effects modeling to examine changes in depressive symptom scores over the 28 day daily interview period and predictors of depressive symptom scores and changes over time. Results from the mixed modeling revealed that while those diagnosed with HIV showed initially high depressive symptoms following diagnosis, their symptoms decreased significantly and on average fell below the cutoff for possible depression approximately 15 days after diagnosis. Among those who tested HIV-negative, on average their depressive symptoms were below the cutoff for possible depression and did not change over time. Among those diagnosed with HIV, disclosure, especially to a partner, on a particular day was associated with higher depressive symptoms that day. However, those who disclosed to their partner during the 28 days after diagnosis had significantly lower depression scores by the end of the 28 days as well as lower depression scores 3 and 6 months after diagnosis than did those who did not disclose to their partner during the 28 days after diagnosis. Scoring higher on HIV-related stigma on a particular day was associated with higher depressive symptoms that day and engaging in positive coping on a particular day was associated with lower depressive symptoms that day. Positive coping also accelerated the decrease in depressive symptoms over time. These data underscore the importance of timely disclosure to partners and suggest that regular depression screening after diagnosis and provision of mental health services could improve HIV care engagement and treatment outcomes.
Literature
1.
2.
Cholera R, Pence BW, Gaynes BN, Bassett J, Qangule N, Pettifor A, et al. Depression and engagement in care among newly diagnosed HIV-infected adults in Johannesburg, South Africa. AIDS Behav. 2016.
3.
Ramirez-Avila L, Regan S, Giddy J, Chetty S, Ross D, Katz JN, et al. Depressive symptoms and their impact on health-seeking behaviors in newly-diagnosed HIV-infected patients in Durban, South Africa. AIDS Behav. 2012;16(8):2226–35.PubMedPubMedCentralCrossRef
4.
Simms V, Gikaara N, Munene G, Atieno M, Kataike J, Nsubuga C, et al. Multidimensional patient-reported problems within two weeks of HIV diagnosis in East Africa: a multicentre observational study. PLoS ONE. 2013;8(2):e57203.PubMedPubMedCentralCrossRef
5.
Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725–30.PubMedCrossRef
6.
Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.PubMedCrossRef
7.
Collins PY, Holman AR, Freeman MC, Patel V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS. 2006;20(12):1571–82.PubMedPubMedCentralCrossRef
8.
Seth P, Kidder D, Pals S, Parent J, Mbatia R, Chesang K, et al. Psychosocial functioning and depressive symptoms among HIV-positive persons receiving care and treatment in Kenya, Namibia, and Tanzania. Prev Sci. 2014;15(3):318–28.PubMedPubMedCentralCrossRef
9.
Tesfaw G, Ayano G, Awoke T, Assefa D, Birhanu Z, Miheretie G, et al. Prevalence and correlates of depression and anxiety among patients with HIV on-follow up at Alert Hospital, Addis Ababa, Ethiopia. BMC Psychiatry. 2016;16(1):368.PubMedPubMedCentralCrossRef
10.
Mast TC, Kigozi G, Wabwire-Mangen F, Black R, Sewankambo N, Serwadda D, et al. Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district, Uganda. AIDS Care. 2004;16(1):81–94.PubMedCrossRef
11.
12.
Williams P, Narciso L, Browne G, Roberts J, Weir R, Gafni A. The prevalence, correlates, and costs of depression in people living with HIV/AIDS in Ontario: implications for service directions. AIDS Educ Prev. 2005;17(2):119–30.PubMedCrossRef
13.
Negash T, Ehlers V. Personal factors influencing patients’ adherence to ART in Addis Ababa, Ethiopia. J Assoc Nurses AIDS Care. 2013;24(6):530–8.PubMedCrossRef
14.
Cook JA, Grey D, Burke J, Cohen MH, Gurtman AC, Richardson JL, et al. Depressive symptoms and AIDS-related mortality among a multisite cohort of HIV-positive women. Am J Public Health. 2004;94(7):1133–40.PubMedPubMedCentralCrossRef
15.
Wagner GJ, Ghosh-Dastidar B, Robinson E, Ngo VK, Glick P, Mukasa B, et al. Effects of depression alleviation on ART adherence and HIV clinic attendance in Uganda, and the mediating roles of self-efficacy and motivation. AIDS Behav. 2016.
16.
17.
Fagan JL, Beer L, Garland P, Valverde E, Courogen M, Hillman D, et al. The influence of perceptions of HIV infection, care, and identity on care entry. AIDS Care. 2012;24(6):737–43.PubMedCrossRef
18.
Kalichman SC, DiMarco M, Austin J, Luke W, DiFonzo K. Stress, social support, and HIV-status disclosure to family and friends among HIV-positive men and women. J Behav Med. 2003;26(4):315–32.PubMedCrossRef
19.
King R, Katuntu D, Lifshay J, Packel L, Batamwita R, Nakayiwa S, et al. Processes and outcomes of HIV serostatus disclosure to sexual partners among people living with HIV in Uganda. AIDS Behav. 2008;12(2):232–43.PubMedCrossRef
20.
Medley AM, Kennedy CE, Lunyolo S, Sweat MD. Disclosure outcomes, coping strategies, and life changes among women living with HIV in Uganda. Qual Health Res. 2009;19(12):1744–54.PubMedCrossRef
21.
Tsai AC, Bangsberg DR, Kegeles SM, Katz IT, Haberer JE, Muzoora C, et al. Internalized stigma, social distance, and disclosure of HIV seropositivity in rural Uganda. Ann Behav Med. 2013;46(3):285–94.PubMedCrossRef
22.
Medley A, Garcia-Moreno C, McGill S, Maman S. Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull World Health Organ. 2004;82(4):299–307.PubMedPubMedCentral
23.
24.
Logie C, Gadalla TM. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009;21(6):742–53.PubMedCrossRef
25.
Amuyunzu-Nyamongo M, Okeng’o L, Wagura A, Mwenzwa E. Putting on a brave face: the experiences of women living with HIV and AIDS in informal settlements of Nairobi, Kenya. AIDS Care. 2007;19(Suppl 1):S25–34.PubMedCrossRef
26.
Simbayi LC, Kalichman S, Strebel A, Cloete A, Henda N, Mqeketo A. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Soc Sci Med. 2007;64(9):1823–31.PubMedPubMedCentralCrossRef
27.
Stevens PE, Hildebrandt E. Life changing words: women’s responses to being diagnosed with HIV infection. Adv Nurs Sci. 2006;29(3):207–21.CrossRef
28.
Varni SE, Miller CT, McCuin T, Solomon SE. Disengagement and engagement coping with HIV/AIDS stigma and psychological well-being of people with HIV/AIDS. J Soc Clin Psychol. 2012;31(2):123–50.PubMedPubMedCentralCrossRef
29.
Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav. 2006;10(5):473–82.PubMedPubMedCentralCrossRef
30.
31.
Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med. 2003;57(1):13–24.PubMedCrossRef
32.
Gonzalez A, Zvolensky MJ, Solomon SE, Miller CT. Exploration of the relevance of anxiety sensitivity among adults living with HIV/AIDS for understanding anxiety vulnerability. J Health Psychol. 2010;15(1):138–46.PubMedPubMedCentralCrossRef
33.
Heckman BD, Catz SL, Heckman TG, Miller JG, Kalichman SC. Adherence to antiretroviral therapy in rural persons living with HIV disease in the United States. AIDS Care. 2004;16(2):219–30.PubMedCrossRef
34.
Turner-Cobb JM, Gore-Felton C, Marouf F, Koopman C, Kim P, Israelski D, et al. Coping, social support, and attachment style as psychosocial correlates of adjustment in men and women with HIV/AIDS. J Behav Med. 2002;25(4):337–53.PubMedCrossRef
35.
Pakenham KI, Rinaldis M. The role of illness, resources, appraisal, and coping strategies in adjustment to HIV/AIDS: the direct and buffering effects. J Behav Med. 2001;24(3):259–79.PubMedCrossRef
36.
Gable SL, Reis HT, Elliot AJ. Behavioral activation and inhibition in everyday life. J Pers Soc Psychol. 2000;78(6):1135–49.PubMedCrossRef
37.
Pemberton R, Fuller Tyszkiewicz MD. Factors contributing to depressive mood states in everyday life: a systematic review. J Affect Disord. 2016;200:103–10.PubMedCrossRef
38.
Tennen H, Affleck G, Armeli S, Carney MA. A daily process approach to coping. Linking theory, research, and practice. Am Psychol. 2000;55(6):626–36.PubMedCrossRef
39.
Tennen H, Hall JA, Affleck G. Depression research methodologies in the Journal of Personality and Social Psychology: a review and critique. J Pers Soc Psychol. 1995;68(5):870–84 (discussion 85–91).PubMedCrossRef
40.
Kiene SM, Bateganya MH, Lule H, Wanyenze RK. The effect of motivational interviewing-based counseling during outpatient provider initiated HIV testing on high-risk sexual behavior in rural Uganda. AIDS Behav. 2016;20(9):1928–36.PubMedPubMedCentralCrossRef
41.
Uganda Ministry of Health (MOH). Routine HIV testing and counseling manual. Kampala: MOH; 2006.
42.
Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19(1):1–15.PubMedCrossRef
43.
Kaaya SF, Fawzi MC, Mbwambo JK, Lee B, Msamanga GI, Fawzi W. Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatr Scand. 2002;106(1):9–19.PubMedCrossRef
44.
Tsai AC, Weiser SD, Steward WT, Mukiibi NF, Kawuma A, Kembabazi A, et al. Evidence for the reliability and validity of the internalized AIDS-related stigma scale in rural Uganda. AIDS Behav. 2013;17(1):427–33.PubMedPubMedCentralCrossRef
45.
Tsai AC, Bangsberg DR, Frongillo EA, Hunt PW, Muzoora C, Martin JN, et al. Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc Sci Med. 2012;74(12):2012–9.PubMedPubMedCentralCrossRef
46.
47.
Hinton WL, Du N, Chen YC, Tran CG, Newman TB, Lu FG. Screening for major depression in Vietnamese refugees: a validation and comparison of two instruments in a health screening population. J Gen Intern Med. 1994;9(4):202–6.PubMedCrossRef
48.
Winokur A, Winokur DF, Rickels K, Cox DS. Symptoms of emotional distress in a family planning service: stability over a four-week period. Br J Psychiatry. 1984;144:395–9.PubMedCrossRef
49.
Lee B, Kaaya SF, Mbwambo JK, Smith-Fawzi MC, Leshabari MT. Detecting depressive disorder with the Hopkins Symptom Checklist-25 in Tanzania. Int J Soc Psychiatry. 2008;54(1):7–20.PubMedCrossRef
50.
Kalichman SC, Simbayi LC. HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sex Transm Infect. 2003;79(6):442–7.PubMedPubMedCentralCrossRef
51.
Kalichman SC, Simbayi LC, Jooste S, Toefy Y, Cain D, Cherry C, et al. Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS Behav. 2005;9(2):135–43.PubMedCrossRef
52.
Barta WD, Tennen H, Kiene SM. Alcohol-involved sexual risk behavior among heavy drinkers living with HIV/AIDS: negative affect, self-efficacy, and sexual craving. Psychol Addict Behav. 2010;24(4):563–70.PubMedPubMedCentralCrossRef
53.
Barta WD, Kurth ME, Stein MD, Tennen H, Kiene SM. Craving and self-efficacy in the first five weeks of methadone maintenance therapy: a daily process study. J Stud Alcohol Drugs. 2009;70(5):735–40.PubMedCrossRef
54.
Barta WD, Kiene SM, Tennen H, Abu-Hasaballah KS, Ferrer R. The idiographic study of inconsistent condom use behavior of persons living with HIV. AIDS Care. 2007;19(8):1058–64.PubMedCrossRef
55.
Kiene SM, Simbayi LC, Abrams A, Cloete A, Tennen H, Fisher JD. High rates of unprotected sex occurring among HIV-positive individuals in a daily diary study in South Africa: the role of alcohol use. J Acquir Immune Defic Syndr. 2008;49(2):219–26.PubMedPubMedCentralCrossRef
56.
Sileo KM, Simbayi LC, Abrams A, Cloete A, Kiene SM. The role of alcohol use in antiretroviral adherence among individuals living with HIV in South Africa: event-level findings from a daily diary study. Drug Alcohol Depend. 2016;167:103–11.PubMedPubMedCentralCrossRef
57.
Kiene SM, Barta WD, Tennen H, Armeli S. Alcohol, helping young adults to have unprotected sex with casual partners: findings from a daily diary study of alcohol use and sexual behavior. J Adolesc Health. 2009;44(1):73–80.PubMedCrossRef
58.
Barta WD, Portnoy DB, Kiene SM, Tennen H, Abu-Hasaballah KS, Ferrer R. A daily process investigation of alcohol-involved sexual risk behavior among economically disadvantaged problem drinkers living with HIV/AIDS. AIDS Behav. 2008;12(5):729–40.PubMedCrossRef
59.
Kiene SM, Simbayi LC, Abrams A, Cloete A. Alcohol expectancies and inhibition conflict as moderators of the alcohol-unprotected sex relationship: event-level findings from a daily diary study among individuals living with HIV in Cape Town, South Africa. AIDS Behav. 2016;20(Suppl 1):S60–73.PubMedCrossRef
60.
Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24:518–29.PubMedCrossRef
61.
Kalichman SC, Simbayi LC, Cloete A, Mthembu PP, Mkhonta RN, Ginindza T. Measuring AIDS stigmas in people living with HIV/AIDS: the internalized AIDS-related stigma scale. AIDS Care. 2009;21(1):87–93.PubMedCrossRef
62.
Fleishman JA, Fogel B. Coping and depressive symptoms among people with AIDS. Health Psychol. 1994;13:156–69.PubMedCrossRef
63.
64.
Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17(5):1785–95.PubMedPubMedCentralCrossRef
65.
Martell CR, Addis ME, Jacobson NS. Depression in context: strategies for guided action. New York: W. W. Norton & Co; 2001.
66.
Jacobson NS, Martell C, Dimidjian S. Behavioral activation treatment for depression: returning to contextual roots. Clin Psychol. 2001;8(3):255–70.
67.
Cook SH, Valera P, Wilson PA. HIV status disclosure, depressive symptoms, and sexual risk behavior among HIV-positive young men who have sex with men. J Behav Med. 2015;38(3):507–17.PubMedPubMedCentralCrossRef
68.
69.
Ostermann J, Pence B, Whetten K, Yao J, Itemba D, Maro V, et al. HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania. AIDS Care. 2015;27(Suppl 1):59–64.PubMedPubMedCentralCrossRef
70.
Nachega JB, Mutamba B, Basangwa D, Nguyen H, Dowdy DW, Mills EJ, et al. Severe mental illness at ART initiation is associated with worse retention in care among HIV-infected Ugandan adults. Trop Med Int Health. 2013;18(1):53–7.PubMedCrossRef
71.
Greenberg MA, Stone AA. Emotional disclosure about traumas and its relation to health: effects of previous disclosure and trauma severity. J Pers Soc Psychol. 1992;63(1):75–84.PubMedCrossRef
72.
Pennebaker JW, Beall SK. Confronting a traumatic event: toward an understanding of inhibition and disease. J Abnorm Psychol. 1986;95(3):274–81.PubMedCrossRef
73.
Petrie KJ, Booth RJ, Pennebaker JW, Davison KP, Thomas MG. Disclosure of trauma and immune response to a hepatitis B vaccination program. J Consult Clin Psychol. 1995;63(5):787–92.PubMedCrossRef
74.
Maman S, Mbwambo JK, Hogan NM, Weiss E, Kilonzo GP, Sweat MD. High rates and positive outcomes of HIV-serostatus disclosure to sexual partners: reasons for cautious optimism from a voluntary counseling and testing clinic in Dar es Salaam, Tanzania. AIDS Behav. 2003;7(4):373–82.PubMedCrossRef
75.
Kelley JE, Lumley MA, Leisen JC. Health effects of emotional disclosure in rheumatoid arthritis patients. Health Psychol. 1997;16(4):331–40.PubMedCrossRef
76.
Houben M, Van Den Noortgate W, Kuppens P. The relation between short-term emotion dynamics and psychological well-being: a meta-analysis. Psychol Bull. 2015;141(4):901–30.PubMedCrossRef
77.
Thompson RJ, Berenbaum H, Bredemeier K. Cross-sectional and longitudinal relations between affective instability and depression. J Affect Disord. 2011;130(1–2):53–9.PubMedCrossRef
78.
Patel V, Todd C, Winston M, Gwanzura F, Simunyu E, Acuda W, et al. Common mental disorders in primary care in Harare, Zimbabwe: associations and risk factors. Br J Psychiatry. 1997;171:60–4.PubMedCrossRef
79.
Gupta R, Dandu M, Packel L, Rutherford G, Leiter K, Phaladze N, et al. Depression and HIV in Botswana: a population-based study on gender-specific socioeconomic and behavioral correlates. PLoS ONE. 2010;5(12):e14252.PubMedPubMedCentralCrossRef
80.
Leserman J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008;70(5):539–45.PubMedCrossRef
Metadata
Title
Depressive Symptoms, Disclosure, HIV-Related Stigma, and Coping Following HIV Testing Among Outpatients in Uganda: A Daily Process Analysis
Authors
Susan M. Kiene
Meredith Dove
Rhoda K. Wanyenze
Publication date
01-05-2018
Publisher
Springer US
Published in
AIDS and Behavior / Issue 5/2018
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-017-1953-9

Other articles of this Issue 5/2018

AIDS and Behavior 5/2018 Go to the issue

Original Paper

Loneliness in Older Adults Living with HIV

Original Paper

Sexual Stigma Patterns Among Nigerian Men Who Have Sex with Men and Their Link to HIV and Sexually Transmitted Infection Prevalence

Original Paper

Disclosure and Stigma of a Positive HIV-Serostatus: A Two-Step Cluster Analysis of the HIV Disclosure Scale

Original Paper

Patient-Initiated Repackaging of Antiretroviral Therapy, Viral Suppression and Drug Resistance

Original Paper

Positive and Negative Self-Conscious Emotion and Transmission Risk Following HIV Diagnosis

Original Paper

Reliability, Validity, and Factor Structure of the Hopkins Symptom Checklist-25: Population-Based Study of Persons Living with HIV in Rural Uganda

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24 to hear Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits