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BMC Public Health
Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India – a community based cross sectional study

Authors: Bimal Charles, Lakshmanan Jeyaseelan, Arvind Kumar Pandian, Asirvatham Edwin Sam, Mani Thenmozhi, Visalakshi Jayaseelan

Published in: BMC Public Health | Issue 1/2012

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Abstract

Background

India has around 2.27 million adults living with HIV/AIDS who face several challenges in the medical management of their disease. Stigma, discrimination and psychosocial issues are prevalent. The objective of the study was to determine the prevalence of severe stigma and to study the association between this, depression and the quality of life (QOL) of people living with HIV/AIDS (PLHA) in Tamil Nadu.

Methods

This was a community based cross sectional study carried out in seven districts of Tamil Nadu, India, among 400 PLHA in the year 2009. The following scales were used for stigma, depression and quality of life, Berger scale, Major Depression Inventory (MDI) scale and the WHO BREF scale. Both Stigma and QOL were classified as none, moderate or severe/poor based on the tertile cut off values of the scale scores. Depression was classified as none, mild, moderate and severe. Logistic regression analyses were performed to study the risk factors.

Results

Twenty seven per cent of PLHA had experienced severe forms of stigma. These were severe forms of personalized stigma (28.8%), negative self-image (30.3%), perceived public attitude (18.2%) and disclosure concerns (26%). PLHA experiencing severe depression were 12% and those experiencing poor quality of life were 34%. Poor QOL reported in the physical, psychological, social and environmental domains was 42.5%, 40%, 51.2% and 34% respectively. PLHA who had severe personalized stigma and negative self-image had 3.4 (1.6-7.0) and 2.1 (1.0-4.1) times higher risk of severe depression respectively (p < .001). PLHA who had severe depression had experienced 2.7(1.1-7.7) times significantly poorer QOL.

Conclusions

Severe forms of stigma were equivalently prevalent among all the categories of PLHA. However, PLHA who had experienced severe depression had only developed poor QOL. A high level of social support was associated with a high level of QOL.
Literature
1.
2.
Herek GM: Thinking about AIDS and stigma: A psychologist’s perspective. J Law Med Ethics. 2002, 30: 594-607. 10.1111/j.1748-720X.2002.tb00428.x.CrossRefPubMed
3.
Priya R, Sathyamala C: Contextualising AIDS and human development: Long-term illness and death among adults in labouring low-caste groups in India. AIDS Care. 2007, 19 (Suppl 1): S35-S43.CrossRefPubMed
4.
Steward WT, Herek GM, Ramakrishna J, Bharat S, Chandy S, Wrubel J, Ekstrand ML: HIV-related stigma: Adapting a theoretical framework for use in India. Soc Sci Med. 2008, 67: 1225-1235. 10.1016/j.socscimed.2008.05.032.CrossRefPubMedPubMedCentral
5.
Subramanian , Gupte M, Dorairaj V, Periannan V, Mathai A: Psycho-social impact and quality of life of people living with HIV/AIDS in South India. AIDS Care. 2009, 21: 473-481. 10.1080/09540120802283469.CrossRefPubMed
6.
Thomas B, Rehman F, Suryanarayanan D, Josephine K, Dilip M, Dorairaj V, Swaminathan S: How stigmatizing is stigma in the life of people living with HIV: a study on HIV positive individuals from Chennai, South India. AIDS Care. 2005, 17: 795-801. 10.1080/09540120500099936.CrossRefPubMed
7.
8.
Stevelink SAM, Van Brakel WH, Augustine V: Stigma and social participation in Southern India: differences and commonalities among persons affected by leprosy and persons living with HIV/AIDS. Psychol Health Med. 2011, 16: 695-707. 10.1080/13548506.2011.555945.CrossRefPubMed
9.
10.
Pallikadavath S, Garda L, Apte H, Freedman J, WILLIAM S: HIV/AIDS in rural India: context and health care needs. J Biosoc Sci. 2005, 37: 641-655.CrossRefPubMed
11.
Mahendra VS, Gilborn L, Bharat S, Mudoi R, Gupta I, George B, Samson L, Daly C, Pulerwitz J: Understanding and measuring AIDS-related stigma in health care settings: a developing country perspective. SAHARA J. 2007, 4: 616-625.CrossRefPubMed
12.
Steward WT, Bharat S, Ramakrishna J, Heylen E, Ekstrand ML: Stigma Is Associated with Delays in Seeking Care Among HIV-Infected People in India. Journal of the International Association of Physicians in AIDS Care (JIAPAC). 2012, 10.1177/1545109711432315. Published Online First
13.
Maman S, Abler L, Parker L, Lane T, Chirowodza A, Ntogwisangu J, Srirak N, Modiba P, Murima O, Fritz K: A comparison of HIV stigma and discrimination in five international sites: The influence of care and treatment resources in high prevalence settings. Soc Sci Med. 2009, 68: 2271-2278. 10.1016/j.socscimed.2009.04.002.CrossRefPubMedPubMedCentral
14.
Chandra P, Deepthivarma S, Manjula V: Disclosure of HIV infection in South India: patterns, reasons and reactions. AIDS Care. 2003, 15: 207-216. 10.1080/0954012031000068353.CrossRefPubMed
15.
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: 1823-1831. 10.1016/j.socscimed.2007.01.006.CrossRefPubMedPubMedCentral
16.
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: 473-482. 10.1007/s10461-006-9099-1.CrossRefPubMedPubMedCentral
17.
Wingood GM, Diclemente RJ, Mikhail I, McCree DH, Davies SL, Hardin JW, Harris Peterson S, Hook EW, Saag M: HIV discrimination and the health of women living with HIV. Women Health. 2007, 46: 99-112.CrossRefPubMed
18.
Ekstrand M, Garbus L, Marseille E: Country AIDS Policy Analysis Project. UCSF. 2003, AIDS Policy Research Center, University of California, San Francisco
19.
Kumarasamy N, Safren SA, Raminani SR, Pickard R, James R, Krishnan AKS, Solomon S, Mayer KH: Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: a qualitative study. AIDS Patient Care STDS. 2005, 19: 526-537. 10.1089/apc.2005.19.526.CrossRefPubMed
20.
Steward WT, Chandy S, Singh G, Panicker ST, Osmand TA, Heylen E, Ekstrand ML: Depression is not an inevitable outcome of disclosure avoidance: HIV stigma and mental health in a cohort of HIV-infected individuals from Southern India. Psychol Health Med. 2011, 16: 74-85. 10.1080/13548506.2010.521568.CrossRefPubMedPubMedCentral
21.
22.
Jayarajan N, Chandra PS: HIV and mental health: An overview of research from India. Indian J Psychiatry. 2010, 52: 269-10.4103/0019-5545.69245.CrossRef
23.
Chandra PS, Krishna VAS, Ravi V, Desai A, Puttaram S: HIV related admissions in a psychiatric hospital a five year profile. Indian J Psychiatry. 1999, 41: 320-324.PubMedPubMedCentral
24.
Leserman J, Jackson ED, Petitto JM, Golden RN, Silva SG, Perkins DO, Cai J, Folds JD, Evans DL: Progression to AIDS: The effects of stress, depressive symptoms, and social support. Psychosom Med. 1999, 61: 397-406.CrossRefPubMed
25.
Leserman J, Barroso J, Pence BW, Salahuddin N, Harmon JL: Trauma, stressful life events and depression predict HIV-related fatigue. AIDS Care. 2008, 20: 1258-1265. 10.1080/09540120801919410.CrossRefPubMedPubMedCentral
26.
McArthur JC, Brew BJ, Nath A: Neurological complications of HIV infection. Lancet Neurol. 2005, 4: 543-555. 10.1016/S1474-4422(05)70165-4.CrossRefPubMed
27.
Gendelman H, Lipton S, Tardieu M, Bukrinsky M, Nottet H: The neuropathogenesis of HIV-1 infection. J Leukoc Biol. 1994, 56: 389-398.PubMed
28.
Zelaya CE, Sivaram S, Johnson SC, Srikrishnan AK, Suniti S, Celentano DD: Measurement of self, experienced, and perceived HIV/AIDS stigma using parallel scales in Chennai, India. AIDS Care. 2012, 10.1080/09540121.2011.647674. Published Online First
29.
Mahalakshmy T, Hamide A, Premarajan K: Quality of life and its determinants in people living with human immunodeficiency virus infection in Puducherry India. Indian J Community Med. 2011, 36: 203-10.4103/0970-0218.86521.CrossRefPubMedPubMedCentral
30.
Wig N, Lekshmi R, Pal H, Ahuja V, Mittal CM, Agarwal SK: The impact of HIV/AIDS on the quality of life: a cross sectional study in north India. Indian J Med Sci. 2006, 60: 3-12. 10.4103/0019-5359.19670.CrossRefPubMed
31.
Mrus JM, Williams PL, Tsevat J, Cohn SE, Wu AW: Gender differences in health-related quality of life in patients with HIV/AIDS. Qual Life Res. 2005, 14: 479-491. 10.1007/s11136-004-4693-z.CrossRefPubMed
32.
Berger BE, Ferrans CE, Lashley FR: Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001, 24: 518-529. 10.1002/nur.10011.CrossRefPubMed
33.
Bech P, Rasmussen NA, Olsen LR, Noerholm V, Abildgaard W: The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. J Affect Disord. 2001, 66: 159-164. 10.1016/S0165-0327(00)00309-8.CrossRefPubMed
34.
Olsen LR, Jensen DV, Noerholm V, Martiny K, Bech P: The internal and external validity of the Major Depression Inventory in measuring severity of depressive states. Psychol Med. 2003, 33: 351-356. 10.1017/S0033291702006724.CrossRefPubMed
35.
36.
Castro A, Farmer P: Understanding and addressing AIDS-related stigma: from anthropological theory to clinical practice in Haiti. Am J Public Health. 2005, 95: 53-59. 10.2105/AJPH.2003.028563.CrossRefPubMedPubMedCentral
37.
Bharat S, Aggleton P: Facing the challenge: household responses to HIV/AIDS in Mumbai, India. AIDS Care. 1999, 11: 31-44. 10.1080/09540129948180.CrossRefPubMed
38.
Kurien M, Thomas K, Ahuja RC, Patel A, Shyla PR, Wig N, Mangalani M, Sathyanathan , Kasthuri A, Vyas B, Brogen A, Brojen A, Sudarsanam TD, Chaturvedi A, Abraham OC, Tharyan P, Selvaraj KG, Mathew J: Screening for HIV infection by health professionals in India. Natl Med J India. 2007, 20: 59-66.PubMed
39.
Nebhinani N, Mattoo SK, Wanchu A: Psychiatric morbidity in HIV-positive subjects: a study from India. J Psychosom Res. 2011, 70: 449-454. 10.1016/j.jpsychores.2010.09.021.CrossRefPubMed
40.
Chandra PS, Desai G, Ranjan S: HIV & psychiatric disorders. Indian J Med Res. 2005, 121: 451-467.PubMed
41.
Fleischer NL, Fernald LC, Hubbard AE: Depressive symptoms in low-income women in rural Mexico. Epidemiology. 2007, 18: 678-685. 10.1097/EDE.0b013e3181567fc5.CrossRefPubMed
42.
Gupta R, Dandu M, Packel L, Rutherford G, Leiter K, Phaladze N, Korte FP, Iacopino V, Weiser SD: Depression and HIV in Botswana: A population-based study on gender-specific socioeconomic and behavioral correlates. PLoS One. 2010, 5: e14252-10.1371/journal.pone.0014252.CrossRefPubMedPubMedCentral
43.
Myer L, Stein DJ, Grimsrud A, Seedat S, Williams DR: Social determinants of psychological distress in a nationally-representative sample of South African adults. Soc Sci Med. 2008, 66: 1828-1840. 10.1016/j.socscimed.2008.01.025.CrossRefPubMedPubMedCentral
44.
Gielen AC, McDonnell KA, Wu AW, O’Campo P, Faden R: Quality of life among women living with HIV: the importance violence, social support, and self-care behaviors. Soc Sci Med. 2001, 52: 315-322. 10.1016/S0277-9536(00)00135-0.CrossRefPubMed
45.
Remor E: Social support and quality of life in patients with HIV infection. Aten Primaria. 2002, 30: 143-149.CrossRefPubMed
46.
Nyamathi A, Ekstrand M, Zolt-Gilburne J, Ganguly K, Sinha S, Ramakrishnan P, Suresh P, Marfisee M, Leake B: Correlates of Stigma among Rural Indian Women Living with HIV/AIDS. AIDS Behav. 2011, 10.1007/s10461-011-0041-9. Published Online First
47.
Kohli RM, Sane S, Kumar K, Paranjape RS, Mehendale SM: Assessment of quality of life among HIV-infected persons in Pune, India. Qual Life Res. 2005, 14: 1641-1647. 10.1007/s11136-004-7082-8.CrossRefPubMed
48.
Nirmal B, Divya KR, Dorairaj VS, Venkateswaran K: Quality of life in HIV/AIDS patients: A cross-sectional study in south India. Indian J Sex Transm Dis and AIDS. 2008, 29: 15-10.4103/0253-7184.42708.CrossRef
49.
Finn M, Sarangi S: Humanizing HIV/AIDS and its (re)stigmatizing effects: HIV public “positive” speaking in India. Health (London). 2009, 13: 47-65. 10.1177/1363459308097360.CrossRef
50.
51.
Voelker R: Protease inhibitors bring new social, clinical uncertainties to HIV care. JAMA. 1997, 277: 1182-1184. 10.1001/jama.1997.03540390012005.CrossRefPubMed
52.
Shan D, Ge Z, Ming S, Wang L, Sante M, He W, Zhou J, Liu S, Wang L: Quality of Life and Related Factors among HIV-Positive Spouses from Serodiscordant Couples under Antiretroviral Therapy in Henan Province China. PLoS One. 2011, 6: e21839-10.1371/journal.pone.0021839.CrossRefPubMedPubMedCentral
Metadata
Title
Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India – a community based cross sectional study
Authors
Bimal Charles
Lakshmanan Jeyaseelan
Arvind Kumar Pandian
Asirvatham Edwin Sam
Mani Thenmozhi
Visalakshi Jayaseelan
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-463

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