Emotional support and gender in people living with HIV: Effects on psychological well-being

Department of Psychology, University Complutense of Madrid, 28223 Madrid, Spain.
Journal of Behavioral Medicine (Impact Factor: 3.1). 07/2009; 32(6):523-31. DOI: 10.1007/s10865-009-9222-7
Source: PubMed


Current research indicates that emotional support is strongly associated with physical and psychological adjustment in persons living with HIV/AIDS. While gender- differences in health and health behaviors of HIV positive patients are well studied, less is known about how men and women living with HIV/AIDS may differentially perceive and integrate support into their lives, and how it subsequently affects their psychological well-being. This cross-sectional study examines how emotional support received from partners and family/friends and gender explains psychological well-being (i.e., stress, depression, anxiety) in a sample of 409 partnered European HIV positive individuals. We hypothesized that gender would modify the associations between support and psychological well-being such that men would benefit more from partner support whereas women would benefit more from family/friend support. Results revealed that regardless of the source of support, men's well-being was more positively influenced by support than was women's well-being. Women's difficulties in receiving emotional support may have deleterious effects on their psychological well-being.

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Available from: Victoria Gordillo, Oct 06, 2015
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    • "Likewise, stigmatization of PLHIV, which may impair opportunity for housing, employment, income, quality of social relationships, and health-care treatment (Hatzenbuehler, Phelan, & Link, 2013) may have a direct role in the depressive symptoms and decreased QoL observed here. Among PLHIV, women experience more stigma (Murphy , Austin, & Greenwell, 2006; Steward et al., 2008; Subramanian, Gupte, Dorairaj, Periannan, & Mathai, 2009), have lower emotional support (Gordillo et al., 2009; Zierler et al., 2000), poorer QoL (Mahalakshmy, Premarajan, & Hamide, 2011; Reis, Santos, & Gir, 2012), and CART adherence (Hanif et al., 2013) and lower incomes and employment leading to greater socioeconomic burden (Charles et al., 2012), possibly contributing to their greater depression. "
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    ABSTRACT: Depression is the most common psychiatric co-morbidity among people living with HIV (PLHIV), with prevalence rates ranging from 25% to 36%. Depression impacts negatively upon adherence and response to combined antiretroviral therapy (CART) and the transmission of HIV infection through increased sexually risky behavior. This cross-sectional study presents data from a reference HIV-outpatient service in Dourados (Brazil) that evaluated the association between depressive symptoms, health-related quality of life, and clinical, socioeconomic, and demographic factors in newly diagnosed HIV/AIDS patients. Using the Beck Depression Inventory (BDI), the prevalence of depressive symptoms was 61% with a predominance of self-deprecating and cognitive-affective factors. Depressive symptoms were associated with lower income (p = 0.019) and disadvantaged social class (p = 0.005). Poorer quality of life was related to depressive symptoms (p < 0.0001), low educational level (p = 0.05), and lower income (p = 0.03). These data suggest that socioeconomic factors, including level of income and education, are mediating the risk of depression and poor quality of life of PLHIV. Possible explanations for this effect are discussed, including the possible role of stigma.
    AIDS Care 03/2015; 27(8):1-7. DOI:10.1080/09540121.2015.1017442 · 1.60 Impact Factor
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    • "USAID [15] identified the recruitment of heterosexual couples as a primary target for HIV and AIDS-related research and intervention, with the couple emerging as a focal point in the HIV prevention, education, testing and treatment continuum. In particular, there is a need to conceptualize how men and women living with HIV and AIDS understand themselves and their identities in relation to their illness, integrate support into their lives and negotiate the impacts of this condition on their psychosocial well-being [16]. Given the high prevalence of HIV infection amongst mineworkers and the relatively high levels of risk that they are exposed to in terms of HIV infection, heterosexual male mineworkers and their spouses or long-term live-in partners, who were HIV positive and seroconcordant, were selected as the sample of couples for this study. "
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    ABSTRACT: Introduction This article explores the complex, dynamic and contextual frameworks within which men working in a mining community and their live-in long-term partners or spouses (termed “couples” in this study) respond to the introduction of HIV into their heterosexual relationships; the way in which partners adopt gendered positions in enabling them to make sense of their illness; how they negotiate their respective masculine and feminine roles in response to the need for HIV-related lifestyle changes; as well as the gendered nature of partner support in relation to antiretroviral therapy (ARV) adherence. Methods We conducted an in-depth qualitative study with a sample of 12 HIV-positive seroconcordant heterosexual couples in a South African mining organization. Transcripts based on semi-structured couple's interviews were analyzed using an inductive emergent thematic analytical method. Results The findings present compelling evidence that the impact of HIV and AIDS is mitigated, in the main, by the nature of the dyadic relationship. Where power and agency were skewed in accordance with traditional gender scripts, the impact of HIV and AIDS was deleterious in terms of negotiating disclosure, meeting expectations of care and support, and promoting treatment adherence. As a corollary, the study also revealed that where the relational dynamic evidenced a more equitable distribution of power, the challenge of negotiating illness was embraced in a way that strengthened the couples’ affiliation in profound ways, manifested not simply in a reduction in risk behaviours, but in both partner's courage to re-visit sensitive issues related to managing their relationship in the context of a debilitating illness. Conclusions Gendered positioning (by self and others) was found to play a crucial role in the way couples experienced HIV and ARV treatment, and underscored the positive role of a couples-counselling approach in the negotiation of the illness experience. However, as part of a broader social project, the findings highlight the need to address the shortcomings of a public health discourse on illness normalization that reifies and reinforces skewed gender relations. In essence, the findings make a compelling case for targeting couples as the primary unit of analysis and intervention in HIV and AIDS praxis, not only to enhance treatment and prevention outcomes, but to impact on and potentially transform the lived identity of such relationships, in AIDS-affected communities. We recommend early intervention with couples in terms of couples HIV testing, risk-reduction counselling and gender-based interventions giving couples opportunities to revisit and challenge their prevailing gendered identities. We note, however, that these efforts will be undermined in the long term, if the structural drivers of HIV risk and vulnerability, contained within macro-level social, economic and cultural practices, are not simultaneously addressed.
    Journal of the International AIDS Society 05/2013; 16(1):18021. DOI:10.7448/IAS.16.1.18021 · 5.09 Impact Factor
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    • "This could be caused by communication difficulties (low literacy, perhaps limited English), uncertainty what questions to ask, or reluctance to challenge health workers perceived to have authority. Interpersonal problems are more common for women, which is consistent with a multi-centre HIV study in 13 European countries which found that women received less emotional support than men and were also less likely to benefit from it[33]. "
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    ABSTRACT: We aimed to determine for the first time the prevalence and severity of multidimensional problems in a population newly diagnosed with HIV at outpatient clinics in Africa. Recently diagnosed patients (within previous 14 days) were consecutively recruited at 11 HIV clinics in Kenya and Uganda. Participants completed a validated questionnaire, the African Palliative Outcome Scale (POS), with three underpinning factors. Ordinal logistic regression was used to evaluate risk factors for prevalence and severity of physical, psychological, interpersonal and existential problems. There were 438 participants (62% female, 30% with restricted physical function). The most prevalent problems were lack of help and advice (47% reported none in the previous 3 days) and difficulty sharing feelings. Patients with limited physical function reported more physical/psychological (OR = 3.22) and existential problems (OR = 1.54) but fewer interpersonal problems (OR = 0.50). All outcomes were independent of CD4 count or ART eligibility. Patients at all disease stages report widespread and burdensome multidimensional problems at HIV diagnosis. Newly diagnosed patients should receive assessment and care for these problems. Effective management of problems at diagnosis may help to remove barriers to retention in care.
    PLoS ONE 02/2013; 8(2):e57203. DOI:10.1371/journal.pone.0057203 · 3.23 Impact Factor
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