Harm of Symptoms Ignored

posted: 08/10/2010

Symptoms are common among people with HIV, and when they are ignored, as they often are by doctors, symptoms worsen people's taking of HIV treatment and lead to more risky sex.
Physical and psychological symptoms are highly common among people with HIV in the UK says a new report in the online issue of Sexually Transmitted Infections.
Physical and mental distress is high especially for people having unprotected sex with a partner of an unknown or different HIV status, and when people are struggling to take HIV treatments properly.
 

Symptoms unnoticed and untreated
From the moment of HIV infection, HIV is associated with a high rates of distressing symptoms. The World Health Organization recommends that controlling pain and symptoms should be an essential part of HIV care.
However, research suggests that doctors often do not detect the symptoms, and that many people with HIV have untreated pain and other symptoms.
 

How common are symptoms and what happens?
Investigators in London and south-east England were concerned that symptoms were being overlooked. They wanted to see how common symptoms were and if having symptoms was linked to differences in HIV treatment-taking, unprotected sex, and telling sex partners about HIV status.
So in 2005-06 778 patients took part in the study looking back at any symptoms over the last seven days.
 

Study participants were asked to provide basic information about themselves (age, gender etc) and to say if they had experienced any of 26 physical or psychological symptoms in the past seven days. The distress caused by symptoms was scored on a scale of 0-4. Those taking HIV treatment were asked to report their level of adherence in the previous week. All were asked if they had had unprotected sex with a partner who was HIV-negative or of unknown status in the previous three months, and if they disclosed their HIV status to partners.
 

Who are they?
Most (66%) of the people in this study were gay or bisexual men and were white (67%). The mean age was 40 years. A little over half (51%) of patients were born in the UK, and 45% had a degree.
Taking treatments – lots to improve
Over two-thirds (67%) of people were taking HIV treatments, and most people are not taking HIV treatments very well. Complete adherence to treatment was reported by 42%; partial adherence by 36%; and poor adherence by 22%. A third of people taking treatment had changed their HIV combination once and 40% reported multiple treatment changes.
 

Risky sex
A total of 11% of patients reported unprotected sex in the previous three months with a partner who may have been HIV-negative, and 6% had never disclosed to a sex partner
 

Symptoms all over
Symptoms were highly prevalent. The mean number of reported symptoms was 18. The mean symptom physical distress score was 0.81, the mean psychological distress score was 1.34, and the global distress score was 1.16.
Lack of energy was reported by 71% of patients, tiredness by 68%, difficulty sleeping by 62%, poor concentration by 61%, worry by 70%, sadness by 66%, diarrhoea by 54% and sexual problems by 53%.
 

Educated, white – less symptom harm
Having a university degree was associated with less symptom-related physical, emotional and overall distress.
In addition, white patients reported less symptom related distress than those of other ethnicities. The investigators think that this could be because many black African patients in the UK are diagnosed late when they are already ill and experiencing symptoms.
Telling others easier with few symptoms; more symptoms leads to risky sex
Disclosure of HIV was significantly associated with fewer symptoms, and reporting unprotected sex with a partner who may have been HIV-negative was associated with a greater number of psychological symptoms.
“Interestingly”, write the investigators, “currently being on antiretroviral therapy was not significantly associated with any of the symptom measures.”
 

Those on treatment
Then they looked at only the people taking HIV treatment. Poor adherence was significantly associated with psychological and global distress. Switching treatment was associated with both physical and psychological distress caused by symptoms, as well as a greater number of total symptoms.
Being born in the UK and having a degree were both associated with a lower burden of physical symptoms.
“The data…reveal high 7-day prevalence and associated distress of burdensome symptoms”, comment the investigators, who conclude: “It is essential that quality management of HIV disease routinely assess these distressing problems, so that key outcomes of risk behaviour and adherence may be optimally influenced.”
 

Source

Reference
Harding R et al. Symptoms are highly prevalent among HIV outpatients and associated with poor adherence and unprotected sexual intercourse. Sex Transm Infect, online edition, 2010 (click here for access to free abstract and paid-for full text).

High Stigma and Consequences

posted: 10/07/2009

People with HIV face high levels of stigma, and this is consistently associated with lack of social support, poor physical and mental health, poverty, and younger age, according to the results of a study of all the studies published in the June AIDS Care.

A total of 24 studies conducted since 2000, involving a wide range of people with HIV, were included in the analysis.

The authors suggest “health professionals caring for people living with HIV as well as HIV-related stigma interventions and support programmes could benefit from an enhanced understanding of correlates of HIV-related stigma.”

Stigma has been associated with HIV since the beginnings of the epidemic and is experienced by individuals in different ways. HIV-positive people are often blamed for their infection, on occasion even by healthcare providers.

HIV also disproportionately affects groups that are already stigmatised, including gay men, injecting drugs users and migrant populations.

Earlier research has shown that HIV-related stigma is associated with mental health needs, social exclusion, lower quality of life, and poor physical health. Moreover, studies have also indicated that age, gender, income, race/ethnicity, and sexual orientation are associated with stigma.

However, studies examining HIV-related stigma have varied by their sample size and population, measures of stigma, data collection and statistical analysis. It has therefore been difficult to compare their findings, or generalise them to wider populations of individuals living with HIV.

Investigators therefore conducted a meta-analysis of recently published studies that measured HIV-related stigma. Their aims were to establish the strength and direction of the association between HIV-related stigma and physical, mental and emotional health, and also to determine the associations between stigma and a number of demographic characteristics.

A total of 24 studies published in peer-reviewed journals since 2000 were included in this analysis. These studies involved a total of 5600 HIV-positive individuals from diverse backgrounds. The investigators found that a wide variety of factors were associated with stigma.

Stigma PLUS

The other factors associated with HIV stigma included

• having more advanced HIV disease  
• poorer physical health 
• poorer mental health 
• experiencing discrimination
• younger age
• lower income

Stigma LESS

However, adequate social support and good mental health were both significantly associated with less reported stigma.

Stigma has strong links with lack of social support, poor physical health, poor mental health, lower income and younger age

Although there was considerable variability in the way the included studies assessed individuals’ experiences of stigma and their health and well-being, the investigators nevertheless found that “high stigma levels were consistently and significantly associated with lack of social support, poor physical health, poor mental health, lower income and younger age.”

Recommended

The authors recommend that “effective interventions to challenge HIV-related stigma should operate on multiple levels and target several populations.” Wider-ranging structural interventions are also needed, and the authors suggest these should provide “legal protection from HIV-related stigma and discrimination as well as address poverty through increasing access to employment for people living with HIV and ensuring adequate disability insurance”.

Source and reference details