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Slow and Steady But Not Related to HIV Stigma: Physical Activity in South Africans Living with HIV and Chronic Pain

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Abstract

HIV stigma may influence physical activity in people living with HIV (PLWH) and chronic pain. We prospectively examined the relationship between stigma, activity and chronic pain in a convenience sample of PLWH initiating antiretroviral therapy in an inner-city clinic in Johannesburg, South Africa. Participants wore accelerometers to measure daily duration and intensity of activity for 2 weeks. Stigma was assessed with the Revised HIV Stigma Scale. Participants [n = 81, 89% female, age mean (SD) 42 (8)] were active for a median of 7 h daily (IQR 5.2, 9.2), but at very low intensity, equivalent to a slow walk [median (IQR): 0.39 m s−1 (0.33, 0.50)]. Duration and intensity of activity was not associated with stigma, even after controlling for age, self-assessed wealth, pain intensity and willingness to engage in physical activity (p-values > 0.05). As stigma did not associate with greater activity, drivers of sustained activity in South African PLWH remain unclear.

Resumen

El estigma del VIH puede influir en la actividad física de las personas que viven con el VIH (PVVS) y el dolor crónico. Se examinó prospectivamente la relación entre el estigma, la actividad y el dolor crónico en una muestra de conveniencia de PVVS que iniciaba la terapia antirretroviral en una clínica del centro de la ciudad en Johannesburgo, Sudáfrica. Los participantes usaron acelerómetros para medir la duración diaria y la intensidad de la actividad durante dos semanas. El estigma se evaluó con la escala revisada de estigma del VIH. Los participantes [n = 81, 89% mujeres, media de edad (SD) 42 (8)] tenían una actividad de intensidad muy baja, para una mediana de siete horas diarias (IQR 5.2, 9.2), pero, equivalente a una marcha lenta [mediana (IQR): 0.39 m s−1 (0.33, 0.50)]. La duración y la intensidad de la actividad no se asociaron con los niveles de estigma, incluso después de controlar la edad, la riqueza autoevaluada, la intensidad del dolor y la voluntad de participar en la actividad física (valores de p > 0.05). Como el estigma no se asoció con una mayor actividad, los impulsores de la actividad sostenida en las PVVS sudafricanas siguen sin estar claros.

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Data Availability

All data, analysis scripts and analysis script outputs are available at Zenodo: https://doi.org/10.5281/zenodo.6631582.

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Acknowledgements

We are grateful to the patients of Ezintsha for taking part and the Ezintsha research staff for welcoming our team and their spirit of collaboration. We are also grateful to Flo Khumalo for research assistance and interpretation, and Andani Ratshinanga and Zipho Zwane for help with data collection.

Funding

Funding was received from a South African Medical Research Council Self-Initiated Research Grant and the Medical Faculty Research Endowment Fund of the University of the Witwatersrand, South Africa.

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Authors and Affiliations

  1. Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Antonia Wadley, Peter Kamerman & Tapiwa Chinaka

  2. Department of Psychology, Royal Holloway University of London, Egham, UK

    Tamar Pincus & Michael Evangeli

  3. Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    W. D. Francois Venter, Godspower Akpomiemie & Michelle Moorhouse

  4. Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    Romy Parker

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Contributions

Conceptualization: AW, TP, ME, RP; Methodology: AW, TP, ME, TC; Data analysis: PK; Writing—original draft preparation: AW, PK; Writing—review and editing: AW, PK, TP, ME, TC, FV, GA, MM, RP; Funding acquisition: AW, RP; Resources: AW, FV, GA, MM.

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Correspondence to Antonia Wadley.

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Competing Interests

Antonia Wadley, Peter Kamerman, Tamar Pincus, Michael Evangeli, Tapiwa Chinaka, Michelle Moorhouse and Romy Parker declare that they have no competing interests. Venter’s unit receives funding from the Bill and Melinda Gates Foundation, SA Medical Research Council, National Institutes for Health, AIDS Fonds, Unitaid, Foundation for Innovative New Diagnostics and the Children's Investment Fund Foundation, has recently received funding from USAID, and receives drug donations from ViiV Healthcare, Merck, J&J and Gilead Sciences for investigator-led clinical studies. The unit does investigator-led studies with Merck and ViiV providing financial support and is doing commercial drug studies for Merck. The unit performs evaluations of diagnostic devices for multiple biotech companies. Individually, he receives honoraria for educational talks and advisory board membership for Gilead, ViiV, Mylan, Merck, Adcock-Ingram, Aspen, Abbott, Roche, J&J, Sanofi and Virology Education.

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The study received ethical clearance from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand (Clearance No: M170560) and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki.

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Wadley, A., Kamerman, P., Pincus, T. et al. Slow and Steady But Not Related to HIV Stigma: Physical Activity in South Africans Living with HIV and Chronic Pain. AIDS Behav 27, 1950–1961 (2023). https://doi.org/10.1007/s10461-022-03928-7

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