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Depression Among Alcohol Consuming, HIV Positive Men on ART Treatment in India

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Abstract

Depression, as well as other psychosocial factors, remains largely unaddressed among people living with HIV (PLHIV) in low and middle-income countries. Depression is a common occurrence among PLHIV and is elevated in those who consume alcohol. This paper will document the presence of depressive symptoms in alcohol-consuming male PLHIV receiving antiretroviral treatment (ART) in India. It examines the correlates of depressive symptoms and uses the data from in-depth interviews to explain the nature of the statistical relationships obtained from an NIH-funded a multilevel, multi-centric intervention study. A cross-sectional, baseline survey was administered to 940 alcohol consuming, male PLHIV in five hospital-based ART Centers in urban Maharashtra, India via face to face interviews from October 2015 to April 2016. An additional 55 men were recruited independently to engage in in-depth interviews on alcohol use and other factors related to adherence. The results of the survey showed that approximately 38% of PLHIV reported having moderate to severe depressive symptoms. Depressive symptoms were positively associated with higher levels of family-related concerns (OR 1.18; 95% CI 1.12–1.23), work difficulties (OR 2.04; 95% CI 1.69–2.69) and HIV-related self-stigma (OR 1.05; 95% CI 1.03–1.07) and a lower level of ART service satisfaction (OR 0.58 95% CI 0.44–0.77). The results of in-depth interviews showed that PLHIV’s tenshun (a Hindi term most closely corresponding to depressive symptoms) resulted from feelings of guilt and concerns about how family, friends, and neighbors might react to their HIV status and the potential for loss of a job as a result of disclosure of their HIV status at work. The level of depressive symptoms among male PLHIV involved in ART treatment points to the need to strengthen the psychological component of PLHIV treatment in India.

Resumen

La depresión y otros factores psicosociales siguen sin abordarse en gran medida entre las personas que viven con el VIH (PVVIH) en los países de ingresos bajos y medianos (PIBM). La depresión es una ocurrencia común entre las personas que viven con el VIH y es elevada en aquellos que consumen alcohol. Este documento documentará la presencia de síntomas depresivos en las PVVIH, masculinos, consumidores de alcohol que reciben tratamiento antirretroviral (TAR) en la India. Examina las correlaciones de los síntomas depresivos y utiliza los datos de las entrevistas en profundidad para explicar la naturaleza de las relaciones estadísticas obtenidas de un estudio de intervención multicéntrico de multinivel financiado por el NIH. Una encuesta transversal, encuesta inicial, se administró a 940 personas que consumen alcohol y viven con el VIH en cinco centros de terapia antirretroviral en el área rural de Maharashtra, en la India. Estas entrevistas fueron hechas en persona de octubre de 2015 a abril de 2016. Se reclutaron 55 hombres adicionales para participar en entrevistas en profundidad y captar sobre el consumo de alcohol y otros factores relacionados con la adherencia. Los resultados de la encuesta mostraron que aproximadamente el 38% de las PVVIH informaron tener síntomas depresivos moderados a severos. Los síntomas depresivos se asociaron positivamente con mayores niveles de preocupaciones familiares (OR = 1.18, IC 95% = 1.12-1.23), dificultades con el trabajo (OR = 2.04, IC 95% = 1.69-2.69) y la auto-estima relacionado con el VIH (OR = 1.05, IC 95% = 1.03-1.07), pero un nivel más bajo de satisfacción con el servicio de ART (OR = 0.58 IC 95%: 0.44-0.77). Los resultados de las entrevistas en profundidad mostraron que el tenshun de PVVS (el término para la depresión) se debió a sentimientos de culpa y preocupaciones sobre cómo la familia, los amigos y los vecinos podrían reaccionar a su estado de VIH y la posible pérdida de trabajo como resultado de la divulgación de su estado de VIH en el trabajo. El nivel significativamente más alto de síntomas depresivos entre las PVVIH masculinos en tratamiento de ART indica la necesidad de fortalecer el componente psicológico del tratamiento de PVVIH en la India.

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Acknowledgements

This project is a collaboration of the India offices of the International Center for Research on Women, the Population Council, the Network of Maharashtran Positive People (NMP +), the University of Connecticut School of Medicine, and the Institute for Community Research in Hartford, CT. We would like to acknowledge the project team with special thanks to the research investigators who so diligently and effectively collected the interview and survey data for this article and project.

Funding

This study was funded by National Institute on Alcohol Abuse and Alcoholism Grant No. U01AA021990-01.

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Authors and Affiliations

  1. Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA

    Toan Ha & Stephen L. Schensul

  2. Institute for Community Research, Hartford, CT, USA

    Mitchell Irving & Jean J. Schensul

  3. Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT, USA

    Marie A. Brault

  4. International Center for Research on Women, Asia Regional Office, Mumbai, India

    Priti Prabhughate

  5. Population Council, Mumbai, India

    Melita Vaz

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  1. Toan Ha
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Correspondence to Toan Ha.

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Conflict of interest

Toan Ha declares that he has no conflict of interest. Stephen L. Schensul declares that he has no conflict of interest. Mitchell Irving declares that he has no conflict of interest. Marie A. Brault declares that she has no conflict of interest. Jean J. Schensul declares that she has no conflict of interest. Priti Prabhughate declares that she has no conflict of interest. Melita Vaz declares that she has no conflict of interest.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ha, T., Schensul, S.L., Irving, M. et al. Depression Among Alcohol Consuming, HIV Positive Men on ART Treatment in India. AIDS Behav 23, 1623–1633 (2019). https://doi.org/10.1007/s10461-018-2339-3

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