Anxiety symptoms and felt stigma among young people living with perinatally or behaviourally-acquired HIV in Ukraine: A cross-sectional survey

Abstract

Background Ukraine has the second largest European HIV epidemic. This study aimed to describe stigma, demographic and social factors and their association with anxiety among perinatally and behaviourally-HIV-infected (PHIV; BHIV) young people in Kiev and Odessa. Methods 104 PHIV and 100 BHIV young people aged 13–25 years completed a confidential tablet-based survey. Survey tools included the Hospital Anxiety and Depression Scale (HADS) (anxiety sub-scale scores of 8–10 indicating mild and ≥11 moderate/severe symptoms in last 7 days), Rosenberg Self-Esteem Scale (RSES) and HIV Stigma Scale (HSS) (short version, composite of disclosure, negative self-image and public attitudes sub-scales). Unadjusted Poisson regression models were fitted to explore factors associated with moderate/ severe anxiety symptoms. Results PHIV and BHIV young people were of median age 15.5 [IQR 13.9–17.1] and 23.0 [21.0–24.3] years, having registered for HIV care a median 12.3 [10.3–14.4] and 0.9 [0.2–2.4] years previously; 97% (97/100) and 66% (65/99) respectively were on ART. Overall 43% (95%CI 36–50%) reported any and 13% (95%CI 9–19%) moderate/severe anxiety symptoms, with no difference by HIV acquisition mode (p = 0.405) or gender (p = 0.700). 42% (75/180) reported history of an emotional health problem for which they had not been referred/attended for care. Moderate/severe anxiety symptoms were associated with HIV-related stigma (prevalence ratio (PR) 1.24 95%CI 1.14–1.34 per HSS unit increase), lower self-esteem (PR 0.83 95%CI 0.78–0.90 per RSES point increase), CD4 ≤350 cells/mm3 (PR 2.29 95%CI 1.06–4.97), having no-one at home who knew the respondent’s HIV status (PR 9.15 95%CI 3.40–24.66 vs all know) and, among BHIV, less stable living situation (PR 6.83 95%CI 1.99–23.48 for ≥2 vs no home moves in last 3 years) and history of drug use (PR 4.65 95%CI 1.83–11.85). Conclusions Results indicated unmet need for psychosocial support. Further work is needed to explore strategies for mental health support, particularly around disclosure, self-esteem and stigma.