People Living With HIV/AIDS In China Research Articles

Substance Use and Psychosocial Status among People Living with HIV/AIDS Who Encountered HIV Stigma in China: Stratified Analyses by Socio-Economic Status.

This study examined whether the impact of HIV stigma on psychosocial status and substance use among people living with HIV/AIDS (PLWHA) differed by their socio-economic status (SES) in a Chinese setting. A total of 2,987 PLWHA were recruited from 12 sites with the highest number of cumulative HIV incidence in Guangxi, China. Participants were asked to provide information regarding their psychosocial status (e.g., depression, anxiety), history of substance use (e.g., tobacco, alcohol and drug) and SES (e.g., education, monthly income, residence type, and job category). By employing stratified multivariate regression analyses, we assessed stratum-specific impacts of HIV stigma on PLWHA’s psychosocial status and behaviors of substance use based upon participants’ SES. The impact of HIV stigma differed significantly on psychosocial status across SES gradients. Psychosocial status among people with higher education was more sensitive to HIV stigma compared with PLWHA who were less educated. The odds of substance use behaviors were higher among people with better monthly income than their low-income peers. Our study is the first paper to document the paucity of SES stratified analyses between HIV stigma and psychosocial status and substance use among PLWHA in China. We call for tailored intervention programs to target PLWHA with different backgrounds and characteristics in order to help them to better manage their seropositivity.

Dentists' and dental students' attitudes, knowledge, preparedness, and willingness related to treatment of people living with HIV/AIDS in China.

This study aims to assess the attitudes, knowledge, preparedness, and willingness of dentists and dental students to treat people-living-with-HIV/AIDS (PLWHA) in China, and to determine the factors associated with willingness to treat. We surveyed dentists and dental students in hospitals and dental schools in five regions in China with varying PLWHA prevalence. Survey questions covered demographics, as well as four categories regarding treating PLWHA: knowledge (scaled 0-1), attitude (scaled 1-4), preparedness (scaled 1-4), and willingness to treat (scaled 1-4). Composite scores for each category were calculated as weighted means. Confounder-adjusted regression analysis was performed to determine the factor(s) correlated with willingness to treat. We collected 394 (84 percent) and 462 (90 percent) useable surveys from dentists and dental students respectively. Dentists' mean composite scores were 0.63 (poor knowledge), 2.1 (negative attitude), 2.8 (adequate preparedness), and 2.5 (neutral willingness). Students' mean composite scores were 0.64 (poor knowledge), 2.3 (negative attitude), 2.7 (adequate preparedness), and 2.6 (positive willingness). Forty-five percent of dentists and 59 percent of dental students had scores indicating positive willingness to treat. Attitude was the only factor consistently correlated with willingness to treat. Dentists and dental students scored low in all categories except for preparedness. It is imperative that knowledge of HIV/AIDS and attitudes toward PLWHA be further improved during dental training to increase the access to and effectiveness of dental care of PLWHA in China and to enhance their quality of life.

Antiretroviral Therapy Initiation Following Policy Changes: Observations From China.

China's HIV/AIDS treatment policies have been evolving over the preceding decade. This study describes patterns of antiretroviral therapy (ART) initiation for a sample of people living with HIV/AIDS (PLHIV) in rural Anhui, China, where most PLHIV were infected via paid plasma donation during the 1990s. A total of 481 PLHIV who were receiving ART were included in our analyses. Times between HIV diagnosis and the initiation of ART were examined relative to the time points when major ART-related policies changed in China. More than half (53%) of PLHIV who had been diagnosed by 2003 received ART within 6 months, whereas 93% of PLHIV who had been diagnosed in 2010 or later received ART within 6 months. The study results provide additional support that the "Four Frees and One Care" policy in 2003 and the relaxation of ART eligibility in 2010 have facilitated the initiation of treatment for PLHIV in China.

Emotional, physical and financial burdens of stigma against people living with HIV/AIDS in China

ABSTRACTNumerous researches have shown pernicious effects of stigma against people living with HIV/AIDS (PLWHA). However, no available studies have reported these negative effects including emotional, physical to financial burdens to PLWHA. In the current study, we aim to explore different types of stigma (e.g., perceived, internalized and enacted) and the relevant consequences among PLWHA in China. A cross-sectional study was conducted from 2012 to 2013 in the Guangxi Autonomous Region in China. The validated Berger HIV Stigma Scale was used to measure various types of stigma. We employed a series of linear, logistic and polytomous regression models to assess the association between stigma and different consequences while accounting for potential confounders for each specific model. Of the total sample, 2987 PLWHA provided valid responses with 63% being male and having an average age of 42.9 years. Perceived, internalized and enacted HIV stigma were prevalent among participants, and resulted in various burdens with different magnitudes in their life contexts. Specially, PLWHA who reported higher perceived and internalized stigma were more likely to be imposed on emotional and physical burdens (p < .05). People who reported higher enacted stigma had heavier financial burden compared to their peers (p < .05). Our findings revealed that devastating consequences of HIV-related stigma in China. The prevalent stigmatizing attitudes have pushed PLWHA to the fringes of society and affected them at multiple aspects in their life context. We call for tailored efforts to overcome stigma and discrimination against PLWHA.

Task shifting of HIV/AIDS case management to Community Health Service Centers in urban China: a qualitative policy analysis

BackgroundThe growing number of people living with HIV/AIDS (PLWHA) in China points to an increased need for case management services of HIV/AIDS. This study sought to explore the challenges and enablers in shifting the HIV/AIDS case management services from Centers for Disease Control and Prevention (CDCs) to Community Health Service Centers (CHSCs) in urban China.MethodsA qualitative method based on the Health Policy Triangle (HPT) framework was employed to gain in-depth insights into four elements of the task shifting strategy. This included a review on published literature and health policy documents, 15 focus group discussions (FGDs) and 30 in-depth interviews (IDIs) with four types of key actors from three cities in China. A total of 78 studies and 17 policy files at the national, municipal and local levels were obtained and reviewed comprehensively. Three semi-structured interview guides were used to explore key actors’ views on shifting the HIV/AIDS case management services to CHSCs.ResultsIt is necessary and feasible for CHSCs to engage in case management services for PLWHA in local communities. The increasing number of PLWHA and shortage of qualified health professionals in CDCs made shifting case management services downwards to CHSCs an urgent agenda. CHSCs’ wide distribution, technical capacity, accessibility and current practice enabled them to carry out case management services for PLWHA. However our findings indicated several challenges in this task shifting process. Those challenges included lack of specific policy and stable financial support for CHSCs, inadequate manpower, relatively low capacity for health service delivery, lack of coordination among sectors, PLWHA’s fear for discrimination and privacy disclosure in local communities, which may compromise the effectiveness and sustainability of those services.ConclusionsShifting the HIV/AIDS case management services from CDCs to CHSCs is a new approach to cope with the rising number of PLWHA in China, but it should be implemented alongside with other efforts and resources such as increasing public funding, planned team building, professional training, coordination with other sectors and education on privacy protection as well as non-discrimination to make this approach more effective and sustainable. Policy makers need to ensure both political feasibility and resources accessibility to facilitate this shifting process.

Perceived discrimination, social support, and perceived stress among people living with HIV/AIDS in China

Perceived stress among people living with HIV/AIDS (PLWH) was associated with severe mental health problems and risk behaviors. Discrimination toward PLWH in China is prevalent. Both perceived discrimination and social supports are determinants of the stress level among PLWH. Psychological support services for PLWH in China are scarce. It is unknown whether social support is a buffer between the perceived discrimination and perceived stress. With written consent, this study surveyed 258 PLWH recruited from multiple sources in two cities in China. Instruments were validated in previous or the present study, including the perceived stress scale for PLWH (PSSHIV), the perceived social support scale (PSSS), and the perceived discrimination scale for PLWH (PDSHIV). Pearson correlations and multiple regression models were fit. PDSHIV was associated with the Overall Scale and all subscales of PSSHIV, whilst lower socioeconomic status in general and lower scores of PSSS were associated with various subscales of PSSHIV. The interaction item (PSSS×PSDHIV) was nonsignificant in modeling PSSHIV, hence no significant moderating effect was detected. Whilst perceived discrimination is a major source of stress and social support can reduce stress among PLWH in China, improved social support cannot buffer the stressful consequences due to perceived discrimination. The results highlight the importance to reduce discrimination toward PLWH and the difficulty to alleviate its negative consequences. It is warranted to improve mental health among PLWH in China and it is still important to foster social support among PLWH as it has direct effects on perceived stress.

Measles Control in Guangxi, China: High Risk Counties Selection and its Mass Campaign from 1999-2008

Background: Few studies of HIV+ individuals in China have examined the associations between HIV-related stress with sleep disturbance and fatigue, which are common complaints among people living with HIV/AIDS (PLWHA). We carried out this study to examine the relationships among perceived stress, sleep disturbance, and fatigue in PLWHA in China. Methods: A mixed methods study design was used during data collection in Shanghai, China, from December 2009 to March 2010. Qualitative in-depth interviews were conducted with 19 HIV+ females. Additionally, crosssectional audio computer-assisted self-interviews (ACASI) were conducted to collect quantitative data from a convenience sample of 107 HIV+ patients (84% were male) including the following scales: 1) Perceived Stress Scale for PLWHA, 2) General Sleep Disturbance Scale, and 3) Fatigue Scale. Results: The major themes that emerged from the in-depth interviews were around life stress with HIV, sleep disturbance, and fatigue. Participants presented varying amounts of stress around worrying about whether to disclose their diagnosis and whether they might transmit the disease to their family. In addition, in the cross-sectional data, 40% of the participants reported clinically significant sleep disturbances (GSDS > 3) with an average of 3 nights of disturbed sleep in the past week (M=2.87, SD=1.21) and moderate fatigue severity (M=5.24, SD=2.27). In mediation analyses, the data suggests that the relationship between perceived stress and fatigue was largely (53%) mediated through sleep disturbance. Conclusions: Chinese PLWHA described how stress had caused them to become sleepless and fatigued. The quantitative data also demonstrated significant levels of sleep disturbance and fatigue, where were due to perceived stress with HIV disease. A systematic self-management intervention to decrease perceived stress should be designed and implemented in mental health resource-limited settings such as China in order to reduce sleep disturbance and fatigue.

Size, Composition, and Strength of Ties of Personal Social Support Networks Among Adult People Living with HIV/AIDS in Henan and Beijing, China

To characterize the level of personal support available to people living with HIV/AIDS (PLWHA) in Henan and Beijing, China, face-to-face interviews were conducted to collect information on network size, composition, and strength of ties. The number of people as sources of support for participants in Henan varied from 1 to 13 and 1 to 16 in Beijing. In Henan, family members were more likely to provide support than non-relatives and they provided support more frequently; in Beijing non-relatives were more likely to provide support than family members. Family members were closer to PLWHA than non-relatives in both sites, but the closest type of relative and non-relative supporters were different between Henan and Beijing. PLWHA in Henan and Beijing receive considerable social support, but there is still opportunity for additional social support. Efforts should be made to mobilize civil society to provide support for PLWHA in China.

Women, Poverty, and the Epidemic in China: Case Studies on Rural People Living with HIV/AIDS

Based on in-depth interviews with 110 People Living with HIV/AIDS (PLWHA), this qualitative study is a preliminary endeavor to delineate the socio-cultural scripts of rural PLWHA in China including their illness experience, everyday lives, and strategies of coping with stigma, poverty, and social barriers. This study documents the new wave of the “feminization of HIV/AIDS” in China. There is a gender difference of infection routes. Women were infected through heterosexual contact much more frequently than men. This study also discusses power struggles and gender asymmetries between rural couples living with HIV/AIDS, especially on the issues of “disclosure of the illness” and “condom negotiation.” Even when the disease has changed the family structure and women become the main financial supporters, gender inequality within a family is not changed in that women remain not the main decision makers and continue to suffer most from poverty. In conclusion, this article locates women's HIV-related experience within the social ecology of HIV/AIDS, and explores how gender inequality intersects with traditional customs and ethics, economic and political policy, medical system, and patriarchal values to heighten women's vulnerability to both the illness and poverty.

Development of the Perceived Stress Scale for People Living with HIV/AIDS in China

Stress among people living with HIV/AIDS (PLWHA) is associated with psychological morbidity. There are only a few stress scales specially developed for PLWHA and none of them is in Chinese. This study develops and validates a new Chinese Perceived Stress Scale among PLWHA (PSSHIV) in Shenzhen of Guangdong Province and Hengyang of Hunan Province in China during September 2006 through July 2007. In-depth interviews were administered to 58 PLWHA (33 males, mean age, 32) to generate the items, while 215 other PLWHA were interviewed in another survey to validate the instrument (136 males, mean age, 33). Exploratory factor analysis yielded 8 factors (percent variance explained, 71.47%), namely: social/psychological problems, sexual relationship, functional problems, social acceptance/rejection issues, work-related issues, family/offspring issues, accessibility to treatment, and treatment outcomes. The Cronbach alpha values ranged from 0.76 to 0.94 for the overall scale and the 8 subscales. The scores of the overall scale, the social/psychological problems, and functional problems subscales of the PSSHIV were significantly correlated with the Perceived Stress Scale (PSS), Depression, Anxiety and Stress Scale (DASS), and all domains of the Medical Outcomes Study HIV Health Survey (MOS-HIV) (correlation coefficient = 0.50 to 0.71 for positive correlations, and -0.73 to -0.21 for negative correlations, p < 0.05). The other 6 subscales of the PSSHIV were significantly correlated with the PSS, subscales of the DASS, and MOS-HIV (correlation coefficient = 0.16 to 0.39 for positive correlation, -0.58 to -0.15 for negative correlation, p < 0.05). This new instrument collected information from the PLWHA from qualitative interviews and the items are specific to the HIV/AIDS context. PSSHIV can be used for assessing the level of stress faced by PLWHA in China.

Correlation between the function of monocytes/macrophages and disease progression in people living with HIV/AIDS in several provinces in China

To investigate the functional states of peripheral blood monocytes/macrophages and their relation with the disease progression in people living with HIV/AIDS (PWHA). Peripheral blood samples were collected from 57 PWHA who didn't receive antivirus treatment before and 32 healthy controls in Jilin, Liaoning, and Henan provinces. Flow cytometry was used to detect the expression of the early activation molecule CD69 in the CD14(+) cells. The plasma HIV RNA level was determined using real-time PCR. The CD69 expression rate in the CD14(+) T cells of the PWHA group was 27% +/- 4%, significantly higher than that of the controls (P < 0.01). The CD69 expression rate of the AIDS group was 39% +/- 3%, significantly higher than those of the HIV group and long-term nonprogressors (LTNP) group (26% +/- 3% and 20% +/- 4% respectively, both P < 0.05), that of the HIV groups being significantly higher than that of the LTNP group too (P < 0.05). The side scatter value of the CD14(+) T cells of the PWHA group was 76 +/- 16, significantly higher than that of the control group (50 +/- 12, P < 0.05). The monocyte/macrophage CD69 expression rate was significantly negatively correlated with the absolute value of CD4(+) T cells (r = -0.872, P < 0.01), and not correlated with the value of CD8(+) T cells (P > 0.05). The monocyte/macrophage CD69 expression rate was significantly positively correlated with the HIV-1 RNA viral load (r = 0.697, P < 0.01). The activation and the phagocytosis function of the monocytes/macrophages of the PWHA in China are higher than those of the healthy control. They are positively correlated with the disease progression.

Validation of a Chinese version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) among Chinese people living with HIV/AIDS in Hong Kong

To evaluate the Chinese version of the 35-item Medical Outcomes Study HIV Health Survey (MOS-HIV) in Chinese people living with HIV/AIDS (PLWHA). A cross-sectional survey of 242 ethnic Chinese PLWHA in Hong Kong was conducted. Cronbach's alphas of the eight multi-item scales of the MOS-HIV ranged from 0.78 to 0.90. Item-total and inter-scale correlation coefficients were acceptable. Factor analysis of the MOS-HIV identified two factors (Mental Health Summary scores and Physical Health Summary scores, or MHS and PHS), accounting for 63% total variance. The PHS and MHS correlated significantly with the WHOQOL-BREF(HK) and the three sub-scales of Profile of Mood States used in this study. Both PHS and MHS were significantly associated with self-perceived change in health status. PHS but not MHS was associated with Karnofsky Performance Status scores. PHS was also associated with disease stage. The MOS-HIV however, did not distinguish between groups of different CD4 cell counts. It is likely that the quality of life of these PLWHA of different disease stages was good in general. There is a large demand for evaluating treatments and services programs offered to PLWHA in China. The validated Chinese MOS-HIV would facilitate such research activities.