Factors associated with mental health symptoms in women living with HIV in Southern India: An
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Vol. 7(5), pp. 84-93, June, 2015 DOI: 10.5897/IJPC2015.0310 Article Number: 561A9A854027 International Journal of Psychology and ISSN 1996-0816 Copyright © 2015 Counselling Author(s) retain the copyright of this article http://www.academicjournals.org/IJPC Full Length Research Paper Factors associated with mental health symptoms in women living with HIV in Southern India: An exploratory study Kendall Sauer1*, Courtney Welton-Mitchell2,3, Sara Anderson1 and N. M. Samuel4 1 Graduate School of Professional Psychology, University of Denver (DU), United States. 2 Josef Korbel School of International Studies, DU, United States. 3 Institute of Behavioral Science, University of Colorado, United States. 4 Concern for AIDS Research and Education Center (C.A.R.E.) Namakkal, India. Received 8 April, 2015; Accepted 24 June, 2015 Limited research has focused on the mental health of HIV-infected women in resource poor settings such as rural India. This study attempts to fill this gap in the literature, through conducting standardized interviews with 20 HIV-infected women in rural, Southern India. Variables of interest included trauma exposure, mental health symptoms, shame, guilt, social support, negative social reactions, coping, and HIV knowledge. Results indicate most women experienced HIV-related stigma in the form of negative social reactions, and limited social support. Many reported a history of interpersonal violence, and moderate to severe symptoms of post-traumatic stress and depression. Feelings of shame, guilt, and self-blame were significantly correlated with mental health symptoms. Seeking comfort in religion, such as engaging in meditation or prayer, was a preferred strategy for coping with HIV-infection. Despite the small sample size, this exploratory study provides important information about the challenges facing women living with HIV in settings where HIV is highly stigmatized. Future research should examine predictors of mental health outcomes in a larger sample, and evaluate the efficacy of interventions designed to reduce negative social reactions, shame, and self-blame, and increase social support. Key words: HIV stigma, social support, mental health, shame, India. INTRODUCTION More than two and half million people in India are such as a large trucking industry, cultural prohibitions estimated to be living with HIV and AIDS; of these, 39% against talking about sexual practices even among are women (World Bank, 2012). The southern states married couples (Pallikadavath et al., 2005), and the have some of the highest rates of infection, including the disenfranchised status of women (Claeson and Indian state of Tamil Nadu (World Bank, 2012). Factors Alexander, 2008) have been identified as contributing to *Corresponding author. E-mail: email@example.com. Author agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License
Sauer et al. 85 the spread of HIV among women in India."In addition to woman in India may experience IPA in their lifetime the physical health challenges HIV-infected women may (Silverman et al., 2008). IPA appears to be a risk factor face, HIV status has been associated with poor mental for contracting HIV among Indian women (Go et al., health outcomes, especially in resource poor communities 2003). Intimate partner abuse has also been linked to low (Das and Leibowitz, 2011; Wu et al., 2007). Various quality of life among women living with HIV (McDonnell et factors such as HIV-related stigma, including negative al., 2005), and has been associated with negative mental social reactions, lack of social support, risk of health outcomes, including post-traumatic stress, interpersonal violence, shame and guilt, may increase the depressive symptoms (Campbell et al., 2008), and risk of mental health difficulties, especially for HIV- substance abuse (McDonnell et al., 2005). Domestic infected women. violence may also be a barrier to receiving HIV services HIV-related stigma and negative social reactions are (Decker et al., 2009). common among women living with HIV (Brown et al., Considering this, it is perhaps not surprising that 2003; Hollen, 2010; Vlassoff et al., 2012). HIV-related women living with HIV are at increased risk for poor stigma is defined as the perception and experience of mental health outcomes. Depression is one of the most discrimination from others based on HIV-related attitudes common psychological disorders experienced by those and beliefs (Mahajan et al., 2008). HIV-related stigma living with HIV (Chandra et al., 2005). In one study of has been associated with mental health symptoms HIV-infected women in urban Tamil Nadu, India, 40% (Brown et al., 2003), and diminished quality of life reported depressive symptoms (Charles et al., 2011). (Steward et al., 2009; Thomas et al., 2007; Nyamathi et Much like IPA, depression is considered to be both a risk al., 2013). Stigma has also been associated with factor for contracting HIV, and a common outcome of decreased likelihood of attending medical appointments, living with a life-threatening illness (Collins et al., 2006; increased alcohol consumption, high rates of social Prince et al., 2007). Persons living with HIV are at isolation (Nyamathi et al., 2013; Moskowitz et al., 2009), increased risk of - suicide (Cooperman and Simoni, higher CD4 counts, and a lack of medication adherence 2005), anxiety disorders and post- traumatic stress (Rintamaki et al., 2006). Specifically for HIV-infected (PTSD) (Breuer et al., 2011; Jin et al., 2006; Nyamathi et women of Southern India, stigma and negative self-image al., 2013). Mental health symptoms can have a direct have been linked with risk for depression (Charles et al., impact on disease state; those with clinical levels of 2011). Such women are also likely to be victims of overt depression and PTSD are more likely to have a lower discrimination that may include social banishment (Van CD4 count and higher viral loads (Boarts et al., 2006; Hollen, 2010; Vlassoff et al., 2012). Breuer et al., 2011). Due to the relationship between In addition to stigma, is not uncommon for HIV-infected mental health symptoms and HIV status, there is a need persons to report low levels of social support, and to further understand factors which may be associated resulting social isolation (Sivaram et al., 2009). with poor mental health among this population. Inadequate social support for HIV-infected populations Given the myriad challenges HIV-infected women may has been associated with poor mental and physical face, including the possibility of societal rejection, it may health outcomes (Moskowitz et al., 2009), and lack of not be surprising that women living with HIV experience medication adherence (Gonzalez et al., 2004; Simoni et feelings of shame and guilt. Shame has been linked to al., 2006; Weaver et al., 2005; Vyavaharkar et al., 2007). physiological responses that negatively impact HIV Adequate social support has been associated with a disease outcomes (Dickerson et al., 2004). Shame has reduction in negative affect (Simoni et al., 2006), also been associated with a decreased likelihood of being decreased depression (Gonzalez et al., 2004), reductions tested for HIV (Kalichman and Simbayi, 2003), and an in stress, enhanced coping (Weaver et al., 2005), and increase in risky sexual behaviors (Sikkema et al., 2009). other positive mental health outcomes for persons living Specifically, in Southern India, shame and guilt were with HIV and AIDS (Gielen et al., 2001; Serovich et al., found to be associated with HIV-infection and subsequent 2001). One study of HIV-infected women in India reductions in social and familial support (Tarakeshwar et indicated that women experienced a decline in social al., 2007). support after contracting the virus, and experienced In light of these concerns, it is important to consider resulting mental health symptoms, including a lack of coping strategies that may be effective in mitigating hope for the future (Majumdar, 2004). mental health consequences associated with HIV. Some Women living with HIV are also at increased risk of research indicated that HIV-infected women in rural India interpersonal violence, including intimate partner abuse may use religion and spirituality as preferred coping (IPA) (Campbell et al., 2008; Fonk et al., 2005; Gielen et strategies (Majumdar, 2004; Nyamathi et al., 2013), and al., 2001). Across various studies, including India, women may focus an increasing amount of energy on securing with a history of intimate partner abuse appear to have the well-being of their children (Majumdar, 2004). higher rates of HIV (Stockman et al., 2013; UNAIDS, Although such approaches have typically been considered 2013). Although actual rates are likely influenced by healthy or adaptive forms of coping, navigating daily life underreporting, research indicates one-third of married with HIV and AIDS can also result in harmful or
86 Int. J. Psychol. Couns. seemingly maladaptive forms of coping. For example, construct equivalence between Tamil and English versions. some HIV-infected individuals may use avoidant strate- Data were collected at participants’ residences in order to reduce the burden on participants associated with asking them to travel to gies such as hiding medications, avoiding healthcare the NGO office. The research team traveled to participant homes at appointments, and not disclosing one’s HIV status a pre-arranged day/time. Each interview took approximately one (Nyamathi et al., 2013). Avoidant coping strategies have hour. Upon completion participants received a bag of rice or packet been associated with negative health outcomes, reduced of oil as compensation for their time. quality of life, and psychological distress (Nyamathi et al., 2013). Measures Participant demographics: Demographics including age, marital Current study status, number of children, resources compared to others in the community, education, employment status, and religion were There is limited research examining various factors measured. associated with mental health outcomes among HIV- infected women in countries such as India. This study is HIV-related stigma, negative social reactions: Social reactions were measured using three adapted items based on the Social designed to explore challenges facing HIV-infected Reactions Questionnaire (SRQ; Ullman, 2000). Participants were women in rural Southern India in hopes of informing asked -Did anyone do any of the following when they found out future research and clinical interventions. Specifically, about your health situation: indicate you are to blame for the we investigated - HIV-related stigma in the form of situation; stop spending time with you; treat you differently? negative social reactions and social support; interpersonal Cronbach’s alpha for these items was 0.97. violence; mental health symptoms including depression Social Support: Social support was measured using three items and PTSD; shame, guilt, and HIV knowledge. from the Interpersonal Support Evaluation List (Cohen and Hoberman, 1983). Although this scale has not been validated for use with this specific population, it has been administered in various METHODS settings including Taiwan (Chen et al., 2000) and Venezuela (Bastardo and Kimberlin, 2000). It has also been administered in Participants populations with HIV (Bastardo and Kimberlin, 2000; Yi et al., 2006). The following questions were included with a 4-item Study participants were selected from HIV-infected women receiving response scale from definitely true to definitely false - there are nutrition and health services at a local non-governmental several people I trust to help solve my problems; when I feel lonely organization (NGO). Data collection took place over several weeks there are several people I can talk to; if I were sick I could easily during the summer of 2013. An institutional review board (IRB) at a find someone to help me. Because the Cronbach’s alpha was low university in the U.S. and an IRB-equivalent in New Delhi approved for the combined items (0.25), items were examined individually. study procedures prior to data collection. Trauma exposure, including interpersonal violence: Trauma exposure was measured using an adapted 5-item version of the Procedure Life Events Checklist (Blake et al., 1995). We did not ask about “life threatening illness,” because HIV-infection is a criterion for receipt Participant recruitment began with an information session about the of services at the local NGO where participants were recruited. We research for all clients receiving services from the local NGO. The asked about childhood and adulthood exposure to the following information session allowed potential participants an opportunity to events: natural disasters, motor vehicle accidents, physical assault meet the research team and ask questions about the project. After by a family member (e.g. partner, husband, mother-in-law), physical the information session, the research team reached out by phone to assault by someone outside of the family, and sexual assault. determine interest. Participants were contacted at random. A final sample of 20 participants was recruited in this manner for this Depression: The Hopkins Symptom Checklist (HSCL-25) is a self- exploratory research. report scale intended to measure symptoms of anxiety and Consistent with local consent procedures, the consent form was depression. The HSCL has been validated for use with a variety of verbally reviewed with each participant prior to engaging in a cultural groups (Klein et al., 2001). For this study, the 15-item structured interview. The voluntary nature of the research was depression subscale was used, with response options from 1 = not emphasized in the consent form, and an ‘opt-in’ procedure was at all to 5 = extremely. One researcher-created somatic symptom used to determine participation, making it relatively easy for women item was added to the scale based on suggestions from local NGO to choose to not participate. Finally, consent was obtained by staff: Headaches or other pain in my body when thinking about the signature or thumbprint, as some women were not literate. problems in my life. An additional item about sexual interest or Structured interviews were used to collect information about pleasure was dropped based on the difficulties local staff had mental health symptoms, HIV-related stigma in the form of negative administering the item. Cronbach’s alpha indicated good internal social reactions, social support, interpersonal violence and consistency for all items (0.89). exposure to other adverse events, shame, guilt, coping skills, HIV transmission knowledge, and demographics (e.g. religion, age, PTSD: The Harvard Trauma Questionnaire (HTQ) is a self-report marital status, number of children). The structured interview was scale developed for research and assessment of trauma symptoms based on a standardized questionnaire detailed in the following in Indochinese refugees (Mollica et al., 1992). Various adaptations section. of the HTQ have been validated for use with Cambodian, Laotian, The questionnaire was translated into Tamil by a local translator Vietnamese, Arabic, Farsi, Serbo-Croation, and Russian-speaking and back translated into English by U.S. and Indian researchers. populations (Klein et al., 2001). The HTQ has been used in Tamil Each item was reviewed to ensure clarity and to maintain Nadu for research and screening of PTSD after the 2004 tsunami
Sauer et al. 87 (Kumar et al., 2007). For this study, 13 HTQ items were selected and five percent (n=1) did not indicate any religion. All for use based on recommendations for cultural appropriateness. participants reported being married, but only 15 percent Participants were asked about problems people may experience after a stressful event and how much these problems affected (n=3) indicated that they currently lived with her husband. [them] in the past week. For all 13 symptom statements, response Twenty-five percent (n=5) reported being separated from options ranged from 1 = not at all to 4 = extremely. Cronbach’s their husbands and 60 percent (n=12) were widows at the alpha for the 13 items was good (0.83). time of the survey. Ninety-five percent (n=19) reported having children (M =1.90; SD=1.21). Seventy-five Shame and Guilt: The 15-item State Shame and Guilt scale percent of women (n=15) reported having no more than (SSGS) was originally developed to capture state shame and guilt in psychology experiments (Marschall et al., 1994). Although this fifth standard (or approximately 6th grade in the US measure has not been previously validated in this cultural context, it school system) education (years of education M= 4.80; has been used in a variety of naturalistic settings (Gruenewald et SD=3.72). Seventy-five percent (n=15) were employed in al., 2004; Tangney and Dearing, 2006). There are five items for some capacity at the time of the survey, with the majority each of three subscales. An example of a shame item is I want to engaged with day labor or other sporadic work. Ninety- sink into the floor and disappear. An example of a guilt item is I felt percent (n=18) reported having less than (money, other bad about something I did. Participants are asked to rate how they are feeling currently on a 5-point scale from 1 = not feeling this way resources) or much less than others in the community. at all, to 5 = feeling this way very strongly. The Cronbach’s alpha for the shame subscale was 0.64. For the guilt subscale the HIV-related Stigma, Negative Social Reactions: The Cronbach’s alpha was low (0.36); however, we included these scale majority of respondents reported HIV-related stigma, items given the exploratory nature of this study. indicating others blamed them for their HIV status (74%), and stopped spending time when them due to their status Coping: The Brief COPE is a 28-item scale that measures utilization of 14 types of coping derived from both theory and research (68%). (Carver et al., 1989; Carver, 1997). The instrument was piloted in a racially diverse sample in the USA and has since been translated Social Support: Perceived social support was low: nearly into numerous languages (Carver, 1997; Kapsou et al., 2010). all respondents indicated they did not have many people Previous studies using the Brief COPE have focused on to talk with (95%), or to help them problem-solve (84%). immigrants, caregivers, students, and refugees (Chase et al., 2013; More than half (68%) indicated that they don’t have Sarfo-Mensah, 2009). The dispositional version of the Brief COPE was administered (Carver, 1997). Participants were asked: In order anyone to help them when they are sick. to cope with stressful life events, such as your current health status, how often do you do the following? Cronbach’s α for the full coping Trauma exposure, interpersonal violence: Most women scale was poor (0.59), suggesting the scale did not measure a reported multiple types of trauma exposure. On average unified construct, so items were examined individually. each participant reported 1.5 events (median= 2; range=0-4). Ten percent reported a history of exposure to HIV knowledge: An investigator created 11-item inventory was natural disasters. Fifteen percent reported having been in used to capture knowledge about HIV transmission: Yes or no, “Is a motor vehicle accident. Thirty-five percent of women HIV transmitted by…?”- sex with an infected person; contaminated needles; blood transfusion; God’s will; hugging; shaking hands; reported physical assault by a stranger. Twenty six- sharing the same bathroom; insects; donating blood; sharing eating percent reported a history of an unwanted sexual utensils. This measure was used based on feedback from local staff experience. Notably the most frequent form of trauma and considering what was relevant for the local cultural context. exposure (65%) was physical assault by a close family member (e.g. partner, husband, mother-in-law). Further- more, 80 percent reported interpersonal abuse by either RESULTS a family member or stranger. Eighty-percent of all reported incidents occurred during adulthood, with 20 All data were analyzed using Statistical Package for the percent occurring during childhood. Only fifteen percent Social Sciences (IBM, SPSS Statistics, 20.0 and 21.0). did not endorse at least one form of exposure to adverse Prior to analysis, variables of interest were examined for events. violations of statistical assumptions (e.g., skew, kurtosis, extreme outliers). No outliers were in need of modification. Depression: Traditionally, an average score of >1.75 Descriptive statistics were run on variables of interest to on the HSC is comparable to a diagnosis of clinical examine prevalence rates (e.g. for exposure to inter- depression. When calculating each participant’s average personal violence, depression symptoms). Pearson- score, the denominator was adjusted to reflect excluded correlations were used to explore associations between items. Ninety-four percent of respondents (n=18, 2 mental health symptoms and other variables described missing cases) had an average score >1.75 (M=3.32; previously in the literature review and measures sections. SD=0.71). However, because the HSC has not been normed or validated for use in this specific population, Participant demographics: Average age of participants diagnostic cut-offs may be misleading. (N = 20) was 43 years (SD =7.10, range= 28-55 years). As a result, we also examined the range of scores in Eighty-five percent indicated Hinduism was their primary this sample (range = 19-54; M = 43; SD = 9.27), and split religion (n=17), ten percent (n=2) reported Christianity, the sample into thirds representing low, medium and high
88 Int. J. Psychol. Couns. Table 1. Mean scores for depression symptoms (HSC). Depression symptoms (back translated) Mean (SD) 1. There is crying/weeping 3.7 (.56) 2. I feel headache or some pain 3.6 (.68) 3. I don’t have hope regarding my future 3.5 (.95) 4. I feel very sad 3.5 (.83) 5. I don’t put effort in my work 3.5 (.83) 6. I feel that I have lost something 3.4 (.93) 7. I have extreme sleep 3.3 (1.2) 8. I feel loneliness 3.2 (1.1) 9. I don’t feel hungry 3.2 (1.1) 10.I feel so guilty 2.6 (1.1) 11.I have many unwanted thoughts about my life 2.5(1.4) 12.I feel I have been caught in a trouble 2.5(1.3) 13.I don’t bother, I don’t show interest 2.5 (1.1) 14.I feel I am not fit for anything 2.3 (1.2) Table 2. Mean scores for PTSD symptoms (HTQ). PTSD symptoms (back translated) Mean (SD) 1. I get angry very easily (I am so angry) 3.6 (.61) 2. I am constantly thinking about the event 3.5 (1.0) 3. I am very much emotional, I try to behave like in some other way 3.5 (.95) 4. I am thinking I should not repeat this event again 3.3 (.92) 5. I am afraid/frightened of my future 3.3 (1.1) 6. I am being so hyper (anxious) because of this problem 3.2 (.83) 7. I am feeling that the problem will repeat again 3.1 (1.1) 8. I cannot sleep 3.0 (1.3) 9. I cannot concentrate 2.8 (.94) 10. I am not interested in my daily activities 2.7 (1.0) 11. I cannot control my emotions 2.5 (.89) 12. I am trying to withdraw from the thoughts surrounding the experience 2.3 (1.3) 13. Nightmares 1.9 (.85) symptom groups. Based on this, 11% of participants have 52), and examined lower and upper thirds, to correspond mild symptoms, 28% have moderate symptoms, and 61% roughly to relatively mild and more severe symptom have severe depressive symptoms. Symptom items with scores among this group. Based on this, 11% endorsed the highest mean severity included: crying, somatic pain, mild symptoms (13-26), 33% endorsed moderate lack of hope, and sadness. See Table 1 for individual symptoms (27-39), and 56% endorsed severe symptoms HSC item means. (40-52). The items with the highest mean severity included anger and rumination. See Table 2 for individual PTSD: Traditionally, an average score of >2.5 on the HTQ item means. HTQ indicates a diagnosis of PTSD. When calculating each participant’s average score, the denominator was Shame and guilt: The mean shame subscale score was adjusted to reflect excluded items. Eighty-three percent 14.26 (SD=4.51, range = 9-17, out of a possible 5-25). had a score of >2.5 (M =2.91; SD= 0.58), indicating an The guilt subscale score was M=17.11; SD=4.12 unusually high incidence of PTSD symptoms in this (range=7-20, out of a possible 5-25). Feeling very small population (n = 18). However, as with the depression and as if I am drowning in this problem were frequently scale, diagnostic cut-offs may be misleading because the endorsed items. HTQ has not been normed or validated for use in this specific population. As with the depression measure, we Coping: Each item was scored on a scale of 1 to 4, looked at the range of scores in this sample (range = 13- where 1= I haven’t been doing this at all and four= I have
Sauer et al. 89 Table 3. Mean scores for individual coping items. Item (back translation, modified Brief COPE, Carver, 1997) 1 = I haven't been doing this at all; 4 = I've Mean (SD) been doing this a lot (N = 20) I will engage prayers or meditation 3.9 (.31) I would seek religious belief for comfort 3.9 (.31) I would show more interest or desire in what I’m going to do 3.8 (.55) I would accept the truth of what has happened 3.6 (.75) I will receiving counseling help/advice from others 3.6 (.83) For comfort, I will seek some other person 3.6 (.82) I would see what other people do and ask advice from them 3.6 (.75) I will search for others’ help 3.5 (.83) I will try some things which could overcome it 3.5 (.83) I will think about and judge myself again and again* 3.4 (1.09) I will order what I have to do 3.4 (1.0) I will try to divert my attention 3.3 (.80) I would accept and try to live with it 3.2 (1.18) I will concentrate on some other works 3.1 (1.00) I will come out from these unwanted thoughts 3.1 (1.02) I will try to face this in some other angle 2.9 (1.18) I would feel disturbed; always blame myself 2.9 (1.25) Instead of thinking about it, I will concentrate on TV, reading books, sleeping or other thoughts 2.6 (1.31) I will see the goodness of what has happened 2.3 (1.16) I couldn’t/won’t believe that it happened 2.1 (1.37) I would contradict the thoughts 1.95 (1.28) I will say this is not true 1.9 (1.04) I will compromise 1.9 (1.14) I would make a joke of it 1.8 (1.20) I would take it as a joke 1.5 (.89) *this item significantly associated with symptoms of depression, r (20) = .74; p
90 Int. J. Psychol. Couns. Table 4. HIV knowledge items. Is HIV transmitted by… Percentage endorsing “yes” 1. person to person 100 2. sex with an infected person 95 3. contaminated needles 95 4. blood transfusion 90 5. God (God’s will) 18 6. insects 16 7. sharing eating utensils 11 8. hugging 5 9. donating blood 5 10. shaking hands 0 11. sharing the same bathroom 0 Table 5. Correlations between interpersonal abuse, shame, guilt, depression and PTSD symptoms. interpersonal abuse (Y/N) shame guilt PTSD depression - .325 .239 .257 .236 * - .462 .324 .565 ** ** - .883 .837 ** - .908 - *
Sauer et al. 91 study in which women indicated that turning to religion Despite the limitations, there are several strengths of and praying were a helpful means of coping with this exploratory study. The research highlights challenges stressors associated with being HIV-infected. Mental facing women living with HIV in settings such as rural health interventions should capitalize on this preferred Southern India where having HIV is highly stigmatized, coping strategy, ensuring women have adequate access and can leave one socially ostracized. This study also to opportunities to practice religious and spiritual adds to the limited research examining various factors activities. Social support seeking was also a preferred potentially associated with mental health outcomes for coping strategy, despite the seemingly common negative HIV-infected women in lower-income settings such as social reactions and a reported lack of available social rural India. Finally, this study has the potential to inform support. Given this preference, and the difficulties with therapeutic interventions for this population, including access to adequate social support, community-wide anti- programs targeting – violence prevention, HIV awareness stigma campaigns should be investigated to determine and anti-stigma campaigns, and feelings of shame, guilt, the potential benefits for this population. and self-blame. Future research should explore these Finally, misconceptions surrounding HIV transmission potential applications with a larger sample and using a were reported, despite the fact that all women surveyed longitudinal design. are receiving services from a local organization, including HIV education. Additional HIV trainings with an emphasis on increasing knowledge about modes of transmission for ACKNOWLEDGEMENTS HIV-infected women and community members could be a focus for future interventions. Community education may Thanks to the C.A.R.E. Center for making this work also decrease HIV-related stigma and increase social possible, including M. Stella, Dr. Buela, and participants support for HIV-infected women. who allowed us to bear witness to their stories. Thanks Many of the aforementioned factors were examined for too for support from the University of Denver, International potential associations with mental health outcomes. The Disaster Psychology (IDP) program, including Dr. Judith small sample size resulted in limited statistical power to Fox, and former IDP students Megan Hunter, Rachel detect associations however, and as such, may have Tepfer, Andrea Varner, Tracy Abbott, Laura Poole, and resulted in inaccurate null results. For example, there Alex Weber. was no significant correlation between a history of inter- personal violence and PTSD or depression symptoms. Previous research however, suggests a typically robust Conflict of Interests relationship between interpersonal violence and mental health outcomes (Campbell et al., 2008; Kilpatrick et al., The authors have not declared any conflict of interests. 2003; Pico-Alfonso et al., 2006). In addition, somewhat surprisingly, negative social reactions and social support were not significantly correlated with mental health REFERENCES outcomes. Negative social reactions however, may Bastardo YM, Kimberlin CL (2000). Relationship between quality of life, influence feelings of shame, guilt, and self-blame – all social support and disease-related factors in HIV-infected persons in factors that were significantly associated with mental Venezuela. Aids Care 12(5):673-684. health outcomes in this sample. Future research should Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, Keane TM (1995). The development of a clinician examine the potential relationship between negative administered PTSD scale J. Trauma. Stress 8(1):75-90. social reactions and shame, guilt, and self-blame to Boarts JM, Sledjeski EM, Bogart LM, Delahanty DL (2006). The determine how these constructs may be related. differential impact of PTSD and depression on HIV disease markers This exploratory study has some limitations. Most and adherence to HAART in people living with HIV. AIDS Behav. 10(3):253-261. notably, the sample size is small. In addition, the survey Breuer E, Myer L, Struthers H, Joska JA (2011). HIV/AIDS and mental instruments were not specifically normed and validated health research in sub-Saharan Africa: a systematic review. Afr. J. for use with this population. Although the research team AIDS Res. 10(2):101-122. focused on equivalence of constructs during the Brown L, Macintyre K, Trujillo L (2003). Interventions to reduce HIV/AIDS stigma: what have we learned?. AIDS Educ. Prev. 15(1): translation process, it is possible that some variables of 49-69. interest were not fully understood as intended. Finally, Campbell JC, Baty ML, Ghandour RM, Stockman JK, Francisco L, participant answers may have been influenced by the Wagman J (2008). The intersection of intimate partner violence presence of researchers affiliated with the local service against women and HIV/AIDS: a review. Int. J. Inj. Contr. Saf. Promot. 15(4):221-231. provider, and in some cases, family or other community Carver CS, Scheier MF, Weintraub JK (1989). Assessing coping members were coming in and out of the room during strategies: A theoretically based approach. J .Pers. Soc. Psychol. interviews. Attempts were made by the research team to 56:267–283. address this, but these may have been inadequate, Carver CS (1997). You want to measure coping but your protocol’s too long: Consider the brief cope. Int. J. Behav. Med. 4(1): 92-100. potentially resulting in under or over-endorsing of some Chandra PS, Desai G, Ranjan S (2005). Indian J. Med. items. Res. 121(4):451-467.
92 Int. J. Psychol. Couns. Charles B, Jeyaseelan L, Pandian AK, Sam AE, Thenmozhi M, Kumar MS, Murhekar MV, Hutin Y, Subramanian T, Ramachandran V, Jayaseelan V (2011). Association between stigma, depression and Gupte MD (2007). Prevalence of Posttraumatic Stress Disorder in a quality of life of people living with HIV/AIDS (PLHA) in South India-A Coastal Fishing Village in Tamil Nadu, India, After the December community based cross sectional study. Health Qual. Life Outcomes. 2004 Tsunami. Am. J. Public Health. 97(1). 9(84). Leserman J (2008). Role of depression, stress and trauma in HIV Chase LE, Welton-Mitchell C, Bhattarai S (2013). “Solving tension”: disease progression. Psychosom. Med. 70(5):539-545. coping among Bhutanese refugees in Nepal. Int. J. Mig, Health Soc. Mahajan AP, Sayles JN, Patel VA, Remien RH, Ortiz D, Szekeres G, Care. 9(2):71-83. Coates TJ (2008). Stigma in the HIV/AIDS epidemic: a review of the Chen CH, Tseng YF, Chou FH, Wang SY (2000). Effects of support literature and recommendations for the way forward. AIDS 22(2):S67. group intervention in postnatally distressed women: a controlled Majumdar B (2004). An exploration of socioeconomic, spiritual, and study in Taiwan. J. Psychosom. Res. 49(6):395-399. family support among HIV-positive women in India. J. Assoc. Nurses Claeson M, Alexander A (2008). Tackling HIV in India: Evidence-based AIDS Care 15 (3):37-46. priority setting and programming. Health Aff. 27(4): 1091-1102. Marschall D, Sanftner J, Tangney JP (1994). The state shame and guilt Cohen S, Hoberman HM (1983). Positive events and social supports as scale. Fairfax, VA: George Mason University. buffers of life change stress. J. Appl. Soc. Psychol. 13(2):99-125. McDonnell KA, Gielen AC, O’Campo P, Burke JG (2005). Abuse, HIV Collins PY, Holman AR, Freeman MC, Patel V (2006). What is the status and health-related quality of life among a sample of HIV relevance of mental health to HIV/AIDS care and treatment programs positive and HIV negative low income women. Qual. Life Res. in developing countries? A systematic review. AIDS 20(12):1571- 14(4):945-957. 1582. Mollica RF, Caspi Y, Bollin P, Truong T, Tor S, LaVelle J (1992). The Cooperman NM, Simoni JM (2005). Suicidal ideation and attempted Harvard trauma questionaire: validating a cross-cultural instrument suicide among women living with HIV/AIDS. J. Behav. Med. for measuring torture, trauma, and posttraumatic stress disorder in 28(2):149-156. Indochinese refugees. J. Nerv. Ment. Dis. 180(2):111-116. Das S, Leibowitz GS (2011). Mental health needs of people living with Moskowitz JT, Hult, JR, Bussolari C, Acree M (2009). What works in HIV/AIDS in India: A literature review. AIDS Care. 23(4):417-425. coping with HIV? A meta-analysis with implications for coping with Decker MR, Seage GR, Hemenway D,Raj A, Saggurti N, Balajah, serious illness. Psychol. Bull. 135(1):121. Silverman JG (2009). Intimate partner violence functions as both a NACO (2014). Annual Report 2013-2014. Department of AIDS Control. risk marker and risk factor for women’s HIV infection: Findings from Ministry of Health and Family Welfare Government of India. Indian husband-wifes dyads. J. Acquir. Immune Defic. Syndr. Nyamathi A, Heravian A, Salem B, Suresh P, Sinha, S, Ganguly K, Liu 51(5):593-600. Y (2013). Physical and mental health of rural southern Indian women Dickerson SS, Gruenewald TL, Kemeny ME (2004). When the social living with AIDS. J. Int. Assoc. Provid. AIDS Care. 12(6):391-396. self is threatened: Shame, physiology, and health. J. Pers. Pallikadavath S, Garda L, Apte H, Freedman J, & Stone WR (2005). 7(26):1191-1216. HIV/AIDS in rural India: context and health care needs. J. Biosoc. Fonk K, Els L, Kidula N, Ndinya-Achola J, Temmerman M (2005). Sci. 37(05):641-655. Increased risk of HIV in women experiencing physical partner Pico-Alfonso MA, Garcia-Linares M, Celda-Navarro N, Blasco-Ros C, violence in Nairobi, Kenya. AIDS Behav. 9(3):335-340. Echeburúa E, Martinez M (2006). The impact of physical, Gielen AC, McDonnell KA, Wu AW, O’Campo P, Faden R (2001). psychological, and sexual intimate male partner violence on women's Quality of life among women living with HIV: the importance violence, mental health: depressive symptoms, posttraumatic stress disorder, social support, and self care behaviors. Soc. Sci. Med. 52(2):315- state anxiety, and suicide. J. Womens Health 15(5):599-611. 322. Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, & Rahman Go VF, Sethulaskshmi CJ, Bentley ME, Sivaram S, Srikrishnan, AK, A (2007).No health without mental health. Lancet. 370(9590):859- Solomon S, Celentano DD (2003). The HIV-prevention messages 877. and gender norms clash: The impact of domestic violence on Rintamaki LS, Davis TC, Skripkauskas S, Bennett C, Wolf MS (2006). women’s HIV risk in slums of Chennai, India. AIDS Behav. 7(3):263- Social stigma concerns and HIV medication adherence. AIDS Patient 273. CARE and STDs, 20(5):359-369. Gonzalez JS, Schneiderman N, Penedo FJ, Antoni MH, Duran RE, Sarfo-Mensah AG (2009). Coping methods and meaning making of McPherson-Baker S, Fletcher MA (2004). Social support, positive Liberian refugees in the Buduburam refugee camp of Ghana. states of mind, and HIV treatment adherence in men and women University of Connecticut. living with HIV/AIDs. Health Psychol. 23(4):413 - 418. Serovich JM, Kimberly JA, Mosack KE, Lewis TL (2001). The role of Gruenewald TL, Kemeny ME, Aziz N, Fahey JL (2004). Acute threat to family and friend social support in reducing emotional distress among the social self: Shame, social self-esteem, and cortisol activity. HIV-positive women. AIDS Care. 13(3): 335-341. Psychosom. Med. 66(6):915- 924. Sikkema KJ, Hansen NB, Meade CS, Kochman A, Fox AM (2009). Hunter M, Gray R, Welton-Mitchell C & Samuel NM (2015). “They will Psychosocial predictors of sexual HIV transmission risk behavior not even give me a cup of water”: Stress and coping among women among HIV-positive adults with a sexual abuse history in child- hood. living with HIV in Southern India. Int. J. Psychol. Couns. 7(2):40-46. Arch. Sex. Behav. 38: 121–34. Jin H, Hampton, Atkinson J, Yu X, Heaton RK, Shi C, Marcotte TP, Silverman JG, Decker MR, Saggurti N, Balajah D, Raj A (2008). Grant I (2006). Depression and suicidality in HIV/AIDS in China. J. Intimate partner violence and HIV infection among married women. Affect. Disorders 94(1):269-275. JAMA, 300(6):703-710. Kalichman SC, Simbayi LC (2003). HIV testing attitudes, AIDS stigma, Simoni JM, Frick PA, & Huang B (2006). A longitudinal evaluation of a and voluntary HIV counselling and testing in a black township in social support model of medication adherence among HIV-positive Cape Town, South Africa. Sex. Transm. Infect. 79(6):442-447. men and women on antiretroviral therapy. Health Psychol. 25(1):74. Kapsou M, Panayiotou G, Kokkins CM, Demetriou AG (2010). Sivaram S, Zelaya C, Srikrishnan AK, Latkin C, Go VF, Solomon S, Dimensionality of coping an empirical contribution to the construct Celentano D (2009). Associations between social capital and HIV validation of the brief-cope with a Greek-speaking sample. J. Health stigma in Chennai, India: considerations for prevention intervention Psychol. 15(2):215-229. design. AIDS Educ. Prev. 21(3):233-250. Kilpatrick DG, Ruggiero KJ, Acierno R, Saunders BE, Resnick HS, Best Steward WT, Herek GM, Ramkrishna J, Bharat S, Chandy S, Wrubel J, CL (2003). Violence and risk of PTSD, major depression, substance Ekstrand M (2009). HIV related stigma: Adapting a theoretical abuse/dependence, and comorbidity: results from the National framework for use in India. Soc. Sci. Med. 67(8):1225-1235. Survey of Adolescents. J. Consult. Clin. Psychol. 71(4):692. Stockman JK, Lucea MB, Campbell JC(2013). Forced sexual initiation, Klein WC, Hovens JE, Rodenburg JJ (2001). Posttraumatic stress sexual intimate partner violence and HIV risk in women: A global symptoms in refugees: assessments with the Harvard Trauma review of literature. AIDS Behav. 17(3):832-847. Questionnaire and the Hopkins symptom Checklist-25 in different Tarakeshwar N, Srikrishnan AK, Johnson S, Vasu C, Solomon S, languages. Psychol. Rep. 88(2):527-532. Merson M, Sikkema K (2007). A social cognitive model of health for
Sauer et al. 93 HIV-positive adults receiving care in India. AIDS Behav. 11(3):491- The World Bank (2012). HIV/AIDS in India. Wu DY, Munoz M, Espiritu 504. B, Zeladita J, Sanchez E, Callacna M, Shin S (2007). Burden of Thomas BE, Rehman F, Suryanarayanan D, Josephine K, Dilip M, depression among impoverished HIV-positive women in Peru. J. Dorairaj VS, Swaminathan S (2005). How stigmatizing is stigma in Acquir. Immune Defic. Syndr. 48(4): 500-504. the life of people living with HIV: a study on HIV positive individuals Wu E, El-Bassel N, Witte SS, Gilbert L, Chang M (2003). Intimate from Chennai, South India. AIDS Care 17(7):795-801. partner violence and HIV risk among urban minority women in Ullman SE (2000). Psychometric characteristics of the Social Reactions primary health care settings. AIDS Behav. 7(3):291-301. Questionnaire: A measure of reactions to sexual assault victims. Yi MS, Mrus JM, Wade TJ, Ho ML, Hornung RW, Cotton S, Tsevat J Psychol. Women Quart. 24:169–183. (2006). Religion, spirituality, and depressive symptoms in patients UNAIDS (2013). HIV in Asia and the Pacific. UNAIDS Reports. Geneva. with HIV/AIDS. J. Gen. Int. Med. 21(S5):S21-S27. Van Hollen C (2010). HIV/AIDS and the Gendering of Stigma in South India. Cult. Med. Psychiatr. 34:633-657. Vlassoff C, Weiss MG, Rao S, Ali F, Prentice T (2012). HIV-related Stigma in Rural and Tribal Communities of Maharashtra, India. J. Health. Popul. Nutr. 30(4):394. Vyavaharkar M, Moneyham L, Tavakoli A, Phillips KD, Murdaugh C, Jackson K, Meding G (2007). Social support, coping, and medication adherence among HIV-positive women with depression living in rural areas of the southeastern United States. AIDS Patient Care STDS. 21(9):667-680. Weaver KE, Llabre MM, Durán RE, Antoni MH, Ironson G, Penedo FJ, Schneiderman N (2005). A stress and coping model of medication adherence and viral load in HIV-positive men and women on highly active antiretroviral therapy (HAART). Health Psychol 24(4):385.
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