The role of internalised stigma and emotional suffering in forming adherence to antiretroviral therapy in young patients with perinatal HIV infection

Aim of the study. To analyse the incidence and pattern of emotional suffering and internalised stigma, as well as their impact on adherence to antiretroviral therapy (ART) in young patients living with perinatal HIV infection.

Materials and methods. We studied 105 patients with perinatal HIV infection (53 men (50.4%) and 52 women (49.6%)), describing their medical, social and laboratory characteristics such as CD4-lymphocyte count (cells/μL) and HIV RNA detection (copies/mL) in blood at the moment of their transition to adult follow-up and 3 years afterwards. We performed an in-depth crosssectional psychological and psychometric study of 41 patients aged 18–25 (23 men (56%) and 18 women (44%)) with perinatal HIV infection monitored since childhood at the dispensary department of the AIDS Centre. The following methods were used: the HADS scale (Hospital Anxiety and Depression Scale, 1983), the “Major Stigma Factor Test” (2015) with questions adapted for HIV disease and the Morisky-Green Medication Adherence Scale. A survey of 105 patients with HIV PPI was conducted: 53 men (50.4%), 52 women (49.6%), their social status and the course of HIV infection were characterized (the number of CD4 lymphocytes (cells/μL) and HIV RNA in blood plasma (copies/mL) retrospectively at the age of 18 on the moment of transition to an adult dispensary and in dynamics (~ 3 years later). Then 41 patients aged 18–25 years (23 (56%) men, 18 (44%) women) were selected from the main group using a continuous method and an in-depth cross-sectional psychological and psychometric examination was conducted using the HADS scale (Hospital Anxiety and Depression Scale, 1983); “A test to identify the leading factor of stigmatization” (2015) [with modification of questions for HIV infection; adherence assessment scales (Morisky-Green)].

Results and discussion. The incidence of stigma/internalised stigma was more frequent in men than in women and was associated with long-term ART intake. All other stigma/internalised stigma factors (individual, family/friends, social) were not statistically significant. Depressive states were more often found in women than in men. Our ART adherence analysis did not yield statistical differences. The average age of patients at the time of the study was 20.9±1.5 years. The duration of the disease is comparable to the age of the study group which is due to infection. The average age of HIV infection detection was 2.5±4.2 years. In 79% of patients ART was started at the age of 7.2±4.5 years. According to the results of the patient survey, 5.8% of respondents created their own family (including with the birth of 1 child), and only one in five (20%) reported having a job, 8.6% had a disability. The existing dependence on nicotine, as well as the experience of alcohol and drug consumption (recreational use) were noted in 12.3%, 4.7 and 2.8% of patients, respectively.

Conclusion. This study showed correlations between decreased adherence to ART, emotional suffering and internalised stigma in patients with perinatal HIV infection. Psychocorrection and psychopharmacological treatment may prove effective for stabilising patients’ mental state, reducing internalised stigma factor and consequently increasing adherence to treatment. In light of the high frequency of depressive disorders associated with stigma/internalised stigma in young people with perinatal HIV infection, it is advisable to put available effective diagnostic methods and tools (scales, questionnaires) in the daily clinical practice of infectious disease physicians and paediatricians for early detection of mental disorders.

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