Stigma associated with mental stress and reduced quality of life among HIV-infected women in western China:a cross-sectional study

Abstract

Abstract Background: Stigma has been identified as a crucial risk factor for mental stress and quality of life among HIV-infected patients. However, little attention has been paid to these factors among Asian populations and women rendered vulnerable by their psychological characteristics. In addition, the relationships between stigma, social capital, mental stress and quality of life remain to be elucidated. Methods: A total of 553 HIV-infected women were recruited in Xijiang, China from September 2021 to August 2022. Stigma was assessed using the 12-item Short HIV Stigma scale; mental stress (anxiety, depression) was assessed using the 20-item Self-Rating Anxiety scale (SAS) and 10-item Center for Epidemiological Studies Depression (CESD) scale; social capital was assessed using the Personal Social Capital Scale (PSCS-8);quality of lifewas assessed using the WHO QOL-HIV-BREF scale. A generalized linear model (GLM) and structural equation model (SEM) were used to examine the associations between stigma, social capital, mental stress and quality of life. Results: The HIV-related stigma scale showed actual discrimination score 6.57±2.56, fear of publicity score 7.31±2.34, public attitude score 6.56±2.52, and negative self-image score 6.74±2.55. Quality of life scores were 11.87±2.33 (physiological domain), 9.91±2.42 (psychological domain), 13.31±3.17 (social relation domain) and 11.19±2.84 (environmental domain). SAS-20 and CESD-10 scores were 81.25±50.11 and 9.02±5.55, respectively. After adjusting for age, education, marital status, employment status, residence and monthly income, each 10-point increase in stigma score was associated with 49.3% (OR=1.493, 95%CI:1.218, 1.840) and 51.5% (OR=1.515, 95%CI:1.235, 1.868) increases in anxiety symptoms and depression risk, respectively. In the SEM, stigma was associated with mental stress (β=0.25, p=0.014), which decreased the quality of life of HIV-positive women (β=0.17, p=0.032). The direct effect of social capital on mental stress was significant (β=0.18, p=0.033). Conclusion: Stigma and depression play important roles in quality of life among HIV-infected women. Immediate measures should be taken to reduce stigma and provide psychological guidance, which might contribute to decreasing mental stress and improving quality of life among HIV-infected women.