The Vive + study reveals that women with HIV would have a poorer self-perception of their health status and higher levels of depression
The Vive + study, promoted by the Center for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), has evaluated the quality of life, habits and lifestyles of people with HIV in Catalonia and the Balearic Islands (Spain) through a survey carried out in collaboration with 17 hospital HIV care units in these geographical areas - which were already working in a coordinated manner because they were within the PISCIS cohort - and the Working Group on HIV Treatments (gTt-HIV), the community entity that publishes La Noticia del Día. The PISCIS cohort is an open, multicenter study that carries out clinical and epidemiological follow-up of patients with HIV in Catalan and Balearic Islands hospitals.
The study recorded sociodemographic information related to quality of life and well-being, sexual behaviors, lifestyles, perception of stigma and discrimination, as well as the use and satisfaction with health care services aimed at this population.
A total of 1,060 people with HIV were included in the study between October 2019 and March 2020. People were selected for convenience to obtain a representative sample from each hospital and completed a questionnaire through a tablet.
78.0% of the participants identified themselves as men, 17.9% as women, and 3.3% as trans people. The median age was 50 years. 33.4% of the participants were of foreign origin and up to 66.9% of those of foreign origin came from Latin American and Caribbean countries.
Half of the participants had higher education. 54.8% had a job at the time of inclusion in the study, while 39.8% were unemployed, retired or sick.
Up to 10.5% of the women were engaged in housework. Women and trans people were significantly more likely to work as caregivers. Income levels were significantly lower in women than in men.
The clinical characteristics of the participants were extracted from the PISCIS cohort database. 90% of the participants had undetectable viral load and 88.4% had CD4 counts greater than 350 cells / mm3 (only 2.7% had a CD4 count less than 200 cells / mm3). 31.5% of the participants had been living with HIV for more than 9 years.
The main route of transmission of the participants (59.5%) was sexual transmission between gay men, bisexuals and other men who have sex with men (GBHSH).
More than half of the people interviewed (56.5%) responded that they had disclosed their HIV serological status to a few people in the environment, while 15.6% responded that they had not disclosed their serological status outside the health field.
The level of perceived stigma was quantified through a validated scale and was found to be higher in trans people and in people under 39 years of age. By modes of transmission, the highest level of perceived stigma was observed in injecting drug users.
The most prevalent comorbidities among the people who responded to the survey were hypertension (25.5%) and heart disease (14.4%). Women had a higher prevalence of cardiovascular, metabolic and respiratory diseases and trans people showed a higher prevalence of liver disease. In the case of intravenous drug users, this was the group with the highest prevalence of chronic diseases.
All in all, 82.8% responded having a good perception of their state of health. In general, the study participants had poorer scores on the mental dimension compared to the physical one. Women, trans people, and injecting drug users had poorer scores on both dimensions.
Depressive symptoms, evaluated through the validated PHQ-9 questionnaire, were reported by 44% of the participants. Gender differences were found in the prevalence and severity of symptoms.
61% of women and 60% of trans people had depressive symptoms, compared to 40% of men.
Regarding social role and isolation, these were evaluated by means of two validated questionnaires and this allowed us to observe certain trends. Thus, the scores on social isolation were lower than the population mean, indicating a lower degree of social isolation. Trans people and intravenous drug users were the ones who presented the worst results both in social isolation and in satisfaction with the social role.
Regarding sex, 83% of the participants showed satisfaction with their sexual life, the lower proportions being women and trans people.
Regarding sexual behaviors, the use of condoms for vaginal or anal penetration was higher, although variable. This could be indicating both the limitations inherent to the use of condoms and an increase in knowledge of the treatment as prevention (the undetectable concept is equal to non-transferable or I = I).
Regarding substance use, 28% of the women and 24% of the men presented problematic alcohol consumption based on the answers to a series of questions based on the validated AUDIT-C questionnaire. 42% of the participants were active smokers.
Regarding other substances, cannabis was the most used substance in the last 12 months. 18% of the participants stated that they had used injected drugs throughout their lives, although 77% of these people had used them for the last time more than 5 years ago.
Regarding the most consumed substances for use in sexual contexts in the last year, these were nitrates, cocaine, erection enhancers, GHB / GBL and cannabis.
Men and trans people, those born in countries other than Spain, people under 39 years of age and GBHSH men had higher consumption of substances in sexual contexts.
Regarding the satisfaction and use of the health system and support services, the majority of participants reported being satisfied with the care received, the degree of satisfaction being higher in the HIV Units (99.2%), compared to Primary Care ( 90.0%) and support services / NGOs (87.2%).
The high percentage of people who had never had contact with support services / NGOs stood out, specifically 78.1% of Spaniards, 85.4% of those over 60 years of age and 86.4% of heterosexual men . This last point should make us rethink whether these services are adequately designed to meet the current needs of people with HIV.
The full report of the Vive + study can be accessed on the Pisces cohort website at the following link.
Source: Elaboración propia (gTt-VIH).
References: Bayes-Marin I, Egea-Cortés L, Jorge Palacio-Vieira, Jocelyn Mesías, Andreu Bruguera, José María Miró, Jordi Casabona, Juliana Reyes-Urueña. Vive +: Calidad de vida, hábitos y estilos de vida de las personas que viven con VIH en Cataluña y las Islas Baleares. Resultados encuesta 2020. Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya – CEEISCAT. 2021. Badalona, España.