Family support, discrimination, and quality of life among ART-treated HIV-infected patients: a two-year study in China.

BACKGROUND: By September 2016, approximately 653,865 people in China were living with HIV/AIDS (PLWHA) and 492,725 people were receiving antiretroviral therapy (ART). PLWHA frequently experience discrimination in all domains of their personal and social lives. The World Health Organization includes discrimination in its list of social determinants of health factors that have been linked to poor physical and psychological health. This paper identifies the family support enjoyed and discrimination faced by people infected with HIV and examines the effect they have on patients' quality of life (QOL) as they undergo ART in China. METHODS: We conducted this observational cohort study of ART-treated patients with HIV in Guangxi Province using a questionnaire survey at baseline, 6, 12, and 24 months, starting in 2010. Descriptive analysis was used to describe the demographic characteristics (e.g., age, sex, educational level, marital status, and employment status) of participants. Generalized estimating equations (GEE) were employed to examine the relationships between family support, discrimination, and QOL. RESULTS: In the study, 90.4% (n = 281) of patients received family support at baseline, here defined as the initiation of ART, 91.8% (n = 244) received family support 6 months into ART, 95.5% (n = 220) at 12 months, and 94.3% (n = 230) at 24 months. The proportion of patients who did not feel discriminated against by their families was 87.2% (n = 274) at baseline, 90.4% (n = 229) 6 months into ART, 90.0% (n = 210) at 12 months, and 94.5% (n = 219) at 24 months. Patients' overall QOL scores were positively associated with having received family support (OR = 2.74, P = 0.040, 95% CI: 1.68-4.47), not feeling discriminated against by their families (OR = 1.3, P = 0.041, 95% CI: 1.07-1.59) or discrimination from patients themselves, including never experiencing fear of abandonment by family (OR = 2.05, P = 0.025, 95% CI: 1.49-2.82). CONCLUSIONS: Family support along with no or minimal discrimination was found to contribute to QOL among people infected with HIV. Their overall QOL tended to improve significantly as ART continued. This suggests that strategies meant to improve and strengthen family support, care for PLWHA, and promote HIV screening among high-risk populations should be explored by both policy makers and researchers.

Two-year prospective cohort study on quality of life outcomes among people living with HIV after initiation of antiretroviral therapy in Guangxi, China.

The long-term impact of antiretroviral therapy (ART) on quality of life (QOL) is not well understood in China. From 2007-2008, 332 treatment-naïve, HIV-infected adults from five hospitals in Guangxi were enrolled in a 2-year prospective cohort study. Information was collected at the time of ART initiation and during 6-, 12-, and 24-month follow-up visits. Significant improvements were observed across all QOL domains during the first 6 months on ART as measured using the WHOQOL-HIV BREF instrument. These were closely tracked by increases in CD4+ T cell counts, total lymphocyte counts, and the Karnofsky performance scores (p < .05). After 6 months, improvements were smaller and uneven across QOL domains; social relationships was the only domain to not significantly improve at 24 months compared to baseline. Poorer and socially isolated participants had lower QOL outcomes. Strengthening ART program interventions to increase social support for patients may increase QOL outcomes.

Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China.

OBJECTIVE: To evaluate the effectiveness of a needle social marketing strategy to reduce needle sharing and hepatitis C Virus (HCV)/HIV transmission among injecting drug users (IDU) in China. DESIGN: Two-armed, prospective, community-randomized prevention trial. SETTING: Four counties/townships in Guangxi and Guangdong provinces; one randomized to intervention the other to control in each province. PARTICIPANTS: Injecting drug users: 823 (443 intervention, 382 control) at baseline and 852 (415 intervention, 407 control) at the second cross-sectional survey 12 months later. INTERVENTION: A needle social marketing programme, including promotion of safe injection norms and increased access to clean needles over a 12 month period. MAIN OUTCOME MEASURES: Cross sectional surveys at baseline and follow-up compared changes in drug using behaviours and HIV and HCV rates in the intervention and control communities. RESULTS: Needle sharing behaviours were similar in the two groups at baseline (68.4 vs. 67.8%), and dropped significantly to 35.3% in the intervention community and remained relatively stable in the control community (62.3%; P < 0.001). In a subset of cohort of new injectors, the incidence of HCV was significant lower in intervention than in control in both provinces (P < 0.001, P = 0.014) and overall (P < 0.001) but HIV was only significantly lower in intervention in Guangdong (P = 0.011). CONCLUSION: Needle social marketing can reduce risky injecting behaviour and HIV/HCV transmission among injecting drug users in China and should be expanded.

[Evaluation of a pilot study on needle and syringe exchange program among injecting drug users in a community in Guangdong, China].

OBJECTIVE: To evaluate the feasibility and effectiveness of needle and syringe exchange program among a community of injecting drug users (IDUs) on AIDS prevention. METHODS: A quasi-experiment design was used in a controlled community intervention study. Needle and syringe exchange program was implemented for 10 months in IDUs of an intervention community, including peer education and health education, provision of free needles and syringes, and collecting back of used needles and syringes by trained peer educators and local health workers, whereas no intervention measure in a control community was instituted. Interviews with IDUs were conducted before and after intervention with a snowballing strategy to evaluate its effectiveness. RESULTS: A total of 428 and 429 IDUs were interviewed with structured questionnaire before and after intervention in intervention and control communities, respectively. Results revealed that awareness of HIV-related knowledge increased from 29.4% to 58.7% in the intervention community. Multivariate logistic regression analysis showed that awareness of HIV-related knowledge was higher in those who had read health education materials (OR = 2.93, 95% CI 2.12 - 4.04). As compared with the baseline data, frequency of sharing needles and syringes in past 30 days in the intervention community decreased from 48.9% to 20.4% in before intervention community (chi(2) = 41.02, P = 0.001), whereas there was no significant change in the control community. The causes of sharing needles and syringes in the intervention community included 'disable to get needle and syringe during the night', 'lack of needle and syringe when injecting at friend's home', 'not daring to buy needle and syringe for fear of being arrested' and 'no money to buy needle and syringe', declined markedly. CONCLUSIONS: Needle and syringe exchange program was feasible and effective in reducing their risky drug injecting behavior among IDUs in communities. Such strategy should be adopted in the country to reduce rapid spread of HIV.

[Qualitative study of drug-using and sexual behaviors of drug users in Guangxi].

OBJECTIVE: To understand where and how drug-using and sexual behaviors occurred among drug users. METHODS: Twenty-five drug users were recruited from detoxification centers and communities. In-depth interview was used to collect information about drug-using and sexual behaviors. Each subject was interviewed separately and privately for about 2 - 3 hours. RESULTS: Most drug users shifted from oral taking drugs to injecting drugs in order to reduce economic burden and look for "high feeling". Reasons for not injecting among few drug users included 'perceiving information on harm of injection', 'over-dose death' or 'infection with HIV'. Most drug users knew that HIV transmit through sharing needles or having sexual intercourse without using a condom. However, needles were shared at night when drug or needles were scarce. Promiscuous sexual relationship was common among drug users. Most female drug users had engaged in prostitution but few used condoms. CONCLUSION: High-risk drug injecting behaviors and high-risk sexual behaviors were prevalent among drug users despite knowledge on HIV transmission and prevention. Thus, education alone would not work unless specific intervention programs are taken.