AIDS Patients Cite Stigma, Depression

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Many HIV/AIDS Patients Haven't Disclosed Their Health Status to Partners, Survey Finds

By Bill Hendrick
WebMD Health News

Reviewed By Laura J. Martin, MD

July 22, 2010 -- Seventeen percent of people with HIV/AIDS have not told their spouses or partners about their health status, even though 96% reported having disclosed their HIV status to at least one person, an international survey finds.

The survey of more than 2,000 HIV-infected people in a dozen countries reveals that in the U.S., 42% of people with the virus feel isolated because of their infection, compared to 37% worldwide. And 42% of people with HIV in the U.S. report feeling depressed.

Survey results make it clear that many people with HIV/AIDS still feel that HIV-associated stigma and discrimination persist. Other findings of the survey:

• 97% of people surveyed are satisfied with their health care provider and 84% believe they are being treated according to their individual needs.
• 74% say the benefits of HIV/AIDS treatments outweigh the side effects.
• More than half of those surveyed say they are living with at least one co-morbidity, that is, another major health problem such as heart disease, gastrointestinal problems, or hepatitis C in addition to HIV/AIDS.
• 65% of respondents considered at high risk for heart disease say they are not talking to doctors frequently about their heart problems.
• 62% say they have not discussed smoking cessation with their doctors and 69% say they have not discussed hepatitis C.

Patient-Doctor Conversations

The revelation of a significant gap in patient-health care provider conversation can affect the long-term health and quality of life of people with the virus that causes AIDS, researchers say.

They say that when deciding on treatments, doctors should consider factors such as family history, whether patients smoke, have diabetes, cardiovascular disease, or are depressed, because some treatments may be better than others.

"It is extremely common for patients living with HIV/AIDS to have co-morbid conditions that may be exacerbated by the HIV virus or antiretroviral medications," Jurgen Rockstroh, MD, PhD, a professor of medicine at the University of Bonn, says in a news release. "We are seeing patients who are dying from complications related to co-morbidities, such as hepatitis C co-infection and heart disease."

Rockstroh is one of the authors of the AIDS Treatment for Life International Survey task force, along with other scientists. Their 2010 findings are being presented by the International Association of Physicians in AIDS Care at the 28th international AIDS conference in Vienna, Austria.

Moving Past the Stigma

The findings represent a "global call to action to encourage more individualized patient-physician dialogue to ensure that patients' personal needs, past health history, and current medical status are considered, as well as quality-of-life issues," says another of the researchers, Jose M. Zuniga, PhD, president and CEO of the Chicago-based International Association of Physicians in AIDS Care, or IAPAC. "Expanding patient-physician conversations to include all aspects of a patient's well-being is crucial for long-term survival and positive treatment outcomes."

Regarding antiretroviral therapy, 43% of respondents say they have missed at least one dose in the past month, and forgetfulness was cited as the most common reason.

Jean Nachega, MD, PhD, of the ATLIS 2010 Task Force, says varying levels of adherence to drug regimens across geographic regions may be due in part to limitations in health literacy.

"This critical issue requires educational, behavioral, and clinical interventions that will increase literacy about treatment adherence and HIV drug resistance to help people attain optimal adherence levels, which are crucial for achieving and maintaining treatment success," says Nachega, a professor of medicine at Stellenbosch University in South Africa.

The survey covers people in the United States, Brazil, France, Germany, Italy, Russia, Spain, the United Kingdom, Australia, Korea, South Africa, and Ivory Coast.

Interviews were conducted with 2,035 HIV-positive men and women.

The survey was funded by Merck & Co., which operates in many countries as Merck Sharp & Dohme.

SOURCES: News release, International Association of Physicians in AIDS Care.

Zuniga, J. ATLIS 2010 (AIDS Treatment for Life International Survey).

International AIDS Conference, Vienna, Austria, July 18-23, 2010.

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