Mental Health and Social Support Among HIV-Positive Injection Drug Users and Their Caregivers in China
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ORIGINAL PAPER
Mental Health and Social Support Among HIV-Positive Injection Drug Users and Their Caregivers in China M. Claire Greene • Jianping Zhang • Jianhua Li • Mayur Desai • Trace Kershaw
Published online: 3 January 2013 Springer Science+Business Media New York 2012
Abstract The burden of HIV/AIDS in China is due to injection drug use. Non-clinical caregivers provide much of the care for HIV patients but are often not included in HIV care or research. The objective of this study is to examine the relationships between the caregiver context and mental health of HIV-positive injection drug users and their caregivers. We interviewed 96 patient–caregiver dyads using quantitative methods. A conceptual model was developed as a framework for multivariate linear regression modeling. The strongest predictor of poor patient mental health was lack of social support, which was largely determined by the caregiver’s stigma towards HIV/AIDS and caregiver burden. Patient disability and caregiver burden were the primary predictors of poor caregiver mental health. The interrelated nature of caregiver and patient mental health supports the inclusion of caregiver health into the patient’s HIV/AIDS treatment to maximize support provision and health for the patient and caregiver. Keywords HIV/AIDS Caregiver China Mental health Social support Injection drug use
M. C. Greene M. Desai T. Kershaw Yale School of Public Health, New Haven, CT 06510, USA J. Zhang School of Public Health, Kunming Medical University, Kunming 650031, Yunnan Province, China J. Li Yunnan Institute of Drug Abuse, Kunming 650228, Yunnan Province, China T. Kershaw (&) Yale School of Public Health, Room 415, 60 College, New Haven, CT 06510, USA e-mail: [email protected]
Introduction In 2005, injection drug users made up 44 % of the estimated HIV/AIDS cases throughout China and were the highest risk group nationally [1]. HIV-positive injection drug users are particularly vulnerable and highly stigmatized in China [2–4]. Additionally, it has been shown that physicians who care for HIV patients felt stigmatized by other clinicians [5], which may explain why 30 % of physicians in Yunnan Province have refused to provide care to HIV-positive patients [6]. These circumstances have transferred much of the responsibility of care for individuals with HIV to non-clinical caregivers. Nonclinical caregivers refer to an individual who is not a health or clinical care provider, yet offers care and support related to the health and wellbeing of the patient. Caregiving behaviors include medical and treatment assistance, personal care, and financial and emotional support related to the patient’s illness [7, 8]. Caregiver Mental Health Fulfilling the role of caregiver for someone with a chronic health condition can be taxing on the caregiver’s health, particularly his or her mental health. Caregiver mental health has long been ignored; however, negative health outcomes associated with providing care have become evident and therefore necessitate further atten
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