عنوان

Anxiety among Women Living with HIV in Kazakhstan

شماره

TL51818

زبان متن نوشتاري يا گفتاري و مانند آن

انگلیسی

عنوان اصلي

Anxiety among Women Living with HIV in Kazakhstan

نام عام مواد

[Thesis]

نام نخستين پديدآور

Mishkin, Kathryn

نام ساير پديدآوران

Shaw, Benjamin

نام ناشر، پخش کننده و غيره

State University of New York at Albany

تاریخ نشرو بخش و غیره

2019

متن يادداشت

142 p.

جزئيات پايان نامه و نوع درجه آن

Dr.P.H.

کسي که مدرک را اعطا کرده

State University of New York at Albany

امتياز متن

2019

متن يادداشت

Research shows that mental illness has an impact on the health and quality of life of women living with HIV. As a result, many countries have adopted integrated care models to provide holistic treatment to women living with HIV. However, some countries, where the HIV burden is particularly high, have been ineffective at addressing the mental health needs of these women, primarily because of a compartmentalized health care structure that limits interaction among sectors. By describing the prevalence of anxiety and comorbid anxiety-depression among women living with HIV in affected areas, there is an opportunity for effective policies to be developed to support the mental health needs of these women. Through improving access to mental health treatment for women living with HIV, there is the opportunity to improve access to screening, diagnosis, and treatment for the general population as well. Eastern Europe and Central Asia is an example of a region facing a high HIV burden. It is the only region in the world where HIV infections have continued to rise at an epidemic-level speed since 2010. Furthermore, as AIDS-related deaths decrease globally, this region is experiencing an increase in AIDS-related deaths. As a country located in this region, Kazakhstan has one of the highest incidences of HIV in the world. Women are increasingly representing a greater proportion of new HIV infections in Kazakhstan, with 44% of all new HIV cases occurring among women in 2014. This pattern of women representing a greater proportion of people living with HIV is consistent with regional trends and suggests a changing pattern in HIV transmission. Compared to men, who are more likely to contract HIV through injection drug use and unprotected heterosexual sex outside of marriage, women are at risk for contracting HIV largely due to unprotected heterosexual sex, often in marriage. The literature shows that mental illness, including depression and anxiety, has an impact on the health outcomes and quality of life of women living with HIV. Because HIV infections are increasing rapidly in Kazakhstan, particularly among women, there is an urgent need to understand the extent to which women living with HIV are affected by mental illness. This research in Kazakhstan is vital because there is very little known about prevalence of mental illness in the form of anxiety and comorbid anxiety-depression in general in the country, let alone among women living with HIV. Through this research, there is an opportunity to inform policies for better care of HIV-positive women through integration of care between HIV and mental health services. This research focuses on a specific population, women living with HIV, to document the relationship between HIV medication adherence and mental illness and inform HIV-mental health integration of care for this group. Because of this need, the dissertation presents the validity of one particular anxiety screening tool, the GAD-7, among Kazakh women living with HIV; presents the prevalence of anxiety and depression among a cohort of women living with HIV; and, explores predictors of anxiety and depression among women living with HIV in Kazakhstan. The data used for this dissertation are from a collaborative research study between the Kazakh National Medical University and the University at Albany. The study used data collected from 410 women aged 18 years and older living with HIV who were seeking services at an AIDS treatment clinic in Almaty, Kazakhstan. Information about sociodemographic characteristics, behaviors, and mental illness symptoms were collected through a 106-question survey in the Russian language. Of the 410 women included in the sample, the mean years since HIV diagnosis was 5.7 years, 27% spoke Kazakh at home, roughly half were aged 30-39 years, 80% had at least one child, 12% had not achieved primary school, 37% were not able to purchase food or clothes, 35% were not employed, the majority (61%) did not drink alcohol and most (59%) did not smoke cigarettes, and 13% were injection drug users. The results showed that 11% reported moderate anxiety and 4% reported severe anxiety. 13% reported depression and 9% reported having both anxiety and depression. Results also showed that the GAD-7 has excellent internal consistency within this sample in Kazakhstan, according to the Cronbach's alpha. An association between several factors and three forms of mental illness: anxiety or depression, anxiety, and anxiety and depression was found. In bivariate analysis, women with poor financial status, women with low educational, women with fewer than two children, and women who were injection drug users were significantly more likely to have anxiety or anxiety and depression. Women who spoke Kazakh at home were significantly less likely to have any of the forms of mental illness. Women who were diagnosed within the past year were more likely to have anxiety and depression compared to women who were diagnosed over five years ago, controlling for age. In multivariable logistic regression, women were more likely to have anxiety or depression if they had low financial status (OR 8.31, 95% CI: 1.90-36.28) and low educational attainment (OR 2.85, 95% CI: 1.04-7.77) and they were less likely to have anxiety if they spoke Kazakh at home (OR 0.36, 95% CI: 0.15-0.87). Women were more likely to have anxiety if they had low educational attainment (OR 3.99, 95% CI: 1.39-11.43) and they were less likely to have anxiety if they spoke Kazakh at home (OR 0.32, 95% CI: 0.12-0.88), controlling for covariates. Women were more likely to have low educational attainment (OR 5.10, 95% CI: 1.13-23.10), and if they had received their HIV diagnosis within the past year compared to over five years ago (OR 4.70, 95% CI: 1.39-15.90). Based on these findings, the GAD-7 may be considered a useful tool for screening anxiety among women living with HIV in Kazakhstan. In resource-limited situations, the poorest and least educated women living with HIV and those who have received their HIV diagnosis recently should be targeted for mental health screening. Additionally, because women who spoke Kazakh at home appear to be protected against anxiety, more research about the pathways between Kazakh culture and mental health is needed. Finally, this dissertation's findings suggest a significant need for better integrated care for women living with HIV and mental illness in Kazakhstan.

اصطلاح موضوعی

Asian studies

اصطلاح موضوعی

Public health

اصطلاح موضوعی

Virology

اصطلاح موضوعی

Womens studies

مستند نام اشخاص تاييد نشده

Mishkin, Kathryn

مستند نام اشخاص تاييد نشده

Shaw, Benjamin

مستند نام تنالگان تاييد نشده

State University of New York at Albany

نام الکترونيکي

فرمت انتشار

p

نوع ماده

[Thesis]

کد کاربرگه

276903

سطح دسترسي

a

تكميل شده

Y