Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, United States of America.
Rakai Health Sciences Program, Kalisizo, Uganda.
PLoS One. 2024 Oct 10;19(10):e0290809. doi: 10.1371/journal.pone.0290809. eCollection 2024.
Poor mental health occurs more frequently among people living with HIV. Understanding what mental health problems occur and at what point during the continuum of HIV care is critical to ensure these problems are identified and appropriately addressed. We explored how mental health is experienced along the HIV care continuum in Rakai, Uganda.
We conducted qualitative semi-structured in-depth interviews with 20 adults living with HIV and 10 health workers from March to December 2020. Interviews followed a timeline approach. Responses were analyzed using content analysis.
At the time of HIV diagnosis, nearly all participants described a range of strong emotions, including shock, fear and intense worry. Most participants described continued fear and intense worry leading up to, and at the time of, ART initiation. However, they said these emotions often subside after ART is initiated and viral suppression is achieved. Across interviews and at multiple points of the continuum, participants discussed how fear and worry led individuals to be "thinking too much" or be in "deep thoughts" and experience self-hatred. Individuals who stopped taking ART were thought to have more severe mental health problems ("madness", psychosis, suicidality). Participants were divided about the mental health of persons who returned to care after disengagement.
In this setting, mental health problems experienced by people living with HIV are dynamic across the care continuum. With expanded HIV testing campaigns and Universal Test and Treat policies, targeted interventions for psychosocial support at the time of testing and ART initiation remain critical.
艾滋病毒感染者更常出现心理健康问题。了解在艾滋病毒护理连续体的哪个阶段发生何种心理健康问题对于确保发现这些问题并进行适当处理至关重要。我们探讨了在乌干达拉凯，艾滋病毒护理连续体中人们的心理健康状况。
我们于 2020 年 3 月至 12 月间对 20 名艾滋病毒感染者和 10 名卫生工作者进行了半结构化深入访谈。访谈遵循时间线方法。使用内容分析法分析响应。
在艾滋病毒诊断时，几乎所有参与者都描述了一系列强烈的情绪，包括震惊、恐惧和强烈的担忧。大多数参与者描述了在开始接受抗逆转录病毒治疗 (ART) 之前和期间持续存在的恐惧和强烈担忧。然而，他们表示，这些情绪通常在开始接受 ART 并实现病毒抑制后会缓解。在整个访谈过程中和连续体的多个点上，参与者讨论了恐惧和担忧如何导致个人“想太多”或陷入“沉思”并产生自我仇恨。停止接受 ART 的个人被认为有更严重的心理健康问题（“疯狂”、精神病、自杀倾向）。在脱离护理后重新回到护理中的人的心理健康状况，参与者意见不一。
在这种情况下，艾滋病毒感染者在整个护理连续体中经历的心理健康问题是动态的。随着艾滋病毒检测运动的扩大和普遍检测和治疗政策的实施，在检测和开始接受 ART 时针对心理社会支持的有针对性的干预措施仍然至关重要。
