Injecting drug use, gender and home-based care: Factors associated with depression, anxiety and social support in people living with HIV in Northern Viet Nam

Background: Although mental health and social support in people living with HIV (PLHIV) has been widely researched in developed countries, limited information exists in Asia - particularly among drug users and women.

Methods: A mixed-method longitudinal intervention controlled trial was conducted with 822 PLHIV (32% female) enrolled in two HIV out-patient clinics in northern Vietnam. The study included a double-baseline, two rounds of post-intervention data collection and embedded qualitative study. The Hopkins Symptom Checklist was used to identify clinical depression and anxiety and a modified Duke-UNC Social Support Scale measured inter-relational social support.

Results: 42% of participants suffered from depression: 53% female, 37% male; and 24.8% anxiety (32% female, 22% male). Women were at greater odds of experiencing depression (OR4.49;p<0.001) and anxiety (OR2.80;p=0.001), as were men engaged in injection drug use in the past six months (depression: OR2.97;p=0.001; anxiety: OR3.18;p=0.001). Social support scores were just below optimal levels; receiving home-based care services was associated with better support (p=0.037), depression with worse social support (p<0.001). Women who participated in qualitative interviews described spousal drug use, concerns about children's future, financial insecurity and physical ill-health as contributors to mental health and sub-optimal social support, while men cited lack of employment and children's future wellbeing as primary sources of worry.

Conclusions: There is significant unmet mental health need among PLHIV in this cohort. Data indicate the importance of integrating gender-sensitive mental health care and maintaining social support provided through home-based care services for drug using and non-drug using populations into routine HIV care.