Social Determinants of Depression among HIV Positive Patients in Karachi, Pakistan

Objective

            The study aimed to calculate the estimated proportions of depression, stigma, and social support. The study also intended to identify the association between socio-demographic characteristics, social determinants like stigma, and social support and depression among the HIV positive patients in Karachi, Pakistan.

Methodology

            An analytical cross-sectional study was conducted among 200 HIV positive patients, who were recruited from the Sindh AIDS Control Program Treatment Center Karachi, Pakistan, from April to June 2014. Data was collected through a modified truncated questionnaire consisting of four parts measuring socio-demographic and background characteristics of the participants’ depression, social support, and stigma through an investigator designed questionnaire, the Self-Reporting Questionnaire (SRQ 20), the Social Provisions Scale, and the BERGER HIV Stigma Scale, respectively.  Data was analyzed using descriptive and inferential statistics. Logistic regression analyses were performed to study the risk factors of depression.

Results

            A total of 200 people living with HIV/AIDS were interviewed. The mean age of the participants was 34 years ±10.9 years. The findings of the study revealed that, among the total participants, more than half of the females (69.4%) suffered from depression while the number of males who suffered depression was 91 (55.5%).  The results of the Social Provisions Scale score showed that 99 (49.5%) of the participants missed social support from families and friends, while 101 (50.5%) participants appreciated the provision of social support. The results of the Berger HIV stigma scale were quite significant, as a majority of the HIV positive participants (76%) felt stigmatized, while only a few (24%) never felt stigmatized or humiliated. The logistic regression analysis indicated a significant association between Gender (p=0.034), socio-economic status (p=0.001), history of substance abuse (p=0.00), employment status (p= 0.001), and depression.

Conclusion

            The findings from our study confirm an association between socio-demographic variables like gender, socio-economic status, history of substance abuse and employment status, whereas, social support was found as a buffering factor against depression. Though, depression was found to be less common among people experiencing the stigma associated with the disease, given the fact that social support from family, relatives and friends might have neutralized its effect. All the same, the prevalence of depression and its associated factors is much reported in literature, yet its treatment remains a highly underfunded component of HIV prevention, care and treatment. These findings call for identification and treatment of such mental disorders as an integral part of HIV prevention and treatment strategies for HIV positive populations. Along with that, the findings put a heavy responsibility on the shoulders of medical and social service providers to develop strategies which do not stereotype this vulnerable population, and remove the barriers that hinder their adjustment in the society.