Transcript Psychosocial profile of men living with HIV who were also

18e Annual Canadian Conference on HIV/AIDS Research, Vancouver 2009
Ludivine Veillette-Bourbeau1
Joanne Otis1, 2
Gaston Godin3, 4
And the MAΨA Study Group
1 Canada Research Chair in Health Education, Université du Québec à Montréal
2 Department of Sexology, Université du Québec à Montréal
3 Canada Research Chair on Behaviour and Health, Université Laval
4 Faculty of Nursing Science, Université Laval

Not enough evidence-based intervention programs exist to improve the
quality of life (QOL) of people living with HIV (PLHIV), and even less
for IDU. Most programs for this group concern injection risk reduction
(Garfein & al., 2007; Strathdee & al., 2006; Wright & al., 2006), drug
abuse treatment or needle exchange (Strathdee & al., 2006).

Therefore, to develop evidence-based and effective program for HIV
positive men who are also IDU, we need to understand the factors
associated with their QOL, as proposed at the first step of intervention
mapping.
2

Intervention Mapping (IM):
›
›
›
›

Tool for planning, developing and evaluating health promotion and education programs
Socio-ecological approach to health
Series of 6 iterative steps and associated tasks
Systematic application of theory, empirical findings from the literature (evidence), and additional
qualitative and quantitative data from targeted population and community
› Participation of all actors in the process
Step1: Needs assessment
› Scientific, epidemiological, behavioral and social analysis of an at-risk group or community and its
problems. Importance of taking into account the heterogeneity of target population
› Effort to understand the characteristic of the community, its members, and its strengths
Bartholomew, L.K.; Parcel, G.S.; Kok, G; Gottlieb N.H. (2006). Planning Health Promotion Programs: an
Intervention Mapping Approach
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
In a sample of people living with HIV (PLHIV), describe the
psychosocial characteristics that differentiate men IDU from other
subgroups: heterosexual men non-IDU, men who have sex with men
(MSM) non-IDU and women.
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Data come from the MAYA study, a longitudinal study on quality of life
of PLHIV in Montreal, Canada.
 A total of 904 participants were recruited between 2004 and 2007 through
11 medical clinics and HIV community organizations in Montreal.
 Participants were met at 6-months interval (T0, T1, T2 & T3)

› They completed a questionnaire in a face-to-face interview.
Of these participants, 124 (13.7%) were men IDU including heterosexual
and MSM.
 For this presentation, we cross-sectionally analyzed this data.

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
Analyses:
1. Descriptive analyses (frequencies, means, standard deviations) were executed on sociodemographic variables (age, annual income, relationship, etc.).
2. ANOVA were used to differentiate the 4 subgroups on several variables:
 Quality of life and its dimensions;
 Psychological factors (self-esteem, psychological distress (depression, anxiety) and orientation
to life (meaningfullness, comprehensibility and menageability));
 Coping strategies;
 Social dimensions (network diversity, social integration with friends, family and partner).
3. Stepwise multivariate logistic regression was performed to identify the characteristics
associated with belonging to the IDU subgroup. Significant variables for the IDU group
in the ANOVA analyses were integrated into the model.
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VARIABLES
Socio-demographic Characteristics of MAYA
Heterosexual
MSM
Participants
(N=903)
Men IDU
Women (n=178)
(n=108)
(n=493)
p
N (%)
N (%)
N (%)
N (%)
Age (M ± SD)
43.06 ± 7.56
45.27 ± 8.78
45.75 ± 9.39
38.73 ± 9.73
0.0001
Number of years with HIV (M
± SD)
10.28 ± 5.65
11.25 ± 5.47
12.48 ± 6.80
11.53 ± 5.50
0.006
0.0001
1
1
In a relationship
Yes
21 (16.9)
26 (24.1)
192 (38.9)
114 (64)
Primary school
59 (48) 2
41 (38)
42 (8.5)
40 (22.5)
High school
42 (34.1)
39 (36.1)
147 (29.8)
60 (33.7)
College or university
22 (17.9)
28 (25.9)
304 (61.7)
78 (43.8)
≤15 000$
94 (79.7)
78 (74.3)
181 (37.8)
104 (61.9)
15 000$
24 (20.3)
27 (25.7)
298 (62.2)
64 (38.1)
Heterosexual
93 (75)
108 (100)
3 (0.6)
170 (95.5)
Homosexual
23 (18.5)
0 (0.0)
453 (91.9)
3 (1.7)
8 (6.5)
0 (0.0)
37 (7.5)
5 (2.8)
Education
0.0001
Annual income
0.0001
Sexual orientation
1
Bisexual
Men IDU are significantly different than MSM.
2 Men IDU are significantly different than the 3 other
subgroups.
0.0001
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Variation of QOL Dimensions According to 4 Subgroups
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5.5
5
4.5
4.55
4.93
5.2
5.23
5.18
5.37
5.41
5.39
5.82
5.52
5.29
4.71
4
3.5
3
Global QOL*
Physical health*
Men IDU
Heterosexual men
Medical care**
MSM
Women
Scores vary from 1 (low QOL) to 7 (high QOL)
* 0,001 – men IDU have significantly lower QOL than the 3 other subgroups
**  0,001 – men IDU have significantly lower QOL than MSM
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Variation of QOL Dimensions According to 4 Subgroups (continued)
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5.5
5
5.27
5.43
5.52
5.22
4.81
4.5
4.16
4
4
4.45
3.5
3
Cognitive functioning*
Men IDU
Sexual functioning*
Heterosexual men
MSM
Women
* 0,001 – men IDU have significantly lower QOL than MSM & women
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Variation in Level of Psychological Distress According to 4 Subgroups
9.52
10
8
6
4
7.6
7.1
4.83
4.49
7.09
7.51
5.1
2
0
Depression*
Men IDU
Heterosexual men
MSM
Anxiety**
Women
Score from 0 to 7 = normal
Score from 8 to 10 = borderline Score 11 & more = clinical caseness.
More the person have a high score, more she’s depressed or anxious.
* <0,001 – men IDU are significantly more depress than the 3 other subgroups
** <0,001 – men IDU are significantly more anxious than heterosexual men & MSM
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Variation in Score on Orientation to Life Scale According to 4 Subgroups (T3; N=668)
22
20
18
19.59
20.51
21.41
18.7
17.77
18.16
18.54
16.45
16
14
12
10
Meaningfullness*
Men IDU
Manageability**
Heterosexual men
MSM
Women
Scale vary from 1 (low comprehension) to 7 (high comprehension) (sum: 4 items for each factor).
•<0,001 – men IDU give significantly less meaning to their life than MSM and women
** <0,001 – men IDU feel significantly less able to manage their life than the 3 other subgroups
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Results From ANOVA on Coping Strategies
VARIABLES
Men IDU (1)
(n=124)
M ± SD
Heterosexual men
(2) (n=108)
M ± SD
MSM (3)
(n=493)
M ± SD
Acceptance
2.21 ± 0.76
2.19 ± 0.80
2.44 ± 0.70
Positive reframing
1.69 ± 0.90
1.87 ± 0.85
Active coping
planning
1.63 ± 0.69
Venting
1.39 ± 0.92
Substances use
1.54 ± 1.05
Women (4) (n=178)
p
Post-hoc
2.21 ± 0.80
0.0001
13
23
1.96 ± 0.88
2.04 ± 0.85
0.004
13
14
1.89 ± 0.68
1.78 ± 0.68
1.90 ± 0.67
0.004
14
1.47 ± 0.93
1.44 ± 0.89
1.38 ± 0.90
0.769
-
0.0001
21
31
41
42
43
0.71 ± 1.00
0.56 ± 0.87
M ± SD
0.29 ± 0.71
Scores vary from 0 (never use) to 3 (often use)
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Results From ANOVA on Social Dimensions
Men IDU (1)
Heterosexual men
MSM (3)
Women (4)
VARIABLES
(n=124)
(2) (n=108)
(n=493)
(n=178)
p
Post-hoc
M ± SD
M ± SD
M ± SD
M ± SD
Social network / Scale (Sum) : talk to this person (0 : no/1 : yes). More the score is high, more the social network is diversified.
1<2
1<3
Social network
1<4
<0.0001
2.88
±
1.51
3.60
±
1.72
4.12
±
1.71
4.87
±
1.89
diversity
2<3
2<4
4<3
Social integration / Scale (Sum) : integration (-2 : never/+2 : very often). More the score is high, more the participant is integrated with this persons
(eg.: feels useful).
1<2
1<3
Family
<0.0001
1<4
-3.05 ± 3.45
-0.62 ± 3.95
0.25 ± 3.63
2.45 ± 3.47
(3 items)
2<4
3<4
1<3
Friends
1<4
<0.0001
-0.04±3.36
0.17±3.21
1.61±2.79
1.97±2.89
(3 items)
2<3
2<4
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
Compared to the other three subgroups, men IDU had significantly lower
scores on quality of life, family and friends social integration scales, and
on the orientation to life scale (manageability factor).

Men IDU also present more psychological distress, and more frequently
use alcohol and drug as a coping strategy than the other subgroups.

The reality of men IDU is similar to the reality of heterosexual men nonIDU on two aspects: their social network was less diversified and their
score on the social integration scale concerning their friends was lower
than the score of MSM non-IDU and women.
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Multivariate Logistic Regression on Variables Associated to IDU Group (stepwise) (n=560)
Final model
Variables in the equation
OR
95% CI
Socio-demographic variables
Sexual orientation: heterosexual
5.55
2.93 – 10.50
Number of years with HIV
0.94
0.89 – 0.99
Social support
Network diversity
0.80
0.65 – 0.97
Social support & integration: family
0.87
0.80 – 0.96
Coping strategies
Substances use
p-value
Cases correctly classified
2.10
1.57 – 2.82
0.0001
90%
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

The specificities of the needs of men living with HIV who use injection drugs must be addressed.
Beyond clinical follow-up, systematic interventions should be offered to men IDU living with HIV
with the following objectives:
› reducing psychological distress;
› diversifying coping strategies;
› promoting social integration and social support.
Others studies supported this finding. Social support (Préau & al., 2007) and depression
(Marcellin & al., 2007) must be improved in the context of psychosocial intervention with HIV
positive IDU.
 Following the intervention mapping framework, this assessment process will be completed by the
validation of these conclusions in partnership with community organizations in the perspective of
future interventions.
 Limitations:

› Data introduced here cannot be generalized to all HIV positive men IDU because of their number (n=124)
and recruitment bias (volunteer participants).
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
Acknowledgments
› Thank you to all the participants who agreed to share their experience with

us.
› A particular thanks to Marie-Eve Girard for her help and support in
production of this presentation.
› Thank you to the administrative and technical personnel of the MAΨA
project (coordinator, interviewers, nurses, etc.).
› And thanks to the researchers of MAΨA study to have allowed me to
work on these data.
Correspondence
› Ludivine Veillette-Bourbeau ([email protected])
› Joanne Otis ([email protected])
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
Alary, Michel, co-investigator, Population health research unit,
Hôpital du Saint-Sacrement du CHA

Beck, Eduard, co-investigator, Direction de santé publique MontréalCentre

Côté, José, co-investigator, Faculty of nursing, Université de
Montréal

Côté, Pierre, co-investigator, Clinique médicale du Quartier Latin

Cox, Joseph, co-investigator, Centre for immunodeficiency
treatment, Hôpital général de Montréal

Dascal, André, co-investigator, Infectious diseases and microbiology,
Hôpital général Juif SMBD

Gaul, Neil, collaborator, Department of family medicine, Hôpital
Maisonneuve-Rosemont

Lalonde, Richard, collaborator, Montreal Chest Institute

Lapointe, Normand, co-investigator, Maternal and Infantile Centre
for AIDS, Hôpital Sainte-Justine

Lavoie, René, co-investigator, COCQ-sida

Leblanc, Roger, collaborator, Clinique médicale Projet L.O.R.I

Machouf, Nima, co-investigator, Clinique médicale l’Actuel

Rouleau, Danielle, co-investigator, Department of medical
microbiology and infectiology, Hôpital Notre-Dame du CHUM

Toma, Emil, co-investigator, Department of medical
microbiology and infectiology, Hôpital Hôtel-Dieu du CHUM

Trottier, Benoît, collaborator, Clinique médicale l’Actuel

Vincelette, Jean, co-investigator, Department of medical
microbiology and infectiology, Hôpital Saint-Luc du CHUM

Zunzunegui, Maria Victoria, co-investigator, Department of
social and preventive medicine, Université de Montréal
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
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
Marcellin, F.; Préau, M.; Ravaux, I.; Dellamonica, P.; Spire, B. & Carrieri, M.P. (2007). Self-reported fatigue
and depressive symptoms as main indicators of the quality of life (QOL) of patients living with HIV and
Hepatitis C: implications for clinical management and future research. HIV clinical trials, vol. 8 (5), p. 320327.

Préau, M.; Protopopescu, C.; Spire, B.; Sobel, A.; Dellamonica, P.; Moatti, J.P.; Carrieri, M.P. & MANIF2000 Study Group. (2007). Health related quality of life among both current and former injection drug users
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
Strathdee, A. & Patterson, T.L. (2006). Behavioral Interventions for HIV-Positive and HCV-Positive Drug
users. AIDS and Behavior, vol. 10 (2), p. 115-130.

Wright, N. MJ. & Tompkins, C. NE. (2006). A review of the effectiveness of primary prevention
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