RESEARCH PAPER
Socio-economic inequality in HIV-related perceived stigma, mental health, and quality of life among people living with HIV in Iran: a cross-sectional study
1
Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
2
Infectious Diseases Research Center, Arak University of Medical Sciences, Arak, Iran
Submission date: 2023-10-21
Final revision date: 2024-01-05
Acceptance date: 2024-01-06
Publication date: 2025-03-31
Corresponding author
Maryam Zamanian
Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran.
Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran.
HIV & AIDS Review 2025;24(1):56-62
KEYWORDS
TOPICS
ABSTRACT
Background:
Socio-economic inequality is one of the most important issues in public health. This study aimed to assess socio-economic inequalities resulting from human immunodeficiency virus (HIV)- related perceived stigma, mental health, and quality of life (QoL) among people living with HIV (PLHIV) in Markazi Province, Iran.
Material and methods:
This cross-sectional study included PLHIV in Markazi Province in 2019. An 12-item perceived stigma, general health questionnaire, and WHOQOL-HIV BREF questionnaire were administered to measure the perceived stigma, mental health, and QoL among PLHIV. Asset-based approach and principal component analysis were used to assess the socio-economic status (SES) of participants. Finally, concentration indices and 95% CI (confidence interval) were calculated to evaluate inequality among PLHIV.
Results:
A total of 123 PLHIV older than 18 years participated in the study. The mean age of participants was 41.1 (SD = 10.2) years, 66% of whom were males. The results of the study revealed that concentration indices were 0.03 (95% CI: 0.01-0.04%; p = 0.001) for perceived stigma, –0.21 (95% CI: –0.34 to –0.07%; p = 0.002) for mental disorders, and 0.07 (95% CI: 0.06-0.09%; p = 0.001) for QoL.
Conclusions:
The findings indicated that SES inequalities resulting from perceived stigma, QoL, and mental disorders are high among PLHIV. It was observed that, although perceived stigma was a critical issue among PLHIV with higher SES, low QoL and mental disorders were important factors among those with lower SES. Therefore, policy-makers in public health should be informed to plan and implement HIV-related strategies to decrease these inequalities.
Socio-economic inequality is one of the most important issues in public health. This study aimed to assess socio-economic inequalities resulting from human immunodeficiency virus (HIV)- related perceived stigma, mental health, and quality of life (QoL) among people living with HIV (PLHIV) in Markazi Province, Iran.
Material and methods:
This cross-sectional study included PLHIV in Markazi Province in 2019. An 12-item perceived stigma, general health questionnaire, and WHOQOL-HIV BREF questionnaire were administered to measure the perceived stigma, mental health, and QoL among PLHIV. Asset-based approach and principal component analysis were used to assess the socio-economic status (SES) of participants. Finally, concentration indices and 95% CI (confidence interval) were calculated to evaluate inequality among PLHIV.
Results:
A total of 123 PLHIV older than 18 years participated in the study. The mean age of participants was 41.1 (SD = 10.2) years, 66% of whom were males. The results of the study revealed that concentration indices were 0.03 (95% CI: 0.01-0.04%; p = 0.001) for perceived stigma, –0.21 (95% CI: –0.34 to –0.07%; p = 0.002) for mental disorders, and 0.07 (95% CI: 0.06-0.09%; p = 0.001) for QoL.
Conclusions:
The findings indicated that SES inequalities resulting from perceived stigma, QoL, and mental disorders are high among PLHIV. It was observed that, although perceived stigma was a critical issue among PLHIV with higher SES, low QoL and mental disorders were important factors among those with lower SES. Therefore, policy-makers in public health should be informed to plan and implement HIV-related strategies to decrease these inequalities.
REFERENCES (41)
1.
Pandey A, Galvani AP. The global burden of HIV and prospects for control. Lancet HIV 2019; 6: e809-e811. DOI: 10.1016/S2352-3018(19)30230-9.
3.
Hassanzadeh J, Mohammadbeigi A, Eshrati B, Rezaianzadeh A, Rajaeefard A. Determinants of inequity in health care services utilization in Markazi Province of Iran. Iran Red Crescent Med J 2013; 15: 363-370.
5.
related inequality in early uptake of HIV testing among pregnant women: an analysis of data from a national cross-sectional survey, South Africa. BMJ Open 2017; 7: e013362. DOI: 10.1136/bmjopen-2016-013362.
6.
Vahedi S, Rezapour A, Mohammadbeigi A, Khosravi A. Economic inequality in outpatient healthcare utilization: the case of Iran. J Res Health Sci 2018; 18: e00424.
7.
Faust L, Yaya S, Ekholuenetale M. Wealth inequality as a predictor of HIV-related knowledge in Nigeria. BMJ Glob Health 2017; 2: e000461. DOI: 10.1136/bmjgh-2017-000461.
8.
O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing Health Equity Using Household Survey Data. A guide to techniques and their implementation. Washington, DC: The International Bank for Reconstruction and Development/The World Bank; 2008.
9.
Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 2006; 21: 459-468.
10.
Nikolopoulos GK, Fotiou A, Kanavou E, Richardson C, Detsis M, Pharris A, et al. National income inequality and declining GDP growth rates are associated with increases in HIV diagnoses among people who inject drugs in Europe: a panel data analysis. PLoS One 2015; 10: e0122367. DOI: 10.1371/journal.pone.0122367.
11.
Haacker M, Birungi C. Poverty as a barrier to antiretroviral therapy access for people living with HIV/AIDS in Kenya. Afr J AIDS Res 2018; 17: 145-152.
12.
Karimian M, Motevalian A, Damghanian M, Rahimi-Movaghar A, Sharifi V, Amin-Esmaeili M, et al. Explaining socioeconomic inequalities in illicit drug use disorders in Iran. Med J Islam Repub Iran 2017; 31: 108. DOI: 10.14196/mjiri.31.108.
14.
moon B. Decomposing economic disparities in risky sexual behaviors among people who inject drugs in Tehran: Blinder-Oaxaca decomposition analysis. Epidemiol Health 2017; 39: e2017049. DOI: 10.4178/epih.e2017049.
15.
Reinius M, Wettergren L, Wiklander M, Svedhem V, Ekström AM, Eriksson LE. Development of a 12-item short version of the HIV stigma scale. Health Qual Life Outcomes 2017; 15: 115. DOI: 10.1186/.
17.
Moradzadeh R, Zamanian M. HIV-related stigma among people living with HIV in Iran: a cross-sectional study. J Assoc Nurses AIDS Care 2021; 32: 610-618.
18.
Moradzadeh R, Navidi I, Zamanian M. Validity and reliability of the human immunodeficiency virus-related stigma questionnaire in Persian. J Int Assoc Provid AIDS Care 2023; 22: 23259582231189094. DOI: 10.1177/23259582231189094.
19.
Montazeri A, Harirchi AM, Shariati M, Garmaroudi G, Ebadi M, Fateh A. The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version. Health Qual Life Outcomes 2003; 1: 66. DOI: 10.1186/1477-7525-1-66.
20.
Shelton NJ, Herrick KG. Comparison of scoring methods and thresholds of the General Health Questionnaire-12 with the Edinburgh Postnatal Depression Scale in English women. Public Health 2009; 123: 789-793.
21.
Salehi M, Niroumand S, Erfanian MR, Sajjadi RB, Dadgarmoghaddam M. Validation of Persian version of WHOQOL-HIV BREF questionnaire in Islamic Republic of Iran. East Mediterr Health J 2016; 22: 647-653.
22.
WHOQOL-HIV Instrument. Users Manual. Scoring and Coding for the WHOQOL-HIV Instruments. Department of Mental Health.
23.
and Substance Dependence World Health Organization. Geneva: World Health Organization; 2002.
24.
Kazemi-Galougahi MH, Mansouri A, Akbarpour S, Bakhtiyari M, Sartipi M, Moradzadeh R. Income-related inequality in completed suicide across the provinces of Iran. Epidemiol Health 2018; 40: e2018012. DOI: 10.4178/epih.e2018012.
25.
Moradzadeh R, Nadrian H, Golboni F, Kazemi-Galougahi MH, Moghimi N. Economic inequalities amongst women with osteoporosis-related fractures: an application of concentration index decomposition. Health Promot Perspect 2016; 6: 190-195.
26.
Abdollahpour I, Nedjat S, Salimi Y, Moradzadeh R, Mansournia MA, Sahraian MA, et al. No association between socioeconomic status and risk of multiple sclerosis: a population-based incident case-control study in a developing country. Mult Scler Relat Disord 2018; 25: 292-296.
27.
Jolliffe IT, Cadima J. Principal component analysis: a review and recent developments. Philos Trans A Math Phys Eng Sci 2016; 374: 20150202. DOI: 10.1098/rsta.2015.0202.
28.
Rasoolinajad M, Abedinia N, Noorbala AA, Mohraz M, Badie BM, Hamad A, et al. Relationship among HIV-related stigma, mental health and quality of life for HIV-positive patients in Tehran. AIDS Behav 2018; 22: 3773-3782.
29.
Moradzadeh R, Navidi I, Zamanian M. Assessing the quality of life of HIV-infected people and the its associated factors in Markazi Province 2020-2021. Journal of Arak University of Medical Sciences 2021; 24: 748-759.
30.
Moradzadeh R, Zamanian M. Psychological health among people living with HIV in Iran. HIV AIDS Rev 2023; 22: 245-250.
31.
Lim T, Zelaya C, Latkin C, Quan VM, Frangakis C, Ha TV, et al. Individual-level socioeconomic status and community-level inequality as determinants of stigma towards persons living with HIV who inject drugs in Thai Nguyen, Vietnam. J Int AIDS Soc 2013; 16 (3 Suppl 2): 18637. DOI: 10.7448/IAS.16.3.18637.
32.
Wabiri N, Taffa N. Socio-economic inequality and HIV in South Africa. BMC Public Health 2013; 13: 1037. DOI: 10.1186/1471-2458-13-1037.
33.
Kalichman S, Shkembi B, Hernandez D, Katner H, Thorson KR. Income inequality, HIV stigma, and preventing HIV disease progression in rural communities. Prev Sci 2019; 20: 1066-1073.
34.
Ransome Y, Kawachi I, Braunstein S, Nash D. Structural inequalities drive late HIV diagnosis: the role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing. Health Place 2016; 42: 148-158.
35.
Moradzadeh R, Mansournia MA, Ghiasvand R, Baghfalaki T, Nadrian H, Holakouie-Naieni K. Impact of age at menarche on breast cancer: the assessment of recall bias. Arch Iran Med 2019; 22: 65-70.
36.
Moradzadeh R, Mansournia MA, Baghfalaki T, Nadrian H, Gustafson P, McCandless LC. The impact of maternal smoking during pregnancy on childhood asthma: adjusted for exposure misclassification; results from the National Health and Nutrition Examination Survey, 2011-2012. Ann Epidemiol 2018; 28: 697-703.
38.
Baneshi MR. Methodological considerations in using the Network Scale Up (NSU) for the estimation of risky behaviors of particular age-gender groups: an example in the case of intentional abortion. PLoS One 2019; 14: e0217481. DOI: 10.1371/journal.pone.0217481.
39.
Zamanian M, Zolala F, Haghdoost AA, Baneshi MR. Effect of estimation method, definition of ratio, and the plausible range in estimating social network size. Social Network Analysis and Mining 2018; 8: 1-7.
40.
Moradi G, Ghaderi E, Sargolzaei M, Fallahi H, Eybpoosh S, Tayeri K, et al. HIV/AIDS surveillance system in the Islamic Republic of Iran: history, structures and processes. Iran J Epidemiol 2019; 15: 204-214.
41.
Noroozi M, Rahimi E, Ghisvand H, Qorbani M, Sharifi H, Noroozi A, et al. Decomposition of economic inequality in needle and syringe programs utilization to its determinants among men who inject drugs in tehran using blinder–oaxaca decomposition method. Subst Use Misuse 2018; 53: 1170-1176.
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