The psychosocial impact of HIV infection in men with haemophilia: controlled investigation and factors associated with psychiatric morbidity

Abstract

The aim of the investigation was to establish the prevalence of psychosocial problems in men with haemophilia and HIV infection, and to identify factors associated with psychological morbidity. A cross-sectional controlled study including 37 HIV seropositive and 36 HIV seronegative men with haemophilia under the care of the Oxford Haemophilia Centre were included in the investigation. The outcome measures included current psychological status (PSE, POMS, Beck Hopelessness Scale and Self-Esteem) and psychiatric history; coping and health beliefs (Self-Control Schedule, Hardiness Scale, Health Locus of Control Scale); social functioning (Modified Social Adjustment Scale); and sexual functioning. The results showed that seropositive individuals, whether symptomatic or not, had significantly worse total PSE scores and had higher levels of hopelessness. In addition, symptomatics had worse depression scores (POMS) than seronegatives. However, levels of psychiatric morbidity were generally low, even in the seropositive group. High levels of psychological morbidity were associated with high levels of hopelessness, unfavourable social adjustment, past psychiatric history and symptomatic HIV disease. Seropositives reported greater negative impact on their sex lives, and sexually active seropositives reported a significantly greater prevalence of sexual dysfunction than seronegatives. The majority of seropositives reported regular condom use during intercourse, and also continuing concerns about infecting their sexual partners in spite of it. In summary, it was found that men with haemophilia an HIV infection have higher levels of psychological distress and sexual problems than seronegatives. The skilled staff involved in their treatment are in a good position to identify their difficulties and ensure that good care is provided.

PIP: At the Oxford Haemophilia Centre at Churchill Hospital in Oxford, England, psychiatrists compared data on 37 HIV seropositive hemophiliacs (31 asymptomatics and 6 symptomatics) with data on 36 HIV seronegative hemophiliacs to determine the prevalence of psychosocial conditions in HIV seropositive men and factors related to those conditions. HIV seropositive men had much higher Present State Examination scores than did the HIV seronegative men (5.9 vs. 2.2; p=.005). This was true for both symptomatic and asymptomatic HIV seropositive men (7.3 and 5.7, respectively). Nevertheless, these levels of psychological disturbance were basically the same as the general outpatient medical population as was also the case with depression scores (POMS). Still symptomatic HIV seropositive men were more likely to be depressed than HIV seronegative men (6.4 vs. 3.6; p=.02). The most important finding was that both symptomatic and asymptomatic HIV seropositive men felt significantly higher levels of hopelessness than did the HIV seronegative men (6.5 vs. 2.6; p=.0004, asymptomatic-5.8 and symptomatic=9.7). Hopelessness indicated an increased risk of suicide which is independent of depression. Past psychiatric history (r=0.38), hopelessness (r=0.55), and poor social adjustment (r=0.55) accounted for 49.8% of the variance (p.001). HIV seropositive men exhibited more psychosexual dysfunction especially premature and delayed ejaculation (30% vs. 4% and 20% vs. 0, respectively; p.05) than HIV seronegative men. Among the men who had a sexual relationship, HIV seropositive men tended to always use condoms during intercourse (79% of asymptomatics and 100% of symptomatics vs. 25% of HIV seronegatives; p=.0004). Even though they used condoms, HIV seropositive men were more likely to worry about infecting their partners than HIV seronegative men (p=.02).