Anxiety and depression among women living with HIV in Kazakhstan.

An increase in new HIV infections among women in Kazakhstan has motivated efforts to improve access to comprehensive health services. This study estimates anxiety and depression frequency among women seeking HIV services. A cross-sectional survey was administered to women seen at the Almaty AIDS Center. Bivariable analyses (e.g., Chi-square, means with 95% confidence intervals) were performed to assess the relationship between anxiety (score of 10 or more on the Generalized Anxiety Disorder-7 Scale (GAD-7)), major depression (Patient Health Questionnaire 8 (PHQ-8)), and comorbid anxiety and major depression with sociodemographic characteristics, health functioning, and medication history. Of the 410 participants, 62 (15.1%) had a GAD-7 ≥ 10; 52 (12.7%) met major depression criteria; 35 (8.5%) met both criteria, and 79 (19.3%) met GAD-7, major depression, or both criteria. Women reporting depression or anxiety were more likely to lack food security (p < 0.01), not finish secondary school (p < 0.01), speak Russian at home (p < 0.01), perceive their health to be poor (p < 0.01), and report poorer physical and mental health functioning (p < 0.05). No medications approved for the treatment of anxiety or depression were reported. The considerable number of women reporting major depression and anxiety symptoms suggests a need for improving access to mental health care.

Developing effective HIV education in Central Asia: a cross-sectional study among Kazakh medical students.

INTRODUCTION: The HIV epidemic continues to expand in Central Asia, bridging from injecting drug users to the general population, largely through heterosexual transmission. This study describes medical students' attitudes and behaviours regarding HIV and sexual practices in response to recently introduced HIV curriculum. METHODOLOGY: Medical students in Almaty, Kazakhstan, were invited to participate in a cross-sectional survey between April and November, 2013. The survey assessed participant's risk behaviours (e.g., injecting drug use, condom use), concerns related to HIV infection risk (e.g., medical care exposures, personal behaviours), and ability to identify HIV-positive individuals without asking their status. Bivariate analyses (Chi-square test or Fisher's exact test) and multivariate analysis (log-binomial regression) were conducted. RESULTS: Of 647 medical students, the majority were female (82.2%) and single (92.8%) with a median age of 21-22 years. Sexual activity was reported by 176 (27.2%); males were substantially more likely to report sexual activity (74.8% males vs. 16.9% females, p <.0001). The majority of sexually active medical students (65.6% and 68.3% males and females, respectively) believe they can determine if their partner is HIV-positive without asking or seeking a laboratory test. This proportion is much higher (92.6%) among married or cohabitating women. No association between perceived ability to ascertain HIV status and condom use was identified. CONCLUSIONS: The medical students in our study had a relatively naïve perception of HIV risk, and their knowledge of risk did not translate to appropriate precautionary behaviours. Much work remains if the epidemic in Central Asia is to be contained.

Relationship between vitamin D and human immunodeficiency virus (HIV) viral load among HIV-infected patients in Kazakhstan.

INTRODUCTION: Human immunodeficiency virus (HIV) is associated with inflammation. An association between vitamin D deficiency and inflammation also exists. Our study attempts to examine whether there may be a relationship between vitamin D and HIV viral load (HIV RNA) by: 1) characterizing the distribution of 25-hydroxyvitamin D (25-OHD), and 2) determining if 25-OHD is independently associated with HIV RNA. METHODOLOGY: A cross-sectional study among HIV-infected adults was conducted. Demographics, clinical / social / HIV characteristics and data on antiretroviral therapy were collected by questionnaire, medical records and laboratory testing. All patients provided blood samples. Bivariate and multivariate analyses were conducted to quantify the relationship between vitamin D and HIV RNA. RESULTS: Among the 564 patients, the median (interquartile range, IQR) 25-OHD value was 24.42 (16.22 - 34.10) ng/mL. The mean (standard deviation, SD) log-HIV RNA was 3.51 (1.11) copies/mL. There were 304 patients (53.9%) with an undetectable HIV RNA (< 500 copies/mL). In the bivariate analyses, no differences were observed between patients with and without an undetectable HIV RNA in mean (SD) 25-OHD, 25-OHD insufficiency (< 30 ng/mL), or 25-OHD deciles. In the log-binomial regression analyses, there was no association between 25-OHD and an undetectable HIV RNA (prevalence ratio: 1.00, 95% confidence interval: 0.99 - 1.01, p = 0.67). CONCLUSIONS: No relationship was observed between 25-OHD and HIV RNA among HIV-infected patients in Kazakhstan.