HIV Demographics & Psychographics

Part
01
of two
Part
01

HIV Patient Psychographic

Psychographic characteristics of an individual at a higher-than-average risk of contracting HIV include suffering from psychological distress or mental health disorders, having low social support, neuroticism, disagreeableness, having low levels of conscientiousness, extroversion, abusing alcohol or drugs, suffering from minority stressors, and being in economically dependent partnerships. An analysis of these psychographic factors is below.

Psychological Distress

  • A 2017 study on people at risk of contracting HIV found that psychological distress can lead to risky sexual behaviors, which suggests that "poor mental health may be a risk factor for HIV acquisition."
  • Psychological distress is defined as "general term for a state of emotional suffering that can be associated with common mental disorders," the most prevalent of which is depression, affecting approximately 350 million people worldwide.
  • Other disorders that have been linked to high-risk sexual behaviors include anxiety and post-traumatic stress disorder.
  • Mental health problems "play a critical role in HIV acquisition across populations, increasing the risk of HIV acquisition by four to ten-fold."
  • In the U.S., the prevalence of HIV is significantly higher (up to 6%) in adults with serious mental illnesses when compared to the general population (0.5%).
  • In uninfected men, psychological distress was associated with engaging in transactional sex and inconsistent condom use, both of which increase the risk of HIV contraction.
  • In uninfected women, psychological distress was associated with engaging in transactional sex, engaging in sex work, and inconsistent condom use, all of which increase the risk of HIV contraction.
  • Mental health issues can also interfere with HIV prevention efforts such as regular testing and medication adherence.

Low Social Support

  • In a study published in the Industrial Psychiatry Journal in 2017, it was found that of cognitive, physical, emotional, social, and philosophical coping resources, HIV-positive men scored the lowest in social coping resources.
  • This indicates these individuals are not "embedded in social networks that are able to provide support in times of stress."

Neuroticism

  • Approximately one-third of HIV-positive men in the study published in the Industrial Psychiatry Journal had high neuroticism scores.
  • High scores in the neuroticism domain "signifies people who have a tendency to experience negative effects such as fear, sadness, and anger; maladjustment is seen in many facets and thus individuals who score less on neuroticism are emotionally stable and calm."
  • Other studies have shown that high neuroticism scores tend to be positively correlated with risky sexual behaviors; however, the results are mixed, with others who have scored high in the neuroticism domain engaging less in risky health behaviors.
  • Overall, though, studies indicate that lower neuroticism scores "define an emotionally stable person who is able to hold on his/her impulses, thus a relatively higher score in this domain highlights the behavioral problems in this group of patients, possibly leading to high-risk behaviors."
  • Neuroticism is also linked to lower coping skills, as "neuroticism predicts exposure to interpersonal stress and tendencies to appraise events as highly threatening and coping resources as low."
  • People who have high neuroticism scores generally predict less "problem-solving and cognitive restructuring."

Disagreeableness

Low Levels of Conscientiousness

Extroversion

  • Although high extroversion scores are associated with slow disease progression in infected individuals due to a lower risk of social isolation, they are also associated with riskier behaviors in uninfected individuals.
  • Extroversion alone does not appear to be negatively linked with high-risk behavior, but when combined with high neuroticism scores and low agreeable and conscientiousness scores, extroversion points to the "tendency of being impulsive with a lower self-control regarding pleasurable activities and thus highlights, in totality, a high risk-taking personality."

Substance Abuse

  • A study published in 2018 indicated that "substance use has been shown to increase the risk of HIV infection." Therefore, it is assumed that individuals who choose a lifestyle that includes substance abuse are more likely to contract HIV.
  • Nearly 50% of HIV-infected individuals have reported "current or past histories of drug or alcohol disorders."
  • People who abuse substances can be up to 10 times as likely to contract HIV as non-substance users.
  • Drug use has shown to be associated with "increased risk of opportunistic infections" such as HIV.

Minority Stressors

  • Minority stressors that are commonly associated with the LGBTQ population, such as "homophobia (internal and external), machismo, racism, prejudice, and injustices," can often "result in psychological distress that can lead to risky sexual behaviors putting this population at higher risk for HIV and STDs"
  • For instance, in the study "HIV in Sexual and Gender Minority Populations," it was stated that "transgender women have 35 times the risk of acquiring HIV infection than other adults of reproductive age, and HIV prevalence is twice as high among African American transgender women compared with transgender women of other racial and ethnic groups."
  • This increase in risk may be linked to the higher incidence of mental health disorders and psychological distress in transgender and gender non-binary individuals.
  • Psychological distress can occur in these individuals due to "overlapping risk factors, including gender dysphoria, high rates of psychological and physical abuse, social exclusion, stigma, and victimization."
  • As previously mentioned, psychological distress is associated with risky sexual behaviors, which are correlated with an increased risk of HIV contraction.
  • Moreover, transgender women have a "higher prevalence of substance use disorders compared with the general population."
  • As previously mentioned, substance abuse has been linked with a higher risk of HIV infection, therefore, if transgender women use substances at higher rates, then they are at an increased risk of contracting HIV as well.

Economically Dependent Partnerships

  • According to a study conducted on young men who have sex with other men, economically dependent partnerships (EDP) are "both a survival method and a risk factor for HIV."
  • One in five young men in the study started a new relationship with another man for economic needs.
Part
02
of two
Part
02

HIV- Insights

Some insights that explain why there is a rise in HIV amongst certain demographics consist of human sexuality preferences, HIV association to African American, Targeted Youth, HIV in the Southern United States, and how low income rises the increase.

Human Sexuality Preferences.

  • According to the Centers for Disease Control and Prevention report, the number of HIV infections for females decreased while that of males remained stable between 2010 and 2016. The 2016 reports indicate the rate for males to be 23.9, 4.7 times higher compared to that of females that was at 5.7.
  • According to the 2017 HIV diagnosis report, 78% of the youth were men with women making up to 13%. This male population that was HIV positive consisted of infection transmitted through male-to-male sexual contact, injection drug use, both injection drug use and male-to-male sexual contact, heterosexual contact and other possible reasons.
  • With male-to-male sexual contact taking up to 93% of the infected population, it is evident that sexual preference among the male sex highly contributed to the imbalance between HIV rates compared to women.
  • One of the reasons HIV transmission is higher among young gays and bisexual men is due to the drive of lack of knowledge regarding certain sexual practices and their increased exposure to HIV. A study done by the CDC of high school pupils confirmed that men to men sexual practices occur without the use of a condom and with multiple partners due to their lifetime.
  • Additionally, biological factors such as anal sex being a more likely instance to spread HIV compared to vaginal sex, likeliness for bisexual and young gay men to engage in drugs, as well as stigma among the young makes them less likely for HIV testing.

HIV and African American

  • The Black/African American ethnicity consist of the highest prevalence with a total of 13% in the US population but accounts for 43% of HIV diagnosis in the US. Derived from this population, 73% were men while 26% were women.
  • Within the African American population, 60% were bisexual or gay men. This correlates to the human sexuality insight on the factors that result in higher HIV rates among the African community.
  • Black Americans bare the highest risk of HIV infections not because they engage more to risky associated behaviors but rather due to higher prevalence levels compared to other racial/ethnic groups.
  • Poverty, access to healthcare inaccessibility, discrimination, and stigma contribute to the varying HIV rates among the African Americans and other racial/ethnic groups. Regions that are prone to new HIV infections include the American South that house a large population of black Americans.
  • Furthermore, African Americans are less likely to own private health insurance compared to the whites and therefore, HIV individuals are less likely to have access to medication and hence more likely to spread HIV.

Targeted Youth

  • In the 2017 report, young adults aged 13-29 accounted for 41% of HIV diagnosis with those aged 13-24 accounting for 21% which roughly translated to one out of every five individuals to be infected.
  • The report portrayed decrease among other age groups between 2010 to 2016 but a 6% increase among those between the age of 13-29.
  • The major contribution of this increase was brought about by the minority young men of various ethnic groups that had same sex partners especially the men. This group accounts for 6 out of 10 diagnosis among young adults in 2017. The highest rate amongst this group consisted of Young Hispanic/Latino men with 17% followed by African American men with 9%.
  • The youth are more prone to use injection drugs, join a transgender, or even end up in prison which record high levels of HIV infection which leaves then vulnerable.
  • Moreover, an estimated 50,900 of 24 year old are HIV infected however 44% of the population is unaware. This portrays this group to be less likely to get tested, follow HIV treatment or virally suppressed.

HIV in the Southern United States

  • Thirty-eight percent of the population in the US lives within the Southern States; however an estimated 51% accounts for new HIV cases every year. Compared to all the over regions, the South diagnosed 52% more cases. Eight out of ten of the States with the highest levels of HIV are located in the South.
  • Despite the urban areas having a majority of HIV rates, the suburban and rural areas of this region have recorded higher HIV new diagnosis compared to other regions of the US. This region is highly impacted by race with African American consisting of the highest population.
  • Factors that drive the rise of HIV diagnosis in this region consist of socioeconomic factors such as high unemployment and poverty. Compared to other regions, the south has the poorest median household income which contributes to lower health outcomes.
  • Culture factors also contribute to the increase of new HIV diagnosis such as stigma. This results in alternative behaviors such as sex work and substance abuse which result in an increase of HIV exposure.

Low Income Increases Risk

  • According to the Centers for Disease Control and Prevention, The annual household income varies in four levels. The highest population with 52% falls under US$ 0-9,999 followed by 24% with US$ 10,000-19,999, then 19% with US$ 20,000-49,999 and lastly 3% that earns more than US$ 50,000.
  • This data reveals that individuals living below the U.S. poverty level were less or equal to 20%.
  • This population is therefore mostly likely struggle to access treatment that is effective especially in the adolescent and young population. A quarter of this population that access treatment are reluctant in staying on it with some of their reasons being financial instability.
  • With low income, the population that is unable to attain treatment provide a risk to the entire population in terms of HIV contraction. This is especially supported by the weakened Affordable Care Act enacted by President Trump that will lead to increased health insurance costs.
Sources
Sources