Study Title: SUNRISE Study: Urban and Island Experiences of HIV Treatment and Stigma What is this study about? This study aims to understand how living in urban areas versus islands affects the experiences of people living with HIV (PLWH) in Portugal. Specifically, the investigators want to explore how stigma and mental health (such as depression and anxiety) differ between these two settings. The investigators are also interested in understanding how the number of pills a person takes daily (called "pill burden") impacts their mental health and satisfaction with treatment. Why is this study important? Stigma related to HIV can make it harder for people to stick to their treatment and can negatively affect their mental health and overall well-being. By comparing urban and island settings, the investigators hope to identify unique challenges faced by PLWH in different environments. This information will help the investigators to develop better strategies to support people living with HIV, no matter where they live. Who can participate? Adults (18 years or older) who have been diagnosed with HIV. People who have been on antiretroviral therapy (HIV treatment) for at least six months. Individuals living in urban areas or island region. What will happen during the study? Participants will complete a one-time interview during their regular HIV care visit. The interview will include questions about: Their experiences with HIV-related stigma. Their mental health (including depression and anxiety). Their satisfaction with their current HIV treatment. The number of pills they take daily and how this affects their daily life. All information will be kept confidential, and participation is voluntary. What are the potential benefits of participating? This study will help to understand the challenges faced by people living with HIV in different parts of Portugal. This knowledge can lead to improved support services and treatment options for PLWH in the future. What are the risks of participating? There are no physical risks associated with this study. However, some questions may touch on sensitive topics, such as stigma or mental health. How will the results be used? The results of this study will be shared with the scientific community, healthcare providers, and organizations that support people living with HIV. The goal is to use this information to improve care and reduce stigma for PLWH in Portugal and beyond. Who is conducting this study? This study is led by researchers from the Faculty of Medicine of Lisbon, in collaboration with hospitals in Portugal mainland, the Azores, and Madeira.
Study Type
OBSERVATIONAL
Enrollment
300
Unidade Local de Saúde de Santa Maria
Lisbon, Portugal
Levels of HIV-Related Stigma in Urban versus Island Settings
This outcome measures the levels of HIV-related stigma experienced by individuals living with HIV (PLWH) in urban and island settings in Portugal. Stigma is assessed using a validated HIV Stigma Scale, which evaluates perceived and internalized stigma (range: 0-48, where higher scores indicate greater perceived stigma). The results will be compared between the two geographic cohorts to identify differences in stigma experiences.
Time frame: Cross-sectional assessment at baseline (one-time measurement during study enrollment).
Prevalence of Depression and Anxiety in Urban versus Island PLWH
This outcome measures the prevalence of depression and anxiety among individuals living with HIV in urban and island settings. Depression is assessed using the Patient Health Questionnaire-9 (PHQ-9 ; range: 0-27, where higher scores indicate more severe depression), and anxiety is assessed using the Generalized Anxiety Disorder-7 scale (GAD-7; range: 0-21, where higher scores indicate more severe anxiety). Results will be compared between the two cohorts to identify differences in mental health outcomes.
Time frame: Cross-sectional assessment at baseline (one-time measurement during study enrollment).
Association Between Stigma and Mental Health Indicators (Depression and Anxiety)
This outcome evaluates the association between HIV-related stigma (measured using the HIV Stigma Scale; range: 0-48, where higher scores indicate greater stigma) and mental health indicators (depression measured using the Patient Health Questionnaire-9, PHQ-9; range: 0-27, where higher scores indicate more severe depression; and anxiety measured using the Generalized Anxiety Disorder-7, GAD-7; range: 0-21, where higher scores indicate more severe anxiety). The goal is to determine whether higher levels of stigma are associated with worse mental health outcomes, adjusting for potential confounding variables such as age, gender, and duration of HIV treatment. Statistical analysis will include multiple linear regression models to assess these associations. The regression models will estimate the strength and direction of the associations, controlling for covariates.
Time frame: Cross-sectional assessment at baseline (one-time measurement during study enrollment).
Association Between Pill Burden and Mental Health Impact in People Living With HIV
This outcome evaluates the association between the number of daily pills (pill burden) for HIV treatment and its impact on mental health (depression measured using the Patient Health Questionnaire-9, PHQ-9; range: 0-27, where higher scores indicate more severe depression; and anxiety measured using the Generalized Anxiety Disorder-7, GAD-7; range: 0-21, where higher scores indicate more severe anxiety). The goal is to determine whether a higher pill burden is associated with worse mental health outcomes, adjusting for potential confounding variables such as age, gender, and duration of HIV treatment. Statistical analysis will include multiple linear regression models to assess these associations. The regression models will estimate the strength and direction of the associations, controlling for covariates.
Time frame: Cross-sectional assessment at baseline (one-time measurement during study enrollment).
Association Between HIV Treatment Satisfaction and Stigma/Mental Health Indicators
This outcome evaluates the association between satisfaction with HIV treatment (measured using the HIV Treatment Satisfaction Questionnaire, HIVTSQ; range: 0-60, where higher scores indicate greater satisfaction) and indicators of stigma (HIV Stigma Scale; range: 0-48, where higher scores indicate greater stigma) and mental health (depression measured using the Patient Health Questionnaire-9, PHQ-9; range: 0-27, where higher scores indicate more severe depression; and anxiety measured using the Generalized Anxiety Disorder-7, GAD-7; range: 0-21, where higher scores indicate more severe anxiety). The goal is to determine whether higher treatment satisfaction is associated with lower levels of stigma and better mental health outcomes, adjusting for potential confounding variables such as age, gender, and duration of HIV treatment. Statistical analysis will include multiple linear regression models to assess these associations.
Time frame: Cross-sectional assessment at baseline (one-time measurement during study enrollment).
Assessment and comparison of HIV-Related Knowledge between Urban versus Island Settings
This outcome evaluates the level of knowledge about HIV using the HIV Knowledge Questionnaire-18 (HIV-KQ-18; range: 0-18, where higher scores indicate greater knowledge). The objective is to compare HIV knowledge levels between two regions and identify potential gaps. The analysis will consider key sociodemographic factors such as age, gender and education level. Statistical methods will include independent t-tests or Mann-Whitney U tests for regional comparisons, and multiple linear regression models to examine the association between knowledge scores and sociodemographic variables, adjusting for potential confounders.
Time frame: Cross-sectional assessment at baseline (one-time measurement during study enrollment).
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