A fifth of
HIV-positive adults in the United States regularly experience symptoms of
anxiety, according to research published in AIDS.
Individuals with symptoms of generalised anxiety disorder (GAD) had poor
engagement with the HIV care continuum, and also had high rates of poverty,
homelessness and drug use. There was also evidence of an elevated prevalence of
risky sexual behaviour.

“We estimate that
nearly 1 in 5 people with HIV in the United States experienced recent
symptoms consistent with a diagnosis of GAD,” comment the researchers. “The
significance of the excess burden of anxiety among PWH is compounded by our
finding that GAD symptoms are related to suboptimal HIV care and outcomes in
this population, which few studies have examined.”

Anxiety disorders
are the most common mental health illness in the United States and can cause
significant physical, psychological and social problems. GAD is characterised
by persistent and excessive worry that is difficult to control. As little is known
about the prevalence and associations of GAD among adults with HIV in the
United States, investigators analysed data from the Medical Monitoring Project. This survey carefully sampled 3654 adults who are representative of all people diagnosed with HIV in the United States. 

The prevalence of GAD
was calculated using a validated questionnaire. A trained interviewer asked
participants the following questions: “Over the past two weeks, how often have
you been bothered by any of the following problems?” for seven problems such as “feeling nervous, anxious, or on edge” and “not being able to stop or control worrying”.

The estimated
prevalence of GAD was 19%. In the general population of the US, prevalence is 2.7%.

Symptoms were more common among women than men,
among individuals without a college education, among those living in poverty, and in individuals with recent
experience of homelessness. “Our analysis
supports the findings of others on the relationship between GAD and social
determinants of health such as poverty and housing instability,” note the

Participants with
a disability had a four-times higher prevalence of GAD than individuals who did
not report a disability (33% vs. 8%). Prevalence of GAD among persons reporting
intimate partner violence or sexual violence was 41% and 43%, respectively,
twice the rate observed in participants who did not report such violence.
Individuals with GAD had higher HIV stigma scores (55%) compared to individuals
without GAD (33%).

GAD was associated
with poorer engagement in the HIV care continuum, including use of
antiretroviral therapy (82% vs. 87%), 100% adherence (51% vs. 62%) and viral suppression (56% vs 64%).

symptoms were seven times more common in patients with GAD (75% vs. 11%), and
individuals with GAD were three-times more likely to be in need of mental
health services (23% vs. 7%).

Prevalence of
smoking and drug use was significantly higher among individuals with symptoms
of GAD. In addition, GAD symptoms were
associated with significantly higher prevalence of condomless sex while not
virally suppressed with a partner who was not known to be taking PrEP (9% vs.

“Improving access
to substance use treatment and HIV/STD risk reduction services could be
beneficial for persons experiencing anxiety symptoms,” suggest the authors.
“Collaborate care models – in which medical, mental health, and case management
staff partner to provide comprehensive care – have been found to me more
effective in improving anxiety in patients.”