Improving the Health and Mental Health of People Living With HIV/AIDS

Improving the Health and Mental Health of People Living With HIV/AIDS: 12-Month Assessment of a Behavioral Intervention in Thailand

Li and colleagues examined findings from a randomized controlled intervention trial designed to improve the quality of life of people living with HIV in Thailand. A total of 507 people living with HIV were recruited from 4 district hospitals in northern and northeastern Thailand and were randomized to an intervention group (n=260) or a standard care group (n=247). Computer-assisted personal interviews were administered at baseline and at 6 and 12 months. At baseline, the characteristics of participants in the intervention and standard care conditions were comparable. The mixed-effects models used to assess the impact of the intervention revealed significant improvements in general health (B=2.51; P=.001) and mental health (B=1.57; P=.02) among participants in the intervention condition over 12 months and declines among those in the standard care condition. The authors’ results demonstrate that a behavioural intervention was successful in improving the quality of life of people living with HIV. Such interventions must be performed in a systematic, collaborative manner to ensure their cultural relevance, sustainability, and overall success.

The cognitive-based intervention for this trial was informed by pragmatic aspects of Buddhist thought that emphasise personal responsibility, personal betterment, and change in life; by the lived experience of shame and guilt among Thai people living with HIV; and by the family orientation of Thai society. The four modules delivered over 13 weeks were healthy mind, healthy body, parenting and family relationships, and social and community integration. The trial found a significant improvement in both general health and mental health of participants in the intervention arm over a period of 12 months. Those with improved general health were less likely to be depressed or have internalized shame, and were more likely to report positively about family functioning. A significant association was found between mental health and family functioning. The intervention did not have an effect on the physical health of study participants, all of whom were receiving care in district hospitals throughout the study. Two conclusions are that adapting initiatives to the sociocultural context is essential to increasing their potential for impact and that integrating social and psychological components into HIV programmes can improve both individual and family well-being.