Screening Anxiety in the HIV Clinic

Enbal Shacham; Jennifer C. Morgan; Nur F. Önen; Toshibumi Taniguchi; Edgar Turner Overton


AIDS and Behavior. 2012;16(8):2407-2413. 

In This Article

Abstract and Introduction


Individuals with HIV experience fluctuating levels of distress throughout the course of their infection. This cross-sectional study was conducted to examine the prevalence of and associations between anxiety symptoms, sociodemographic, and biomedical markers among individuals presenting for care. A total of 635 individuals were screened, the majority of whom was male and African American. Younger individuals, African Americans, individuals with less education, and those who were unemployed were more likely to express more severe anxiety symptoms. Individuals who were not currently receiving antiretroviral therapy (ART) were 1.61 times more likely to experience higher anxiety symptoms. Among individuals receiving ART, higher levels of anxiety were associated with less adherence, higher viral loads and lower CD4 cell counts. Current smokers were 1.66 times more likely to have higher rates of anxiety. When controlling for these significant factors, younger, unemployed, and less educated individuals were more likely to express more severe anxiety symptoms. These findings highlight the importance of screening and management of anxiety as an integral component of HIV care.


The Centers for Disease Control and Prevention (CDC) estimates that over 1 million people in the United States are living with HIV infection.[1] In Missouri, approximately 10,000 people are living with HIV infection, 5,000 of whom are in the St. Louis region.[2] Increasingly, HIV infection is being considered and treated as a chronic medical condition.[3] Considerable improvements in the effectiveness and availability of medical treatments for HIV disease have occurred.[1] As individuals with HIV infection are living longer, quality of life issues and secondary prevention efforts are being embedded in comprehensive care practices.[4]

General Anxiety Disorder (GAD) affects approximately 6.8 million American adults,[5] and is more prevalent among patients with chronic diseases.[6] Notably, the amount of psychological distress among individuals with HIV infection is significantly higher than the general population.[7] Furthermore, this population is affected by variable levels of distress throughout the course of their infection with negative consequences.[8–10] During periods of distress, individuals with a chronic illness may not only have lower quality of life, but also have difficulty engaging in behaviors that are health promoting.[11–13] Minimal research has focused on the impact of symptoms of anxiety on HIV management and associated health behaviors. Specifically, the prevalence of anxiety among individuals with HIV and the effect of anxiety on adherence with antiretroviral therapy (ART) and engagement in high-risk and health-compromising behaviors remains to be fully elucidated. With increased understanding of this relationship, simple, evidenced-based interventions can be administered in clinical settings to reduce anxiety. This study was developed to investigate the prevalence of anxiety among individuals with HIV and the association between those symptoms of anxiety and behavioral and HIV-related biomarkers. A better understanding of the relationship between anxiety and barriers to optimal care will enhance the management of HIV and quality of life for individuals with HIV infection.