Qualidade de vida e saúde mental de populações com risco elevado para infecção pelo HIV em tempos de pandemia da Covid-19

Abstract

Introduction: The challenges posed to public health due to the Covid-19 pandemic were aggravated by structural inequalities and inequities between populations, mainly affecting the quality of life (QoL) and mental health of people in vulnerable and at-risk situations. Objective: To evaluate the quality of life and mental health of populations in situations of vulnerability and high risk for HIV infection in times of the covid-19 pandemic. Method: Cross-sectional, analytical, quantitative study, carried out in a reference hospital for infectious diseases, houses and prostitution points, located in João Pessoa-PB, from July 2022 to May 2023. The population was made up of people with high risk for HIV infection. To collect data, the following instruments were used: sociodemographic characterization and risks associated with HIV infection; investigating the effects of the covid-19 pandemic; QoL assessment - WHOQOL bref and the Depression, Anxiety and Stress Ladder - DASS-21. The results were analyzed using descriptive and inferential statistics and the development of a Binary Logistic Regression Model for decision making that best explains the QoL outcome. Results: Of the 268 cases investigated, 132 are part of the group using pre-exposure prophylaxis - G-PrEP and 136 are part of the group that was not using prophylaxis - G-Non-PrEP, of which 66.91% of the latter are not monitored by any health service and 37.50% do not use PrEP because they are unaware of the method. Among the participants, there was a predominance of males, aged between 30 and 34 years, self-declared white or mixed race, single, formal/salaried professional category and family income between one and three minimum wages. In G-PrEP, higher education predominated, while in G-Non-PrEP it was incomplete secondary education. Regarding the risks associated with HIV, in both groups the majority report being men, with sexual orientation prevailing in G-PrEP, homosexual, and in G-Non-PrEP, heterosexual. In G-PrEP, the majority report having an HIV-positive partner and in G-Non-PrEP, they report being gay or a man who has sex with men. In both groups there was a prevalence of syphilis and symptoms of vaginal/urethral or anal discharge. Most G-PrEP say they have had four or more partners and G-Non-PrEP say they have only one partner. Both groups, for the most part, reported not using condoms in the last 3 months, and using illicit drugs. For those who use PrEP, the majority say they have not stopped treatment in the last 30 days. In the WHOQOL-bref analysis, the total quality of life score obtained a median of 72.10 for G-PrEP and 55.00 for G-Non-PrEP. The most affected QoL domain was psychological for G-PrEP and environmental for G-Non-PrEP. In the assessment of mental health, using the DASS-2 scale, there were better median scores in the anxiety subscale; in G-Non-PrEP, the more intense the symptoms, the worse mental health conditions they presented compared to G-PrEP. There was a moderate correlation between all QoL domains and the studied aspects of mental health. The logistic regression model identified a negative impact on the QoL of those who use injectable drugs or not, not using condoms during sexual intercourse, having negative feelings or anxiety about the future resulting from Covid-19, high levels of stress, depression and use of medication for anxiety, depression or stress. Conclusions: The findings of this study showed that a pandemic scenario significantly affects the QoL and mental health of people in vulnerable situations and at risk for HIV infection, providing managers with evidence that favors the development and implementation of psychosocial programs that address the specific needs and challenges faced by a group of vulnerable people, seeing this population in all its completeness.