Embodiment, ecology, and variability in mental health, psychosocial support, and HIV risk in Vietnam Restricted; Files Only
Trang, Kathy (Fall 2020)
Published
Abstract
In 2016, over one billion people worldwide were estimated to be living with a mental health or addictive disorder. Mental health disorders alone accounted for 7% of all disability-adjusted life years, constituting the largest disability burden of any disease category. Among people living with or at high risk for HIV, this burden is magnified. In the context of HIV, mental illness reduces adherence to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP), increases the likelihood of engaging in HIV transmission risk behaviors, and elevates the risk of virologic failure among those HIV-positive. Concomitantly, due to its psychosocial and biological effects, people living with HIV (PLWH) may also be at an increased risk for developing a range of mental health and neurological disorders. HIV-associated neurocognitive disorders, for instance, presents in approximately 21.5% to 60% of PLWH worldwide, while prevalence of common mental health disorders like Post-Traumatic Stress Disorder (PTSD) approximates 30%.
Men who have sex with men (MSM) are at an increased risk for both mental health disorders and HIV infection. Existing research within anthropology, public health, and psychiatry have elucidated their socio-ecological, behavioral, and biological synergy, but are limited by lack of integration between individual and sociocultural levels of analyses, disparity between theoretical orientation and operationalization; and over-reliance on self-report and observation of overt behaviors or interactions to infer often covert processes. This dissertation addresses these primary limitations through a mixed-methods approach that leverages interviews, surveys, and ambulatory and mobile technologies to characterize the everyday processes contributing to heterogeneity in physical and mental health outcomes among MSM. Integrating data drawn from 16-months of fieldwork, this dissertation elucidates the multiple ways through which mental health matters in HIV, including though: absence in clinical programming, sheer burden, and its cognitive, relational, and psychophysiological impacts. Given that pronounced mental health burden in key populations is often observed alongside a lack of mental health and psychosocial support (MHPSS) programming in low-and middle income countries, what this dissertation provides is a case study and evidence base for (i) assessing mental health burden in key populations in culturally sensitive ways, (ii) identifying the mechanisms underlying the nature and excess of mental health burden among this population, and (iii) evaluating the feasibility and acceptability of new technologies in elucidating and intervening in the ongoing impact of trauma in these men’s everyday life.
Table of Contents
CHAPTER 1: Introduction & Dissertation Overview.....................................................................1
CHAPTER 2: Cultural Models of Mental Illness..........................................................................66
CHAPTER 3: Elevated Trauma Exposure and Mental Health Burden........................................ 90
CHAPTER 4: Alone: Social Capital, Resilience, and Loneliness...............................................146
CHAPTER 5: Low-Intensity Measures of Skin Conductance and Heart Rate............................191
CHAPTER 6: Cultural Shaping of Associations.........................................................................224
CHAPTER 7: Feasibility and Acceptability of Mobile EMA.....................................................264
CHAPTER 8: Discussion & Conclusions....................................................................................313
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File download under embargo until 04 January 2027 | 2020-11-04 15:22:31 -0500 | File download under embargo until 04 January 2027 |
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