Substance use, anxiety, and self-management efficacy in HIV-positive individuals: A mediation analysis

Context: In China, the social stigma of both substance use and HIV remains major barrier. HIV-positive individuals have been demonstrated to have higher psychosocial distress in the literature. To ensure quality of life among HIV-positive Chinese individuals, self-efficacy in HIV-related management including substance use and anxiety is the key to suppress viral load and maintain healthy lives. Objectives: We examine the mediation relationship among substance use, anxiety, and self-management efficacy. Method: A cross-sectional study design was used. In total, 137 HIV-positive individuals were recruited from two premier Chinese hospitals: Beijing's Ditan Hospital and Shanghai's Public Health Clinic Center (SPHCC). Results: HIV-positive substance users had significantly lower HIV-management efficacy and higher anxiety scores. About a third of the relations between substance use and anxiety were mediated by HIV-management self-efficacy. Those who used substances in the previous week had higher anxiety levels suggesting the presence of a recency effect. Their higher levels of anxiety could be largely explained by their lower HIV-management efficacy. Conclusion: It is useful for healthcare providers to assess substance use behaviors in HIV-positive individuals as well as provide support in managing anxiety in this population. Meanwhile, enhancing self-management efficacy to ensure healthy lifestyles may support achieving optimal lives with HIV.