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J Subst Use. 2018;23(4):408-414. doi: 10.1080/14659891.2018.1436603. Epub 2018 Feb 22.

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

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School of Nursing, University of California Los Angeles, Los Angeles, CA.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
Psychiatry and of Neuroscience, School of Medicine, Yale University, New Haven, CT.
Ditan Hospital, Capital Medical University, Beijing, China.
Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
Chulalongkorn University, Bangkok, Thailand.
National Cheng Kung University, School of Nursing, Tainan, Taiwan.



In China, the social stigma of both substance use and HIV remains major barriers. HIV+ individuals have been demonstrated to have higher psychosocial distress in the literature. To ensure quality of life among HIV+ Chinese individuals, self-efficacy in HIV-related management including substance use and anxiety is the key to suppress viral load and maintain healthy lives.


We examine the mediation relationship among substance use, anxiety, and self-management efficacy.


A cross-sectional study design was used. 137 HIV+ individuals were recruited from two premier Chinese hospitals: Beijing's Ditan Hospital and Shanghai's Public Health Clinic Center (SPHCC).


HIV+ substance users had significantly lower HIV-management efficacy and higher anxiety scores. About a third of the relations between substance use and anxiety was mediated by HIV-management self-efficacy. Those who used substances in the previous week had higher anxiety levels suggesting the presence of a recent effect. Their higher levels of anxiety could be largely explained by their lower HIV-management efficacy.


It is useful for healthcare providers to assess substance use behaviors in HIV+ 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.

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