Hypervigilance and its socio-emotional consequences among adolescents with HIV

Adolescents with HIV (AWH) experience hypervigilance due to HIV stigma. A mixed-methods study was conducted in three steps to develop a hypervigilance survey instrument from the lived experience of AWH. First, in-depth interviews were conducted with 39 AWH, second, a hypervigilance survey instrument was developed and administered to 106 AWH in the third step. A grounded theory approach was utilized to identify typologies of hypervigilance to develop a 12-item survey instrument. Factor analysis and reliability assessment were conducted to examine its pyschomtric properties. Logistic regression analysis was utilized to examine the association between hypervigilance and health outcomes (depressive symptoms and ART non-adherence). Four themes emerged, these were the salience of stigma, embodiment of hypervigilance, hypervigilant monitoring, and socio-emotional consequences of hypervigilance. Salience of stigma comprised situational cues that triggered HIV stigma. Subthemes of embodiment of hypervigilance were HIV as a focal point of interaction, heightened self-awareness of HIV, suspecting disclosure, and threat of discovery. Socio-emotional consequences were negative self-esteem, social avoidance, and ART non-adherence. The factor analysis yielded one factor. Hypervigilance was associated with an approximately two-fold increase in depressive symptoms (OR = 1.75, CI = 1.05-2.91) and ART non-adherence (OR = 1.83, CI = 1.05-3.21). Findings indicate the need for interventions to target hypervigilance and situational cues to reduce depressive symptoms and ART non-adherence among AWH.