BACKGROUND: In Ukraine, the COVID-19 pandemic and the Russian invasion have adversely affected people with HIV due to disruptions to the economy and health care services, and have dramatically impacted mental health. Resilience is defined as the capacity to recover from difficult life events that can improve health outcomes along the HIV continuum of care. Our objective was to assess mental and physical health and the dynamics of resiliency during the Ukrainian multicrisis.
METHODS: We conducted a four wave survey from May 2020 through May 2022 among older (=50 years) people with HIV (OPWH) in Kyiv, Ukraine to collect data on socio-demographics, mental health, resilience, COVID-19/war experiences and HIV care. The first 3 waves were during the initial stages of the COVID-19 pandemic, while the 4th wave was conducted after the onset of the full-scale Russian invasion in February, 2022. Resilience was assessed with the Brief Resilience Scale as a continuous score (1 to 5). Multivariable imputation by chained equations was used to impute missing data. A nested linear mixed-effect model was used to examine factors associated with mean resilience score, including time point. Backward selection was used to identify a parsimonious multivariable model.
RESULTS: Of the 122 OPWH who completed the baseline survey, 51% were women and the median age at baseline was 54.8 (SD 6.5). In total, 97 people completed all follow up interviews, for a total of 431 observations across the 4 waves. Resilience was found to be positively associated with perceived meaning in life (0.17, 95%CI:0.08–0.27, p<0.001), having at least one substance use disorder (1.58, 95%CI:0.65–2.51, p<0.001), being a woman (1.41, 95%CI:0.56–2.25, p<0.001), and was significantly higher at the fourth wave, after the onset of war (1.33, 95%CI:0.43–2.22, p=0.004). Resilience was negatively associated with increased age (-0.08, 95%CI:-0.15– -0.01, p= 0.021) and having mild-to-severe depression symptoms (-1.67, 95%CI:-2.43– -0.91,p<0.001).
CONCLUSIONS: Counterintuitively, resilience among OPWH has significantly increased since the Russian invasion. Women and OPWH with better psychological health had higher resilience. OPWH with depression and of greater age demonstrated lower resilience. Timely support should be provided to OPWH to ensure continued resilience in multicrisis settings.