STIGMA CONSCIOUSNESS, COPING STRATEGIES AND CD4 COUNTS OF PERSONS WITH HIV/AIDS

ABSTRACT
The study examined the influence of stigma consciousness (a belief or feeling that one will be negatively stereotyped by others) and coping strategies (social support, information and problem) on the CD4 counts (measure of immune system) of People Living With HIV/AIDS (PLWHA) in Anambra state. 430 PLWHA (men=148 & women=282), age (M=35.73, SD=8.4) years served as participants. Three Anti Retroviral Therapy (ART) sites were randomly selected from the three senatorial zones of Anambra state. All PLWHA in the three ART sites’ enrolments were used. Measures of CD4 counts of PLWHA were obtained from ART records. Stigma consciousness was measured using stigma consciousness questionnaire Pinel (1999) while social support scale Turner, Frankel, and Levin (1983), information coping scale (Kalichman et al, 2006), and ways of coping inventory (Folkman & Lazarus, 1980) measured coping strategies. 4-way analysis of variance statistic revealed that stigma consciousness had significant influence on CD4 counts of PLWHA. Social support had significant main effect on CD4 counts of PLWHA. Information coping had significant main effect on CD4 counts of PLWHA. And, problem coping produced significant real effect on CD4 counts of PLWHA. The implication is that psychosocial variables influence immune system of PLWHA. Link between stigma consciousness and CD4 counts of PLWHA is extension of psychoneuroimmunology literature. Outcome of this study will be utilized by PLWHA, psychologists/counselors, healthcare workers, and policy makers. Discussions were based on immunocompetence model of Jemmott and Lock (1984) which holds that psychosocial stressors lower immune system efficiency. Gluhoski (1996) cognitive therapy was recommended for effective psychological intervention measures to reduce negative psychological conditions among PLWHA.


CHAPTER ONE
INTRODUCTION
Generally, the society devalues, rejects and discriminates against people infected with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS). In turn people infected with HIV/AIDS become stigmatized and they live persistently with stigma consciousness, an expectation that one will be stereotyped (Pinel, 1999). Invariably, stigma consciousness spawns psychological devastation that can pose problems on management of HIV/AIDS, especially if the immune system of People Living With HIV/AIDS (PLWHA) as indicated in their CD4 counts are affected by such psychological devastation. (CD4 count is a measure of body’s immune system among PLWHA.) Then, anchorage and adjustment needed to improve their health can be achieved through application of appropriate coping strategies or use of cognitive therapy.

Undoubtedly, PLWHA that are stigmatized experience stigma consciousness. Stigma consciousness is capable of influencing immune system among PLWHA thereby causing either health improvement or deterioration indicated in their CD4 counts. The primary function of immune system is to help the body resist disease (Rice, 1998). Low level of stigma consciousness favours immune system functioning while high stigma consciousness suppresses immune system functioning. CD4 count which measures immune system determines health condition of people living with HIV/AIDS. The strength of body’s immune system among people living with HIV/AIDS is determined through a test called CD4. People diagnosed HIV/AIDS positive are regarded as either living with HIV/AIDS or seropositive individuals. A healthy person has between 500 and 1600 CD4 counts. Mostly, PLWHA have CD4 counts below 350. This varies according to severity of the disease, and can improve with treatment, that is taking Antiretroviral Drug (ARV) through Anti Retroviral Therapy (ART) or even diets. ARV is any drug that is used for suppressing the action of HIV on CD4 counts while ART implies taking such drug as agreed or directed by the doctor. An individual high in stigma consciousness will be more concerned with how he/she appears to others Pinel (1999), a situation that can cause negative emotion. This will cause the individual so concerned to engage in application of one or more coping strategies such as, accessing social support, information coping (seeking or avoidance), and problem coping (focus or avoidance), to improve his or her health condition. An individual infected with HIV/AIDS who seeks correct information, accesses social support, and actually focuses on problems associated with managing HIV/AIDS is likely to develop positive emotion that will favour his/her CD4 counts. CD4 count is used as index for measuring immune system among PLWHA.

Understanding the concept of stigma will enhance actual depiction of stigma consciousness. Stigma has been explained in various terms. For example social scientists have used stigma to denote socially undesirable characteristics and have been interested primarily in its discrediting effects on social interactions (Goffman, 1963; Herek, 1990). Furthermore, stigmatized individuals are regarded as members of the social groups “about which others hold negative attitudes, stereotypes, and beliefs, or which, on average received disproportionately poor interpersonal and/or economic outcomes relative to members of the society at large due to discrimination against members of the social category” (Crocker & Major, 1989). Thus, stigma denotes, but not limited to, undesirable characteristics of people that dichotomise the in-group and the out-group. The latter being stigmatized by the former. So, HIV/AIDS-related stigma can be seen as the negative attitudes, beliefs or stereotypes that people hold, that discriminate those living with HIV/AIDS.

Stigma can be categorized into two. Some recent literatures distinguished between enacted stigma, that is, actual experiences of stigma and discrimination and felt or perceived stigma, that is a stigmatized person’s fear or anticipation of discrimination and rejection, and internal sense of shame (Scambler, 1998; Swendeman, Rotheram-Borus, Comulada, Weiss & Ramos, 2006). Felt or perceived stigma is similar to stigma consciousness. The authors, further noted that felt or perceived stigma may cause people to shape their behaviours to avoid or reduce enacted stigma which may eventually slim their opportunities for seeking support and treatment. And this can bring about negative psychological conditions, leading to poor health condition among PLWHA by affecting their immune systems.

Researches have explained more subtle dimensions of HIV/AIDS stigma. For example, an exploratory factor analysis of an extensive HIV/AIDS’ stigma measure for PLWHA identified four factors: personalized stigma (i.e., social rejection), disclosure concerns, negative self-image (i.e., internalized shame), and concern with public attitudes about people living with HIV/AIDS (Berger, Ferrans, & Lashley, 2001).

In modern usage of the term (stigma), a defining immediate reaction to the stigma seems to be avoidance by others. People act as if physical contact or even proximity to the stigmatized can result in some form of contamination (Pryor, Reeder, Yeadon & Hesson-Mclnnis, 2004). Also, people choose to stand or sit at greater distances from the stigmatized, for example people living with HIV/AIDS, than the non-stigmatized (Mooney, Cohen, & Swift, 1992). Cursory observation has even shown that people avoid accepting edible items or sharing them with PLWHA.

Of course, the individuals who are stigmatized, whose conditions have degenerated into extensive HIV/AIDS’ stigma (Personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes toward people living with HIV/AIDS), and who attempt to affiliate with normal people, may share the same experience of the painted bird (Jerzy Kosinski, as cited in Pryor & others, 2004).

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Item Type: Postgraduate Material  |  Attribute: 115 pages  |  Chapters: 1-5
Format: MS Word  |  Price: N3,000  |  Delivery: Within 30Mins.
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