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: Project Material | Size: 115 pages | Chapters: 1-5
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