Discussion and findings1.0IntroductionThe chapter discusses the findings based on the literature in order to develop a concrete planfor the possible solutions. The psychological distress due to diverse causes in HIV infectedpatient’s needs to be addressed in terms of possible solutions. This is to reduce the mortalityand morbidity of the victims. Hence, the present chapter aims in discussing the findings ofthe literature for the development of possible solutions.2.0. Effect of AIDS on Psychological disorders2.1. Effect of HIV mediated anxiety on medication/therapyThe randomized clinical trial based investigations performed by Blank et al (2011) revealthat the longitudinal models for a period of 12 months and so gave a significant outcome interm of viral load. The intervention group exhibited a significantly greater reduction in logviral load (p<0.001) compared to control group indicating that the studies on long-termbasis are needed for the investigations and to elucidate the impact of HIV on mental statusof the victims. In addition to the viral load, in the proposed studies other parameters such asa detailed type of mental health are to be incorporated. The aspects of assessing the mentalstatus such as anxiety were considered in the patients suffering from other diseases(Baqutayan, 2012). Therefore, such practices can be implemented for HIV infected patients.The outcome of the investigation (Vitiello et al., 2003) revealed that antidepressants are the mostcommonly prescribed medicines (20.9%) followed by anxiolytic (16.7%), antipsychotics (4.7%), and psychostimulants (3.0%). It indicates that the HIV-positive victims undergo for frequent depression in the populationtested. An emphasis can be given for the investigation towards why the HIV positive patients undergo fordepression. What factors contributing for the development of symptoms and mental illness. The presence of HIVpositive in the victims not only influences the victim’s mental health, also influences the caregivers health status. Inan attempt, Kuo et al., (2014) evaluated the South African based caregivers for the assessment of psychologicalstatus utilizing multivariate hierarchical logistic regressions. The authors found that the caregivers who are associatedwith HIV positive patients can develop anxiety (p<0.001) who were living with the patients. This further increasesthe risk of development of psychological symptoms for the patients. Therefore the patients require a mechanical andmoral support to come out from the ‘continuous’ thinking on the HIV and its symptoms. An insight can be devisedfrom the available sources that no source is describing the factors and causes contributing for the assessment of1
mental status in HIV positive patients. Hence, it would be desired to focus an investigation to study the underlyingmechanisms utilizing randomized clinical trials.2.2. Effect of HIV mediated depression on medication/therapyThe inclusion of patients from diverse study groups can avoid the bias and help in understanding how thedepression does affect the medication in HIV patients. The patients with intervention for 6 months showed a lowerextent of depression (mean difference -3.7) and a lower tendency of suicidal behavior (-18%) (Pence et al., 2015).The investigation (Mitzel et al., 2015) revealed that the there exist an association between HIV-related stigma andadherence. The symptoms of depression are strongly related to the HIV adherence while the stigma did not. Theoutcome gave an insight for the importance of treating depressive symptoms in interventions aiming to improvemedication adherence among HIV-infected patients. The investigation did not reveal about the types of designemployed however the outcome showed a significant impact in terms of stigma-related experiences. It was positivewith depressive symptoms and negative towards adherence. Similar to preceding outcomes and methods, theinvestigators did not cover other psychological disorders. Turan et al., (2015) proved the relationbetween internalized stigma and self-reported suboptimal anti retroviral therapy. It wasbased on the relation between the depressive symptoms and low extent of social support,the investigators concluded that there exist an association between internalized stigma andsuboptimal adherence. From the available results, it can be understood that the studies wereutilizes depression and the investigators are trying to establish correlation between stigma and depressive symptoms.Most of the evidences are based on a single center so it is desirable to have the findings from multicenter studies. Inaddition, other aspects of mental status have not been captured. Therefore, the proposed study should focus onanxiety and other mental illness.2.3. Effect of HIV/AIDS on emotionFrom emotional aspects perceptive, Okulicz et al., (2009) investigated the role of viral load onthe reduction of victim immunity utilizing elite and viremic controllers. The outcome revealsthat the elite controllers had favorable time for the development of AIDS (P=0.048) incomparison to viremic controllers. The researchers have not addressed the emotionalaspects of the patients. The use of multiple drug regimens can increase the life span ofvictims and possibly reduce the emotional distress of the patients (Mocroft et al., 2002). Inan attempt, the researchers (Mocroft et al., 2002) proved as the ‘dropping’ rate wasdecreased (P<0.001) with the use of drugs. Moneyham et al., (1997), explain the possiblemechanisms involved in emotional distress. The investigators opined that the physiologicalmediators influence the HIV-related stress on emotional distress. No insight is provided in terms ofpossible approaches for reduction of emotion by physiological and pharmacological interventions.2
Another cause for emotional behavior could be stigma related effects and was correlated with age(Wei et al., 2016). The stigma and age interaction term was significant for negative emotions forthe total sample, with higher age associated with greater experience of negative emotions. Thissuggests that the effect of perceived stigma on negative emotions is moderated by age in HIV-affected individuals. The multiple linear regressions suggest that there exist an emotional regulationpartially mediated the relationship between negative emotions and both types of stigma, includingenacted stigma and perceived stigma (Wei et al., 2016). One source (Asikhia & Mohangi, 2015)is describing about the interventions to reduce the emotional distress in schoolchildren.There was a high prevalence of psychological, behavioral and emotional problems and that theschool support provided to them (teachers' support, the general school environment and the degree ofdiscrimination, labeling and bullying that exists in the school) was not sufficient (Asikhia &Mohangi, 2015). The available sources neither discussing the etiology of emotional aspects in HIVvictims nor proposing the strategies of intervention. Therefore, focus can be given to find out thefactors and establish a link between the emotional distress and HIV utilizing randomized trials.2.4. Effect of socioeconomic conditions on anxiety in HIV infected patientsThe education level, status and position of employment and status of individual in society cancertainly influence the medical interventions and on the disease management. Robinson et al.,(2015) revealed that no investigation dealt with psychological interventions. However, theresearchers evaluated the performance of vocational training and pharmacologicalinterventions. Among the studies, the vocational intervention could not infer a significantoutcome due to lack of adequate data. The pharmacological interventions showed diverseoutcome due to differences in the studies. The individuals with positive HIV and employmentshowed a significant improvement in terms of mitigation compared to those without adequatesocioeconomic condition. Another report from Peltzer & Pengpid (2013) reveals that theincome, level of education, and employment/occupational status was significantly andpositively associated with the level of adherence of treatment. About 73.2% of studiesshowed a positive outcome in terms of adherence of therapy. Despite of positive outcome itappears that the available evidence does not provide conclusive support for the existence of aclear association between socio-economic status and adherence to anti retroviral therapy inadult patients infected with HIV (Peltzer & Pengpid, 2013). Another report describes therelationship between socioeconomic status and HIV infection (Ogunmola et al., 2014)utilizing an analytical case-control study and logistic regression model. The outcome revealsthat HIV positive patients with secondary school levels of education and all categories ofmonthly income showed statistically significant relationships with HIV infection (P=0.0183
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