HIV/AIDS: A Review of the EuroSIDA Study and Associated Factors

The provided content appears to be a collection of articles and research papers related to HIV/AIDS, focusing on various aspects such as family support, socioeconomic factors, stigma, depression, and adherence to therapy. The studies explore the impact of HIV/AIDS on individuals, particularly women, and examine the relationships between socioeconomic status, HIV infection, and mental health outcomes. Additionally, the papers investigate the effects of internalized HIV-related stigma on antiretroviral therapy adherence in women, as well as the role of social isolation and depression in this process.

Does evidence suggest that HIV patients suffer from related emotions,
anxiety and depression?
Abstract
HIV infection has developed as one of the real difficulties of the current world. Regardless
of, awareness and education about this disease, a HIV patient is still thought to be a social
outcaste and is dealt with intensely by the group on the loose. HIV/AIDS has picked up
conspicuousness over the world as a developing general wellbeing issue. There is a complex
yet huge connection between psychological wellness and HIV/AIDS. HIV influences
psychological wellness by its direct neurobiological activity, the effect of having the ailment,
by its treatment including that for opportunistic infections and by its effect on the family. In
addition, the presence of multiple diseases due to suppression of immunity is an additional
variable that add to the unpredictability of evaluation, differential analysis and disease
management. The dissertation describes the searching of literature, review of literature and its
critique. The literature from diverse sources was collected, reviewed and the essentials of the
literature were collated. The outcome based on evidences was discussed for the effect of HIV
mediated anxiety, depression, or emotion on medication/therapy was discussed. The effect of
socioeconomic conditions on anxiety in HIV infected patients was elaborated along with the
possible factors that influence the lifespan of HIV victims. The disease has incurred
significant injury on communities, bringing about high dismalness and mortality. The
casualties of HIV convey the burden of being caretakers for individual who infected with
HIV while also stressing over their own particular wellbeing; be that as it may, little is
thought about how HIV/AIDS influences mental illness among patients. The patients who
reported more worry over being infected with HIV and more greater HIV-related stigma were
critically more inclined to report more prominent symptoms of anxiety and depression. These
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discoveries propose that mediations that decrease HIV-related stigma are probably going to
upgrade psychological function among the patients, which thus will enhance the patient's
personal satisfaction and prosperity. Diverse factors that contribute for mental illnesses
include gender, socioeconomic status, society and culture. In conclusion, studies have
reported depression, anxiety and emotional distress are being the most common psychiatric
morbidities among the afflicted individuals separately. No study dealt with the combination
of mental illnesses in HIV victims. It appears that no article describes the underlying
mechanisms of mental illness in HIV victims. In addition, there is a more requirement for
psychosocial support for HIV-influenced families inside the setting of growing HIV-related
services in healthcare system. The psychosocial mediations among HIV-influenced families
also upgrade the viability for the alleviation of disease manifestations and in order to decrease
the side effects of emotional sickness. A holistic approach to deal with HIV anticipation and
care (coordinated administrations that are family-engaged) that addresses the family's needs
(supporting guardians/parental figures, advancing family working, tending to physical and in
addition emotional well-being requirements, and offering money related support when
required) and additionally the wide scope of requirements for children (access to class,
physical wellbeing needs, advancement of psychological well-being), might be important to
decrease the burden the HIV infection and minimize the negative consequences of HIV
infection for present and future eras. Future research should focus the investigations to
identifying the underlying causes and mechanisms.
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CHAPTER-1
1.1 Literature review
During past few decades, researchers have shown great interest in the phenomena of social
support, particularly in the context of health. According to reports (Maija & Bert, 2008), the
high quality or quantity of social networks have a decreased risk of mortality in comparison
to those who have low quantity or quality of social relationships. Especially the support is
needed for certain diseases like human immunodeficiency virus/acquired immune deficiency
syndrome (HIV/AIDS). HIV/AIDS is confined neither to any one class, community, religion,
age, gender, and group nor to a profession. Therefore, it is the major concern of health
psychologists to fight with AIDS because it is a major health problem of this century (Lefton,
1997). The AIDS is one of the most dreaded diseases that mainly impair body’s immune
system to fight bacteria, viruses, cancer, etc, (Lahey, 1997). Following exposure to HIV, the
person is vulnerable to germs that a normal immune system could destroy. HIV can be
transmitted through sexual/contact or from mother to child through the placenta or by transfer
of whole blood or blood product. However, it is important to note that social support in case
of AIDS is operationalized in several different ways. Most broadly, support can be
conceptualized in terms of the structural components (e.g. social integration). Despite of
marginal support from society, individual with HIV/AIDS experience the threat of major
negative life events and medical conditions. According to reports, the HIV/AIDS patients
could show diverse effects on individual health and wealth including, premature death,
physical disability and pain, loss of employment, social isolation, coasts of medical
treatment, anxiety for future of family members (Alpana & Ila, 2010). Early reports of
psychological responses of HIV infection revealed pervasive feelings of anxiety and
depression (Fleishman & Fugal, 1994). Depression is either mood of clinical syndrome, such
as emotional, motivational, cognitive, somatic or behavioral (Sarason & Sarason, 2000). The
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feeling associated with a depressed mood includes disappointment, helplessness and
hopelessness (Comer, 1995). It indicates that patients with HIV can undergo for diverse complications in
terms of alterations in health condition due to the development of negative thoughts. Therefore, it is desired to
investigate the possible factors that contribute for such emotional distress. This section describes the search strategy
in brief and reviews of available literature.
1.2. Search strategy
The available and popular sources were used to search for the evidences. The sources, diverse online electronic
resources including BNI (British Nursing Index), CINAHL (Cumulative Index to Nursing and
Allied Health Literature), EMBASE (the Excerpta Medica database), Pubmed, The DARE
(Database of Abstracts of Reviews of Effects), HTA (Health Technology Assessment Database) and NHS
(Economic Evaluation Database). The search was made for past 30 years to collect the relevant
sources and link the evidences to the current context. In addition, the available textbooks
(pharmacology, nursing, health education) from the library were also searched for the
evidences. Satisfactory safety measures were made to channel the quest for the pertinent
sources. The keywords utilized for the pursuit incorporate "HIV/AIDS effect on emotion,
negative life occasions, premature death, physical disability, loss of employment, social
isolation, anxiety and depression etc. The outcome of the search for the relevant sources has
been depicted in subsequent sections.
1.3. Effect of HIV mediated anxiety on medication/therapy
Blank et al (2011) investigated the effect of the interventions from the community-based
advanced practice nurse (APN) to promote adherence to HIV and psychiatric treatment
regimens. The investigators conducted a randomized clinical trial utilizing 238 AIDS patients
with mental illnesses. The APNs who were involved in intervention for the patients are
assessed for the mental status and AIDS for 12 months. The intervention group showed a
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significant decrease in viral burden. The authors demonstrated that nursing interventions are
showing positive impact in disease reduction. However, there are no details pertaining to the
type of mental illness in detail. Most aspects are related to assessment of severity of AIDS.
The focus towards the etiology behind the HIV for the mental disorders is missing. It was
also evident from other reports (Vitiello et al., 2003) that the about 20.3% of HIV-infected
patients who receiving medical care are associated with anxiety and other psychotic disorders
(panic disorder, 12.3%; post-traumatic stress disorder, 10.4%; generalized anxiety disorder,
2.8%). Among the patients most patients are consuming psychotropics however, half of the
patients did not receive medication for depressive disorders. Kuo et al., (2014) reported the data from
a cross-sectional survey of families in HIV-endemic South Africa. The researchers studied the relationship between
HIV impacts and caregiver anxiety. The patients included in the study comprises of either not caring of children
orphaned by AIDS; caring for a child orphaned by AIDS but not living with HIV or dual HIV effects. The
outcome of the study (Kuo et al., 2014) suggests that it was not caring for a child orphaned by AIDS per se that
increased risk for anxiety. In addition, female patients appear to be of high risk of anxiety due to negative actions
towards coping responses to stress (Rudolph, 2002) and etiological differences. Equally age can also increase the
risk for anxiety due to an increase in chronic health conditions (Schoevers et al., 2005) and neurological
changes. Due to associated thinking, the patients with positive HIV can develop psychological distress leading to
development of anxiety for instance. The symptoms of anxiety have to be relieved in order to promote and sustain
the health of infected person. In another study, it was quoted that the South African children and adolescents living in
HIV/AIDS-affected families are at elevated risk of both symptoms of anxiety and depressive symptoms (Boyes &
Cluver, 2015). The investigators opined that the poverty and HIV/AIDS-related stigma are as additional risk factors
towards negative mental health outcomes. The study contains youths from high HIV-pervasive groups in South
Africa were met and caught up one year later. Familial HIV/AIDS at pattern appraisal was not specifically
connected with psychological wellness results 1 year later. However, the researchers opined that the usage and
thorough assessment of intense programs in South African people group may enhance emotional wellness results
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for HIV/AIDS-influenced youngsters and youths. In addition, the support from family appears to show some
influence towards the mitigation of infection. Some reports recommend supporting by family (Mohanan &
Kamath, 2009) so that the infected person can reduce the symptoms. Mohanan & Kamath (2009) assessed the
effect of family support on morbidity, mortality, quality of life, and economics in families with at least one HIV-
infected member, in developing countries. The authors utilized numerous databases including CENTRAL, the
Cochrane Database of Systematic Reviews, MEDLINE, AIDSLINE and CINAHL etc. No
trials found pertaining to the inclusion of family members for the support in the studies. It
indicates that there is an insufficient evidence to bring out the effect of family support in
reducing the morbidity and mortality of HIV-infected persons in developing countries.
1.4. Effect of HIV mediated depression on medication/therapy
Pence et al., (2015) investigated the impact of antidepressant efficacy in HIV care for the improvement of adherence
of antiretroviral therapy and depression morbidity. The pseudo-cluster randomized trial was conducted in HIV-
infected adults with major depressive disorder based on US infectious diseases clinics. The depression care
managers used systematic metrics to give HIV primary-care clinicians standardized antidepressant treatment
recommendations during 2010-2013. About 149 participants were randomized to intervention and 155 to usual
care. Diverse patients belonging to majorly men, Black, non-Hispanic, unemployed, and virally suppressed with
high baseline self-reported antiretroviral adherence and depressive severity were included. The outcome reveals that
there was significant improvement in depression. Mitzel et al., (2015) tested the role of depressive symptoms on
adherence of anti HIV-medication adherence. The study was conducted in 66 HIV-infected men who have sex
with men from an outpatient infectious disease clinic. The outcome reveals that the stigma-related experiences were
positively associated with depressive symptoms and negatively associated with adherence. These results highlight
the importance of treating depressive symptoms in interventions aiming to improve medication adherence among
HIV-infected patients. Turan et al., (1999) tried to fill the gap of the research by conducting the
study in women in association between internalized stigma and ART adherence. The multicenter cohort study
was based on questionnaires in 1168 women who were taking ART. Among the women, the minority woman
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showed significant suboptimal ART due to development of depressive symptoms. The authors explained the
probable causes of depression in minority community in general and female in particular contrasted with other
racial/ethnic gatherings. Another cross-sectional study (Medha et al., 2011) depicted the connections between social
bolster, HIV exposure, and melancholy among 340 country African American ladies with HIV ailment living in the
southeastern United States. Three parts of social backing (saw accessibility of bolster, wellsprings of accessible
backing, and fulfillment with accessible backing) were measured alongside HIV exposure and sadness. Seen
accessibility of backing and fulfillment with backing intervened the relationship between HIV divulgence and
sorrow. On the off chance that affirmed in longitudinal studies, these discoveries have suggestions for planning and
executing mediations supporting African American ladies with HIV ailment in revealing their HIV status fittingly,
especially to their youngsters.
1.5 Effect of HIV/AIDS on emotion
Without treatment, a large proportion of HIV-positive people live for a decade or more before the
virus begins to take a noticeable toll. In addition, there is a small proportion of people with HIV who
have immune systems that can naturally resist replication of the virus for an indefinite period of time
(Okulicz et al., 2009). Some people may have outdated concepts of the harm caused by HIV
because earlier antiretroviral drugs and combinations did not treat HIV effectively. However, the
discovery of new classes of antiretroviral in the late 1990s resulted in dramatic reductions in HIV-
related illnesses and deaths in high-income countries. For example, the age-adjusted HIV-related
death rate in the United States dropped from 17 per 100,000 people in 1995 to about five per 100,000
people by the end of the decade (Mocroft et al., 2002). Once the patient is diagnosed for the
positive HIV, can cause lot of emotional distress. Moneyham et al., (1997) investigated the
impact of psychological mediators of HIV-related stressors on emotional distress in 264 HIV
positive women. It appears that the effect of HIV-related stressors on emotional distress was indirect
through cognitive appraisal. The findings indicate that how HIV+ women think about HIV-related
stressors is an important factor that may account for individual variability in the ability to maintain a
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sense of subjective well-being in the face of a devastating fatal disease. Numerous reports are not
available to link the emotional distress and their mechanisms. However on report (Wei et al., 2016)
describes the relation between stigma (discriminatory behaviors), stereotyped attitudes and
emotional behavior. The researchers utilized data from 790 children (age, 6-17 years) affected by HIV
for the analysis and mediation of the model. They found that a significant interaction between
perceived stigma and age suggested that negative emotions increase with age among those who
perceived a higher level of stigmatization. Asikhia & Mohangi (2015) reported the outcome of a
qualitative study utilizing 11 orphaned adolescent (5 boys and 6 girls aged between 15-18 years)
patients with AIDS. All the participants show that a high prevalence of psychological, behavioral and
emotional problems and lack of adequate support from the teachers. From the evidences it appear that
most patients are associated with a lack of support to get rid of the symptoms making the patients to
be emotional and psychological distress. Therefore there is need of adequate support from the
government in the disease management.
1.6. Effect of socioeconomic conditions on anxiety in HIV infected patients
Robinson et al., (2015) evaluated the effect of interventions aimed at sustaining and
improving employment in HIV+ persons utilizing a comprehensive search from 1981 until
December 2014. The evaluation has been done from randomized controlled trials or
controlled before-after studies. All the participants appear that they have undergone for
vocational training and antiretroviral therapy. No studies dealt with psychological
interventions. Among the studies, two studies compared employment outcomes of HIV+
persons on ART therapy to healthy controls. Three other studies compared HIV+ persons on
ART to HIV+ persons not yet on ART. Two studies indicated an increase in the likelihood of
employment over time due to the impact of ART for HIV+ persons compared to HIV+
person’s pre-ART. It indicates that there are no investigations associated with the assessment
of mental illnesses in HIV infected patients. Despite of low quality of interventions it was
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expected to improve ART interventions outcomes of employment for the positive HIV
persons. Due to lack of high quality interventions, it is preferable to have adequate
randomized studies to assess the effectiveness of interventions for HIV+ persons.
1.7 Discussion
Numerous articles found from the PubMed search in comparison to other sources. However
few reports can be found in both the searches for instance PubMed and Cochrane. The
psychological disorders and alterations in mood are often comorbid with chronic illnesses
such as HIV leading to an increase the associated morbidity and mortality rates (Frasure-
Smith and Lesperance, 2005). The review was also extended towards available guidelines. It
was apparent from the guidelines that the guidance is recommending to diagnose the HIV
positive individuals for anxiety and depression using validated tools (Duncan et al., 2015).
Despite of describing the role of HIV on mental illnesses, the guidance (Duncan et al., 2015)
describes separately the aspects of strategies for individual diseases such as HIV, Kidney
diseases, mental illness and cardiovascular diseases. In addition, the reports (Bernard et al.,
2014) describe the diagnosis of HIV infection utilizing an algorithm (Fig-1) and are based on
testing of serum or plasma specimens. WHO (2016) even describing the general features of
disease including, signs and symptoms, transmission of disease; risk factors associated;
diagnosis and disease management. It appears that none of the source is describing the
underlying mechanisms involved in the development of emotional distress, anxiety and
depression in HIV infected patients. However, it was apartment from some of the sources the
personnel who were positive towards the HIV are associated with psychological distress.
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Fig-1: Schematic flow of the diagnosis of HIV (Bernard et al., 2014)
1.8. Development of Recommendations
After summarizing the state of the literature, we next identified gaps in the available
evidence, critical unanswered questions, and promising strategies to address the effects of
HIV on psychological distress. From the evidences it was apparent that there is a need of
involving family members, government, and society to educate the patients. The
individual’s health beliefs are in general influenced by health literacy, and these beliefs are
also contributors to non-adherence. There is a clear need for rigorous studies of the clinical
effects of family support on people with HIV in developing countries. Hence it is aimed to
investigate the effect of HIV associated emotions, anxiety and depression and provide
possible recommendations to reduce such behavior so that the life span of the patients can be
increased.
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CHAPTER-2: CRITIQUE OF LITERATURE
2.1. Literature review
The HIV infected victims fail to resist towards the attack of pathogenic and non-pathogenic
diseases. The complications of the patient are going to be increased. Therefore, the life span
is going to be reduced significantly if untreated. In view of the patient condition, by looking
to other patients, most HIV infected patients develop a kind of psychological distress. Most
researchers contributed for the identification of possible factors and their control towards
management of disease. However, there exist certain gaps in the literature. The gaps have
been identified and depicted in below sections. Late diagnosis and thus more severe illness at the time of
diagnosis can propel the older individuals and makes them to confuse towards for the development of symptoms of
HIV. The review of literature made utilizing diverse sources as depicted in preceding chapter.
A literature critique is an analysis of a piece of literature. The scope of a critique is to
examine each aspect of the work and involves breaking the literary piece apart into its
separate components and evaluating how they fit together to accomplish the piece's purpose.
The outcome of the literature along with positive and negative aspects is shown in this
chapter. The critique would help in developing the objectives and planning the research
further.
2.2. Effect of AIDS on Psychological disorders
2.2.1. Effect of HIV mediated anxiety on medication/therapy
The methods employed by Blank et al (2011) are based on randomized clinical trial in
numerous AIDS patients with mental illnesses. The intervention comprises for the assessment
of mental status and AIDS for a period of 12 months. The entire study duration is relatively
good and is based on clinical trials and showed a significant influence on the results. Despite
of positive influence, it appears that there exist certain limitations in the study. A generalized
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term of ‘mental illness’ is provided however no details are captured on the type of mental
illness in detail. An emphasis towards focus for the assessment of AIDS induced mental
illness should have been covered. The causes behind in the mental illness are missing. The
investigators even did not put additional efforts for the identification of mental illness in the
patients with AIDS. Certain reports describe the use of antipsychotic medication in HIV
infected patients. Among, the investigation performed by Vitiello et al., (2003) focused
mainly on the effectiveness of psychotropic medication on recovery of AIDS. The medical
intervention showed a decrease of disease intensity. However, the authors did not describe
the underlying reasons, why the psychotic symptoms are developed in those individuals. The
outcome of the study reported by Kuo et al., (2014) have covered a broad range of victims
with anxiety as one of the effect in AIDS patients from South African context. The report
gave an insight of how the caregivers are influencing psychologically. However, the
researchers are not addressed the impact of AIDS on patient’s perspective. Similar to other
reports, the investigators are not covered the factors contributing for anxiety and other
psychological disorders. The focus of other reports (Mohanan & Kamath, 2009) is based on
recommendations but not on the mechanism involved for the psychological distress in AIDS
patients.
2.2.2. Effect of HIV mediated depression on medication/therapy
According to the literature it appears that, AIDS patients and their caregivers can undergo depression. Therefore,
most physicians prescribe antipsychotic medication a part from the AIDS medication. Antidepressant efficacy in
HIV care have been evaluated by Pence et al., (2015), did not bring a significant improvement in HIV outcome
despite of following adequate assessment and statistics. The investigators evaluated the adherence of antiretroviral
therapy and depression morbidity. Except depression, no other psychological diseases such as anxiety have been
covered in the investigation. The study was also pseudo cluster randomization, a design most suits for in smaller
number of study participants (Melis et al., 2011). The sample size included is reasonably good however, the
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investigators employed pseudo cluster randomization. A systematic investigation comprising of a structured
statistical design has to be used for the study. Mitzel et al., (2015) tested the role of depressive symptoms on
adherence of anti HIV-medication adherence. The study was based on homosexual patients (66 HIV-infected men
who have sex with men) in an outpatient infectious disease clinic. The investigation did not reveal about the types of
design employed however the outcome showed a significant impact in terms of stigma-related experiences. It was
positive with depressive symptoms and negative towards adherence. Similar to preceding outcomes and methods,
the investigators did not covered other psychological disorders. Turan et al., (2015) attempted to fill the gap of the
research between internalized stigma and anti retroviral therapy. The investigation was carried in more than 1000
women patients. The researchers used an old method for the assessment of depression and are on grading. Novel
methods such as Preguntas con Cartas (Caplan, 2016) should have been used to avoid the bias of the old method.
The study was based on multicenter however inter comparisons of the study was missing. In addition, the aspects of
emotion and anxiety are not covered. A cross-sectional study (Medha et al., 2011) based on southeastern United
States covered the relationship between social bolster, HIV exposure, and melancholy. A part from the
dermatographic data, the investigators (Medha et al., 2011) investigated the effect of independent variables (nine-
item scale with a 3-point Likert-type) on dependent variables, depression. The relationship between independent
and dependent variables is missing. However, the outcome reveals that the rural women from southeastern United
States are often under-diagnosed and inadequately treated for depression. The details pertaining to other disorders
such as emotion and other psychological disorders are missing.
2.2.3. Effect of HIV/AIDS on emotion
Most people across the globe are aware of the curable and non-curable diseases. The diseases that are
not curable can in general pose risk towards the development of emotion in patients. In absence of
adequate preventive measures before diagnosing the HIV infection, the individuals can survive for the
couple of years. Once the disease is diagnosed for the AIDS, individuals can undergo emotional
distress leading to significant reduction of life span. Few reports are available for the investigation of
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AIDS and its influence on HIV infected victims and their family members. The relevant literature was
analyzed critically and the outcome is described in subsequent sections.
Okulicz et al., (2009) reported the role of viral load on the reduction of victim immunity however,
why and how the individual is undergoing for emotional distress is not explained. The link between
the ‘suppression of immunity’ and its repercussions on emotions is missing. However, it can be
understood that certain biological modulators are releasing in the body due to stress that in turn are
contributing for the development of emotional distress. Such changes in biological system could
decrease the life span significantly. To prolong life, investigators (Mocroft et al., 2002)
recommended using either single or multiple regimens from novel source for the mitigation
of diseases. The study was conducted in about numerous patients and found that the
‘dropping’ rate was comedown with the treatment. They talk about the use of drugs in the
treatment but no details been covered pertaining to the emotional distress. The drug use
could decrease viral load therefore the life span of patients can increase. The physiological
mediators contribute for emotional distress it appears. Moneyham et al., (1997) investigated
the impact of HIV-related stressors on emotional distress in HIV positive women. The findings
indicate that how HIV positive women think about HIV-related stressors is an important factor that
may account for individual variability in the ability to maintain a sense of subjective well-being in the
face of a devastating fatal disease. The possible modes by which the reduction of emotional distress
are missing in the report. However, it is possible to from the insight of the outcome (Moneyham et
al., 1997) to reduce the emotional distress to the intensity of the disease. Numerous reports
are not available to link the emotional distress and the underlying mechanisms. However, the
available report (Wei et al., 2016) covers the relation between stigma, stereotyped attitudes and
emotional behavior. The researchers (Wei et al., 2016) utilized data from young children (age, 6-17
years) affected by HIV for the analysis and mediation of the model. Compared to young children, the
thinking capacity and thus emotional distress in adults and geriatrics could differ. Therefore, the focus
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was missed in the adults and elderly patients pertaining to emotional distress. The environment and
society also contributes for the emotional distress due to lack of adequate moral support from peers,
neighbors and surrounding environment. Especially for children who are in schooling stage, adequate
support from teachers is needed to reduce the emotional distress. Experts of psycho-education can
also help in the reduction of emotional distress in children. However most schools do contain neither
experts nor teachers for the intervention. In addition, some schools keep the victims a way and in
isolation from other children i.e., non-HIV children. These activities can force the infected victims to
discrimination of the infected students. It further potentiates them for the development of emotional
distress. Few reports are available in this direction. Among, the relevant one is based on the findings
from the article (Asikhia & Mohangi, 2015). The researchers conducted a study in small group
of adolescents with HIV infection. The depth analysis is missing from the study with respect
to mechanisms, statistical assessment between infected and normal population. From the
literature it can be understood that, pieces of research outcome is available however a link
between the research aspects is missing a part from the emotional distress.
2.2.4. Effect of socioeconomic conditions on anxiety in HIV infected patients
The education background, employment status, culture and society can certainly influence the
medical interventions on the disease management. The literates with adequate employment
status can take precautions in the disease management and vice versa for patients with low
education background. Few articles found for the investigation of socioeconomic conditions
on anxiety in HIV infected patients. Most relevant articles were analyzed and the summary is
depicted in this section. The outcome of Robinson et al., (2015) from a randomized
controlled trial indicates that the patients with below poverty are more victims and the
lifespan of those patients is low compared to the individuals with sound economic status.
This could be due to lack of adequate awareness of the disease symptoms and its risk for the
patients with low poverty. However, no study dealt with psychological interventions. Few
15

studies are based on comparative evaluations for HIV positive persons on anti retroviral
therapy (ART) to healthy controls. It indicates that neither cited report nor available sources
dealt with the assessment of mental illnesses in HIV infected patients.
2.3. Discussion
Among the sources, it appears that few articles are dealt with the role of HIV infection on
depression and emotional distress. However, no article is covering the aspects of HIV
induced anxiety and emotion in detail. Even the mechanism of depression and psychological
change due to AIDS is not covered. Most articles are speaking about the role of medication
on the suppression of AIDS. However, certain validated tools (Duncan et al., 2015) are
available for the diagnosis and treatment of AIDS. In fact, no article refers the use of
validated tools. The validated tools should have been used to rely on the data. The reliability
of the data from the published literature appears to be limited as no investigator had used
validated tools for the research. Well-developed algorithms are available (Fig-1) for the
treatment but no clue about the impact of AIDS on emotion and anxiety (Bernard et al.,
2014). WHO (2016) even describing the general features of disease including, signs and
symptoms, transmission of disease; risk factors associated; diagnosis and disease
management. It appears that none of the source is describing the underlying mechanisms
involved in the development of emotional distress, anxiety and depression in HIV infected
patients. The reported studies utilize a large population from specific country to study the
impact drugs on HIV and/or a specific mental illness. The investigations can contribute to
better understanding of connection between diverse population and HIV. The overall
impression on available data is that the careful examination of data that influence the mental
illness in HIV patients. From the evidences, it can be understood that the personnel who were
positive towards the HIV are associated with psychological distress.
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Fig-1: Schematic flow of the diagnosis of HIV (Bernard et al., 2014)
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CHAPTER-3: DISCUSSION AND FINDINGS
3.1. Introduction
The chapter discusses the findings based on the literature in order to develop a concrete plan
for the possible solutions and design the research. The psychological distress due to diverse
causes in HIV infected patient’s needs to be addressed in terms of possible solutions. This is
to reduce the mortality and morbidity of the victims. Hence, the present chapter aims in
discussing the findings of the literature for the development of possible solutions.
3.2. Effect of AIDS on Psychological disorders
3.2.1. Effect of HIV mediated anxiety on medication/therapy
The randomized clinical trial based investigations performed by Blank et al (2011) reveal
that the longitudinal models for a period of 12 months and so gave a significant outcome in
term of viral load. The intervention group exhibited a significantly greater reduction in log
viral load (p<0.001) compared to control group indicating that the studies on long-term
basis are needed for the investigations and to elucidate the impact of HIV on mental status
of the victims. It indicates that long-term investigations are needed to avoid the bias from
statistical perceptive. In addition to the viral load in the proposed studies, other parameters
such as a detailed type of mental health are to be incorporated. The aspects of assessing the
mental status such as anxiety were considered in the patients suffering from other diseases
(Baqutayan, 2012). Despite of non-availability of such practices, the methods used in other
cases (Baqutayan, 2012) can be applied for the investigation of HIV victims. Therefore,
such practices can be implemented for HIV infected patients. The outcome of the
investigation (Vitiello et al., 2003) revealed that antidepressants are the most commonly
prescribed medicines (20.9%) followed by anxiolytic (16.7%), antipsychotics (4.7%), and
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psycho stimulants (3.0%). It indicates that the HIV-positive victims undergo for frequent
depression in the population tested and similar phenomenon can be anticipated across the
globe. Therefore, an emphasis can be given for the investigation towards depression, why
the HIV positive patients undergo for frequent depression. What factors contributing for the
development of symptoms and mental illness. What are the underlying physiological
mechanisms? The presence of HIV positive in the victims not only influences the victim’s
mental health, also influences the caregiver’s health status. Therefore it is expected that the
caregiver’s even suffer from mental illness. In an attempt, Kuo et al., (2014) evaluated the
South African based caregivers for the assessment of psychological status utilizing
multivariate hierarchical logistic regressions. The authors found that the caregivers who are
associated with HIV positive patients can develop anxiety (p<0.001) who were living with
the patients. This further increases the risk of development of psychological symptoms for
the patients. From these evidences it can be understood that there is lack of adequate
support from psychologically, socially, medically and behavior perceptive. Therefore the
patients require a mechanical and moral support to come out from the ‘continuous’ thinking
on the HIV and its symptoms. A periodic counseling from experts from psychology can aid
in minimizing the disease symptoms. An insight can be devised from the available sources
that no source is describing the factors and causes contributing for the assessment of mental
status in HIV positive patients. Hence, it would be desired to focus an investigation to study
the underlying mechanisms utilizing randomized clinical trials on long term basis. In
addition, the aspects of counseling with experts can be incorporated to study the impact of
counseling on the reduction of symptoms of mental illness.
3.2.2. Effect of HIV mediated depression on medication/therapy
The inclusion of patients from diverse study groups can avoid the bias and help in understanding how the
depression does affect the medication in HIV patients. The inclusion of patients from diverse cultural background
19

could minimize the variability and increase the abilities to understand the severity of disease. The patients with
intervention for 6 months showed a lower extent of depression (mean difference -3.7) and a lower tendency of
suicidal behavior (-18%) (Pence et al., 2015). It indicates that the patients are associated with certain anxiety and
depression. Therefore, the symptoms have significantly reduced with the pharmacological interventions in the
studied groups. It gave an insight for conduct of studies for long time. The investigation (Mitzel et al., 2015)
revealed that there exist an association between HIV-related stigma and adherence. The symptoms of depression
are strongly related to the HIV adherence while the stigma did not. The outcome gave an insight for the importance
of treating depressive symptoms in interventions aiming to improve medication adherence among HIV-infected
patients. The investigation did not reveal about the types of design employed however the outcome showed a
significant impact in terms of stigma-related experiences. It was positive with depressive symptoms and negative
towards adherence. Similar to preceding outcomes and methods, the investigators did not cover other psychological
disorders. The proposed study should cover other types of mental illnesses a part from depression. Turan et al.,
(2015) proved the relation between internalized stigma and self-reported suboptimal anti
retroviral therapy. It was based on the relation between the depressive symptoms and low
extent of social support, the investigators concluded that there exist an association between
internalized stigma and suboptimal adherence. From the available results, it can be
understood that the studies were utilizes 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. In addition, other aspects of mental status have not been captured.
Therefore, the proposed study should focus on anxiety and other mental illness.
3.2.3. Effect of HIV/AIDS on emotion
From emotional aspects perceptive, Okulicz et al., (2009) investigated the role of viral load on
the reduction of victim immunity utilizing elite and viremic controllers. The outcome reveals
that the elite controllers had favorable time for the development of AIDS (P=0.048) in
comparison to viremic controllers. The researchers have not addressed the emotional
20

aspects of the patients. The authors mentioned that the use of multiple drug regimens can
increase the life span of victims and possibly reduce the emotional distress of the patients
(Mocroft et al., 2002), but how they improve the health is not described. The aspects of
counseling with medication and without medication could equally considered as the
variables to address the efficacy of single and combination approaches on the disease
mitigation. The use of combination therapy rather than single drug use could certainly
increase the efficacy thus the lifespan of patient can increase. In an attempt, the researchers
(Mocroft et al., 2002) proved as the ‘dropping’ rate was decreased (P<0.001) with the use
of drugs but no details pertaining to psycho education. A part from pharmacological
interventions, the counseling with psychiatrist can minimize the symptoms of mental
illness. Moneyham et al., (1997), explain the possible mechanisms involved in emotional
distress. The investigators opined that the physiological mediators influence the HIV-related
stress on emotional distress. No insight is provided in terms of possible approaches for reduction of
emotion by physiological and pharmacological interventions. 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 for the total sample, with higher age associated
with greater experience of negative emotions. This suggests 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 regulation partially mediated the relationship between negative
emotions and both types of stigma, including enacted 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 the school support provided to them (teachers' support,
the general school environment and the degree of discrimination, labeling and bullying that exists in
the school) was not sufficient (Asikhia & Mohangi, 2015). The available sources neither discussing
21

the etiology of emotional aspects in HIV victims nor proposing the strategies of intervention.
Therefore, focus can be given to find out the factors and establish a link between the emotional
distress and HIV utilizing randomized trials. The considerations for the incorporation of adequate
sample size should be included in the study to achieve adequate power and minimize the variability.
3.2.4. Effect of socioeconomic conditions on anxiety in HIV infected patients
The education level, status and position of employment and status of individual in society can
certainly influence the medical interventions and on the disease management. Robinson et al.,
(2015) revealed that no investigation dealt with psychological interventions. However, the
researchers evaluated the performance of vocational training and pharmacological
interventions. Among the studies, the vocational intervention could not infer a significant
outcome due to lack of adequate data. The pharmacological interventions showed diverse
outcome due to differences in the studies. In addition, the use of diverse drugs could show
varying influence on the patient. The aspects of physiological variability should have been
considered. The individuals with positive HIV and employment showed a significant
improvement in terms of mitigation compared to those without adequate socioeconomic
condition. This could be due to the availability of adequate resources in terms of financial
status and awareness of HIV infection. Always the education and above poverty status could
minimize the disease symptoms. The victims with adequate work at job do not get time to
think and undergo for psychological distress. Another report from Peltzer & Pengpid (2013)
reveals that the income, level of education, and employment/occupational status was
significantly and positively associated with the level of adherence of treatment. About 73.2%
of studies showed a positive outcome in terms of adherence of therapy. Despite of positive
outcome it appears that the available evidence does not provide conclusive support for the
existence of a clear association between socio-economic status and adherence to anti
retroviral therapy in adult patients infected with HIV (Peltzer & Pengpid, 2013). Another
22

report describes the relationship between socioeconomic status and HIV infection (Ogunmola
et al., 2014) utilizing an analytical case-control study and logistic regression model. The
outcome reveals that HIV positive patients with secondary school levels of education and all
categories of monthly income showed statistically significant relationships with HIV
infection (P=0.018 and P<0.05, respectively). It indicates that there exists a relationship
between socioeconomic status and HIV infection However, no report precisely dealt with the
assessment of mental illnesses in HIV infected patients.
3.3. Discussion
From the outcome of the sources, it can be understood that no single report is available to
address the issues pertaining to the impact of HIV mediated mental illness in patients with
positive HIV. Many of the articles are based on randomized controlled trials. Few articles
dealt with depression and emotional distress. As no articles are available to cover the diverse
mental illness in HIV victims and even adequate diagnosis of the disease. It indicates that,
there is a scope to investigate the mental status of patients with HIV. The proposed research
should address the trend of mental illnesses and elucidate the possible underlying
mechanisms. Despite of availability of advanced tools (Duncan et al., 2015) no study utilizes
the validated tools. The proposed study may be conducted by incorporating statistical
methods in the study design to avoid bias and find out the significance in comparison to
control groups. Certain statistical concepts are incorporated in HIV dynamics in AIDS
research (Wu, 2005) however, the objectives are different. Such concepts may be
incorporated in proposed research. In addition, the variables such as counseling with experts
for patients and caregivers, periodic interactions with teachers in case of schooling children,
patient education and its extent, use of pharmacological interventions in patients can be
included in the proposed investigations. The proposed studies can be conducted in the same
population with large number and for long duration. It is also important to consider the
23

implications of validated tools versus creating new active control groups for the investigation.
One major issue that influences the control trials is the reliability of outcome as the trails are
not validated. Same question could be arisen from the reported literature as the investigations
are neither used a validated tool. The problem of adherence in HIV prevention trials can have
a major effect on scientific viability. For instance, a low adherence in a trial makes it
impossible to measure effectiveness, and can lead to widely divergent results across studies.
Therefore, a focus can be given to increase the adherence towards study so that the outcome
can be trustable.
24

CHAPTER-4: IMPLICATIONS FOR PRACTICE AND PERSONAL
REFLECTION
4.1. Summary of the evidences
From the evidences it gives the idea that differing components including poverty, financial
status and moral and profound contemplations could impacts the unfriendly impacts of HIV
on mental issue. The existence of adolescent spirituality is connected with less nervousness,
wretchedness, and versatile adapting to an interminable ailment contrasted with children. To
comprehend the likely explanations, the present chapter summarizes the implications to
derive views on the management of HIV.
The outcome of this study supported the speculations that more stress over being HIV-
positive and impression of more prominent HIV stigma are associated with more distress in
the HIV positive populace. Stressing over contracting HIV was altogether connected with
more current emotional trouble. Among the sex, ladies with positive manifestations of HIV
gives off an impression of being more inclined for distress and along these lines mental
disarranges. Others would be embarrassed about them on the off chance that they got to be
HIV positive. Such situation can propel the victims to develop emotional distress beyond the
HIV-related worry. In addition, HIV related stigma contributes for a greater psychological
distress, including anxiety, depression, and negative affect (Neuman et al., 2013). A few
studies have recommended that HIV stigma might be particularly adverse to ladies
(Lichtenstein et al., 2002). Ladies who perceive HIV stigma in their society as high might be
hesitant to get tried; this evasion may prompt expanded stress, ensuing enthusiastic misery,
and an absence of access to essential care. The existence of stress over contracting HIV and
HIV stigma is obscure, yet it can be comprehended from the evidences there exist certain
hazard for the improvement of mental issue. This could prompt stress over getting to be HIV-
25

positive, eventually leading to the development of depression and anxiety. The likelihood of
more depression and tension could build stress and stigma over HIV, apart from emotional
and psychological prosperity of patients. However the physiological mechanisms from the
available evidences are not clear why HIV positive patients are developing such symptoms.
The evidences and subsequent review gave an insight for the development of socially
sensitive HIV education programs that additionally address issues of emotional distress. In
considering approaches to address the issues in a particular region that have been
unequivocally affected by the HIV epidemic. The major contributing variables that impact
the improvement of symptoms include the gender, HIV programming and part of
psychological wellness into HIV counteractive action and treatment administrations. Other
variables that may influence life traverse of HIV positive patients and distress to be analyzed
in future research. Besides, in clinical practice, social insurance suppliers ought to survey the
degree of emotional distress in HIV positive patients, as depression and tension may increase
with regards to HIV-related care. For instance, it is conceivable that emotional distress and
dread of having HIV, as opposed to deception or absence of get to, keeps patients from
getting tested or looking for health care services.
The disadvantages of methodologies should be considered when performing new
investigations. The constraints could be either identified with little specimen size to
encourage a helpful testing methodology. Future research is required with both the sexual
orientation of more socially and topographically differing population to look at the
relationship of HIV and emotional distress with regards to social convictions. Most studies
depended on self-report measures, so future research should also use alternative types of
measures, for example, the appraisals and perceptions of health care providers. The cross-
sectional study designs did not address the examination of causal connections so such
investigation and plans can be avoided. Future studies should also analyze whether HIV
26

stress and stigma prompts expanded emotional distress, or if the inverse is valid. Location of
a causal relationship would have various ramifications for health care providers.
It creates the impression that a multidimensional idea is expected to bring awareness in HIV
patients. However, from quality of life (QOL) perceptive, the aspects are questionable.
HIV/AIDS speaks to a high financial effect from society perspective. The self perception of
QOL has been appeared to be a valuable screening item for evaluating worldwide QOL. QOL
relates both to ampleness of the material conditions and to individual sentiments about these
conditions. As wellbeing is by and large referred to as a standout amongst the most
imperative determinants of general QOL, it has been recommended that QOL might be
remarkably influenced by particular ailment process, for example, AIDS. There is absence of
clarity in characterizing QOL and attendant operational difficulties in it yet at the same time
there is earnestness in assessing the QOL in HIV-infected people. Future studies ought to
envelop the assessment of more determinants of QOL in HIV/AIDS. The recognizable
symptoms of HIV can certainly influence the QOL for individuals living with HIV disease.
Adequate and effective management of manifestations is essential for enhancing QOL and
possibly to maintain a muddled day by day regimen of antiretroviral medications. As HIV
sickness is among the most annihilating of ailments, having numerous and significant impacts
upon all parts of life, subsequently the assessment of QOL is essential. In spite of the fact that
examination has proposed connections among different psychosocial and spiritual factors,
symptomatology, and physical wellbeing, a great deal more research is still expected to
archive their potential impacts on invulnerable capacity, and in addition wellbeing status,
illness movement, and QOL among people with HIV infection. It is additionally critical to
underline the part of counsel contact psychiatry in the analysis and treatment of HIV and
AIDS. Stress management interventions for HIV-infected people are a promising way to deal
27

with encourages constructive alteration. Additional studies should focus to center an
assessment for the part of routine QOL evaluation in patients who have HIV/AIDS.
The parents (of either one or both) living with HIV and their children, maternal tension/stress
had an immediate relationship with child rearing aptitudes. Those parents, who were more on
edge about their own wellbeing and working, and more stressed in their parental part, will
probably show poorer child rearing aptitudes particularly they connected with kids less much
of the time in family schedules, had poorer parent-kid correspondence, and had less steady
teach. These discoveries are steady with writing on overall public parent tests, in spite of the
fact that this study shows a wide scope of child rearing abilities are influenced by maternal
stress. This scope of shortfalls demonstrates a solid requirement for child rearing
intercessions for parents living with HIV. Child rearing intercessions need to give guardians
data on (i) how their mental distress can influence family working and child outcome; (ii)
procedures and support for managing their mental strain; (iii) aptitudes for execution of
family schedules, and help with techniques for more established youngsters or other support
to keep up family schedules and checking if the parents and (iv) systems for how parents can
enhance parent-kid correspondence.
The present study also observed that HIV positive manifestations are connected with greater
levels of distress in many patients, well beyond simply stress over contracting HIV. The
discoveries highlight the requirement for more research and program improvement to look at
option methodologies and mediations for diminishing HIV side effects so that the emotional
distress could be diminished. More AIDS training and investigations with preventive action
should be conducted in a socially delicate way to address stress and concern with respect to
HIV status and defaming dispositions towards HIV infected people. By doing this, projects
can ideally start decreasing both social stigma connected to HIV, and also the emotional
distress that may come because of perception of such stigma.
28

4.2. Action plan and personal reflection
Based on the evidences it would be recommended to consider below aspects for future
research. The research is needed to reduce the rate of mortality in the patients with HIV
positive symptoms.
o Clinicians should convey attention to the patients from wellbeing and cost keen.
Clinicians who treat patients with AIDS must not disregard their own needs.
Clinicians might be depleted by the enthusiastic needs of their patients. At the point
when the clinical course is stormy or the patient rejects treatment or commits suicide
the sense of professional isolation and despair might be exceptional. There is solid
socialization against individuals from the healthcare system to examine their own
distress for fear of seeming frail.
o Factors that influence responses: Confronting sentiments of vulnerability and the
disadvantages of the therapeutic medicines accessible may inspire a scope of
responses from wellbeing experts. These dependent variables may be dismissing and
pulling back from the patient, blaming the patient for neglecting to recuperate, or
assuming exorbitant individual liability for the patient's inability to recover. Both
under-and over-treatment of the patient may ensue. Such issues are to be focused
during care of patients at the end stage or when the patients are not responsive to the
treatment. Therapeutic care is progressively given in a complex clinical and moral
scene of open investigation and financial responsibility. The complex nature of
treatment modalities such as transplantation surgery and serious care, for instance,
bring clinicians face to face with confused ethical issues on dragging the end of life or
allocating assets. Requests are made for "evidence-based care," but in numerous areas
confirmation is either inaccessible or restricted, creating additional worry among
clinicians.
29

o Education and training: The feedback provided by healthcare professionals to
complex clinical circumstances rely on upon their preparation and education. The
clinical experiences of junior specialists pivoting through a range of specialty,
participating in skill oriented programs minimizes them to give experience of treating
patients over a long stretch. Transient contact with patients with serious interminable
sicknesses in clinic settings may give junior specialists a twisted point of view on the
course of such diseases, the part of medication, the requirements of patients, and their
own particular potential responses. Reviews of medical graduates demonstrate that
they know about these insufficiencies in their preparation. Specialists might be all
around prepared for the biomedical parts of care yet the difficulties of comprehension
and responding properly to the mental, social, psychological measurements of disease
and wellbeing should be tended to. Numerous clinicians also feel that giving
enthusiastic support to families is a wellspring of stretch. Therapeutic training must
cover the aspects on the emotion and their effect on the patient, the patient's family,
and the clinicians treating them. Relational abilities are crucial. Clinicians who feel
that they have received deficient training in communication and management
aptitudes have essentially more elevated amounts of distress than the individuals who
feel they have adequate preparing.
o Team participation and utilization of outer assets: When a clinician is a part of a
multidisciplinary group, it is conceivable to examine complex issues of clinical
affairs, share the burden of care, and facilitate the access expert support and other
staff. Non-administrative offices and volunteer care groups can give social support,
training, and backing for patients with perpetual physical and emotional instabilities.
Clinicians have a key part in connecting patients with such gatherings. These
30

associations can check the social confinement and shame experienced by numerous
patients with perpetual sicknesses.
o Self-care: Working too much extend periods of time is not conductive to give high
quality of healthcare and clinicians should consider applying control over their
clinical work and setting their own particular needs. Clinicians should focus on the
emotional measurements of their work, including how proficient advancement and
preparing may upgrade proficient fulfillment and patient care. Such practice could be
a critical part that connects and exercises outside of work have in providing balance.
Doctors can't give amazing clinical care in the event that they neglect to support
themselves physically, inwardly, and profoundly.
o Counseling in Infected Individuals: Facilitate coordinated collaboration of people
with HIV infection to avoid advance transmission of the ailment. Motivational
meeting has been utilized as a powerful strategy by a portion of the HIV mind
suppliers. In this guiding system, the medicinal services supplier considers the
availability of the customer to change his/her unsafe conduct and helps them resolve
the vacillation connected with changing the conduct. The clinicians should survey the
mental status of the patients for the conceivable side effects amid the cooperation.
4.3. Recommendations for future research
Future research should be able to measure multiple contexts to facilitate comparisons across
studies. The stronger study designs in terms of statistics (e.g., longitudinal, trial) that use
proper correlation or control conditions or take out or control for jumbling factors, are
required. Specifically, the investigations should compare the outcomes across age gatherings.
In addition, it is expected to conduct training programs that are based on age for children and
adolescents.
31

There are also numerous areas where extra research on defensive procedures is essentially
required over the globe where the disease burden is high however look into consideration is
restricted. Strangely, the available evidences are based on HIV-infected children and adults
from low socioeconomic status. Such work gives a concrete foundation to park on basic
quantitative and intervention centered research.
At the individual level, there is a great deal to be found out about the capacity of various
individual level procedures (e.g., relational abilities, self-assuredness, self-regard, positive
thinking, self-adequacy etc). In addition to strengths, the qualities and vulnerabilities because
of unchanging elements, for example, sex or age. At the family level, inquire about on the
part of connection, parental observing, warmth, direction and different components of
guardian relations in the mental health of youngsters living with and influenced by HIV
would give a more grounded confirmation base to indentifying mediation targets. Similarly,
at the larger communities and social level, investigations about the part education, training
programs and social support to reduce the stigma and to mental health in children and
families affected by HIV.
The issues of depression and poor self-regard can be constricted through concrete programs
and by implementing developmental programs for the enhancement of skills (Lyon, et al.,
2011). Therefore, there is a specific requirement for mediation research about that promote
versatility and positive results across all levels of people without regards to socioeconomic
status. For instance, at the kid level, mediations are required that increase service utility,
adapting abilities, self-adequacy, self-regard, and stigma resistance. At the family level,
mediations are required that increase family support and working, child rearing abilities,
correspondence, and common critical thinking. At the group level, mediations are expected to
decrease community stigma, develop effective mitigation programs and increase safe and
health promoting situations.
32

The accessible evidences are helpless against different difficulties past HIV/AIDS, including
neediness and financial status of casualties. For these populaces experiencing dangers at
various levels of the social environment, thought of a scope of defensive procedures is
considerably more basic. This may clarify a portion of the contrasts between results in
psychological well-being results in the surveyed investigations of HIV victims when
contrasted with different studies looking at kids influenced by HIV.
In nutshell, a use of advanced methods and deep investigations to understand the hazard and
defensive procedures in the lives of victims and their families influenced by HIV/AIDS is
needed. The procedures recognize the key factors that influence prevention and intervention
in a way that is holistic, precise and receptive to the complex nature of risks. Indeed, a quality
of the research explored here is the prevalent concentrate on modifiable components of
flexibility, which can be focused on and effectively mediated upon. Few investigations were
focused on only one are i.e., either depression or anxiety. Considering these aspects, based on
evidences it would be desired to identify the probable mechanisms and link them for the
elucidation of underlying causes of emotional distress, depression and anxiety. By addressing
remaining gaps in the evidence base, future research can strengthen our understanding of
appropriate targets for promoting resilience in children and families affected by HIV/AIDS.
33

References
Alpana, S.G., & Ila, 2010. ‘Impact of Counseling upon Anxiety and Depression of AIDS
Patients’ Journal of the Indian Academy of Applied Psychology Vol.36, No.2, pp.
249-253.
Asikhia O.A., & Mohangi K., 2015. ‘A case study of school support and the psychological,
emotional and behavioural consequences of HIV and AIDS on adolescents’. SAHARA
J. Vol, 12. No, pp, 123-33
Baqutayan, S. M. S, 2012. ‘The effect of anxiety on breast cancer patients’. Indian Journal of
Psychological Medicine, vol. 34, no. 2, 119–123. http://doi.org/10.4103/0253-
7176.101774
Bernard M.B., Michele S., Laura G.W., Berry B., Barbara G.W., Kelly E.W., & Michael
A.P., 2014. 'Laboratory Testing for the Diagnosis of HIV Infection: Updated
Recommendations' http://www.cdc.gov/hiv/pdf/hivtestingalgorithmrecommendation-
final.pdf
Blank M.B., Hanrahan N.P., Fishbein M., Wu E.S., Tennille J.A., Ten H.T.R., Kutney-Lee
A.M., Gross R., Hines J.M., Coyne J.C & Aiken L.H, 2011. ‘A randomized trial of a
nursing intervention for HIV disease management among persons with serious
mental illness’ Psychiatr Serv. voil. 62. no. 11, pp.1318-24.
Boyes M.E., & Cluver L.D., 2015. ‘Relationships between familial HIV/AIDS and symptoms of anxiety and
depression: the mediating effect of bullying victimization in a prospective sample of South African
children and adolescents’ J Youth Adolesc. Vol. 44. No, 4, pp. 847-59
Caplan S, 2016. ‘A pilot study of a novel method of measuring stigma about depression
developed for latinos in the faith-based setting’ Community Ment Health J. Vol, 52,
No, 6. pp. 701-9.
34

Duncan C., Laura W., Ahmed N., Angus B., Boffito M., Bower M., Dunn D., Edwards
S., Emerson C., Fidler S., Fisher M., Horne R., Khoo S., Leen C., Mackie N.,
Marshall N., Monteiro F., Nelson M., Orkin C., Palfreeman A., Pett S., Phillips
A., Post F., Pozniak A., Reeves I., Sabin C., Trevelion R., Walsh J., Wilkins
E., Williams I., & Winston A., 2015 ‘British HIV Association guidelines for the
treatment of HIV-1-positive adults with antiretroviral therapy 2015’ Retrieved from
http://www.bhiva.org/documents/Guidelines/Treatment/2015/2015-treatment-
guidelines.pdf
Fleishman, J.A., & Fogel, B., 1994. ‘Copying and Depressive Symptoms Amongs People
with AIDS’. Health Psychology, Vol, 13. No.156. pp, 169.
Frasure-Smith N & Lesperance F., 2005. ‘Depression and coronary heart disease: complex
synergism of mind, body, and environment’. Am Psychol Soc. 14, 39-43
Kuo C., Cluver L., Casale M., & Lane T. 2014. ‘Cumulative effects of HIV illness and
caring for children orphaned by AIDS on anxiety symptoms among adults caring for
children in HIV-Endemic South Africa. AIDS Patient Care and STDs, Vol. 28, No.
6, pp. 318-326.
Lefton, I.A., (1997). Psychology (6th ed). Neetham Heights, MA: Allyn and Becon
Lichtenstein, B., Laska, M.K & Clair, J.M (2002). Chronic sorrow in the HIV-positive
patient: issues of race, gender, and social support. AIDS Patient Care STDS. 16(1),
27-38
Lyon, M. E., Garvie, P. A., Kao, E., Briggs, L., He, J., Malow, R., Lawrence J.D &
McCarter, R. (2011). An Exploratory Study of Spirituality in HIV Infected
Adolescents and their Families: FAmily CEntered Advance Care Planning and
Medication Adherence. The Journal of Adolescent Health : Official Publication of the
35

Society for Adolescent Medicine, 48(6), 633–636.
http://doi.org/10.1016/j.jadohealth.2010.09.006
Maija R & Bert N.U., 2008. ‘Social and Emotional Support and its Implication for Health’
Curr Opin Psychiatry. Vol, 21, no. 2, pp. 201–205
Medha V., Linda M., Sara C., Abbas T., Ruth S., & Lucy A., 2011. ‘HIV-Disclosure, social
support, and depression among HIV-Infected African American women living in the
rural southeastern United States’ AIDS Education and Prevention: Vol. 23, No. 1,
pp. 78-90.
Melis R.J., Teerenstra S., Olde Rikkert M.G & Borm G.F, 2011. ‘Pseudo cluster
randomization: balancing the disadvantages of cluster and individual randomization’
Eval Health Prof. Vol 34, No, 2, pp. 151-63.
Mitzel L.D., Vanable P.A., Brown J.L., Bostwick R.A., Sweeney S.M., & Carey M.P., 2015. ‘Depressive
symptoms mediate the effect of HIV-related stigmatization on medication adherence among HIV-infected
men who have sex with men. AIDS Behav. Vol, 9. No, 8, pp. 1454-9.
Mocroft A., Brettle R., Kirk O., Blaxhult A., Parkin J.M., Antunes F., Francioli P.,
D'Arminio Monforte A., Fox Z & Lundgren J.D. 2002. ‘ Changes in the cause of
death among HIV positive subjects across Europe: results from the EuroSIDA
study’. AIDS. Vol, 16. No, 12, pp. 1663-71.
Mohanan P., & Kamath A., 2009. 'Family support for reducing morbidity and mortality in people with HIV/AIDS'
Cochrane Database Syst Rev. Vol, 8. No, 3 :CD006046. doi: 10.1002/14651858.CD006046.pub2.
Moneyham L., Seals B., Sowell R., Hennessy M., Demi A., & Brake S., 1997. ‘The impact
of HIV on emotional distress of infected women: cognitive appraisal and coping as
mediators’. Sch Inq Nurs Pract. Vol, 11. No, 2, pp. 125-45
Neuman, M., Obermeyer, C. M., For the MATCH study group, Cherutich, P., Desclaux, A.,
Hardon, A., Ky-Zerbo, O., Namakhoma, I & Wanyenze, R. (2013). Experiences of
36

stigma, discrimination, care and support among people living with HIV: A four
country study. AIDS and Behavior, 17(5), 1796–1808. http://doi.org/10.1007/s10461-
013-0432-1
Ogunmola, O. J., Oladosu, Y. O., & Olamoyegun, M. A. (2014). Relationship between
socioeconomic status and HIV infection in a rural tertiary health center. HIV/AIDS
(Auckland, N.Z.), vol, 6, 61–67. http://doi.org/10.2147/HIV.S59061
Okulicz J.F., Marconi V.C., Landrum M.L., Wegner S., Weintrob A., Ganesan A., Hale B.,
Crum-Cianflone N., Delmar J., Barthel V., Quinnan G., Agan B.K., & Dolan M.J.,
2009. 'Clinical outcomes of elite controllers, viremic controllers, and long-term
nonprogressors in the US Department of Defense HIV natural history study'. J Infect
Dis Vol, 200, No. 11, pp.1714-23.
Padma M., & Asha K, 2009., ‘Family support for reducing morbidity and mortality in people with HIV/AIDS’
DOI: 10.1002/14651858.CD006046.pub2View/save citation
Peltzer, K., & Pengpid, S. (2013). Socioeconomic factors in adherence to HIV Therapy in
low- and middle-income countries. Journal of Health, Population, and Nutrition, vol,
31, no, 2, 150-170
Pence B.W., Gaynes B.N., Adams J.L., Thielman N.M., Heine A.D., Mugavero M.J.,
McGuinness T., Raper J.L., Willig J.H., Shirey K.G., Ogle M., Turner E.L., &
Quinlivan E.B., 2015. ‘The effect of antidepressant treatment on HIV and
depression outcomes: results from a randomized trial’. AIDS. Vol, 29. No, 15, pp.
1975-86
Robinson R., Okpo E., & Mngoma N., 2015, ‘Interventions for improving employment
outcomes for workers with HIV’. Cochrane Database of Systematic Reviews, No, 5.
Art. No.: CD010090. DOI: 10.1002/14651858.CD010090.pub2.
37

Rudolph K.D., 2002. ‘Gender differences in emotional responses to interpersonal stress
during adolescence. J Adolesc Health. Vol. 30, No. 4 Suppl, pp. 3-13.
Sarason, I.G., & Sarason, B.R. (2000). Abnormal Psychology. The problem of
maladaptive behaviour, (8th.Ed.) PHI, New Delhi.
Schoevers R.A., Deeg D.J., van Tilburg. W & Beekman A.T., 2005. ‘Depression and
generalized anxiety disorder: co-occurrence and longitudinal patterns in elderly
patients’ Am J Geriatr Psychiatry. Vol. 13, No. 1, .pp. 31-9.
Turan, B., Smith, W., Cohen, M. H., Wilson, T. E., Adimora, A. A., Merenstein, D.,
Adebola A., Eryka L.W., Antonina G. F., Lisa M., Phyllis C.T., Sheri D. W., &
Turan, J. M. (2016). Mechanisms for the Negative Effects of Internalized HIV-
Related Stigma on Antiretroviral Therapy Adherence in Women: The Mediating
Roles of Social Isolation and Depression. Journal of Acquired Immune Deficiency
Syndromes’ Vol, 72. No, 2, pp, 198–205.
Vitiello B., Burnam M.A., Bing E.G., Beckman R & Shapiro M.F, 2003. ‘Use of
psychotropic medications among HIV-infected patients in the United States’ Am J
Psychiatry. Vol 160. No. 3, pp. 547-54.
Wei W., Li X., Harrison S., Zhao J., & Zhao G., 2016. 'The relationships between HIV
stigma, emotional status, and emotional regulation among HIV-affected children in
rural China' AIDS Care. Vol, 28, Suppl 2, pp.161-7
WHO, HIV/AIDS Fact sheet. 2016., Retrieved from
http://www.who.int/mediacentre/factsheets/fs360/en/
Wu H., 2005. ‘Statistical methods for HIV dynamic studies in AIDS clinical trials’. Stat
Methods Med Res. Vol, 14, no, 2, pp. 171-92.
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