Assignment On HIV Infection

Added on - 17 Oct 2019

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Does evidence suggest that HIV patients suffer from related emotions,anxiety and depression?AbstractHIV infection has developed as one of the real difficulties of the current world. Regardlessof, awareness and education about this disease, a HIV patient is still thought to be a socialoutcaste and is dealt with intensely by the group on the loose. HIV/AIDS has picked upconspicuousness over the world as a developing general wellbeing issue. There is a complexyet huge connection between psychological wellness and HIV/AIDS. HIV influencespsychological 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. Inaddition, the presence of multiple diseases due to suppression of immunity is an additionalvariable that add to the unpredictability of evaluation, differential analysis and diseasemanagement. The dissertation describes the searching of literature, review of literature and itscritique. The literature from diverse sources was collected, reviewed and the essentials of theliterature were collated. The outcome based on evidences was discussed for the effect of HIVmediated anxiety, depression, or emotion on medication/therapy was discussed. The effect ofsocioeconomic conditions on anxiety in HIV infected patients was elaborated along with thepossible factors that influence the lifespan of HIV victims. The disease has incurredsignificant injury on communities, bringing about high dismalness and mortality. Thecasualties of HIV convey the burden of being caretakers for individual who infected withHIV while also stressing over their own particular wellbeing; be that as it may, little isthought about how HIV/AIDS influences mental illness among patients. The patients whoreported more worry over being infected with HIV and more greater HIV-related stigma werecritically more inclined to report more prominent symptoms of anxiety anddepression. These1
discoveries propose that mediations that decrease HIV-related stigma are probably going toupgrade psychological function among the patients, which thus will enhance the patient'spersonal satisfaction and prosperity. Diverse factors that contribute for mental illnessesinclude gender, socioeconomic status, society and culture. In conclusion, studies havereported depression, anxiety and emotional distress are being the most common psychiatricmorbidities among the afflicted individuals separately. No study dealt with the combinationof mental illnesses in HIV victims. It appears that no article describes the underlyingmechanisms of mental illness in HIV victims. In addition, there is a more requirement forpsychosocial support for HIV-influenced families inside the setting of growing HIV-relatedservices in healthcare system. The psychosocial mediations among HIV-influenced familiesalso upgrade the viability for the alleviation of disease manifestations and in order to decreasethe side effects of emotional sickness. A holistic approach to deal with HIV anticipation andcare (coordinated administrations that are family-engaged) that addresses the family's needs(supporting guardians/parental figures, advancing family working, tending to physical and inaddition emotional well-being requirements, and offering money related support whenrequired) and additionally the wide scope of requirements for children (access to class,physical wellbeing needs, advancement of psychological well-being), might be important todecrease the burden the HIV infection and minimize the negative consequences of HIVinfection for present and future eras. Future research should focus the investigations toidentifying the underlying causes and mechanisms.2
CHAPTER-11.1 Literature reviewDuring past few decades, researchers have shown great interest in the phenomena of socialsupport, particularly in the context of health. According to reports (Maija & Bert, 2008), thehigh quality or quantity of social networks have a decreased risk of mortality in comparisonto those who have low quantity or quality of social relationships. Especially the support isneeded for certain diseases like human immunodeficiency virus/acquired immune deficiencysyndrome (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 healthpsychologists 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 immunesystem to fight bacteria, viruses, cancer, etc, (Lahey, 1997). Following exposure to HIV, theperson is vulnerable to germs that a normal immune system could destroy. HIV can betransmitted through sexual/contact or from mother to child through the placenta or by transferof whole blood or blood product. However, it is important to note that social support in caseof AIDS is operationalized in several different ways. Most broadly, support can beconceptualized in terms of the structural components (e.g. social integration). Despite ofmarginal support from society, individual withHIV/AIDSexperiencethethreatofmajornegativelifeeventsandmedicalconditions. According to reports, the HIV/AIDS patientscould show diverse effects on individual health and wealth including,prematuredeath,physicaldisabilityandpain,lossofemployment,socialisolation,coastsofmedicaltreatment,anxietyforfutureoffamilymembers (Alpana & Ila, 2010).Earlyreports ofpsychologicalresponsesof HIV infection revealed pervasive feelings of anxietyanddepression(Fleishman&Fugal, 1994). Depression is either mood of clinical syndrome, suchasemotional, motivational,cognitive,somaticorbehavioral(Sarason & Sarason, 2000). The3
feelingassociatedwith adepressedmoodincludesdisappointment,helplessnessandhopelessness(Comer,1995).It indicates that patients with HIV can undergo for diverse complications interms of alterations in health condition due to the development of negative thoughts. Therefore, it is desired toinvestigate the possible factors that contribute for such emotional distress. This section describes the search strategyin brief and reviews of available literature.1.2. Search strategyThe available and popular sources were used to search for the evidences. The sources, diverse online electronicresources including BNI (British Nursing Index), CINAHL (Cumulative Index to Nursing andAllied 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 relevantsources and link the evidences to the current context. In addition, the available textbooks(pharmacology, nursing, health education) from the library were also searched for theevidences.Satisfactory safety measures were made to channel the quest for the pertinentsources. The keywords utilized for the pursuit incorporate "HIV/AIDS effect on emotion,negative life occasions, prematuredeath,physicaldisability,lossofemployment,socialisolation, anxiety and depression etc.The outcome of the search for the relevant sources hasbeen depicted in subsequent sections.1.3. Effect of HIV mediated anxiety on medication/therapyBlank et al (2011) investigated theeffect of the interventions from the community-basedadvanced practice nurse (APN) to promote adherence to HIV and psychiatric treatmentregimens. The investigators conducted a randomized clinical trial utilizing 238 AIDS patientswith mental illnesses. The APNs who were involved in intervention for the patients areassessed for the mental status and AIDS for 12 months. The intervention group showed a4
significant decrease in viral burden. The authors demonstrated that nursing interventions areshowing positive impact in disease reduction. However, there are no details pertaining to thetype 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 wasalso evident from other reports (Vitiello et al., 2003) that the about 20.3% of HIV-infectedpatients 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 thepatients did not receive medication for depressive disorders.Kuo et al., (2014) reported the data froma cross-sectional survey of families in HIV-endemic South Africa. The researchers studied the relationship betweenHIV impacts and caregiver anxiety. The patients included in the study comprises of either not caring of childrenorphaned by AIDS; caring for a child orphaned by AIDS but not living with HIV or dual HIV effects. Theoutcome of the study (Kuo et al., 2014) suggests that it was not caring for a child orphaned by AIDS per se thatincreased risk for anxiety. In addition, female patients appear to be of high risk of anxiety due to negative actionstowards coping responses to stress (Rudolph, 2002) and etiological differences. Equally age can also increase therisk for anxiety due to an increase in chronic health conditions (Schoevers et al., 2005)and neurologicalchanges. Due to associated thinking, the patients with positive HIV can develop psychological distress leading todevelopment of anxiety for instance. The symptoms of anxiety have to be relieved in order to promote and sustainthe health of infected person. In another study, it was quoted that the South African children and adolescents living inHIV/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 factorstowards negative mental health outcomes. The study contains youths from high HIV-pervasive groups in SouthAfrica were met and caught up one year later. Familial HIV/AIDS at pattern appraisal was not specificallyconnected with psychological wellness results 1 year later. However, the researchers opined that the usage andthorough assessment of intense programs in South African people group may enhance emotional wellness results5
for HIV/AIDS-influenced youngsters and youths. In addition, the support from family appears to show someinfluence 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 theeffect 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 includingCENTRAL, theCochrane Database of Systematic Reviews, MEDLINE, AIDSLINE and CINAHL etc. Notrials found pertaining to the inclusion of family members for the support in the studies. Itindicates that there is an insufficient evidence to bring out the effect of family support inreducing the morbidity and mortality of HIV-infected persons in developing countries.1.4. Effect of HIV mediated depression on medication/therapyPence et al., (2015) investigated the impact of antidepressant efficacy in HIV care for the improvement of adherenceof 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 caremanagers used systematic metrics to give HIV primary-care clinicians standardized antidepressant treatmentrecommendations during 2010-2013. About 149 participants were randomized to intervention and 155 to usualcare. Diverse patients belonging to majorly men, Black, non-Hispanic, unemployed, and virally suppressed withhigh baseline self-reported antiretroviral adherence and depressive severity were included. The outcome reveals thatthere was significant improvement in depression. Mitzel et al., (2015) tested the role of depressive symptoms onadherence of anti HIV-medication adherence. The study was conducted in 66 HIV-infected men who have sexwith men from an outpatient infectious disease clinic. The outcome reveals that the stigma-related experiences werepositively associated with depressive symptoms and negatively associated with adherence. These results highlightthe importance of treating depressive symptoms in interventions aiming to improve medication adherence amongHIV-infected patients.Turan et al., (1999) tried to fill the gap of the research by conducting thestudy inwomen in association between internalized stigma and ART adherence. The multicenter cohort studywas based on questionnaires in 1168 women who were taking ART. Among the women, the minority woman6
showed significant suboptimal ART due to development of depressive symptoms. The authors explained theprobable causes of depression in minority community in general and female in particular contrasted with otherracial/ethnic gatherings. Another cross-sectional study (Medha et al., 2011) depicted the connections between socialbolster, HIV exposure, and melancholy among 340 country African American ladies with HIV ailment living in thesoutheastern United States. Three parts of social backing (saw accessibility of bolster, wellsprings of accessiblebacking, and fulfillment with accessible backing) were measured alongside HIV exposure and sadness. Seenaccessibility of backing and fulfillment with backing intervened the relationship between HIV divulgence andsorrow. On the off chance that affirmed in longitudinal studies, these discoveries have suggestions for planning andexecuting mediations supporting African American ladies with HIV ailment in revealing their HIV status fittingly,especially to their youngsters.1.5 Effect of HIV/AIDSon emotionWithout treatment, a large proportion of HIV-positive people live for a decade or more before thevirus begins to take a noticeable toll. In addition, there is a small proportion of people with HIV whohave 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 HIVbecause earlier antiretroviral drugs and combinations did not treat HIV effectively. However, thediscovery 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-relateddeath rate in the United States dropped from 17 per 100,000 people in 1995 to about five per 100,000people by the end of the decade (Mocroft et al., 2002). Once the patient is diagnosed for thepositive HIV, can cause lot of emotional distress. Moneyham et al., (1997) investigated theimpact ofpsychological mediators of HIV-related stressors on emotional distress in 264 HIVpositive women. It appears that the effect of HIV-related stressors on emotional distress was indirectthrough cognitive appraisal. The findings indicate that how HIV+ women think about HIV-relatedstressors is an important factor that may account for individual variability in the ability to maintain a7
sense of subjective well-being in the face of a devastating fatal disease. Numerous reports are notavailable to link the emotional distress and their mechanisms. However on report (Wei et al., 2016)describesthe relation between stigma (discriminatory behaviors), stereotyped attitudes andemotional behavior. The researchers utilized data from 790 children (age, 6-17 years) affected by HIVfor the analysis and mediation of the model. They found that a significant interaction betweenperceived stigma and age suggested that negative emotions increase with age among those whoperceived a higher level of stigmatization.Asikhia & Mohangi (2015) reported the outcome of aqualitative study utilizing11 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 andemotional problems and lack of adequate support from the teachers. From the evidences it appear thatmost patients are associated with a lack of support to get rid of the symptoms making the patients tobe emotional and psychological distress. Therefore there is need of adequate support from thegovernment in the disease management.1.6. Effect of socioeconomic conditions on anxiety in HIV infected patientsRobinson et al., (2015) evaluated the effect of interventions aimed at sustaining andimproving employment in HIV+ persons utilizing a comprehensive search from 1981 untilDecember 2014. The evaluation has been done from randomized controlled trials orcontrolled before-after studies. All the participants appear that they have undergone forvocational training and antiretroviral therapy. No studies dealt with psychologicalinterventions. Among the studies, two studies compared employment outcomes of HIV+persons on ART therapy to healthy controls. Three other studies compared HIV+ persons onART to HIV+ persons not yet on ART. Two studies indicated an increase in the likelihood ofemployment 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 assessmentof mental illnesses in HIV infected patients. Despite of low quality of interventions it was8
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