AN ASSESSMENT OF FACTORS AFFECTING PSYCHOLOGICAL DISTRESS AMONG PEOPLE LIVING WITH HIV OR AIDS IN NIGERIA

1.0 Introduction

1.1 Background of Study

People living with HIV/AIDS (PLWHA) are known to have great emotional needs and they require enormous support for coming to terms with dire affliction status. In addition to being a disease that is associated with a number of physical malfunctions and progressive discomforts like pain, shortness of breath, altered sexual functions and disfigurement, HIV/AIDS is associated with social stigma, it is highly stigmatized disease and this stigmatization can lead to a progression of other grievous psychological stressors such as anxiety, depression, fear, suicidal tendencies and so on, on the prospect of real and anticipated losses, worsening quality of life, fear of physical decline and death, coping with uncertainty, unemployment, homelessness, financial doldrums and the breakup of relationships. HIV/AIDS is a disaster which disrupts the family’s equilibrium by placing a dark and frightening cloud over their future; it is one of the most challenging public health problems of our country.

The HIV/AIDS infected patients can live healthy lives for longer if proper care and support is provided; their immune system can be strengthened by medical treatment, healthy food, regular exercise, rest, care and support. they need a compassionate multifaceted assistance and support which will enable them to find meaning to life, appraising their survival, taping new resources of psychic strength and courage. Some of the feelings the PLWHA experience include shock or anger at being positively diagnosed with HIV, fear over how the disease will progress, fear of isolation by family and friends and worries about infecting others. By bearing such a heavy burden, it is not surprising that depression is twice as common in PLWHA compared to general population (American Psychiatric Association, 2013).

Psychological problems have also been associated with HIV/AIDS risky behaviors, non adherence to HIV/AIDS related medicated and shortened survival rates (Farinpour et al., 2013; cook et al; 2014). The Psychological impact is disproportionately high on those with low socio-economic status as they might be faced with fear, anxiety and hopelessness on the uncertainty of future treatment affordability due to high cost of treatment and care. Globally, there are about 33.3 million PLWHA, in South East Asia region it has been estimated that about 3.5million people are living with HIV/AIDS, India has the world’s third highest total HIV burden, the prevalence of the infection is estimated to be about 0.34% of the population which translates to 2.3million people. In Nigeria, it is estimated that about 3.1million people are living with HIV, 2.8% adult HIV prevalence (15-49years), 210,000 new HIV infections, 150,000 AIDS- related deaths, 34% adults on retroviral treatment. Nigeria has the second largest HIV epidemic in the world, unprotected heterosexual sex accounts for 80% of new HIV infections in Nigeria with the majority of HIV infections occurring in affected populations such as sex workers.

A number of studies of patients who seek HIV/AIDS treatment or preventive health services have indicated that there is fairly high prevalence of psychological problems including depression, anxiety, and hostility (Kalichman, 2010; Cohen et al., 2012). Other research shows that psychological variables, such as depression and other mental health problems, drug or alcohol addictions, or any combination of these are most commonly prevalent among PLWHA (Moore et al., 2013; Wyatt et al., 2012; Whetten et al., 2016). It is estimated that up to 50% of PLWHA suffer from a mental illness, such as depression, and 13% have both mental illness and substance abuse issues (Bing et al., 2011). In the same by Bing and colleague also indicated that one-half of adults of PLWHA had symptoms of a psychiatric disorder; 19% had signs of substance abuse; 13% had co-occurring substance abuse and mental illness (Bing et al., 2011); and one-half of PLWHA had depression (Lesser, 2014).

The question of exactly how HIV/AIDS causes depression has sparked off a lot of controversies. Some of these support the “pre-infection psychopathology” argument, and feel that HIV/AIDS merely acts as a trigger and that only people with a vulnerability to depression before contracting HIV/AIDS become depressed. Others believe in the ability of the HIV/AIDS to create depressive syndromes (Desquilbet et al., 2012). The argument that HIV/AIDS creates depression in people who formerly had no history of the illness, seems more feasible. This can occur in a number of different ways, the first being the argument of social stress

The stigmatization, alienation and breakdown of social support systems contribute greatly to the feelings of helplessness experienced by people affected with HIV/ AIDS. After the knowledge of their HIV positive status, many overreact and think that this is it; they are going to die very soon. It is mainly for this reason that many people may develop depression and lose interest in aspects of life that used to be important to them before knowledge of their HIV positive status.

In a study by Komiti and colleagues (2015) it has been indicated that psychological problems were among the most commonly observed health problems among PLWHA, affecting up to 20% of them and that the prevalence may have been even greater among substance users. Psychological problems have also been associated with HIV/AIDS risky behaviors, non- adherence to medications, and shortened survival rates (Farinpour et al., 2013; Cook et al., 2014). In addition, at times, depression is noted to be often linked with major causes of HIV transmission. These include alcohol consumption before sex, unprotected sexual contact, intravenous drug use, the sharing of HIV contaminated syringes and needles, and (Saylors and Daliparthy, 2015; Luber, 2012).

In a national probability sample of nearly 3,000 PLWHA assessed by Bing and colleagues (2011), they found out that that more than one- third of them screened positive for clinical depression and half of them reported use of illicit drugs. In another screening study carried out by Pence and colleagues (2017), they found relatively similar levels of depression of 35% in PLWHA that had screened positive.

Factors such as alcohol consumption before sex, unprotected sexual contact, intravenous drug use, and sharing HIV contaminated syringes needles are the major causes for HIV transmission (American Psychiatric Association, 2015). A lot of information about HIV/ AIDS prevention efforts and awareness campaigns against the spread of HIV infection is already abundantly available for PLWHA and for the general public. Despite the vast knowledge of how HIV is transmitted, many PLWHA still continue to engage in HIV/AIDS risky behaviors that also further places them to risks contracting secondary infections (e.g., syphilis, gonorrhea, herpesvirus-6) that may accelerate HIV/AIDS (Angelino, 2012).

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1.2 Statement of Problems

This project will address the problems of psychological implication on PLWHA. Despite advances in HIV care, PLWHA face numerous psychological challenges, HIV stigma has been defined as the social discrediting and devaluation of HIV infected persons. PLWHA are sometimes abandoned by their families and are forced to live in destitution which may lead to psychological devastation, inadequate family and community support may lead to poor drug adherence and non-disclosure of their disease status thus arising complications. HIV/AIDS can lead to ostracism and social isolation, some children have a difficult time because of the interminable bullying and mockery at school and neighborhood which may lead to loneliness and low self esteem. Because of the stigma of HIV/AIDS, families are fearful of disclosing the diagnosis and have limited support systems from both inside and outside their family.

PLWHA are deprived of employment because employers and the society at large think that they will not be productive workers and this makes them to lose income leading to financial constraint. They are commonly faced with increased levels of poverty, food insecurity and malnutrition due to loss of education and income caused by illness and increased expense of health care and transport. The risk of committing suicide is significantly high among PLWHA in other to avoid social stigma and discrimination faced by the society, being seen as different, incapable, unproductive and unpleasant through social isolation and inability to afford treatment.

It is estimated that up to 50% of PLWHA suffer mental illness and substance abuse issues (Bing et al; 2009). Depression is noted to be often linked with major causes of HIV transmission, these include; unprotected sexual contact, intravenous drug use, alcohol consumption before sex and the sharing of HIV contaminated syringes and needles (Saylors & Daliparthy, 2010; Luber, 2012). Despite the prevalence of psychological distress experienced by PLWHA, the available body of evidence indicates that depression is frequently under diagnosed and goes untreated on a large scale. Hence, the intent of this study is to investigate the factors affecting psychological distress among people living with HIV/AIDS in Nigeria.

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1.3 Aim and Objectives of Study

The aim of this study is to assess the factors affecting psychological distress among people living with HIV/AIDS in Nigeria. Specifically, this study seeks to achieve the following;

1. To investigate the psychological problems associated with HIV patients
2. To ascertain the causes and various forms of psychological problems (stigmatization and discrimination) against HIV patients
3. To assess the coping mechanisms adopted by people living with HIV/AIDS to cope with social stigma and prevent depression, anxiety and substance abuse

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1.4 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• What are the psychological problems associated with HIV patients attending antiretroviral therapy unit in Federal Medical Center Owerri?
• What are the causes and various forms of psychological problems (stigmatization and discrimination) against HIV patients attending antiretroviral therapy unit in Federal Medical Center Owerri?
• What are the coping mechanisms adopted by people living with HIV/AIDS to cope with social stigma and prevent depression, anxiety and substance abuse?

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1.5 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

• H0: There is no significant psychological problem associated with HIV patients attending antiretroviral therapy unit in Federal Medical Center Owerri
• H1: There is a significant psychological problem associated with HIV patients attending antiretroviral therapy unit in Federal Medical Center Owerri

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1.6 Significance of Study

A huge amount of research has been done around these psychological influences, yet it is felt that not all medical professionals and individuals working with HIV infected or the society they live in are aware of this body of knowledge. No one argues about the importance of following the numbers­ immune cell counts and levels of the virus in the blood nor should they but there is substantial and consistent evidence that depression, stressful life events and trauma accounts for some of the viability in HIV disease course.

It is necessary to investigate the biological and behavioral mediators of the relationships between psychological issues and the immune system also the types of intervention that could lessen the negative health impact of chronic depression and trauma.

Finally, the findings and recommendations based on the outcome of this study will inform policy makers in the study area and the country as a whole on the psychological implications of HIV and also serve as a reference source to future researchers contributing to the existing body of literature on the subject matter.

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1.7 Scope of Study

The study focuses on the Factors Affecting Psychological Distress among People Living with HIV / AIDS in Nigeria.

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1.8 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).