Stigma Consciousness, Coping Strategies And Cd4 Counts Of Persons With Hiv/aids

not known whether social support will influence health condition, that is, immune system among people living with HIV/AIDS. Research is needed in this direction. Of course, this is the interest of this study.

Other coping strategies

Other coping strategies for living with HIV/AIDS may include information coping and problem coping. Evidence has shown that people who tend to actively seek information in their environment are more likely to come to their doctor with more minor complaints and have more medical tests performed than people who are less inclined to seek information (Miller, Brody, & Summerton, 1988). Besides, information seeking is related to problem focused coping, and information avoidance is related to avoidant coping (Carver et al, 1989; Folkman & Lazarus, 1980; Miller & Mangan, 1983). Changes in immune system among PLWHA may be linked to differences in information and problem coping strategies due to psychological conditions they (coping strategies) evoke. Studies have consistently shown that information seeking as coping strategy is associated with health benefits for some people with chronic medical conditions, including HIV/AIDS (Devins & Binik, 1996; Kalichman et al, 2006). According to Kalichman and his colleagues, increased access to information as coping strategy may offer considerable health benefits for people living with HIV/AIDS and may empower people to become more engaged in their health care. Based on the foregoing reviews, the scope of the present study included information and problem coping as one of the psychosocial variables that can influence immune system functioning among people living with HIV/AIDS as measured using CD4 counts.

Cognitive therapy as intervention measure

The problem of stigma consciousness and poor coping strategies can be addressed using proposed Gluhoski (1996) cognitive therapy. People living with HIV/AIDS have been shown to suffer some psychological problems and have altered view of themselves. In line with this, Gluhoski suggests five themes such as altered self-view, health concerns, relationship issue, different view of the future and finding meaning, which aimed at improving the health of people living with HIV/AIDS. The Gluhoski (1996) cognitive therapy is a model of therapeutic intervention that is effective in modifying the self view, easing health concerns, addressing relationship issues, developing a view of the future, and finding meanings into the present condition of PLWHA. The psychosocial problems eminent of stigma consciousness and inappropriate application of coping strategies can be addressed by both people living with HIV/AIDS and healthcare workers by using Gluhoski (1996) cognitive therapy. The strategy for using Gluhoski cognitive therapy in this study was individually tailored to different problems in different individuals. This became necessary since environmental differences might contribute to differences in degree of psychological problems. Environmental differences here refer to differences in accessing social support, and or coping strategies. Based on the foregoing reviews, the present study used stigma consciousness as an internal state and coping strategies to explain health condition of people living with HIV/AIDS by linking levels of stigma consciousness and different coping strategies to the immune system measure as indicated in CD4 count, and matched them with cognitive therapy as intervention measure for living with HIV/AIDS.

Empirical review

Some social psychological variables have been investigated in relation to HIV/AIDS disease progression, such as decline in CD4 cell count, which invariably indicates lower immune system. In one of such studies Mulder et al (1999) tested avoidance as a predictor of the biological course of HIV infection over a 7 – year period in gay men. The study investigated the associations between progression of HIV/AIDS infection and two coping strategies, such as avoidance and active cognitive and behavioural coping. The study utilized 181 HIV – infected gay men who were at asymptomatic stage of infection, had knowledge of their HIV – positive serostatus for at least 6 months, had CD4 cell greater than 200 and not using antiretroviral medication for opportunistic infections. The predictor variables, that is coping style was measured using self-report questionnaire. The coping style measured were problem solving, seeking social support among others. Also, avoidance was measured on four factors including “avoiding difficult situations; focusing on other things to take your mind off things; trying to withdraw from the situation; and letting things take their course”. The outcome of the study indicated among other things that there was no association between active cognitive and behavioural coping and the biological predictor variable, which is CD4 number, a marker of immune system. Faster rate of decline in CD4 cell was associated with less avoidance. Earlier, Solano et al (1993) had shown that some psychosocial factors such as having a fighting spirit were related to less progression of HIV/AIDS infection one year later. This indicates that, to date there are contradictory results with regards to influence of CD4 cell count (immune system marker of HIV/AIDS) and psychosocial factors especially, coping styles. Recently in a study, O’ Cleirigh, Ironson, Weiss and Costa (2007) examined how conscientiousness of seropositive individuals could predict disease progression (CD4 number and viral load) in people living with HIV. The study hypothesized among other things, if conscientiousness would predict slower HIV/AIDS disease progression as measured by CD4 cell number. Also, the study examined whether other psychological factors such as adherence to medication, depression, perceived stress, coping (avoidance and active coping) would mediate the relationship between conscientiousness and disease progression.

The study utilized 119 participants who were at the time of the study, had CD4 cell numbers between 150 and 500 indicating HIV seropositive. The study is a longitudinal type followed up to one year. Conscientiousness was assessed using 12-item conscientiousness scale (Costa & McCrae, 1992), while coping was assessed using COPE scales (Carver, Scheier & Weintraub, 1989), in which two subscales were combined to produce an avoidant coping (denial and behavioural disengagement) and active coping was also used. The CD4 cell was determined by whole-blood colour direct immunofluorescence, using a colour XL-MCL flow cytometer. The test of CD4 cell was completed the same day.