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

Anambra State of south eastern Nigeria. The young woman’s husband died about three years after their marriage of a protracted illness believed to be HIV/AIDS. About one year after the death of her husband, the young woman became sick. When the young woman was diagnosed HIV/AIDS seropositive, she was believed to have been engulfed by stigma consciousness. Rather than seeking intervention, she decided to end up her life by committing suicide through drinking concoction. The idea to commit suicide became known through her mother, whom she disclosed to shortly before giving up. Her reason was to save face since many people must have known about her HIV/AIDS seropositive status, which was evidenced from her late husband’s case. This implies that PLWHA are bogged with internal states in form of emotions that make them experience stigma consciousness that impairs ability to apply appropriate coping strategies thereby affecting their health. Application of appropriate coping strategies and cognitive therapy as intervention measures would have saved her suicidal tendency resulting from stigma consciousness.

Some studies have started to build a psychology of the relatively powerless or disadvantaged by concentrating on the experiences of the stigmatized that are devalued, rejected, and discriminated groups such as PLWHA, by considering what responses they are likely to exhibit when coping with their negative conditions that may affect their health (e.g. Branscombe & Ellemers, 1998; Crocker & Major, 1989; Crosby, 1982; Deschamps, 1982; Dion & Earn, 1975; Major, 1987, 1994; Swim, Cohen, & Hyers, 1998; Tajfel, 1978; Tajfel & Turner, 1986; Branscombe, Schmitt, & Harvey, 1999; Mummendey, Kessler, Link, & Mielke, 1999; Major & O’Brien, 2005; Siegel & Others, 1998; Pinel, 1999; Kalichman & Others, 2006). However, none of the studies provided plausible explanation on the roles of stigma consciousness of the stigmatized individuals on their immune systems. In short, none was designed to tackle the problem. None, at least to the researcher’s awareness, investigated the influence of stigma consciousness on the immune system among PLWHA using CD4 count as measure. Thus, one of the problems of this study was to explore the influence of stigma consciousness on CD4 counts of people living with HIV/AIDS. Social support has been shown to associate with health-related behaviours (e.g. Kaplan, Manuck, Williams & Straw, 1994; seeman & Syme, 1989; Goodenow, Reisine & Grady, 1990; Davison & Neal, 2001). But few studies (e.g. Mulder, de Vroome, Van Griensven, Antoni & Standfort, 1999) have examined the association between social support and immune system using CD4 count as measure among PLWHA. However, these studies were not designed to examine the influence of different levels of social support or interaction with other variables on immune system among PLWHA. Thus, the second problem of this study was to examine the influence of social support on the immune system among PLWHA using CD4 count as measure, and also examine the interaction among stigma consciousness, social support, information coping and problem coping in influencing immune system using CD4 count. Earlier studies have shown that problem-focused coping and information avoidant coping are related (Carver, Scheier, & Weintrant, 1989; Folkman & Lazarus, 1980; Miller & Mangan, 1983) and problem focused and avoidant coping styles are found to be related (Kalichman, Benotsch, Weinhardt, Austin, Luke, & Cherry, 2003; Kalichiman & Others 2006) among PLWHA. This finding was made from the health information using the internet. However, the studies did not consider comparisons between those PLWHA who seek information and those who avoid information; those PLWHA who focus and those who avoid problem on their immune systems. Thus, the third and fourth problems of this study were to investigate the influence of information and problem copings on immune system among those living with HIV/AIDS.

Most social scientists, psychologists/counsellors or healthcare workers may feel aversive caring for people living with HIV/AIDS. This results from lack of understanding some internal states of PLWHA such as stigma consciousness and application of appropriate coping strategies. Often times, experts try to design intervention without considering available coping strategies. Of course, understanding stigma consciousness, and coping strategies implications of PLWHA will surely inform interventions designed to rehabilitate and improve the social well-being and overall health of people living with HIV/AIDS. Finally, Gluhoski (1996) proposed the use of cognitive therapy by psychologists/counselors and other healthcare workers as intervention measure for people living with HIV/AIDS based on review of literatures. There is a need to empirically test the effectiveness of such cognitive therapy as intervention measure for people living with HIV/AIDS in Anambra state. Therefore, in a follow up study, comparisons were made between those who received cognitive therapy and those who did not receive cognitive therapy on stigma consciousness, social support, information coping and problem coping. Therefore, as a result of dearth in scientific knowledge in those areas, this study investigated the influence of stigma consciousness and coping strategies on immune system among people living with HIV/AIDS as indicated in their CD4 cell counts. And, the research provided cognitive therapy for managing HIV/AIDS.

Purpose of the Study

The general purpose of this study was to investigate the influence of stigma consciousness and coping strategies on the immune system among PLWHA as indicated in their CD4 counts. In a study, Pinel (1999) established stigma consciousness among women, gay men and lesbians using stigma consciousness questionnaire for women. This study did not consider investigating how stigma consciousness could influence immune system among PLWHA. So, one of the purposes of the present study was to compare participants who scored high and those who scored low in stigma consciousness scale on their immune system using CD4 counts as measure. Also, studies have considered some coping styles, for example social support, to predict health (Berkman, 1995: Ryff & Singer, 2000). And health risks are greater among lonely people, who often experience more stress, sleep less well, and commit suicide more often (Cacioppo, Hawkley & Bernstson, 2003). However, such studies did not consider the influence of high and low social support on immune system among PLWHA. Therefore, this study compared those who scored high with those who scored low in social support measures on their immune systems as indicated in CD4 counts. Third, this study compared those who seek information with those who avoid information on their immune systems. Also, those who focus on problem were compared with those who avoid problem on their immune systems and finally, interaction effects of stigma consciousness, social support, information coping and problem coping on immune system among PLWHA were sought. Further, a follow up study was conducted to establish evidence for recommending Gluhoski (1996) proposed cognitive therapy as intervention measures for reducing stigma consciousness, increase social support, instill information seeking and problem focus behaviour on people living with HIV/AIDS. So, those who received cognitive therapy as intervention measure were compared with those who did not receive cognitive therapy as intervention measure on stigma consciousness, social support, information, and problem copings.

Relevance of the Study

People living with HIV/AIDS need to reduce their stigma consciousness and adopt one or more coping strategies for effective management. According to Crepaz et al (2008), many people living with HIV benefit from earlier HIV diagnosis and are successfully treated through strict adherence to highly active antiretroviral therapy (HAART). As treatment has evolved to transform HIV into a more manageable chronic disease, an increasing number of PLWHA face emotional and physical challenges as they cope with managing HIV/AIDS over their lifetime. These emotional and physical challenges can be managed if psychological factors such as stigma consciousness and coping strategies are implicated and properly addressed in immune system functioning among PLWHA. In fact, understanding stigma consciousness, and coping strategies, will inform intervention measures necessary to help people living with HIV/AIDS to improve in their immune systems. Illness such as HIV/AIDS attracts stigma which in turn leaves the victim with stigma consciousness that spawns social problems eminent of negative mood or emotions, for example, dissociation, withdrawal, low self-esteem, anxiety among others. High stigma consciousness and poor coping strategies exacerbate these social problems and that can invariably determine differences in immune system among PLWHA.

Undoubtedly, an answer that will explain differences in immune system among PLWHA within the purview of psychology will highlight their psychological internal states. This study provides the answer only when stigma consciousness and coping strategies are implicated in determination of immune system among PLWHA. Based on that, this study has social, therapeutic/counseling, and scientific implications.

In the societal settings, people living with HIV/AIDS feel dissociated from others. They always evaluate themselves with others. Most often, they have negative evaluation of themselves and remain with negative mood that can reduce their immune systems. This makes them have negative social identity of themselves. This also causes them to dissociate and withdraw from others. Thus, they have low interpersonal relationship with the normal people and even their doctor because of poor coping choice. The poor interpersonal relationship need to be improved.

This study will utilize stigma consciousness and coping strategies to explain why PLWHA have different immune systems and the knowledge gained from this study will be useful in rehabilitating PLWHA socially. Gluhoski (1996) proposed cognitive therapy for HIV/AIDS positive individuals, aimed at changing self view, which is considered appropriate intervention to the outcome of the present study.

Understanding stigma consciousness and coping strategies will inform therapeutic/counselling interventions necessary to improve the wellbeing of PLWHA. There is growing evidence that counseling approaches (Brown, Macintyre & Trujillo, 2003) and cognitive therapy (Gluhoski, 1996; Corrigan & Calabrese, 2005; Knight & others, 2006; Crepaz, et al, 2008; Scott-Sheldon, Kalichman, Carey & Fielder, 2008), are effective in helping stigmatized persons to cope with the negative consequences of perceptions of stigma thereby improving their health.

This study used stigma consciousness and coping strategies to explain the use of counselling and cognitive therapy that can help PLWHA improve in their health conditions. Specifically, the study used cognitive therapy derived from Gluhoski (1996) cognitive therapy to explain influence of stigma consciousness and coping strategies on immune system among PLWHA.

Although, in the area of psychoneuroimmunology, studies have linked immune system with psychosocial variables such as grief caused by death of loved one, this study has scientific relevance in that it will be an extension of literature in that direction, by demonstrating a connection between stigma consciousness and CD4 count, a marker of immunity of PLWHA.

To the best awareness of the researcher, this is the first study to demonstrate this. Empirical report on effectiveness of Gluhoski (1996) cognitive therapy provided strong evidence for its use particularly among PLWHA.

In summary, this study is a social psychological attempt to explain the differential health related behaviours among individuals living with HIV/AIDS. Thus, the study investigated the roles of stigma consciousness and coping strategies in contributing to the level of CD4 counts among PLWHA in Anambra state. The implication of stigma consciousness and coping strategies in contributing to immune system functioning have relevance in social and counselling/cognitive therapy. Also, it provided scientific contribution to cognitive therapy for PLWHA and psychoneuroimmunology.