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

CHAPTER TWO

LITERATURE REVIEW

Many literatures have discussed the psychological issues of HIV/AIDS indicating that stigma is attached to the illness, but few have considered the phenomenological experiences of people living with HIV/AIDS in relation to coping strategies they use that help them to improve their health. Perceived or felt stigma may lead to stigma consciousness. Stigma consciousness and coping strategies can influence immune system among PLWHA as indicated in their CD4 counts, and this is supported by immunocompetence model. This chapter opened with theoretical background on immunocompetence (the ability of immune system to protect the body at any time), and further concerned with the review of literature on the nature of HIV/AIDS; immune system, CD4 counts and HIV/AIDS; stigma; stigma consciousness; coping strategies, and finally empirical review.

THEORETICAL BACKGROUND

Immunocompetence model Psychoneuroimmunology literatures have implicated psychosocial variables in immune system functioning. Sarason and Sarason (2008) refer to psychoneuroimmunology as the study of three bodily systems-the nervous system, endocrine and immune system that can communicate through complex chemical signals. Psychosocial factors have connections with neural-immunologic systems that govern adaptive biological responses to stress (Jemmott, 1985), and other negative psychological conditions. According to Kiecolt-Glasser (2002), Sarason and Sarason (2008) it is possible that some people who exhibit severe emotional and behavioural abnormalities show psychoneuroimmunological abnormalities as well. It is also possible that high stigma consciousness in people living with HIV/AIDS that can bring about negative psychological conditions will affect immune system. However, the immune system has ability to protect the body from infections. This idea is the root to immunocompetence model. Immunocompetence is the ability of immune system to protect the body at any given time (Rice, 1998). Immunocompetence model was developed to concern with casual connections between psychosocial variables such as grief following loss of a loved one and biological variables such as immune efficiency (Jemmott & Locke, 1984). The model was based on the hypothesis that psychosocial stressors lower immune system efficiency, which leads to an increase in medical symptoms (either morbidity or mortality). The model further suggests that risk for disease, the course of illness, and remission of symptoms may all be related to the interaction of psychosocial factors with the potency of biological threat, for example CD4 cell. The implication is that immune system can be active and effective or suppressed and less effective depending on some psychosocial variables such as stigma consciousness and application of coping strategies. Stigma consciousness can spawn psychological devastations, which renders immune system less effective, and requires application of coping strategies.

The possibility of stigma consciousness affecting immune system as indicated in CD4 counts may result from hormonal changes during the course of internalizing stigma. Scientists may wish to explore the relationship between stigma consciousness and hormonal changes.

Several earlier studies are in line with the idea of immunocompetence model (e.g.Totman & Kiff, 1979; Kasl, Evans, Niederman, 1979). Even animal studies have been useful in this area of research (e.g.Sklar & Anisman, 1980; Ader, 1983; Bovbjerg, Cohen & Ader, 1987). Therefore, enough evidences have been established on the link between psychosocial variables and immune system.

Thus, there is need to establish connection between stigma consciousness and coping strategies with immune system functioning using CD4 count as measure among seropositive individuals. This study tested the implications of psychosocial variables such as stigma consciousness, social support, information coping, and problem coping on CD4 counts, a measure of immune system among people living with HIV/AIDS.

The nature of HIV/AIDS The acronym HIV/AIDS is derived from two concepts–Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency syndrome (AIDS). Acquired immune deficiency syndrome is diagnosed when infection with Human Immunodeficiency Virus (HIV) has caused a person’s immune system to go down to such extent that the individual begins to show marked conditions associated with various viruses, fungal infections, and parasites. These are organisms which people with healthy immune systems are able to repel successfully (Herek, 1990). Thus, HIV is the retrovirus that causes AIDS (Kalichman, 2003). Some researchers noted that HIV belongs to a class of retrovirus called lent viruses (lent means “slow” in Latin) for it develops slowly as it takes years before symptoms appear; and HIVvirus infects the immune system, that is, the very system that the body uses to repel infections (Doka, 1997; Duh, 1991; Kalichman, 2003). On infection, HIV targets a particular type of white blood cells named T-helper lymphocyte cells or T-helper cells (Doka, 1997), that is CD4 count cell. T-helper cells control several branches of the immune system. They act as the body’s army since they command other immune cells to fight and destroy possible causes of infections and diseases (Doka, 1997; Kalichman, 2003).

As HIV infections last, it impairs the body’s ability to fight against many diseases by destroying T-helper cells. The immune system tries to control HIV by producing antibodies against the virus. Nevertheless, the efforts are only partly effective because HIV hides inside of T-helper cells, gradually infecting more and more cells until the entire immune system can no longer function (Doka, 1997; Kalichman, 2003). It has been observed that a person who is infected with HIV does not necessarily feel sick if he does not yet have AIDS and he can feel healthy for years (Berer, 1993; Squire, 1993).

Thus, it can be palliatively managed just like many other diseases. AIDS is the later stage of HIV infection.

The advancement from HIV stage to AIDS will depend on how fast the body’s immune system is affected (Duh, 1991), and the rate of destruction depends on the number of viruses versus the number and quality of T-cells (CD4 cell) in the body. This implies that a person is diagnosed with AIDS after immune system becomes disabled by HIV or when the person becomes seriously ill from diseases that take advantage of the broken-down immune system (Doka, 1997; Duh, 1991; Evian 1991; Kalichman, 2003). The transition from HIV to AIDS is fragile and difficult to determine, hence the two are considered together as HIV/AIDS. Thus, AIDS is the final phase of infection with HIV.

There are three phases of the HIV/AIDS illness. The first phase has the HIV infection and often it is not noticed and remains silent. In the second phase of HIV/AIDS, the disease becomes more visible with a range of infectious diseases. The third phase is potentially the most damaging of all since it involves an illness of social, cultural and political dimensions, for example stigma, discrimination, and denial (Parker & Aggleton, 2002).

Immune System, CD4 Counts and HIV/AIDS Immunity is the individual’s ability to resist or overcome the effects of diseases or harmful foreign agents. Immune system is vital to both psychological and biological functioning of the human body. Immune system is crucially important to living with HIV/AIDS. As a result of that, a regular part of HIV/AIDS health care involves having blood tests to monitor immune system’s response to ART (medication or diet) by PLWHA. One of the most common laboratory tests conducted is the CD4 cell count. The immune system of an individual living with HIV/AIDS is affected by the number of CD4 cell count present in the body. HIV/AIDS harms the body’s immune system by targeting and infecting the CD4 cells.

CD4 cells are a type of white blood cell whose function in the body is to resist infection and protect the body from illness. The CD4 cells are a major part of the body’s natural first-line defense against illness (Mark, 2007). Once inside the CD4 cells, HIV/AIDS takes over the cells and turns them into what Mark referred to as virus factories within the body, making thousands of copies of itself in each cell. As the amount of virus grows, the original CD4 cell is damaged and eventually destroyed. HIV/AIDS at last kills so many of these cells that the immune system is weakened and the body is no longer able to defend itself against infections.

To Mark (2007), a normal healthy person who is not infected with HIV/AIDS has a CD4 count of between 500 and 1600 cells. This number varies from day to day depending on the physical and emotional stressors on the body. HIV/AIDS infection causes both physical and emotional feelings; thereby reducing the CD4 cell counts of people concerned. For PLWHA, CD4 count declines gradually as HIV/AIDS kills more and more cells. The more CD4 cells a person has, the stronger the immune system is. A CD4 cell count above 500 indicates that the immune system is fairly intact and that the chances of becoming sick are minimal. As the CD4 cell count decreases, the chances of permanent immune system damage and of developing symptoms of HIV/AIDS diseases are increased.