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

As argued earlier, a healthy person has between 500 and 1600 CD cell counts. However, a fall in CD4 cell count below 350 indicates HIV infection whereas progression to AIDS results when CD4 cell count falls below 200 (Mark, 2007; Mulder, de Vroome, Van Griensven, Antoni & Standfort, 1999). This is the point at which administration of antiretroviral (ARV) drugs are recommended to boost up the immune system of people living with HIV/AIDS. In a study, a wide range of daily stressors has been found to produce changes in the immune system especially those that cause negative mood (Stone, Cox, Validmarsdottir, Jandorf & Neal, 1987).

Specifically, CD4 slope has been shown to be an important prognostic marker for the development of AIDS (Schellekens, et al, 1992). Then, CDC (1993) defined development of HIV/AIDS when CD4 cell count drops below 200. Thus, living with HIV/AIDS is life-threatening, debilitating and can cause negative mood or emotion. It is possible that such condition can cause changes in the immune systems among PLWHA, suggesting that stigma consciousness and coping strategies may be implicated in the immune system changes of those living with HIV/AIDS.

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. As argued earlier, a healthy person has between 500 and 1600 CD cell counts. However, a fall in CD4 cell count below 350 indicates HIV infection whereas progression to AIDS results when CD4 cell count falls below 200 (Mark, 2007; Mulder, de Vroome, Van Griensven, Antoni & Standfort, 1999). This is the point at which administration of antiretroviral (ARV) drugs are recommended to boost up the immune system of people living with HIV/AIDS.

In a study, a wide range of daily stressors has been found to produce changes in the immune system especially those that cause negative mood (Stone, Cox, Validmarsdottir, Jandorf & Neal, 1987). Specifically, CD4 slope has been shown to be an important prognostic marker for the development of AIDS (Schellekens, et al, 1992). Then, CDC (1993) defined development of HIV/AIDS when CD4 cell count drops below 200. Thus, living with HIV/AIDS is life-threatening, debilitating and can cause negative mood or emotion. It is possible that such condition can cause changes in the immune systems among PLWHA, suggesting that stigma consciousness and coping strategies may be implicated in the immune system changes of those living with HIV/AIDS. HIV/AIDS stigma

The term stigma comes from ancient Greek practice of physically marking with scars or brands individuals deemed undesirable and to be avoided (Goffman, 1963). The mark signifies social ostracism, disgrace, shame or condemnation (Herek, 1990). Stigma has been used to denote socially undesirable characteristics and social scientists have been interested in its effect on social interaction. As such, Crocker and Major (1989) see stigmatized individuals as members of social groups about which others hold negative attitudes, stereotypes, and beliefs or which on average receive disproportionately poor interpersonal and/or economic outcomes relative to members of the society at large due to discrimination against members of the social group.

According to Goffman (1963) stigma is an attribute that is deeply discrediting within a particular social interaction. He further noted that stigma is a discrepancy between social expectancy and reality which arises during a social interaction when an individual’s actual social identity - the attributes he or she possesses falls short of normative expectations about what that individual should be - his or her virtual social identity. This discrepancy is in an unfavourable direction; the individual is perceived, whether accurately or not, as unable to fulfill the role requirements of ordinary social interaction with normals and consequently is reduced in our minds from a whole and usual to a tainted, discounted one (P.3). According to Goffman, stigma spoils an identity by preventing the stigmatized person from meeting expectations for particular kind of social interaction. Stigma is identified by its level of disruptiveness (Jones, Farina, Hastor, Markus, Miller & Scott, 1984) or its obtrusiveness (Goffman; 1963). This implies the extent to which it interferes with normal flow of social interaction. Any characteristics that are disruptive, elicit high levels of stigma and when internalized degenerate into stigma consciousness, a stigma-worry state (a psychological state in which an individual becomes worry about stigma). According to (Goffman, 1963; Jones & Others, 1984) if others manifest more negative attitudes toward a stigmatized person to the extent that they believe they can be physically, socially, or morally tainted, by interaction with him or her, the stigmatized individual will perceive peril. For example an individual living with HIV/AIDS can continue to feel his phenomenological experience due to lack of anchorage and adjustment. A person who is stigmatized is a person whose social identity or membership in some social category, calls into question his or her full humanity - the person is devalued, spoiled or flawed in the eyes of others (Crocker, Major & Steele, 1998). Thus, stigma can be viewed as the discrediting characteristic which disturbs a person from enjoying normal social interaction with other members of the society. Stigma has been used to denote, but not limited to, undesirable characteristics of people that dichotomise the in-group and the outgroup. The out group being stigmatized by the in-group (Anyaegbunam, in press).

Stigma has been explained in broad perspective. Now, it should be narrowed down to HIV/AIDS. HIV/AIDS – related stigma implies all the unfavorable attitudes, beliefs, behaviours, and policies directed at persons perceived to be infected with HIV/AIDS, whether or not they manifest symptoms of HIV/AIDS (Herek, 1990). HIV/AIDS- related stigma manifest in a variety of ways, including rejection by friends and relatives, fired or forced to resign from their jobs and subjected to violent assault (Herek, 1990).

The stigmatization is likely to instill into people living with HIV/AIDS some psychological conditions or experiences which may persist demanding coping or management strategies to improve in their immune system that may have been damaged by negative emotion or mood.

Psychological experiences of HIV/AIDS related stigma.

The subjective and internal states of people living with HIV/AIDS and who are stigmatized are essential to be x-rayed. As Herek (1999) put it “sensitivity to the mental health consequences of HIV/AIDS-related stigma is important for caregivers, researchers and policy maker”.

Persons with HIV/AIDS bear the burden of societal hostility at a time when they are most in need of social support (Herek, 1990). Anxiety, anger, and depression are experienced by people living with HIV/AIDS (Kelly & St. Lawrence, 1988), and are likely to be exacerbated by HIV/AIDS-related stigma (Herek, 1990). Herek further noted that anxiety results not only from fears about the physical effects of HIV/AIDS as disease, but also from fears about others’ responses: infected and sick people normally anticipate rejection, discrimination, hostility, and even physical violence from others who learn of their condition (Herek & Glunt, 1988).