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Influence of Social Factors on the Course of Hiv/Aids

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Influence of Social Factors on the Course of HIV/AIDS

An estimated 34.2 million people are infected with Human Immunodeficiency Virus (HIV) worldwide (http://www.cdc.gov/hiv/basics/statistics.html). Currently there is no cure for HIV or Acquired Immunodeficiency Syndrome (AIDS); however, a combination of medication and good mental health may treat the disease (http://www.niaid.nih.gov/topics/hivaids/understanding/treatment/pages/default.aspx; http://aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/taking-care-of-yourself/mental-health/). Most of the individuals who are infected with HIV/AIDS experience depression and an increase in life stressors. However, positive social support and disclosure of HIV/AIDS status decreases stress, leading to better mental health (Hays, Turner, & Coates, 1992; Turner-Cobb et al., 2002). The major at-risk groups for HIV/AIDS are adolescents, gays, bisexuals, injected drug users, and minority women (Taylor & Sirois, 2011). In this paper, the influence of social factors on the course of HIV/AIDS is investigated. It is hypothesized that the influence of social support, such as emotional (receiving emotional comfort), informational (receiving information or advice on personal issues), and practical (counting on others for help) on mental health will mitigate the course and experience of HIV. Five empirical studies are explored in an attempt to demonstrate and support the hypothesis.
In a research article by Hay, Turner and Coates (1992), the relationship between three types of social support (emotional, practical, and informational), and depression was investigated using a cross-sectional study over a one-year period. It was hypothesized that social support satisfaction decreases depression. The sample consisted of 508 single bisexual and homosexual men, with a mean age of 40 years living in San Francisco. The participants were selected by multistage probability sampling, from 19 census tracts, with the highest accumulative incidence of AIDS in San Francisco. The results of this study supported the hypothesis that social support satisfaction was negatively correlated with depression over a one-year period. The results also indicated that there is a significant relationship between informational support and stress buffering. This may be due to the sharing of experiences that is associated with psychological well-being. For instance, informational support may be successful in buffering stress on an account of removing the patient’s feeling of loneliness. In addition it helps to reassure the patients of their current situation and help them develop effective coping strategies (Hay, Turner, &Coates, 1992). The strength of this study was its promotion of the importance of psychological health for HIV-infected individuals. On the contrary, one limitation of the study was its cross-sectional design; in other words there was no causal interpretation, resulting in the studies low internal validity. Another limitation was the sample used in the study. The majority of the sample consisted of Caucasian, college graduated, middle class homosexual and bisexual men. This sample does not represent the general population (Taylor & Sirois, 2011), thus resulting in its low external validity. Moreover, the study did not take into account the various sources of support; therefore, no relationship can be drawn regarding the effects between social support and the provider of support. For example, all variables being consistent, a sexual partner’s support may have more influence on the patient’s mental health than a relative’s support. In addition, confounding variables, such as social skills, and personality traits may have been a contributing factor to the relationship between social support and depression (Hay, Turner, &Coates, 1992).
Research conducted by Pakenham and Rinaldis (2001) also focused on social support and its effect on HIV/AIDS. A sample of 114 Australian homosexual and bisexual men with a mean age of 36 years participated in this study. These participants were self-selected from newspaper and newsletter advertisements in AIDS agencies. The results of this study indicated that there is a positive relationship between social support and social adjustment. Moreover, unlike Hay, Turner and Coast’s (1992) findings, Pakenham and Rinaldis’ (2001) found a significant relationship between emotional support (such as self-disclosure, intimacy, etc.) and coping with HIV/AIDS. The result confirms the hypothesis that those with high amount of social support experience less stress during the course of HIV/AIDS. A limitation to this study is its convenient sample. Due to these volunteers not being randomly assigned, their interest to participate in this study maybe a confounding factor. For instance, their personality may have been more extroverted, resulting in their rate of disclosure. Nonetheless, this study’s good sample representation increased the study’s external validity; since eighty-five percent of those who are infected with HIV/AIDS living in Australia are gay and bisexual men. Furthermore, the study’s use of multiple methods, and multidimensional manures of adjustment, resulted in an increase in the reliability of the study (Pakenham, & Rinaldis, 2001).
Using a multiple regression analysis method, Turner-Cobb et al. (2002) investigated the relationship between social support and the patient’s ability to cope with HIV/AIDS. It was predicted that social support would be linked to less mood disturbance. The sample consisted of 78 heterosexual males, and 59 heterosexual females with a mean age of 41 years, living in California. HIV positive patients with mental illnesses were excluded form the study. The results indicated that an increase in social support during a chronic illness decreases mood disturbance. Moreover, HIV/AIDS patients who had a large positive social network displayed a decrease in mortality compared to those who did not. Furthermore, the researchers claimed that social support enhances positive mood, resulting in the patient’s better ability to cope with the disease. However, negative support such as abuse and stigma had a strong positive correlation with HIV-related risk behaviour, such as injected drug use and risky sexual behaviour. One limitation of the study is its low internal validity. Due to the research being a cross-sectional study, there were no causal influences. Another limitation of this study is that it is not representative of the general HIV/AIDS population (Taylor & Sirois, 2011). This study consisted of only heterosexual male and female participants, and it excluded any participants with a mental illness; demonstrating the study’s lack of external validity. However, the inclusion of psychiatric patients who suffer from more psychological difficulties may have effected the internal validity of the study. Some of the strengths of this study include its strong evidence of the link between social support satisfaction and positive state of mind, and the selection of randomly assigned participants (Turner-Cobb et al., 2002).
In the next study the topic of stressful events in relation to early HIV progression is addressed by Evans et al. (1997). It was predicted that an increase in stressful life events would result in an increase in the risk of HIV disease progression. The results support the hypothesis that an increase in stressful life events increases the risk of HIV progression. A longitudinal study of 93 homosexual men with a mean age of 35 years, from urban and rural areas of Florida was conducted; through states’ health departments, advertisement in gay communities, and word of the mouth. A limitation to the study was its lack of external validity. The study contained a small sample size and was not representative of the population (Evans et al., 1997). For example, the sample excluded anyone who was younger than 18 and older than 51, had less than 10 years of education, and a history of drugs and/or mental illness. Another limitation was its shortage of causal inferences, due to its cross-sectional design. However, some of the strengths of this research include its longitudinal study, increasing its reliability. In addition, participants who had physical health problems, and were taking medication in relation to their immune system were excluded form the study; which increased the study’s reliability.
Finally, the topic of disclosure in regard to the patient’s mental health was addressed by Strachan, Bennett, Russo, and Roy-Byrne (2007). The sample consisted of 373 low-income psychiatric outpatients living is Seattle; the majority of which were single, Caucasian, homosexual and bisexual men. Participants were collected from an existing publicly funded program for low-income individuals who were affected by HIV/AIDS. The results indicated a significant positive relationship between the patient’s psychological distress and their CD4 cell counts (Starchan, Bennett, Russo, & Roy-Byrne, 2007). This finding is consistent with Evans’ et al. (1997) conclusion, that an increase in stressful experiences increases the risk of HIV progression. One limitation to this study is its lack of external validity; due to it being unrepresentative of the HIV/AIDS population, since it only consisted of low-income psychiatric patients, and its failure to mention the age range of participants (Taylor & Sirois, 2011). Another limitation to this study is that there was no causal influence, because of the study’s cross-sectional design. Additionally, confounding variables such as poverty and psychiatric problems may have played a role in the patient’s psychological distress. Also, the study failed to elaborate on different types of social support, as not all types of social support are positive. For instance, negative social support lead to stigma and discrimination, resulting in an increase in life stressors (Turner-Cobb et al., 2002). However, because this sample displayed a different population with a large sample size, using a mixed-effects random regression model it can be concluded that this study had a strong reliability (for this population).
Taken together, the results of the above studies indicate that positive social support helps buffer stress and depression, which in turn results in an increase in C4 cell counts, decelerating the progression of HIV disease (Evans et al., 1997; Hay, Turner, & Coates, 1992; Pakenham, & Rinaldis, 2001; Strachan, Bennett, Russo, & Roy-Byrne, 2007; Turner-Cobb et al., 2002). Additionally, there was a negative correlation between social support and risky behaviour, such as IV drug use, and risky sexual behaviour (Turner-Cobb et al., 2002). Although these five empirical studies generally had a good sample size, the studies would have had a stronger external validity if it had included adolescent and children infected with HIV/AIDS. Furthermore, more in depth interviews regarding the patient’s type of relationship with their support provider network should be addressed. For instance, the influence on a patient’s mental health may vary depending on, if the support comes from a relative or a sexual partner. Additionally, the factors that influence social support, and the best way to provide support could be addressed as well. These factors can aid future interventions for HIV/AIDS patients.
Nonetheless, it can be assumed from these five studies that those who disclose their HIV/AIDS status to their social network and receive positive support in return, have enhanced mental health, compared to those who do not; therefore they have a higher chance of surviving the disease due to the increase in CD4 cell counts (Evans et al., 1997; Hay, Turner, & Coates, 1992; Pakenham, & Rinaldis, 2001; Strachan, Bennett, Russo, & Roy-Byrne, 2007; Turner-Cobb et al., 2002).

References
AIDS.gov. (2012). HIV and mental health. Retrieved from: http://aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/taking-care-of-yourself/mental-health/
Center for Disease Control and Prevention. (2013). What about HIV around the world. Retrieved from: http://www.cdc.gov/hiv/basics/statistics.html
Evans, D.L., Leserman, J., Perkins, D.O., Stern, R.A., Murphy, M., Zheng, B., . . . Petitto, J.M. (1997). Severe life stress as a predictor of early disease progression in HIV infection. Am J Psychiatry, 154(5), 630-634. Retrieved from http://ajp.psychiatryonline.org/data/journals/ajp/3676/630.pdf
Hays, R.B., Turner, H., & Coates, T. J. (1992). Social support, AIDS-related symptoms, and depression among gay men. Journal of Consulting and Clinical Psychology, 60(3), 463-469. dio:10.1037/0022-006X.60.3.463
National Institute of Allergy and Infectious Diseases. (2012). Treatment of HIV. Retrieved form: http://www.niaid.nih.gov/topics/hivaids/understanding/treatment/pages/default.aspx
Pakenham, K.I., & Rinaldis, M. (2001). The role of illness, resources, appraisal, and coping strategies in adjustment to HIV/AIDS: The direct and buffering effects. Journal of Behavioral Medicine, 24(3), 259-279.dio: 10.1023/A:1010718823753
Strachan, E.D., Bennett, W. R. M., Russo, J., & Roy-Byrne, P.P. (2007). Disclosure of HIV status and sexual orientation independently predicts increased absolute CD4 cell counts over time for psychiatric patients. Psychosomatic Medicine, 69(1),74-80. dio: 10.1097/01.psy.0000249900.34885.46
Taylor, S. E., & Sirois, F. (2012). Health Psychology (Second Canadian Edition). Toronto: McGraw-Hill Ryerson.
Turner-Cobb, J.M., Gore-Felton, C., Marouf, F., Koopman, C.,Kim, P., Israelski, D., & Spiegel,
D. (2002). Coping, social support, and attachment style as psychosocial correlates of adjustment in men and women with HIV/AIDS. Journal of Behavioural Medicine 24(4),
337-353. dio:10.1023/A:1015814431481

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