Treatment of AIDS: Is Psychological Support as Important as Drug Therapy?
Life shows different calamities. Some are in the form of a disease, others are natural disasters, traumatic accidents, psychological disturbances, remembrances of painful events, and the list goes on. Pain, distress, emotional discomfort, tension, anxiety – these are all part and parcel of such calamities. There is a lot to fight in such circumstances, and a lot to strive for.
In the list mentioned above, diseases are what people face most commonly. All diseases have their own negative effects, but incurable diseases like cancer or AIDS strike like lightening. They not only bring pain and distress, but also financial burden, depression, sadness and hopelessness. Their drastic effects are agonizing for both the patient and the family.
People enduring such ailments think of themselves as a burden on their loved ones. The ailment affects both their systemic and psychological divisions, making the suffering worse. This is a hard time on the patient and the family alike, but more on the patient. Such people deserve and need care. Only pharmacotherapy is not sufficient to cure them, but to reduce pain, improve quality of life and treat the disease, care and sympathy are essential elements of their management.
However, this is not what everyone gets. Not all such patients are lucky enough to have caring loved ones. Many are criticized and abused. They are considered ‘unlucky’ and blamed for bringing bad luck to the family.
People are reluctant in disclosing that their someone is suffering from AIDS. Some people even avoid such patients. They think that HIV is a contagious disease and casual contact with HIV infected patient will make them ill too. In spite of all the moral values coming from conscience and ethical beliefs taught by the religion, many such patients are constantly berated and neglected, which increases their agony, causing their health to take a downhill course. Such diseases are considered a stigma in the community, and people hold different opinions according to their level of education, awareness and ethics. This is more common in poverty stricken areas and middle and low socio-economic groups.
A study conducted in Nigeria brought forward the views of the people that HIV is a disease afflicted on immoral people as a punishment from God. Different people had different reaction for an HIV infected relative. This was concluded to be due to low educational level and cultural beliefs. The government HIV awareness programs were not effective in increasing mass awareness and eliminating misconceptions of public regarding AIDS (1).
Another study declared that HIV is considered a stigma in the society. Many people had the fear of being labeled a prostitute/immoral and of negative family affect due to HIV (2). Such ill opinions about the disease put the patients in confusion, making it difficult for them to break the news among their relatives. They are afraid they will be criticized, looked down upon or hated.
They also fear of losing their dear ones. This was proved by a study conducted in South African setting which claims that HIV is a highly stigmatizing disease. In the research conducted, 5 out of 93 patients had not disclosed the news of their HIV infection to anyone at all, due to the fear of other people’s reaction, reaction of the people they disclose to and untoward negative reactions towards themselves (3).
As already mentioned above, the stigma related with HIV adversely affects the outcomes of antiretroviral therapy. These include social withdrawal, depression, hopelessness, sadness, noncompliance with medications, etc. In the long run, cognitive functions of the patients are also affected by these unfavorable elements directly or indirectly (4).
Another study analyzing the depression in HIV patients showed more depressive scores in women. Patients with severe depressive symptoms did more emotional rapport building but less social rapport building, and their providers did more data gathering/counseling. Providers also rated such patients more negatively. Such patients also felt less respected. The negative attitude of providers might be due to increased psychological demands of such patients and less time and resources to cater them. But this negative attitude eventually blackens patient-provider relationship and the quality of life of such patients (5).
In order to improve the health and quality of life of HIV affected patients and to make the most of antiretroviral therapy, all the negative psychosocial elements should be eliminated. Among these, depression is the most attention requiring field. Reducing it will help to reduce hopelessness and increase compliance towards medications. The health care providers and family both need to work together to remove the gloomy state of HIV patients.
All forums – religious, cultural, social, ethical – should be utilized to their maximum levels to get the utmost gain. This was confirmed by a study in which the author gave his opinion that depressive symptoms are very commonly found in HIV patients which negatively affect their health. Religious programs, perceived stress and social support are very helpful in combating against this. The author emphasized the need to provide psychotherapy to HIV patients to treat their depression and to satisfy their mental, social and spiritual needs (6).
The effect of psychotherapy in improving depression and cognitive function of HIV infected people has been very helpful in improving their health status (7). Group sessions are more effective. However, women are mostly absent from such sessions, which shows gender disparity. This is also an issue worth addressing (8).
In this regard, I spoke to my colleagues and health care providers. All of them gave the same opinion that care is necessary to make things better for AIDS patients. Some even said that care is an element necessary not only for diseases, but for all ups and downs of life, and for a person battling with AIDS or similar diseases like this, it was his right. Even a polite smile can raise their self esteem and bring miracles.
It is a well known fact that to cure a disease, emotional and psychological support is as necessary as drug therapy. The family, friends and relatives should take good care of the patient and provide him maximum support. They should never make the patient consider himself a burden. The patient is already combating against a highly dreadful disease, and is already in a lot of distress. He needs all the support he can get to make this journey tolerable and a bit pleasant.
At higher levels, authorities should increase education and knowledge in people about AIDS. Awareness programs should especially dictate that AIDS is not a contagious disease and will not spread by casual contact with the victim. The need for pleasant social interactions with the patient should also be emphasized so that the mass will know the difficult condition of HIV infected patients and this will also improve their attitude towards them. Health care providers should be dictated to listen patiently to all the complaints of these patients and establish a better connection with the patient, giving them best care. There is no doubt that AIDS is an agonizing and distressing ailment, but proper attention, strong support and tender care can make this miserable journey a lot more better and tolerable.
1. Muoghalu CO, Jegede SA. Perception of HIV/AIDS among the Igbo of Anambra State, Nigeria. SAHARA J. 2013 Mar;10(1):42-54.
2. Mukolo A, Blevins M, Hinton N, Victor B, Vaz LM, Sidat M, Vergara AE. Negative labeling and social exclusion of people living with human immunodeficiency virus/acquired immune deficiency syndrome in the antiretroviral therapy era: insight from attitudes and behavioral intentions of female heads of households in Zambézia Province, Mozambique. AIDS Care. 2013 Nov 26.
3. Linda P. To tell or not to tell: negotiating disclosure for people living with HIV on antiretroviral treatment in a South African setting. SAHARA J. 2013 Jul;10 Suppl 1:S17-27.
4. Vance DE. The cognitive consequences of stigma, social withdrawal, and depression in adults aging with HIV. J Psychosoc Nurs Ment Health Serv. 2013 May;51(5):18-20.
5. Jonassaint CR, Haywood C Jr, Korthuis PT, Cooper LA, Saha S, Sharp V, Cohn J, Moore RD, Beach MC. The impact of depressive symptoms on patient-provider communication in HIV care. AIDS Care. 2013;25(9):1185-92.
6. Dalmida SG, Koenig HG, Holstad MM, Wirani MM. The psychological well-being of people living with HIV/AIDS and the role of religious coping and social support. Int J Psychiatry Med. 2013;46(1):57-83.
7. Rubenstein D, Sorrentino D. Psychotherapy with HIV/AIDS patients: assessment and treatment plan development. Am J Psychother. 2008;62(4):365-75.
8. Himelhoch S, Medoff DR, Oyeniyi G. Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: a systematic review and meta-analysis. AIDS Patient Care STDS. 2007 Oct;21(10):732-9.