A missing link in the fight against HIV & AIDS in Africa
By JONATHAN MUNDELL (1)
The work and research done in Africa to stem the tide of the HIV & AIDS epidemic have, in the past, largely been focused on prevention and medical treatment, but seem to have neglected a rather important aspect, namely the provision of psychological and sociological support for those infected with the virus. While it is incredibly important to prioritise the prevention and treatment of HIV & AIDS, it is just as important to provide effective support for those who are infected. There seems to have been a huge gap in the strategies used to tackle the epidemic in Africa. Non-infected individuals have been targeted with various prevention and awareness campaigns and HIV infected individuals who have developed AIDS can now access treatment in most countries across the continent. However, people that lie in between these two groups, namely those who are infected with HIV, but not yet in need, or not yet in a position where they are able to access treatment, have largely been forgotten. In fact the provision of psychosocial support for people living with HIV has been largely neglected in general.
This month has seen both South Africa and Botswana taking positive strides in attempts to close this gap. The Positive Living Helper Cells Support Group (PLHCSG), in Selebi-Phikwe, Botswana, has implemented a buddy programme, which involves pairing two people living with HIV as “buddies” so that they may support each other on issues related to HIV & AIDS. This is a six month pilot project and is aimed at increasing psychological support for and among people living with HIV & AIDS. In South Africa, Mothers2Mothers, one of South Africa’s success stories in attempts to support people living with HIV, have launched a hotline (0800-MOTHERS) this month, which will allow HIV-positive expectant and new mothers to access information and support regarding the prevention of mother-to-child transmission (PMTCT) programme. The hotline will be staffed by HIV-positive women who have successfully given birth to HIV-negative babies through the PMTCT process. Strategies such as these can have a huge, multifaceted impact, not only on the lives of the individuals that receive the much needed support, but on the overall progress made in stemming the tide of the rampant epidemic.
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With the emergence of new medical care regimens known as highly active antiretroviral therapy (HAART), people living with HIV have a longer life expectancy and better physical health and quality of life. These powerful antiretroviral (ARV) medications have transformed HIV from a once acute illness, into a now manageable chronic illness. This does not, however, mean that an individual diagnosed HIV-positive has it much easier now than those before. A chronic illness challenges one’s ability to adapt to environmental stressors, and often obstructs an individual’s attempt to fulfil personal dreams and ambitions, or sometimes even to simply meet basic needs. Additionally, a chronic illness is also often accompanied by many other related stressors, such as physical and mental deterioration, role changes, relationship issues, employment concerns and preparing for an uncertain future, just to name a few. These advances in HIV treatment over the past few years have generated important changes that one needs to take into account when working in the field of HIV & AIDS. Although the advances in the treatment of HIV have improved the life expectancy and health of people infected with HIV, a cure still remains elusive, and individuals living with the virus have no choice but to face the challenges of living with a chronic medical condition. The continuous improvement of medication, and consequent improvement in life-expectancy, has led to people living with HIV becoming more susceptible to multiple psychological and sociological problems.
Being diagnosed as HIV-positive is a serious life crisis requiring considerable coping resources. When receiving an HIV diagnosis a person has to deal with a life threatening disease, issues such as death, HIV-related symptoms, change in life expectancy, change in body image, decisions about disclosure, mistrust in relationships, stigma and possible social isolation and rejection (2) (3). HIV infection has a draining effect on intrapersonal, interpersonal and material resources and should be thought of as an unrelenting force with an uncertain course, and not as a single stressful life event (4). The psychosocial effects of living with HIV seem to work together with the immune system in a vicious cycle. Progressive immune deterioration and the onset of HIV & AIDS-related symptoms, together with the variety of other stressors experienced by people infected with HIV, often lead to psychological stress (5). It has also been suggested that people’s feelings can affect their immune system (6). As a person, therefore, becomes gradually sicker due to the progression of the virus, psychological distress may increase, and with the onset and progression of such psychological distress, the immune system deteriorates even more. It is therefore just as important, or perhaps even more important, that people living with HIV receive effective psychological and sociological support, as it is to provide effective medical treatment.
Many subsystems exist within the context of HIV, and these subsystems interrelate, and should not be viewed as independent entities. HIV & AIDS have been described as the ultimate biopsychosocial phenomenon, as its impact is not only limited to the immune system, but also to the social network, psychological functioning, culture and religion of individuals. Psychological and sociological intervention seem to be necessary steps in the HIV-positive individual’s journey toward adjusting to their HIV infection, as it would seem that the psychosocial impact of HIV is just as severe as its physical debilitation. It is therefore critical that attempts to combat the effects of the epidemic do not only focus on prevention and treatment, but also take into account the various other facets of this complex killer.
(1) Jonathan Mundell is Director: HIV & AIDS in Africa Unit at Consultancy Africa Intelligence (jonathan.mundell@consultancyafrica.com)
(2) Hudson, A.L., Lee, K.A., Miramontes, H., & Portillo, C.J. (2001). Social interactions, perceived support and level of distress in HIV-positive women. Journal of the Association of Nurses in AIDS Care, 12(4), 68-76.
(3) Skinner, D. & Mfecane, S. (2004). Stigma, discrimination and the implications for people living with HIV/AIDS in South Africa. Journal of Social Aspects of HIV/AIDS, 1(3), 157-164.
(4) Kalichman, S.C. (1995). Understanding AIDS: A guide for mental health professionals. American Psychological Association, Washington, DC.
(5) Kalichman, S.C., Sikkema, K.J. & Somlai, A. (1996). People living with HIV infection who attend and do not attend support groups: A pilot study of needs, characteristics and experiences. AIDS Care, 8 (5), 589-599.
(6) Littrell, J. (1996). How psychological states affect the immune system: Implications for interventions in the context of HIV. National Association of Social Workers, 21 (4), 287-295.
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