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Volume 1, 2016, Issue 2, Pages 41-44; Paper doi: 10.15412/J.JCC.02010201; Paper ID: 20013.
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HIV/AIDS Patients Referring to the AIDS Behavioral Clinic in Yazd, Iran
(Research Paper)
  • 1 Nursing Department, Shahid Sadoughi University of Medical Science, Yazd, Iran
  • 2 General Practitioner, AIDS behavioral clinic, Yazd, Iran
  • Correspondence should be addressed to Zahra Pourmovahed, Nursing Department, Shahid Sadoughi University of Medical Science, Yazd, Iran; Tel: ; Fax: ; Email: movahed446@yahoo.com.

Abstract

HIV/AIDS is a dangerous infection and one of the four major causes of death in humans. Fear of stigmatization, feelings of anxiety and despair and other psychological problems are observed in HIV/AIDS patients. Therefore, knowledge of their psychological status increases the impact of health care services delivered to these patients. The aim of this study is to evaluate the level of hopelessness in HIV/AIDS patients who had referred to the AIDS Behavioral Clinic in Yazd, Iran. This cross-sectional descriptive study was performed on 50 patients referring to AIDS Clinic in Yazd province, Iran. Sampling was in the form of census and data was collected through self-report questionnaires, patients’ files and the level of hopelessness, using Beck criteria. The results indicated that 42%, 22%, and 24% of patients had mild, moderate and severe hopelessness, respectively, and their mean score of hopelessness was 9.34±5.69. Also, factors such as alcohol consumption (p = 0.012), employment (p < 0.001) and family support (p = 0.049) had a statistically significant relationship with hopelessness; this relationship was reverse with regard to alcohol consumption (with an average of 6.14 ± 3.46). As hopelessness is higher in unemployed patients and lower in patients with family support, it is recommended that special needs of HIV patients be surveyed by the authorities and appropriate measures be taken to solve them.

Keywords

Hopelessness, HIV, AIDS, Despair

1. INTRODUCTION
H

IV/AIDS (Human immunodeficiency virus infection and acquired immune deficiency syndrome) is a dangerous infection and a major health problem. It involves a range of social, economic, cultural, and psychological dimensions (1). According to World Health Organization’s studies, it is estimated that the number of HIV/AIDS patients are 80,000 in Iran, but only a quarter of them has been identified in the country. This could be attributed to the stigma in society which makes people with high-risk behaviors refuse to perform diagnostic tests. Therapeutic advances have improved the health and increased the life span of HIV/AIDS patients (2, 3), therefore, the number of these people is on the rise. Different societies have different attitudes towards infected people and, in many cases, these attitudes were negative (4). HIV/AIDS patients face fear of stigma, anxiety, hopelessness and other psychological problems (5, 6). Hopelessness is a mental state that can be the basis of some mental disorders. It exposes itself as a negative attitude towards the self and the future (7). Beck considers hopelessness a sign of depression and states that hopelessness both cripples the will and creates a tendency to escape from a situation which seems intolerable (8). As the disease progresses in HIV/AIDS patients, they experience psychological problems including feelings of hopelessness, social exclusion, and, as a result, social isolation (1). These people are in a state of notoriety and stigma and face psychosocial problems that could affect their treatment protocol. Therefore, it is important to pay attention to their psychological problems in order to increase the effectiveness of health care services and improve the quality of patients’ lives (9). This study aimed to evaluate the level of hopelessness in HIV/AIDS patients referring to AIDS Behavioral Clinic in Yazd, Iran. The results of the research can be used to present strategies needed to reduce patients’ hopelessness and mental problems as well as to benefit from better health care services.

2. MATERIALS AND METHODS

This study is a cross-sectional descriptive research conducted on 50 patients referring to AIDS Behavioral Clinic in Yazd, Iran. Sampling was in the form of census and the data included demographic information and information about the disease (disease stage, route of exposure, CD4 count, medication taken), drug and alcohol abuse, consulting with psychiatrist and family support extracted from patient’s file. The sampling period lasted 6 months. The level of hopelessness was also measured through Beck criterion. Beck Hopelessness Scale consists of 20 true/false questions each having the score of one or zero. Out of these 20 statements, 9 are false and 11 are true. The sum of all scores can be 0-20. Scores 0-3 indicate the least hopelessness, scores 4-8 indicate mild, scores 9-14 show moderate, and scores above 14 reveal severe hopelessness. Patients voluntarily participated in the research. Finally, the data was analyzed using SPSS 16 and other statistical tests (Kruskal-Wallis and ANOVA).

3. RESULTS AND DISCUSSION

A total of 50 patients referring to the AIDS Behavioral Clinic were studied; 39 patients (78%) were men, 26 (52%) were married, 19 (38%) had a diploma degree, and 13 (46%) were unemployed. Also, 43 patients (86%) were not receiving antiretroviral drugs and 34 patients (68%) were infected through shared needles. Thirty-seven patients (74%) were taking drugs. Thirty-three patients (66%) had a history of injection with shared needles. Thirty-five patients (70%) were taking methadone and 31 (62%) were using sedatives (Table 1 ).

Table 1. Frequency distribution of demographic characteristics of the study

The mean age of patients was 34.84 ±QUOTE 7.6 years, the duration of contracting the disease was 4.95 ±QUOTE 3.66 years, the mean duration of taking antiretroviral drugs was 1 ±QUOTE 0.86 years, and the mean CD4 count was 436.38 ±QUOTE 211.69 mm3. The majority of patients were in the age group 30-40 years (48%) and the lowest number of them were in the age group 40+ (20%). Forty-two percent of patients had mild, 22% moderate, and 24% had severe hopelessness. The mean score of hopelessness was 9.34 ±QUOTE 5.69 (Table 2 ).

Table 2. Frequency distribution of hopelessness status of the studied patients

In this study, variables such as age (p=0.26), method of contraction (p=0.27), and stage of the disease (p=0.7) had no significant relationship with the mean score of hopelessness as revealed through ANOVA test. Variables like sex (p=0.11), marital status (p=0.11), receiving antiretroviral drugs (p=0.65), injection with shared needle (p=0.4), methadone usage (p=0.6), sedative usage (p=0.23), visiting a psychiatrist (p=0.31), and financial support (p=0.35) had no significant relationship with the mean score of hopelessness as revealed through Kruskal-Wallis test. Also, the variables of CD4 (p=0.32) and duration of contracting the disease (p=0.5) had no significant relationship with the mean score of hopelessness as revealed through Kruskal-Wallis test. But, the relationship between alcohol consumption, family support and employment, on one hand, and the mean score of hopelessness, on the other, was statistically significant. Patients who drank alcohol had a lower mean score of hopelessness (6.14 ±QUOTE 3.46) as compared to patients who did not consume alcohol (10.58 ±QUOTE 5.94) (Table 3 ).

Table 3. The mean score of hopelessness in terms of alcohol consumption, family support, and employment

The results showed that CD4 of the majority of patients (32%) was between 200 and 400. Patients with the mean hopelessness score of 9.81 ±QUOTE 5.86 and those whose CD4 was less than 200 obtained the mean hopelessness score of 9.87 ±QUOTE 6.17; Kruskal-Wallis test did not find a significant relationship between these two (P=0.32). The results illustrated that many demographic variables such as age, marital status, and education do not have a significant relationship with the mean score of hopelessness; this confirms the results obtained by Moosa (2012) (10). Swindells (1999) also found that there is no significant relationship between age, sex, marital status and hopelessness and the quality of life in HIV patients (11). Schennesson (2005) also observed that there is no significant relationship between the scores for quality of life, hopelessness and demographic variables in HIV/AIDS patients (12). In this study, there was a statistical correlation between employment and the mean hopelessness score in a way that unemployed people had higher average score regarding hopelessness, a finding that confirms Moosa’s results (10). Unemployment is one of social problems that directs people towards addiction and risky behaviors. Unfortunately, in this study, the highest frequency was for the unemployed group (23 people). Swindells’s results showed that there is a significant relationship between hopelessness score and quality of life, on one hand, and employment, on the other (p<0.001) (11). HIV patients suffer from stigma and may gradually lose their jobs and face social isolation (9). Kasin found a significant relationship between hopelessness of HIV patients and reduced capacity to work (13). Unemployed people are at the risk of developing mental disorders, feeling of worthlessness, frustration, and dissatisfaction with their experience (14). In this study, there was a reverse significant relationship between alcohol consumption and hopelessness score, i.e. those who drank alcohol had a lower score of hopelessness. Perhaps many of the most tragic events of life are temporarily forgotten with alcohol consumption, and the effects of alcohol on the brain system make people care less about future life and stay in a temporary euphoria. HIV infection can lead people to drinking alcohol. Other studies have shown that hopelessness increases the chance of alcohol consumption and that there is a significant relationship between alcohol consumption and hopelessness which confirms the results of this study regarding its significance; but as the relationship between the two is reverse in this study, the results are not consistent with other research’s (15, 16). There was also a significant relationship between family support and mean score of hopelessness, i.e. people enjoying family support had lower mean hopelessness score. Family is the primary element in the prevention of psychological problems in HIV patients. Family environment plays an important role in adjusting behaviors. One study demonstrated that there was a direct, significant relationship between stress factors and hopelessness. On this issue, Stricland et. al. have expressed that 84% of hopelessness behaviors is related to family problems and this applies to HIV patients too (16, 18). In this study, the mean age was 34.84 ±QUOTE 7.6 years, that is, adults and younger adults, who are the most important pillar of the community, grapple with HIV/AIDS because risky behaviors are more common in this age; this confirms the results of Moosa and Ressenfeld (10, 20). The mean score of hopelessness in this research was 9.34 ±QUOTE 5.69 which means moderate hopelessness that is consistent with the results obtained by Govender, Schwarzer and Moosa (10, 20). Kasin also found that the average hopelessness gradually increases in these patients; he reported a moderate to severe hopelessness in the patients (13). This research found that the highest frequency of exposure to HIV is by sharing needles for drug injection which is not consistent with Ressenfeld’s findings. Ressenfeld had found that HIV infection is mostly transmitted sexually. Although the method of contracting HIV/AIDS is changing in the world and goes from injection with shared needle to sexual intercourse, shared needle is still the primary method of transmitting the disease in Iran.

4. CONCLUSION

Hopelessness is higher in unemployed patients. This is probably due to patients’ concerns about having financial independence. It is also lower in people who have family support. Therefore, it is recommended that the special needs of patients with HIV be surveyed by the authorities and appropriate measures be taken to solve them. Accordingly, plans on how to deal with psychological crises and how to enjoy family support is important for these patients.

Not mentioned any funding/ support by authors.

ACKNOWLEDGMENT

This research was project no. 1469 supported by the Deputy of Research and Technology of Shahid Sadoughi University of Medical Sciences in Yazd, Iran. Our acknowledgment and gratitude is hereby expressed to him and all those in the AIDS Behavioral Clinic who helped us conduct the study.

AUTHORS CONTRIBUTION

This work was carried out in collaboration among all

authors.

CONFLICT OF INTEREST

The authors declared no potential conflicts of interests with respect to the authorship and/or publication of this paper.

REFERENCES

1. HIV/AIDS. JUNPo, Organization WH. AIDS epidemic update, December 2006: World Health Organization; 2007. [View at Google Scholar].

2. Cloete A, Phorano O, Ntseane D, Simbayi L, Strebel A, Segwabe M, et al. Four-country report on formative research into the development of a HIV behavioural risk reduction intervention for PLWHA: Botswana, Lesotho, South Africa and Swaziland. 2015. [View at Google Scholar].

3. Eisele TP, Mathews C, Chopra M, Lurie MN, Brown L, Dewing S, et al. Changes in risk behavior among HIV-positive patients during their first year of antiretroviral therapy in Cape Town South Africa. AIDS and Behavior. 2009;13(6):1097-105. [View at Publisher]; [View at Google Scholar]; [View at Scopus].

4. Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Social science & medicine. 2003;57(1):13-24. [View at Publisher]; [View at Google Scholar]; [View at PubMed]; [View at Scopus].

5. Genberg BL, Hlavka Z, Konda KA, Maman S, Chariyalertsak S, Chingono A, et al. A comparison of HIV/AIDS-related stigma in four countries: Negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS. Social science & medicine. 2009;68(12):2279-87. [View at Publisher]; [View at Google Scholar]; [View at Scopus].

6. Group W-H. Preliminary development of the World Health Organsiation's Quality of Life HIV instrument (WHOQOL-HIV): analysis of the pilot version. Social Science & Medicine. 2003;57(7):1259-75. [View at Publisher]; [View at Google Scholar]; [View at PubMed]; [View at Scopus].

7. Beck AT, Steer RA. Beck hopelessness scale: Psychological Corporation San Antonio, TX; 1988. [View at Google Scholar].

8. Kovacs M, Garrison B. Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. American journal of Psychiatry. 1985;1(42):559-63. [View at Publisher]; [View at Google Scholar].

9. Prendergast A, Tudor-Williams G, Jeena P, Burchett S, Goulder P. International perspectives, progress, and future challenges of paediatric HIV infection. The Lancet. 2007;370(9581):68-80. [View at Publisher]; [View at Google Scholar]; [View at PubMed]; [View at Scopus].

10. Moosa M, Jeenah F. Feelings of hopelessness in stable HIV-positive patients on antiretrovirals. Southern African Journal of HIV Medicine. 2010;11(1):40-4. [View at Google Scholar].

11. Singh N, Berman SM, Swindells S, Justis JC, Mohr JA, Squier C, et al. Adherence of human immunodeficiency virus—infected patients to antiretroviral therapy. Clinical Infectious Diseases. 1999;29(4):824-30. [View at Publisher]; [View at Google Scholar].

12. Schönnesson LN, Ross MW, Bergbrant M. Coping modes with HIV disease predict loss from HIV study cohort. International journal of STD & AIDS. 2005;16(7):479-81. [View at Publisher]; [View at Google Scholar]; [View at Scopus].

13. Haatainen KM, Tanskanen A, Kylmä J, Honkalampi K, Koivumaa-Honkanen H, Hintikka J, et al. Gender differences in the association of adult hopelessness with adverse childhood experiences. Social psychiatry and psychiatric epidemiology. 2003;38(1):12-7. [View at Publisher]; [View at Google Scholar]; [View at Scopus].

14. Harper S, Lynch J, Hsu W-L, Everson SA, Hillemeier MM, Raghunathan TE, et al. Life course socioeconomic conditions and adult psychosocial functioning. International Journal of Epidemiology. 2002;31(2):395-403. [View at Publisher]; [View at Google Scholar]; [View at PubMed].

15. Zahra P, Khadigeh D, Mogtaba Y, Hossein T, Hamideh D. Study of the rate of Hopelessness and its associated factors in Youth of Yazd city, Iran. Procedia-Social and Behavioral Sciences. 2010;5:2108-12. [View at Publisher]; [View at Google Scholar]; [View at Scopus].

16. Strickland CJ, Walsh E, Cooper M. Healing fractured families: Parents’ and elders’ perspectives on the impact of colonization and youth suicide prevention in a Pacific Northwest American Indian tribe. Journal of Transcultural Nursing. 2006;17(1):5-12. [View at Publisher]; [View at Google Scholar]; [View at Scopus].

17. Bolland JM. Hopelessness and risk behaviour among adolescents living in high-poverty inner-city neighbourhoods. Journal of adolescence. 2003;26(2):145-58. [View at Publisher]; [View at Google Scholar]; [View at Scopus].

18. Espelage DL, Bosworth K, Simon TR. Examining the social context of bullying behaviors in early adolescence. Journal of Counseling & Development. 2000;78(3):326-33. [View at Publisher]; [View at Google Scholar].

19. Greszta E. [Family environment risk factors of depression in adolescence]. Psychiatria polska. 2005;40(4):719-30. [View at Google Scholar].

20. Rosenfeld B, Gibson C, Kramer M, Breitbart W. Hopelessness and terminal illness: The construct of hopelessness in patients with advanced AIDS. Palliative & supportive care. 2004;2(01):43-53. [View at Google Scholar].

21. Schlebusch L, Govender R. Elevated risk of suicidal ideation in HIV-positive persons. Depression research and treatment. 2015;2015. [View at Google Scholar].

Paper Title: HIV/AIDS Patients Referring to the AIDS Behavioral Clinic in Yazd, Iran
Paper Details: Volume 1, Issue 2, Pages: 41-44
Paper doi:10.15412/J.JCC.02010201
Journal of Client Care
Journal home page: http://journals.lexispublisher.com/jcc
Copyright © 2017 Hamideh Dehghani et al. This is an open access paper distributed under the Creative Commons Attribution License.
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