Objectives. Explore and describe the impact of premature life-threatening illness, stigma, multiple loss of significant others, decreased vocational choice and mobility and decreased financial security among young gay men living with AIDS. It was hypothesized that young gay men with AIDS and the elderly experience similar physical, social, and psychological changes, but the cognitive adaptation to these changes are hindered by the non-normative timing of these events. / Methods. Thirty-two self-identified gay men with AIDS between the ages of 22 to 44 years were recruited from an out-patient clinic in Montreal. These participants were asked to complete a comprehensive questionnaire, which assessed the respondent's daily stress, impact of HIV, health-related quality of life, ways of coping, multiple loss, dependency on informal and formal supports, and preparation for death. Quantitative methods were used to analyse the data. / Results. The hypothesis was confirmed. Respondents reported relatively low levels of health-related quality of life, significant concern over health and financial security, considerable multiple loss, increased dependency on informal and formal supports, proportionally greater use of active coping strategies, and significant concern about discrimination. / Conclusions. A comprehensive method of intervention which addresses all of the biopsychosocial aspects to care is proposed. It is suggested that a coordinated multidisiciplinary approach to clinical and research endeavors should be adopted to address the multidimensional obstacles facing young gay men with AIDS.

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M.Cur. (Psychiatric Nursing) / Please refer to full text to view abstract

Background. People living with HIV/AIDS (PLWHA) are not always cared for by nurses who are competent to deal with mental health problems (MHP) in Blantyre district, Malawi. Little is known regarding nurses’ perceptions about their ability to provide mental health care in the district’s general settings. Purpose. The purpose of the study was to explore nurses’ perceptions about their provision of mental health care to PLWHA in Blantyre district. Methodology. A quantitative study was conducted to explore nurses’ perceptions about their provision of mental health care to PLWHA in Blantyre. Permission was granted by relevant authorities to conduct the study. Between March and April 2010, 165 nurses were randomly sampled from all wards and other departments at a central hospital and five selected health centres. They gave a written consent before joining the study. 151 questionnaires which were completed at participant’s convenient time were personally collected. Descriptive statistics were used to analyse data and nonparametric tests were also used to explore associations amongst variables. Findings. This study found that nurses’ perceptions about their provision of mental health care to PLWHA vary. Most nurses reported positive perceptions about caring for PLWHA who have MHP in general settings although some had negative perceptions. It was apparent that a relationship exists between nurses’ willingness to deal with MHP and perceptions about their knowledge, skills and access to support from mental health specialist. The perceived lack of knowledge, skills and support from mental health specialists were identified as reducing nurses’ ability to provide relevant mental health care to PLWHA. Conclusion. Conclusively, it is logical to say that the more support nurses receive from mental health specialists, the more knowledgeable and skilled they will become in dealing with MHP and, consequently, these nurses may demonstrate more willingness to deal with MHP of PLWHA. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2010.

Diminished affective behavior is a frequently observed concomitant of cognitive dysfunction in the Human Immunodeficiency Virus (HIV), yet little is known about their relationship. A neuropsychological battery and electroencephalogram (EEG) recording was conducted on 29 HIV+ (Mage = 35.6 years, SD =5.36) and 30 HIV- (Mage =32.9 years, SD =6.39) women recruited from a family AIDS care program in South Florida. Using an emotion regulation paradigm, we compared event-related potentials (ERPs) following cues to view-neutral, view-negative and reappraise-negative images from the International Affective Picture System (IAPS). A group X instruction interaction was found for the P200 and early (400-1000 ms) late positive potential (LPP). Executive function, i.e., frequent task-switching predicted the attenuation of the early and late LPP following cues to up-regulate negative emotions. Greater response inhibition predicted attenuation of the LPP during the down-regulation of negative emotions. These findings suggest limited cognitive resources for the reappraisal of emotions in women with HIV. / by Roger Christopher McIntosh. / Thesis (Ph.D.)--Florida Atlantic University, 2012. / Includes bibliography. / Mode of access: World Wide Web. / System requirements: Adobe Reader.

HIV is major public problem in the world and in Sub-Saharan Region in particular. The literature has shown that mental disorders and particularly depression are common among people living with HIV/AIDS, but that little is known about the prevalence of depression and factors associated with it, among people living with HIV/AIDS in Rwanda. A descriptive, cross-sectional study was done to assess the prevalence of depression, the clinical profile and the factors associated with depression among people living with HIV and attending a primary health care centre in Kigali-Rwanda. This study was informed by the stress and vulnerability framework. A questionnaire was used to collect socio-demographic and HIV related medical information, while depression was assessed using the Beck Depression Inventory Scale, with a cut off of less than 10 for no depression and above 10 scoring positive for depression. Respondents were randomly selected from the patient appointment list for patients who were scheduled during the period of data collection and according to the sample selection criteria. The sample consisted of 96 people living with HIV. Permission to conduct the study was requested and obtained from the University of Kwazulu-Natal Ethics Committee, from the CNLS Research and Ethics Committee in Rwanda and from the management of the health care centre to consult patients' files. Data was analyzed using the Statistical Package for the Social Sciences (SPSS for window, 15). Descriptive data was analyzed by means of frequencies, mean and standard deviation. Cross tabulation using Pearson' chi-square test was performed to test the association between sociodemographic factors and HIV related medical information and depression for categorical variables, while t-test for independent simple test was performed for continuous variable. Multi logistic regression analysis was performed to test further association between the above mentioned factors with depression, while controlling for confounders. The results were presented by means of tables, histograms and graphs. The findings of the study revealed that depression is very high among HIV-infected patients attending a primary health care centre in Kigali, with a prevalence of 41.7%. The most frequent depressive symptoms presented were pessimism, fatigability, sad mood; lack of satisfaction, somatic preoccupation, loss of libido, crying spells, work inhibition, irritability, social v withdrawal and loss of appetite. The majority of respondents scored mild to moderate depression, whereas few had moderate to severe depression and only very few scored severe depression. Having considered all other socio-demographic and HIV related medical factors that were studied, being a female, having presented many HIV-related symptoms in the month prior to data collection, and having less than 250 CD4 counts were statistically associated with depression. On the other hand, having high social and family support was a protector factor to depression. Although the results of this study are not generalizable to the Rwandan population living with HIV, they underscore the importance of integrating mental health in HIV/AIDS services for the care of those who present mental problems related to HIV such as depression. / Thesis (MN)-University of KwaZulu-Natal, Durban, 2010.

The present study examined psychosocial variables as predictors of psychological distress and well-being in gay men with Human Immunodeficiency Virus (HIV) and the Acquired Immunodeficiency Syndrome (AIDS). The psychosocial variables investigated included communal and agentic personality variables, social support, as well as social hindrance, and self-determination variables. The total sample comprised 126 gay men. Forty-eight were seropositive for the HIV infection, 40 received a diagnosis of AIDS, and 38 were seronegative for the HIV infection. The participants with HIV and AIDS were recruited from Immunodeficiency clinics and the HIV$-$ participants were friends and acquaintances of the HIV+ and AIDS participants. The three groups of participants completed questionnaires assessing stable personality traits such as dependency and self-criticism, intimacy, affiliation, achievement, and power strivings, perceived and received social support, social hindrance of personal strivings, and levels of self-determination such as introjective and identified striving motivation. / Multiple hierarchical regression analyses were conducted to assess the predictive utility of each independent variable in predicting psychological distress and well-being. Perceived social support, striving intimacy, and striving achievement were found to be negatively associated with distress and positively associated with well-being across the three groups. Dependency, self-criticism, social hindrance, social hindrance of striving power, and introjective striving motivation were positively associated with distress and negatively with well-being. When all significant independent variables were entered in a regression analysis and simultaneously predicted the outcome variables, perceived social support, self-criticism and social hindrance of strivings significantly predicted psychological distress, and perceived social support, self-criticism, identified and introjective striving motivation predicted psychological well-being. Several independent variables were stronger predictors of distress in the HIV+ group than in the AIDS group: striving power, social hindrance of striving power, dependency, and perceived social support. Results suggest that the HIV+ group is distinct psychologically from the AIDS group. The self-concept theory and the cognitive adaptation theory were discussed in order to explain these group differences. The findings of the present study highlight the important impact psychosocial variables can have on the psychological adjustment of gay men with HIV and AIDS.

Ph.D. / The Acquired Immunodeficiency Syndrome (AIDS) has taken on pandemic proportions world wide, providing the health care system with the greatest challenge since its existence. At present, infection with the Human Immunodeficiency virus (HIV) is incurable, fatal and dangerously contagious influencing the health of the public as well as exerting profound effects on political, social and economic circumstances of the world. The challenge was and still is, to develop an effective treatment method for Human Immunodeficiency Virus (HIV) infection and /or Clinical AIDS. Up to the present time no effective treatment method has been found, as the retroviral agents typically only cause a temporary inhibition of the progression of the HIV and not a permanent cessation of the activity of the virus. In the absence of any pharmacological treatment, behavioral interventions and in particular biopsychosocial interventions utilizing cognitive-behavioral therapy and ergometric aerobic exercise take on particular importance as adjunctive treatment methods, especially during the asymptomatic and early symptomatic HIV, (CDC stages 2 and 3 and WR stages 2-4 A), but non-Clinical AIDS stages. Adding Electromyographic-feedback assisted relaxation training to the above therapeutic modalities increased the likelihood of addressing specific physiological variables associated with HIV-seropositivity, and served as a direct operant intervention in indirectly enhancing immune system functioning, through psychophysiological mechanisms or by means of the relaxation effect which it produces. In South-Africa the HIV\ AIDS situation is further compounded by a number of social and economic factors in a society expressing rapid political changes against a background of apartheid. Herein, issues of poverty, violence, proper medical care for HIV sufferers, especially in the rural areas where antiviral medications and other health services are not easily accessible, inadequate housing and unemployment place even greater burdens on the already under-served HIV sufferer. With the above aspects in mind and considering the seriousness of the AIDS pandemic in South-Africa as well as the absence of effective pharmacological agents in curing this disease, an 8-week combined biopsychosocial treatment intervention utilizing individualised cognitive-behavioral therapy, aerobic exercise and Electromyographic-feedback assisted relaxation training was developed. The objective of this research was to determine whether the combined biopsychosocial treatment intervention that had been developed would serve as a successful adjunctive treatment method to the present pharmacological treatments, especially during the asymptomatic and early symptomatic stages of HIV-infection where the apparent sluggishness of immunological functioning may be most amenable to interventions that enhance effector functions and communication between CD4 T-lymphocytes, CD8 T-lymphocytes, macrophages and B cells via increases in lymphokine production. The intervention further aimed to decrease depression, physiological tension and anxiety and fatigue levels, as well as increase vigor-activity levels important in the overall health status of HIV-seropositive patients. The intervention was implemented on a group of South- African asymptomatic and early symptomatic (CDC stages 2 and 3 and WR stages 2-4 A) HIV- seropositives. The results of the research revealed no statistically significant between-group differences in any of the cellular immune measurements. Clinically and statistically significant withingroup differences were however found in baseline to post-test measures of total lymphocyte counts in subjects of the experimental group. Statistically significant between-group differences were also found in the tension-anxiety, depression-dejection, fatigue-inertia and vigor-activity levels of experimental subjects as compared to control group subjects. The study further found that subjects who recorded lower depression and tension-anxiety levels at baseline and post-intervention phases had higher CD4 -T lymphocyte counts and therefore, increased resistance to HIV-related infections and diseases. The study also revealed significant within-group differences in terms of the baseline to post-test relaxation effect of the EMG-feedback assisted relaxation training, as well as clinically significant within-group increases in the CD4-T lymphocyte counts of experimental subjects who experienced this relaxation effect.

M.A. (Psychology) / The Acquired Immunodeficiency Syndrome (AIDS) has become one of the major challenges that the health care system has had to face and will continue to present a significant health challenge well into the 21st century. Up to the present time no effective treatment method has been found as the retroviral agents typically only cause a temporary inhibition of the progression of the Human Immunodeficiency Virus (HlV) and not a permanent cessation of the activity ofthe virus. Psychosocial approaches to the management of HlV have been moderately successful, but more successful then the retroviral agents during the HIV but non Clinical stage. Considering the proportions of the HlV disease, there are few studies in South-Africa, that describe the therapeutic effects of a stress management package consisting of aerobic exercise, group-based cognitive behavioural therapy and relaxation training on mood state changes of asymptomatic and early symptomatic HIV sufferers. Psychological measures, like depression and anxiety have been found to be associated with lowered immune responsivity, thus enhancing the underlying immunodeficiency found in HlV/AIDS sufferers. Past research has also illustrated the benefits that may be derived from aerobic exercise on the physiological mechanisms of the body. The intention of this research, was therefore to further reinforce the positive effects of aerobic exercise by using a biopsychosocial approach in the treatment of HIV, leading to an overall improvement in the immunological status, depression and distress levels of HlV patients, as well as their ability to cope with the disease. The study took place within the context of a wider project, forming a component of the AIDS research conducted by Prof. E.Wolff (Rand Afrikaans University). The study assessed the relevance of this intervention for the South African Setting.

No description available.