The Project File Details
- Name: STIGMA CONSCIOUSNESS, COPING STRATEGIES AND CD4 COUNTS OF PERSONS WITH HIV/AIDS
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ABSTRACT
The study examined the influence of stigma consciousness (a belief or feeling that one will be negatively stereotyped by others) and coping strategies (social support, information and problem) on the CD4 counts (measure of immune system) of People Living With HIV/AIDS (PLWHA) in Anambra state. 430 PLWHA (men=148 & women=282), age (M=35.73, SD=8.4) years served as participants. Three Anti Retroviral Therapy (ART) sites were randomly selected from the three senatorial zones of Anambra state. All PLWHA in the three ART sites’ enrolments were used. Measures of CD4 counts of PLWHA were obtained from ART records. Stigma consciousness was measured using stigma consciousness questionnaire Pinel (1999) while social support scale Turner, Frankel, and Levin (1983), information coping scale (Kalichman et al, 2006), and ways of coping inventory (Folkman & Lazarus, 1980) measured coping strategies. 4-way analysis of variance statistic revealed that stigma consciousness had significant influence on CD4 counts of PLWHA. Social support had significant main effect on CD4 counts of PLWHA. Information coping had significant main effect on CD4 counts of PLWHA. And, problem coping produced significant real effect on CD4 counts of PLWHA. The implication is that psychosocial variables influence immune system of PLWHA. Link between stigma consciousness and CD4 counts of PLWHA is extension of psychoneuroimmunology literature. Outcome of this study will be utilized by PLWHA, psychologists/counselors, healthcare workers, and policy makers. Discussions were based on immunocompetence model of Jemmott and Lock (1984) which holds that psychosocial stressors lower immune system efficiency. Gluhoski (1996) cognitive therapy was recommended for effective psychological intervention measures to reduce negative psychological conditions among PLWHA.
TABLE OF CONTENTS
TITLE PAGE … …. … … … …. … i
CERTIFICATION PAGE … … … … … ii
DEDICATION … … … … … … … iii
ACKNOWLEDGEMENT … … … … … iv
TABLE OF CONTENTS … … … … … v
LIST OF ILLUSTRATIONS … … … … … vi
ABSTRACT … … … … … … … viii
CHAPTER 1
Introduction … … … … … … … 1
Statement of the problem … … … … … 12
Purpose of the study … … … … … … 19
Relevance of the study … … … … … … 21
CHAPTER 2:
Literature Review … … … … … … … 25
Theoretical background … … … … … … 26
Immunocompetence model … … … … … 26
The Nature of HIV/AIDS … … … … … … 28
Immune system, CD4 counts and HIV/AIDS … … … 31
HIV/AIDS stigma … … … … … … … 34
Psychological experiences of HIV/AIDS related stigma … 37
Stigma consciousness … … … … … … 39
Coping strategies …. …. … … … … … 43
Social support … … … … … … … 44
Vi
Other coping strategies … … … … … … 47
Cognitive therapy as intervention measure … … … 48
Empirical review … … … … … … 49
Summary … … … … … … … … 53
Hypotheses … … … … … … … … 54
CHAPTER 3:
Method … … … … …. … … … 56
Participants … … … … … … … … 56
Instruments … … … … … … … … 59
Procedure … … … … … … … … 64
Design/method of data analysis … … … … … 66
Follow up study … … … … … … … 69
CHAPTER 4:
Results … … … … … … … … 73
CHAPTER 5:
Discussions … … … … … … … … 86
Implications of the study … … … … … … 96
Recommendations …. …. … … … … … 98
Limitations of the study … … … … … … 99
Suggestions for further studies …. … … … 100
References… … … … … 101
Appendices … … … … … … … 113
CHAPTER ONE
INTRODUCTION
Generally, the society devalues, rejects and discriminates
against people infected with Human Immunodeficiency Virus/Acquired
Immune Deficiency Syndrome (HIV/AIDS). In turn people infected
with HIV/AIDS become stigmatized and they live persistently with
stigma consciousness, an expectation that one will be stereotyped
(Pinel, 1999). Invariably, stigma consciousness spawns psychological
devastation that can pose problems on management of HIV/AIDS,
especially if the immune system of People Living With HIV/AIDS
(PLWHA) as indicated in their CD4 counts are affected by such
psychological devastation. (CD4 count is a measure of body’s immune
system among PLWHA.) Then, anchorage and adjustment needed to
improve their health can be achieved through application of
appropriate coping strategies or use of cognitive therapy.
Undoubtedly, PLWHA that are stigmatized experience stigma
consciousness. Stigma consciousness is capable of influencing immune
system among PLWHA thereby causing either health improvement or
deterioration indicated in their CD4 counts. The primary function of
immune system is to help the body resist disease (Rice, 1998). Low
level of stigma consciousness favours immune system functioning
while high stigma consciousness suppresses immune system
functioning. CD4 count which measures immune system determines
health condition of people living with HIV/AIDS. The strength of body’s
immune system among people living with HIV/AIDS is determined
through a test called CD4. People diagnosed HIV/AIDS positive are
regarded as either living with HIV/AIDS or seropositive individuals. A
healthy person has between 500 and 1600 CD4 counts. Mostly,
PLWHA have CD4 counts below 350. This varies according to severity
of the disease, and can improve with treatment, that is taking
Antiretroviral Drug (ARV) through Anti Retroviral Therapy (ART) or
even diets. ARV is any drug that is used for suppressing the action of
HIV on CD4 counts while ART implies taking such drug as agreed or
directed by the doctor. An individual high in stigma consciousness will
be more concerned with how he/she appears to others Pinel (1999), a
situation that can cause negative emotion. This will cause the
individual so concerned to engage in application of one or more coping
strategies such as, accessing social support, information coping
(seeking or avoidance), and problem coping (focus or avoidance), to
improve his or her health condition. An individual infected with
HIV/AIDS who seeks correct information, accesses social support, and
actually focuses on problems associated with managing HIV/AIDS is
likely to develop positive emotion that will favour his/her CD4 counts.
CD4 count is used as index for measuring immune system among
PLWHA.
Understanding the concept of stigma will enhance actual depiction
of stigma consciousness. Stigma has been explained in various terms.
For example social scientists have used stigma to denote socially
undesirable characteristics and have been interested primarily in its
discrediting effects on social interactions (Goffman, 1963; Herek,
1990). Furthermore, stigmatized individuals are regarded as members
of the social groups “about which others hold negative attitudes,
stereotypes, and beliefs, or which, on average received
disproportionately poor interpersonal and/or economic outcomes
relative to members of the society at large due to discrimination
against members of the social category” (Crocker & Major, 1989).
Thus, stigma denotes, but not limited to, undesirable characteristics of
people that dichotomise the in-group and the out-group. The latter
being stigmatized by the former. So, HIV/AIDS-related stigma can be
seen as the negative attitudes, beliefs or stereotypes that people hold,
that discriminate those living with HIV/AIDS.
Stigma can be categorized into two. Some recent literatures
distinguished between enacted stigma, that is, actual experiences of
stigma and discrimination and felt or perceived stigma, that is a
stigmatized person’s fear or anticipation of discrimination and
rejection, and internal sense of shame (Scambler, 1998; Swendeman,
Rotheram-Borus, Comulada, Weiss & Ramos, 2006). Felt or perceived
stigma is similar to stigma consciousness. The authors, further noted
that felt or perceived stigma may cause people to shape their
behaviours to avoid or reduce enacted stigma which may eventually
slim their opportunities for seeking support and treatment. And this
can bring about negative psychological conditions, leading to poor
health condition among PLWHA by affecting their immune systems.
Researches have explained more subtle dimensions of HIV/AIDS
stigma. For example, an exploratory factor analysis of an extensive
HIV/AIDS’ stigma measure for PLWHA identified four factors:
personalized stigma (i.e., social rejection), disclosure concerns,
negative self-image (i.e., internalized shame), and concern with public
attitudes about people living with HIV/AIDS (Berger, Ferrans, &
Lashley, 2001).
In modern usage of the term (stigma), a defining immediate
reaction to the stigma seems to be avoidance by others. People act as
if physical contact or even proximity to the stigmatized can result in
some form of contamination (Pryor, Reeder, Yeadon & Hesson
Mclnnis, 2004). Also, people choose to stand or sit at greater distances
from the stigmatized, for example people living with HIV/AIDS, than
the non-stigmatized (Mooney, Cohen, & Swift, 1992). Cursory
observation has even shown that people avoid accepting edible items
or sharing them with PLWHA.
Of course, the individuals who are stigmatized, whose conditions
have degenerated into extensive HIV/AIDS’ stigma (Personalized
stigma, disclosure concerns, negative self-image, and concern with
public attitudes toward people living with HIV/AIDS), and who attempt
to affiliate with normal people, may share the same experience of the
painted bird (Jerzy Kosinski, as cited in Pryor & others, 2004).
The painted bird circled from one end of the flock to the other, vainly trying to convince its kin that it was one of them. But, dazzled by its brilliant colours, they flew around it unconvinced. The painted bird would be forced farther and farther away as it zealously tried to enter the ranks of the flock.
What could occupy the psychological conditions of the painted
bird? The painted bird should really feel rejected, negative self-image,
devalued, discredited, and internal sense of shame. Thus, the painted
bird is likely to became stigma conscious, a situation in which the
painted bird internalized those psychological conditions and become
worried about them. Applied to people living with HIV/AIDS, that are
stigmatized, there is likely to arise a condition of stigma consciousness
that is, how likely they are to expect that others will negatively
stereotype them because of their HIV/AIDS seropositive status. Thus,
stigma consciousness is conceptualized in this study as psychological
internal state, which disposes those living with HIV/AIDS to believe or
feel that others will negatively stereotype them because of their
HIV/AIDS seropositive status.
In fact, when people experience life-threatening illness such as
HIV/AIDS, they tend to engage in self- reevaluation and negative
social identities can be the outcome. And so, they tend to apply one
or more copying strategies to shock-absorb the psychological
devastations that occur. Coping involves cognitive processes that
begin with perception of a stimulus. As soon as the individual living
with HIV/AIDS perceives a condition as threatening, he or she
engages in appraisal and evaluation of the extent to which any action
he or she takes will be useful in saving the situation. The individual
consciously or unconsciously propagates coping mechanism
immediately he discovers that as route to relief. Social psychological
researches have shown that humans are active agents who have an
amazing ability to recover from negative life events (Major, 1994;
Taylor & Brown, 1988). However, this is only possible by consciously
or unconsciously applying appropriate coping strategies.
Further, coping has to do with how people try to deal with a
problem or handle the emotions such problem produce (Davison &
Neal, 2001). Also, coping can be discerned as any action taken to
reduce the effect of some stressful circumstances by an individual in
his or her environment, or an escape from their adversity (Weber &
Manning, 2001). Also, coping is the cognitive and behavioural efforts
to manage specific external and/or internal demands appraised as
taxing or exceeding the resources of the individual (Folkman &
Lazarus, 1988). Thus, coping is said to have occurred when people
engage in generating their assumed positive behaviours as responses
to forces that affect them, while coping strategies imply application of
any coping mechanism to checkmate negative psychological and
physical feelings.
People have different perceptions in terms of illness that
threatens both their psychological and physical health. For instance,
people living with HIV/AIDS may perceive HIV/AIDS infection as
sickness that can infest anybody and decide to seek information on
treatment, intervention, and supports whereas others may perceive it
as an end to life and become hopeless. According to Carver (1998, as
cited in Chukwudozie, 2008) such differences in perception could be
among the strongest determinants of how individuals fare in situations
of stressful or life-threatening experience, for example living with
HIV/AIDS. These may determine how PLWHA fare with regards to
their health as measured by CD4 count, which is the indicator of
immune system.
There are many dimensions of coping, which people can adopt
while in different experiences of life. To Lazarus and Folkman (1984,
1980) and Kalichman et al (2006) there are two broad dimensions of
coping which include problem-focused and avoidant coping. This
involves taking direct action to solve the problem or making efforts to
reduce the negative emotional reactions to stress, for example, by
distracting oneself from the problem, or relaxing and information
seeking and avoidant coping which refers to seeking information that
will be relevant for the solution of the problem or avoid information
that will cause harm or emotional problem or distress. Such coping
measures have psychological implications on immune system
functioning.
Scholars have argued that coping is not a generalised
disposition that is aroused by situations that threaten people, but a
specific behaviour that varies in the substance of people’s problems
and social roles that they dispense. Thus, the effectiveness of coping
choice is not only determined by how well they solve our problems
and hardships, but also how well they prevent the hardships from
resulting in damaging emotions (Scheck & Kinicki, 2000). Damaging
emotion can affect health condition of PLWHA by reducing their
immune systems as indicated in CD4 counts. Stigma consciousness
and inappropriate application of coping strategies can cause damaging
emotions among PLWHA, hence affecting their health by making
immune system inactive.
It is possible that stigma consciousness could interact with
coping strategies, for instance, social supports available to the
individuals living with HIV/AIDS to influence their immune systems.
Social support is the physical and emotional comfort given to people
by their family, friends, co-workers and others. It is knowing that one
is part of a community of people who love and care for one, and value
and think well of one (Wikipedia, 2008). Social support can act as a
moderating factor in the development of psychological and/or physical
disease, for example, clinical depression, hypertension, and HIV/AIDS’
stigma consciousness as a result of stressful situations they produce.
Two types of social support have been identified (Davison &
Neal, 2001). These include structural social support which refers to
a person’s basic network of social relationships, for example marital
status and a number of friends; and functional social support
which has to do with the quality of a person’s relationships, for
example, whether the person believes he/she has friends to call on in
time of need (Cohen & Wills, 1985). In a study, Pryor and his
colleagues (2004) found high proportion of family and friends being
aware of serostatus of a person living with HIV/AIDS not to be
associated with enacted stigma, that is actual experience and with
lower perceived stigma, that is the feeling of anticipated stigma
(stigma consciousness). Also, in the same study, men were found to
report less perceived stigma than women. The authors noted that
women tend to have higher levels of depression and anxiety than men
regarding their HIV/AIDS status. And young women living with
HIV/AIDS would appear to benefit from targeted interventions that
help them cope with feelings and fears about HIV/AIDS infections.
But, whether stigma consciousness will be implicated in influencing
immune system among PLWHA remains unexplored in literature. Also,
few studies have examined application of coping strategies such as
social support, information coping, and problem coping as influencing
the health condition of PLWHA by affecting their immune systems.
Statement of the Problem
Current statistics showed that reasonable population of
Nigerians is living with HIV/AIDS. For instance, Society for Family
Health (2009) reported that the population of 39.9 million Nigerians
was living with HIV/AIDS. These people living with HIV/AIDS need to
be rehabilitated psychologically. No doubt, Anambra State has some
proportions of that figure, hence its choice as area of study.
As we know, stigma is attached to HIV/AIDS. People living with
HIV/AIDS who internalize stigma will be vulnerable to stigma
consciousness. Stigma consciousness is likely to exacerbate the CD4
counts of those living with HIV/AIDS thereby reducing their immune
systems. Therefore, management of HIV/AIDS will continue to pose
problems unless psychosocial variables such as stigma consciousness,
social support, information and problem copings are x-rayed and
matched with appropriate intervention measures, for example Gluhoski
(1996) cognitive therapy. Of course, investigations of psychosocial
variables affecting immune system as measured in CD4 counts and
matching them with appropriate intervention measures are the
concern of this study.
Psychologists have noted that individuals are unique. And as
such, no two persons are exactly alike with respect to experiences
relating to stigma consciousness. This implies that even PLWHA can
differ in their level of stigma consciousness. Nevertheless, it is unclear
whether stigma consciousness will influence immune system among
PLWHA. To the best knowledge of the researcher, this problem has
remained unstudied with respect to health implication among PLWHA
with regards to their immune system, using CD4 count as measure.
It is clear that when an individual is infected with life-threatening
illness, he/she will experience negative emotion or mood that will
affect his or her immune system. Thus, the individual is bound to
apply one or more coping strategies to shockabsorb psychological and
physical devastation associated with such illness. People Living with
HIV/AIDS are bound to apply a good number of coping strategies to
build up hope for survival, improve their health and social well-being
otherwise they become hopeless and fall prey to some psychological
problems such as dissociation, health deterioration by reduction in
immune system and may eventually commit suicide. This can be
improved with application of appropriate coping strategies. This study
considered social support, information coping, and problem coping as
coping strategies necessarily applied by PLWHA in attempt to improve
their health condition.
People living with HIV/AIDS who are highly bogged with stigma
consciousness may suffer some social illnesses resulting from
inappropriate application of coping strategies. Such social illnesses
may include social withdrawal, lack of social affiliation, dissociation,
anxiety, depression, hopelessness, emotional instability and cognitive
imbalance, which affect health negatively. Such psychological
problems may result to health deterioration by reducing immune
system. Use of coping strategies may be important for health
improvement. Such social problems without psychological intervention
have presumably caused a young woman of 25 years old and
HIV/AIDS seropositive from a community in Anambra State to commit
suicide.
In fact, the circumstances surrounding the death of the young
woman formed source of inspiration for this study to be conducted in
Anambra State of south eastern Nigeria. The young woman’s husband
died about three years after their marriage of a protracted illness
believed to be HIV/AIDS. About one year after the death of her
husband, the young woman became sick. When the young woman
was diagnosed HIV/AIDS seropositive, she was believed to have been
engulfed by stigma consciousness. Rather than seeking intervention,
she decided to end up her life by committing suicide through drinking
concoction. The idea to commit suicide became known through her
mother, whom she disclosed to shortly before giving up. Her reason
was to save face since many people must have known about her
HIV/AIDS seropositive status, which was evidenced from her late
husband’s case. This implies that PLWHA are bogged with internal
states in form of emotions that make them experience stigma
consciousness that impairs ability to apply appropriate coping
strategies thereby affecting their health. Application of appropriate
coping strategies and cognitive therapy as intervention measures
would have saved her suicidal tendency resulting from stigma
consciousness.
Some studies have started to build a psychology of the
relatively powerless or disadvantaged by concentrating on the
experiences of the stigmatized that are devalued, rejected, and
discriminated groups such as PLWHA, by considering what responses
they are likely to exhibit when coping with their negative conditions
that may affect their health (e.g. Branscombe & Ellemers, 1998;
Crocker & Major, 1989; Crosby, 1982; Deschamps, 1982; Dion & Earn,
1975; Major, 1987, 1994; Swim, Cohen, & Hyers, 1998; Tajfel, 1978;
Tajfel & Turner, 1986; Branscombe, Schmitt, & Harvey, 1999;
Mummendey, Kessler, Link, & Mielke, 1999; Major & O’Brien, 2005;
Siegel & Others, 1998; Pinel, 1999; Kalichman & Others, 2006).
However, none of the studies provided plausible explanation on the
roles of stigma consciousness of the stigmatized individuals on their
immune systems. In short, none was designed to tackle the problem.
None, at least to the researcher’s awareness, investigated the
influence of stigma consciousness on the immune system among
PLWHA using CD4 count as measure. Thus, one of the problems of
this study was to explore the influence of stigma consciousness on
CD4 counts of people living with HIV/AIDS.
Social support has been shown to associate with health-related
behaviours (e.g. Kaplan, Manuck, Williams & Straw, 1994; seeman &
Syme, 1989; Goodenow, Reisine & Grady, 1990; Davison & Neal,
2001). But few studies (e.g. Mulder, de Vroome, Van Griensven,
Antoni & Standfort, 1999) have examined the association between
social support and immune system using CD4 count as measure
among PLWHA. However, these studies were not designed to
examine the influence of different levels of social support or
interaction with other variables on immune system among PLWHA.
Thus, the second problem of this study was to examine the influence
of social support on the immune system among PLWHA using CD4
count as measure, and also examine the interaction among stigma
consciousness, social support, information coping and problem coping
in influencing immune system using CD4 count.
Earlier studies have shown that problem-focused coping and
information avoidant coping are related (Carver, Scheier, & Weintrant,
1989; Folkman & Lazarus, 1980; Miller & Mangan, 1983) and problem
focused and avoidant coping styles are found to be related
(Kalichman, Benotsch, Weinhardt, Austin, Luke, & Cherry, 2003;
Kalichiman & Others 2006) among PLWHA. This finding was made
from the health information using the internet. However, the studies
did not consider comparisons between those PLWHA who seek
information and those who avoid information; those PLWHA who focus
and those who avoid problem on their immune systems. Thus, the
third and fourth problems of this study were to investigate the
influence of information and problem copings on immune system
among those living with HIV/AIDS.
Most social scientists, psychologists/counsellors or healthcare
workers may feel aversive caring for people living with HIV/AIDS. This
results from lack of understanding some internal states of PLWHA such
as stigma consciousness and application of appropriate coping
strategies. Often times, experts try to design intervention without
considering available coping strategies. Of course, understanding
stigma consciousness, and coping strategies implications of PLWHA
will surely inform interventions designed to rehabilitate and improve
the social well-being and overall health of people living with HIV/AIDS.
Finally, Gluhoski (1996) proposed the use of cognitive therapy by
psychologists/counselors and other healthcare workers as intervention
measure for people living with HIV/AIDS based on review of
literatures. There is a need to empirically test the effectiveness of such
cognitive therapy as intervention measure for people living with
HIV/AIDS in Anambra state. Therefore, in a follow up study,
comparisons were made between those who received cognitive
therapy and those who did not receive cognitive therapy on stigma
consciousness, social support, information coping and problem coping.
Therefore, as a result of dearth in scientific knowledge in those
areas, this study investigated the influence of stigma consciousness
and coping strategies on immune system among people living with
HIV/AIDS as indicated in their CD4 cell counts. And, the research
provided cognitive therapy for managing HIV/AIDS.
Purpose of the Study
The general purpose of this study was to investigate the
influence of stigma consciousness and coping strategies on the
immune system among PLWHA as indicated in their CD4 counts. In a
study, Pinel (1999) established stigma consciousness among women,
gay men and lesbians using stigma consciousness questionnaire for
women. This study did not consider investigating how stigma
consciousness could influence immune system among PLWHA. So,
one of the purposes of the present study was to compare participants
who scored high and those who scored low in stigma consciousness
scale on their immune system using CD4 counts as measure.
Also, studies have considered some coping styles, for example
social support, to predict health (Berkman, 1995: Ryff & Singer, 2000).
And health risks are greater among lonely people, who often
experience more stress, sleep less well, and commit suicide more
often (Cacioppo, Hawkley & Bernstson, 2003). However, such studies
did not consider the influence of high and low social support on
immune system among PLWHA. Therefore, this study compared those
who scored high with those who scored low in social support measures
on their immune systems as indicated in CD4 counts.
Third, this study compared those who seek information with
those who avoid information on their immune systems. Also, those
who focus on problem were compared with those who avoid problem
on their immune systems and finally, interaction effects of stigma
consciousness, social support, information coping and problem coping
on immune system among PLWHA were sought.
Further, a follow up study was conducted to establish evidence
for recommending Gluhoski (1996) proposed cognitive therapy as
intervention measures for reducing stigma consciousness, increase
social support, instill information seeking and problem focus behaviour
on people living with HIV/AIDS. So, those who received cognitive
therapy as intervention measure were compared with those who did
not receive cognitive therapy as intervention measure on stigma
consciousness, social support, information, and problem copings.
Relevance of the Study
People living with HIV/AIDS need to reduce their stigma
consciousness and adopt one or more coping strategies for effective
management. According to Crepaz et al (2008), many people living
with HIV benefit from earlier HIV diagnosis and are successfully
treated through strict adherence to highly active antiretroviral therapy
(HAART). As treatment has evolved to transform HIV into a more
manageable chronic disease, an increasing number of PLWHA face
emotional and physical challenges as they cope with managing
HIV/AIDS over their lifetime. These emotional and physical challenges
can be managed if psychological factors such as stigma consciousness
and coping strategies are implicated and properly addressed in
immune system functioning among PLWHA. In fact, understanding
stigma consciousness, and coping strategies, will inform intervention
measures necessary to help people living with HIV/AIDS to improve in
their immune systems. Illness such as HIV/AIDS attracts stigma which
in turn leaves the victim with stigma consciousness that spawns social
problems eminent of negative mood or emotions, for example,
dissociation, withdrawal, low self-esteem, anxiety among others. High
stigma consciousness and poor coping strategies exacerbate these
social problems and that can invariably determine differences in
immune system among PLWHA.
Undoubtedly, an answer that will explain differences in
immune system among PLWHA within the purview of psychology will
highlight their psychological internal states. This study provides the
answer only when stigma consciousness and coping strategies are
implicated in determination of immune system among PLWHA. Based
on that, this study has social, therapeutic/counseling, and scientific
implications.
In the societal settings, people living with HIV/AIDS feel
dissociated from others. They always evaluate themselves with
others. Most often, they have negative evaluation of themselves and
remain with negative mood that can reduce their immune systems.
This makes them have negative social identity of themselves. This also
causes them to dissociate and withdraw from others. Thus, they have
low interpersonal relationship with the normal people and even their
doctor because of poor coping choice. The poor interpersonal
relationship need to be improved. This study will utilize stigma
consciousness and coping strategies to explain why PLWHA have
different immune systems and the knowledge gained from this study
will be useful in rehabilitating PLWHA socially.
Gluhoski (1996) proposed cognitive therapy for HIV/AIDS
positive individuals, aimed at changing self view, which is considered
appropriate intervention to the outcome of the present study.
Understanding stigma consciousness and coping strategies will inform
therapeutic/counselling interventions necessary to improve the well
being of PLWHA. There is growing evidence that counseling
approaches (Brown, Macintyre & Trujillo, 2003) and cognitive therapy
(Gluhoski, 1996; Corrigan & Calabrese, 2005; Knight & others, 2006;
Crepaz, et al, 2008; Scott-Sheldon, Kalichman, Carey & Fielder, 2008),
are effective in helping stigmatized persons to cope with the negative
consequences of perceptions of stigma thereby improving their health.
This study used stigma consciousness and coping strategies to explain
the use of counselling and cognitive therapy that can help PLWHA
improve in their health conditions. Specifically, the study used
cognitive therapy derived from Gluhoski (1996) cognitive therapy to
explain influence of stigma consciousness and coping strategies on
immune system among PLWHA.
Although, in the area of psychoneuroimmunology, studies have
linked immune system with psychosocial variables such as grief caused
by death of loved one, this study has scientific relevance in that it will
be an extension of literature in that direction, by demonstrating a
connection between stigma consciousness and CD4 count, a marker of
immunity of PLWHA. To the best awareness of the researcher, this is
the first study to demonstrate this. Empirical report on effectiveness of
Gluhoski (1996) cognitive therapy provided strong evidence for its use
particularly among PLWHA.
In summary, this study is a social psychological attempt to
explain the differential health related behaviours among individuals
living with HIV/AIDS. Thus, the study investigated the roles of stigma
consciousness and coping strategies in contributing to the level of CD4
counts among PLWHA in Anambra state. The implication of stigma
consciousness and coping strategies in contributing to immune system
functioning have relevance in social and counselling/cognitive therapy.
Also, it provided scientific contribution to cognitive therapy for PLWHA
and psychoneuroimmunology.
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