A psycho–social profile and HIV status in an African group
An estimated 30 to 36 million people worldwide are living with the Human Immunodeficiency Virus (HIV). In 2009 about 5.7 million of the 30 to 36 million people who are infected with HIV were living in South Africa, making South Africa the country with the largest number of people infected with HIV in the world (UNGASS, 2010). Van Dyk (2008) states that HIV infection and Acquired Immunodeficiency Syndrome (AIDS) are accompanied by symptoms of psycho–social distress, but relatively little is known of the direct effect of HIV and AIDS on psychological well–being. The psychological distress is mainly due to the difficulties HIV brings to daily life and the harsh reality of the prognosis of the illness (Van Dyk, 2008). It is not clear whether people infected with HIV who are unaware of their HIV status show more psychological symptoms than people in a group not infected with HIV. The research question for the current study was therefore whether people with and without HIV infection differ in their psycho–social symptoms and strengths before they know their HIV status. Accordingly, the aim of this study was to explore the psychosocial health profiles of people with and without HIV and AIDS before they knew their infection status. A cross–sectional survey design was used for gathering psychological data. This was part of a multi–disciplinary study where the participants’ HIV status was determined after obtaining their informed consent and giving pre– and post–test counselling. This study falls in the overlap of the South African leg of the Prospective Urban and Rural Epidemiology study (PURE–SA) that investigates the health transition and chronic diseases of lifestyle in urban and rural areas (Teo, Chow, Vaz, Rangarajan, & Ysusf, 2009), and the FORT2 and 3 projects (FORT2 = Understanding and promoting psychosocial health, resilience and strengths in an African context; Fort 3 = The prevalence of levels of psychosocial health: Dynamics and relationships with biomarkers of (ill) health in the South African contexts) (Wissing, 2005, 2008) on psychological well–being and its biological correlates. All the baseline data were collected during 2005. Of the 1 025 participants who completed all of the psychological health questionnaires, 153 (14.9%) were infected with HIV and 863 were not infected with HIV (since the HIV status of nine of the participants was not known, they were not included in the study). In the urban communities 435 participants completed the psychological health questionnaires, of whom 68 (15.6%) were infected with HIV and 367 were not infected with HIV. In the rural communities, 581 participants completed the psychological health questionnaires, of whom 85 (14.6%) were infected with HIV and 496 were not infected with HIV. The validated Setswana versions of the following seven psychological health questionnaires were used: Affectometer 2 (AFM), Satisfaction With Life Scale (SWLS), Community Collective Efficacy Scale (CCES), Mental Health Continuum Short Form (MHC–SF), New General Self–efficacy Scale (NGSE), Sense of Coherence Scale (SOC) and the General Health Questionnaire (GHQ). Descriptive statistics were determined for all measures for all the participants with, and without HIV. Significant differences in psychosocial profiles among individuals with and without HIV and AIDS and also between those in the rural and urban areas were determined by means of t–tests and by a multivariate analysis of variance (MANOVA). Practical significance was determined by the size of the effects. The results for the entire group showed statistically significant differences between the two groups of participants who were infected with HIV and those not infected with HIV regarding their sense of coherence and their perspective on the community’s capacity to succeed in joint activities, but these differences were of only small practical significance. The HIV–infected participants in the urban areas displayed statistically and practically a lower sense of coherence and viewed themselves as less capable of meeting task demands in community contexts, than did the participants not infected with HIV. Though the participants not infected with HIV in the rural group had, statistically and practically, a significantly greater capacity to succeed in joint community activities than the participants infected with HIV, an interesting finding was that the participants infected with HIV experienced more positive affect than the participants not infected with HIV. The research showed that people with and without HIV infection differ in some respects in their psycho–social symptoms and strengths even before they are conscious of their HIV status. It is striking that the differences found on the psychological measures for the participants reflected a personal sense of social coherence and perspective on their community’s capacity to succeed in joint activities, which was lower in the case of participants infected with HIV, and might therefore have led to high–risk social behaviours and consequent infections. It might be that the participants with a relatively lower sense of social coherence, integration, and co–operation towards collectively achieving meaningful goals were more inclined to manifest behaviours that would lead to detrimental consequences (in this case HIV infection) for themselves and others. The higher level of positive affect in the rural group of the participants infected with HIV is still unexplained and requires further research.
- ETD@PUK