HIV and AIDS –

psychosocial impact
and coping

Sachi Kariappa
 Table of Contents

01 About the Disease 04 Medical Management

HIV Infection and

Psychosocial Impact
02 Transmission 05 and Coping

Signs, Symptoms and

03 Diagnosis
01 About the
Disease
 What is HIV ?
• AIDS stands for acquired immunodeficiency syndrome, a pattern of devastating
infections caused by the human immunodeficiency virus, or HIV, which attacks and
destroys certain white blood cells that are essential to the body's immune system.
• When HIV infects a cell, it combines with that cell's genetic material and may lie
inactive for years. Most people infected with HIV are still healthy and can live for years
with no symptoms or only minor illnesses.
• They are infected with HIV, but they do not have AIDS. After a variable period of time,
the virus becomes activated and then leads progressively to the serious infections and
other conditions that characterize AIDS. Although there are treatments that can extend
life, AIDS is a fatal disease. Research continues on possible vaccines and, ultimately, a
cure
 Continued…
• The HIV virus is a retrovirus, a type of virus containing
RNA.
• There are three types of retrovirus: oncogenic
retroviruses which cause cancer, foamy retroviruses
which have no effect at all on the health status of the
individual, and lentiviruses, or slow viruses, which have
slow long term effects. HIV is a lentivirus.
• The HIV virus is structured with an outer coat and an
inner core. The RNA is situated in the core and
contains eight viral genes, and also contains enzymes,
which are essential for replication.
 Epidemiology

People living with 23.49 New cases in India

69, 000
HIV in India lakh in 2019

Children living with

AIDS related deaths 58, 000 79,000 HIV in India.
02 HIV Infection
and
Transmission
 Modes of Transmission

Person –person Transfusion with

through fluid Use of HIV Mother to infant infected blood or
exchanging contaminated during pregnancy, blood products
behaviours injection equipment labour and delivery
or breastfeeding
 HIV Infection

HIV targets two groups As the body's CD4+ cells

In an HIV-infected HIV attaches itself
of white blood cells are depleted, the
person, the CD4+ to the CD4+
called CD4+ immune system
lymphocytes are lymphocyte and
lymphocytes and weakens and is less
killed by the virus, makes its way
macrophages. able to fight off viral
while the inside. This causes
Normally, CD4+ cells and bacterial
macrophages act as the cell to produce
and macrophages help infections. The
reservoirs, carrying more HIV but, in
recognize and destroy infected person
HIV to a number of doing so, the cell is
bacteria, viruses or becomes susceptible
vital organs. destroyed.
other infectious agents to a wide range of
that invade a cell and "opportunistic"
cause disease. infections
 Stages of
Infection
Acute HIV Infection
• HIV multiplies rapidly and
spreads throughout the body.
• The virus attacks and
destroys the CD4 cells.
• The level of HIV in the blood
is very high increasing the
risk of transmission
• A person may experience
significant health benefits if
they start ART during this
stage.
Chronic HIV Infection
• HIV continues to multiply in
the body but at very low
levels.
• People with chronic HIV
infection may not have any
HIV-related symptoms.
• Without ART, chronic HIV
infection usually advances to
AIDS in 10 years or longer.
• While it is still possible to
transmit HIV to others during
this stage, people who take
ART have effectively no risk
of transmitting HIV to an HIV-
negative partner through
sex.
AIDS
• Because HIV has severely
damaged the immune
system, the body cannot
fight off opportunistic
infections
• People with HIV are
diagnosed with AIDS if they
have CD$ count of less than
200 cells/mm3 or if they
have certain opportunistic
infections.
• Once a person is diagnosed
with AIDS, they can have a
high viral load and are able
to transmit HIV to others very
easily.
• Without treatment, people
with AIDS typically survive
about 3 years.
03 Signs
Symptoms and
Diagnosis
Symptoms of the Disease
Acute HIV infection: Fever,
headaches, excessive fatigue, chills,
muscle pain swollen glands and in
some cases lack of symptoms

Chronic HIV Infection: Coughing,

fatigue, breathing difficulties,
weight loss, diarrhoea.

AIDS: Persistent high fevers over 37.8

C, Severe chills and night sweats, white
spots in the mouth, severe fatigue,
different coloured rashes, persistent
headaches, memory problems,
pneumonia
 Diagnosis
To be diagnosed with AIDS, a
person with HIV must
have an AIDS-defining
condition or have a CD4
count less than 200
cells/mm³ (regardless of
whether the person has an
AIDS-defining condition).
Blood tests are the most common way to
diagnose the human immunodeficiency
virus (HIV), the virus that causes acquired
immunodeficiency syndrome (AIDS).
These tests look for antibodies to the
virus that are present in the blood of
infected individuals. The primary tests for
diagnosing HIV and AIDs include: ELISA
Test  which stands for enzyme-linked
immunosorbent assay, is used to detect
HIV infection
04 Medical
Management
 Highly Active
Retroviral Therapy
is a combination of three or more
drugs, such as protease inhibitors and
other anti-retroviral medications. The
treatment is highly effective in
slowing the rate at which the HIV
virus replicates itself, which may slow
the spread of HIV in the body. The
goal is to reduce the amount of virus
in your body, or the viral load, to a
level that can no longer be detected
with blood tests.
 Effective HIV treatment
require strict adherence to
complex regimens of multiple
medications

People undergoing anti-HIV

therapies must achieve atleast
90% medication adherence to
maintain suppression of HIV
replication

HIV treatment demands

among the most strict
medication adherence because
the HI-virus rapidly mutates
and adapts to pressures
asserted by the immune cells.
05 Psychosocial
Impact and
Coping
 Psychological Response
● At the early stages, prior to the appearance of overt symptoms,
HIV positive individuals often report high levels of anxiety or
depression similar to those of the general population. As
symptoms appear, anxiety and depression increase in otherwise
non-clinically depressive HIV populations.
● HIV positive individuals are often aware that the increase in
symptoms are indices of disease progression. One source of
psychological distress is the recognition of the virus taking its
toll. Another related source is the intense feeling of loss of
physical strength, abilities, weight and attractiveness that
accompany disease progression.
 Disease
Progression
● Receiving an AIDS diagnosis on the basis of
either symptomology or CD4 level has a
particular significance to HIV infected
individuals. These markers of progression
indicate an increased likelihood of illness
and a shortened survival time.
● Men diagnosed with AIDS are significantly
more depressed and anxious than HIV
positive men who are either asymptomatic
or who are symptomatic but lack a
diagnosis
 Impact on Quality of Life

● Patients with more advanced disease, obtain significantly lower

scores in all six dimensions of quality of life than do those with
fewer symptoms.
● In addition, to the number of symptoms, the frequency of
symptoms has a significant adverse effect on quality of life
outcomes. There are also differences in quality of life among HIV
patients. In particular, the quality of life of patients with P. cariini
pneumonia is lower than that of HIV patients with other
diagnoses.
 Impact On Quality Of Life, continued…
● Older patients with HIV disease report lower scores on perceptions of their
health and physical role and social functioning than do their younger HIV
infected counterparts. They also have poorer prognoses.
● Women with HIV disease have lower scores on role and social functioning
than do men. They are often abandoned by their partners after a positive
HIV diagnosis. Then, alone in the face of the infection, they have to
combat the effects caused by the disease and somehow move forward,
taking care of their children,
● Injection drug users(IDUs) have lower scores on all six quality of life
dimensions than do homosexual men. These differences in quality of life may
also reflect the fact that the prognosis for patients with HIV disease is worse
in women and IDUs than in homosexual men as IDUs have less access to
medical care and social support systems than do white homosexual men.
Quality of Life: Disclosure about HIV status
● Includes decisions about whom to tell, when to tell and what to
say among individuals in work settings, social networks and the
family. Some times disclosure is forced when symptoms become
obvious.
● With the continuing public misinformation and fear, and
discrimination against HIV infected individuals that exists at the
interpersonal, institutional and governmental levels, these
decisions can have important ramifications. Common and
enduring examples of this discrimination can be found in the
efforts of insurance companies to avoid providing coverage for
HIV infected individuals and the travel restrictions placed on HIV
infected persons.
Disclosure about HIV status, continued…

● Decisions about informing family can involve disclosing

previously guarded information about sexual lifestyles or drug
use. Thee decisions often involve a struggle between maintaining
privacy and secrecy, and the need for social and financial
support.
● A related issue for the HIV infected individual involved
protecting others from HIV. The importance of informing
partners and modifying high risk sexual and/or drug use practices
begins with the notification of HIV-positive serostatus and does
not diminish.
 Treatment and Daily Functioning

● Disease progression is accompanied by increasing involvement

with the medical community, including prophylactic therapies
designed to slow progression, experimental therapies and clinical
trials, and treatment of opportunistic infections.
● The medical monitoring of these interventions , including
physician visits, laboratory tests, and other diagnostic activities
can be exceedingly disruptive to an individual’s lifestyle,
particularly with regard to work- related activities.
Eventually ,most HIV patients have to limit work and social
activities because of the energy and time requires for managing
the medical aspects of their condition.
 Coping
● People living with AIDS may use coping methods focused on
positive reappraisal and escape-avoidance factors, thus focused
on emotion.
● They used positive reappraisal in order to create new meanings
for the stress, facing it with a positive attitude, leading to
personal growth. Thus, they attribute new meanings to the
disease in order to see it from a different perspective, that is, a
positive perspective.
● Escape-avoidance is a way people use to escape problems. There
are denial and lack of interest in dealing with disease-related
stressors, which may negatively contribute for improving the
clinical picture, as it may seem like a way of fantasizing possible
solutions for the problems, without actually taking concrete
actions to modify the reality .
 Coping, continued….
● The main coping strategies used were maintaining confidentiality about their
seropositive condition, optimism towards treatment, search for social
support, rationalization, social comparison, spirituality/religiosity, avoidance
and distraction.
● Coping through avoidance and social isolation has a greater association
with mental health problems such as depression.
● Furthermore, passive coping represents a solution to patients who
believe that there are no measures capable of counteracting the stressors
associated with the disease, leading to other disorders such as propensity
to alcohol abuse in order to escape from the problem.
THANK YOU