The study participants are youths who are attending ART clinic in four different public hospitals from two different regional state of Ethiopia. Majority of the participants were male. See Table 1.
Table 1
biographic data of the participants
Participants | Gender | Age | Hospital |
---|
P1 | M | 16 | JU hospital |
P2 | M | 17 | JU hospital |
P3 | F | 17 | JU hospital |
P4 | M | 14 | JU hospital |
P5 | F | 14 | JU hospital |
P6 | F | 17 | JU hospital |
P7 | M | 16 | MTU teaching hospital |
P8 | M | 15 | MTU teaching hospital |
P9 | M | 15 | MTU teaching hospital |
P10 | F | 17 | MTU teaching hospital |
P11 | M | 17 | MTU teaching hospital |
P12 | M | 15 | MTU teaching hospital |
Totally 12 HIV positive youths, six youths from each hospital participated in this study. As a result of data analysis, 2 main themes and 8 sub-themes were identified, which include: life experience (first disclosure, emotional change, fear of consequence, suicidal ideation), and the perception (influence on daily life, coping style, healthy life style, stigma).
Theme one: Experience
During first exposure
The results of this study showed that patients experienced unpleasant experiences in the face of receiving a positive diagnosis of the HIV. Patients' unpleasant experiences at that moment include emotional shock, fear of the consequences, feeling guilty, discouragement and escape from reality (8). Some youths reported that they didn’t have any emotional reaction when disclosed test result positive.
In this study, some of the participant’s idea was explained in verbatim. P2 male client from the grade 11 reported that “I was taking my ART drug for the past 17 years but was told that I am HIV positive at the age seven. At that time I didn’t realize anything good and bad about HIV/AIDS. For this reason I didn’t face any emotional challenge during exposure”.
Another participant P10 female participant from grade 11 had different reaction during her first disclosure. She reported that “I was informed that I am HIV positive when my classmate is talking to some other classroom students. Since beginning that day I stopped taking medication whom I was taking every night realizing that the drug is for HIV. I asked my mom the reason why I am taking the medication and she took me clinic and the doctor told me that I am HIV positive and should take my medication every day.
Emotional change
With these different levels of emotional reaction, people living with HIV can sometimes experience heightened levels of emotional and psychological issues including fear, guilt, abandonment, lack of worth and harassment. People with HIV have a higher chance of developing mood, anxiety, and cognitive disorders. Depression is one of the most common mental health conditions faced by people with HIV. It is important to remember that mental disorders are treatable. Receiving an HIV diagnosis can be life changing and somebody may feel many emotions, sadness, hopelessness, or anger. HIV may challenge the sense of well-being or complicate existing mental health conditions. HIV, and some opportunistic infections, can also affect your nervous system and can lead to changes in your behavior (9).
P10 reported that “At that time I was depressed and even though to end my life but latter I blamed my mom and dad for the positive result and even dropped school with fear of rejections from friends”.
Fear of consequence
Nosophobia is the extreme and irrational fear of developing an ailment that either is or is perceived as life threatening (10). Common culprits include cancer, kidney disease, and HIV. Fear of illness, stigma, and being discriminated against or judged negatively if a test shows that they have HIV are some of the obstacles. HIV phobia can lead folks to avoid spaces, places, and activities that they have deemed “higher risk” (even if those activities aren't higher risk). So, another symptom is an aversion to certain things. It can also lead to excessive consumption of news, information, and media about HIV and AIDs. The lack of information and awareness combined with outdated beliefs lead people to fear getting HIV. Additionally, many people think of HIV as a disease that only certain groups get. This leads to negative value judgements about people who are living with HIV. Over time, this low level of inflammation takes a toll on the body, putting the person with HIV at greater risk for health conditions such as cardiovascular disease, kidney disease, diabetes, bone disease, liver disease, cognitive disorders, and some types of cancer. Stigma is a damaging social phenomenon (11). In the case of people living with HIV (PLWH), stigma has negative effects on health outcomes, including non-optimal medication adherence, lower visit adherence, higher depression, and overall lower quality of life
P1 “the first fear comes to my mind is suffer with the symptom of HIV/AIDS, before that I prefer peaceful death before symptom appears”
Suicidal ideation
When one is tested positive for HIV, one can think that the whole world has ended and that there is no hope for the future, whilst others see it as stepping stone to a better life(12). It is true that with the correct care and support, living with HIV can be made easier. However without this, the results can be catastrophic. HIV/AIDS continues to be associated with an under-recognized risk for suicidal behavior. Suicidal behavior among people living with HIV/AIDS is not only a predictor of future attempted suicide and completed suicide, but it is also associated with poor quality of life and poor adherence with antiretroviral therapy (13). The thought of ending life is very common in this study. Majority of the participant especially in the first exposure experienced suicidal thought around first disclosure of their status while some others experience after stigma and discrimination (14).
P6 “I thought that the whole world has ended and that there is no hope for the future”
Theme two: Perception
And the perceptions HIV/AIDS-infected individuals has numerous impacts on daily life, copping style, life style and stigma at different level.
Influence on daily life
People living with HIV-AIDS frequently experience stigma and discrimination, especially in the surrounding community (15). With these different levels of stigma to deal with, people living with HIV can sometimes experience heightened levels of emotional and psychological issues including fear, guilt, abandonment, lack of worth and harassment. This triggers psychological problems, including anxiety, depression, and the risk of suicide. The stress associated with living with a serious illness or condition, such as HIV, can affect a person's mental health. People with HIV have a higher chance of developing mood, anxiety, and cognitive disorders. Depression is among the most common mental health conditions faced by people with HIV (16).
P3 female respondent “the life to me is very difficult now, all students from school segregated me. I am so lonely, nobody understands me, and nobody talks me. For this reason I prefer staying home than going to school. When I stayed home I feel free”.
P4 “it seems to me everybody is talking about my issue for this reason I am not comfortable in every scenario to participate in different activities freely”.
In this research we explored that some of the respondents stigmatize themselves simply with the fear of rejection and abandon.
Copping style
Despite the availability of antiretroviral drugs, globally HIV/AIDS has become among the top causes of morbidity and mortality while they struggle to overcome significant challenges that affect their ability to live independently (17). HIV affects not only physical and psychological aspects of health but households, communities, and the development and economic growth of nations. Some others in these study reported that their copping strategy is having faith with GOD. While some others participate in sport and other leisure activities with their friends (18).
P9 “may be GOD created me for the reason, I don’t worry much for what was happened in my life because I didn’t bring it. Now I am serving in church and still my life is good.”
Life style
In this study some participants reported that they hide themselves under using different types of substance. Substance use disorder treatment, medical care, housing, mental health care, nutritional care, dental care, ancillary services, and support systems are very important for clients with HIV (19). Staff need training on the availability of these services in their communities to effectively provide appropriate referrals and services, case managers. It may need additional training to work in an integrated setting or across HIV- and SUD-specific settings. Stable rehabilitation for an individual with HIV and a SUD could be the determining factor in maintaining treatment adherence (4). It also includes trainings on techniques to build rapport and therapeutic alliance, such as motivational interviewing, reflective listening, and using understandable language. The above mentioned are very hard to get in developing country like Ethiopia because of the limited resource (20). But it could be easy if given attention to create awareness on symptoms and illness of substance related problems beside with the interactions of medication he/she is using for ART and how to cope with stigma coming from the community, institution and even from some professionals and self.
P3 “living with HIV/AIDS is somewhat difficult, thanks to physician now I am healthy even feels nothing about HIV. Around the time I was told that I had HIV/AIDS everything was dark to me. Through process I realized that living with HIV/AIDS is nothing and reshaped my life with positive life styles as I recommended from my physician. Then life gets easier, my confidence increased, started generating income in small shop and started supporting my grand mom whom was my care giver since my mother was died when I was child and I didn’t know my dad in person”.
Stigma
Stigmatizing attitudes are still pervasive within the world especially in Africa and mostly in Ethiopia and can negatively impact an individual’s willingness to seek care and remain engaged in it. Stigmatizing beliefs may be related to fear of transmission or ideas about who is at risk for being diagnosed with HIV (21). Supporting medication adherence is important for people living with HIV to take their HIV medication every day, exactly as prescribed (22). This is what counselor can do to support them in establishing a medication routine and sticking to it. Also needs what might have and how individual can help them stay healthy. These phenomenological studies shows Status of mental wellbeing, stigma and discrimination among PLWHA Jimma town, Ethiopia. Health professionals’ mental health skills, attitude, stigma and discrimination on individual, family, or group counseling; stress management and coping sessions; educational sessions; home visits; and respite care. Peer support groups in particular have been used successfully as part of a comprehensive psychosocial support program in different studies (23, 24). Therefore, addressing the psycho-social issues for people living with HIV (PLHIV) is central to a comprehensive approach to their care and support. Talking openly about HIV can help normalize the subject. It also provides opportunities to correct misconceptions and help others learn more about HIV. But be mindful of how you talk about HIV and people living with HIV. We can all help end HIV stigma through our words and actions in our everyday lives. Lead others with your supportive behaviors.
P1 “ohh….. Stigma is very bad. It makes life miserable, I was stigmatized and discriminated as much as possible the whole my childhood life. Even told from neighbors not play with their children because they knew that I am HIV positive. At that time I didn’t know anything about, simply they warn me not get in their house. Because this always I cry and I wish my mom is alive”.