This literature reappraisal aims at researching the Global load of HIV and its relationship with mental wellness, Identifying mental and psychological wellness issues experienced by the HIV positive patients. The reappraisal besides aims at analysing the effects of these mental wellness issues in disease patterned advance and overall impact of these issues on their quality of life. Furthermore, the reappraisal will besides research some of the Global and regional enterprises for proviso of mental wellness installations to this vulnerable population. Finally the reappraisal concludes with the critical assessment and spreads with my research inquiry and attack.
Methodology/ Search scheme
A systematic and comprehensive literature hunt was conducted to reexamine and analyse the bing literature on the topic under survey. A general to specific attack and skimming of the rubric and abstracts was followed to segregate relevant articles. Several nursing and non-nursing informations bases were searched. The hunt scheme is summarized in Figure. I. Initially the hunt was started from the Google bookman cyberspace based database to acquire clasp of the general position of the research job. The Google bookman hunt revealed more than 100,000 consequences which were refined through cardinal words. The hunt was built on with the cardinal words in nursing databases like CINAHL plus ( cumulative index to nursing and allied wellness literature ) , Medline and PubMed, Figure. I. For the intent of seeking more relevant surveies on the research job, lineage attack was followed ; commendations from already searched articles from the databases were used to track other surveies on the similar subject. Manual hunt was besides performed in AKUH periodicals like, Current sentiment in HIV and AIDS, HIV medical specialty and Journal of HIV/AIDS & A ; Social Services. This literature reappraisal paper is based on synthesis of 8 surveies and 2 literature reappraisals extracted from different beginnings, combination of Western and Asiatic context, and a combination of qualitative and quantitative surveies. Abstractions, conference proceedings and commentaries were excluded. However, WHO, UNAIDS and World Bank studies on HIV were included. No surveies were found from Pakistani context in respect to mental wellness issues among HIV patients.
Background and significance of the Research job
Global Burden of HIV
Human Immunodeficiency Virus ( HIV ) remains a existent menace to the wellness and socioeconomic well-being of many of the states of the universe. Harmonizing to the World Health Organization ( 2011 ) planetary sum-up of the AIDS epidemic, the entire figure of people populating with HIV is 34.0 million out of which 30.7 million are grownups, 16.7 million are adult females and 3.3 million histories for kids & lt ; 15 old ages of age. There is a considerable fluctuation in tendencies globally. Kilmarx ( 2009 ) indicates a lessening in HIV prevalence in Burma, Cambodia, and Thailand, whereas increasing quickly in Pakistan, Vietnam, and some states of Indonesia. Furthermore, there is an increasing advancement of new infections in the really thickly settled states of Bangladesh and China. Ma, Zhang, He et Al ( 2007 ) lists the major factors lending towards HIV globally and in most Asiatic states which are, injection drug usage, sex work, male-male sex, and overlap in these behaviours.
Relationship between HIV and mental wellness
HIV is one of the most complicated societal challenges faced by modern-day societies due to its strong ties with sexual and social stigmatized behaviour. Asante ( 2012 ) states that one time diagnosed with HIV, it may take to lower self- regard, uneffective header and societal isolation and hapless psychological well-being. The WHO ( 2008 ) study on HIV AIDS and mental wellness comment mental wellness and HIV/AIDS as closely interlinked. Mental wellness jobs including substance maltreatment are associated with increased hazard of HIV infection and AIDS and interfere with their intervention. While on the other manus, some mental upsets occur as a direct consequence of HIV infection.
It is of import to understand that mental wellness issues in HIV positive patients may be associated with negative experiences and hapless attachment to intervention regimens, taking to greater HIV hazard behaviour, and lower quality of life which is a critical factor in HIV attention and bar. WHO ( 2008 ) besides affirms the exposure of mental upsets that may interfere with the ability to get or utilize information about HIV and pattern safe behaviours. Collins, Hollman, Freeman, and Patel ( 2006 ) reveal that depression consequences in worst results for people populating with HIV and those with anxiousness, temper and substance maltreatment upsets demonstrate a less or decelerate response towards anti-retroviral therapy as compared to those without any mental unwellness.
Critical Analysis of the Literature
Based on the critical analysis of the research articles, following subjects were identified which are discussed in item below. The surveies were a combination of qualitative and quantitative, largely cross-sectional surveies with assorted methods. A assortment of tools were used in these surveies to analyze different facets e.g. demographic informations, behaviours and mental wellness issues.
Prevalence of Mental Health issues among HIV positive persons
World Health Organization ( 2008 ) study on HIV AIDS and mental wellness study higher rates of depression in HIV-positive people compared with control groups both in low- and high income states. Surveies in India have systematically reported a high prevalence of mental wellness jobs among HIV positive patients as compared to the general population ( Das & A ; Leibowitz, 2011 ) . Similar survey in United States besides reveals 22-32 % prevalence of depression in HIV infected persons which is 2-3 clip higher than prevalence of depression in general community ( Bing, et al. , 2001 ) . The findings from these surveies are important and thought arousing in footings of prevalence of mental wellness issues among HIV population as compared to controls. These findings suggest the demand for turn toing mental wellness issues pertinent to HIV population.
Stigma and Discrimination
A important figure of research workers reported that societal stigma and favoritism of HIV septic persons, ( Das & A ; Leibowitz, 2011 ; Li, Lee, Thammawijaya, Jiraphongsa, & A ; Rotheram-Borus, 2009 ) fright and weakness ( Whetten, Reif, Whetten, & A ; Murphy-McMillan, 2008 ) , cause greater mental and psychological convulsion which finally leads to mental wellness jobs. The stigma attached with being HIV positive creates a sense of ineptitude and the persons develop an attitude of conveying the virus as retaliation. Shin, et al. , ( 2011 ) performed a qualitative analysis to place the factors that contribute to hapless emotional wellness and its impact among Peruvian HIV-infected persons. Focus group treatments with patients and suppliers were conducted. Analysis revealed a thoughtful penetration into the profound impact of stigma, depression, isolation, and deficiency of societal support among these patients. Furthermore it was found that populating with HIV, contributed significantly to mental wellness jobs experienced by HIV-positive persons. The survey besides reported incidences of sing hopelessness, stigma, and socio-economic marginalisation of many of these patients one time diagnosed with HIV. These consequences were consistent with another survey by Jin, Zhao, Zhang, Feng, and Wu ( 2010 ) to look into the psychological position and the psychosocial experiences of HIV-positive people. The results of this survey suggest that HIV-positive people in eastern China besides suffered from psychological hurt and see a negative psychosocial environment one time stigmatized as HIV positive. These surveies reveal that HIV positive persons experience important stigma and favoritism which has a profound impact on their psychological and mental wellness and its association with their overall quality of life.
Depression, Mood /Anxiety upsets and substance maltreatment
In one of the survey by Bing, et al. , ( 2001 ) to mensurate the prevalence of mental upsets and drug usage among HIV positive persons in United States, half of the population screened positive for either one or more psychiatric upsets ( temper upsets, dysthymic depression, generalised anxiousness upsets and major depression ) . Furthermore, about half of the population reported usage of illicit drug out of which 12 % were drug dependant. Similar survey in Denmark by Rodkjaer, Laursen, Balle, and Sodemann, ( 2010 ) found to hold a 38 % prevalence of depression among the HIV positive participants. The normally reported mental wellness issues in assorted other surveies were found to be mood/ anxiousness diagnosing ( 39 % ) substance maltreatment ( 21 % ) clinically relevant depression ( 76 % ) and post-traumatic emphasis upset ( 11 % ) ( Pence, Miller, Whetten, Eron & A ; Gaynes, 2006 ) , depression 62.3 % and anxiousness 82.3 % severally ( Morrison, et al. , 2011 ) . Studies in India besides support the high prevalence of depressive upsets, anxiousness, accommodation upsets, self-destructive purposes and efforts and intoxicant dependance among HIV positive persons ( Collins, Hollman, freewoman & A ; Patel, 2006 ) . Whetten, Reif, Whetten, and Murphy-McMillan ( 2008 ) attributed mental unwellness including depression, anxiousness, and posttraumatic emphasis upset ( PTSD ) related to HIV, as associated with hapless wellness results including attachment to medicine regimens and HIV hazard behaviour, such as unprotected sex and needle sharing. The overall impact suggests the increased magnitude of mental wellness upsets including depression, substance maltreatment, general anxiousness upsets, self-destructive ideation, self-destructive efforts and substance maltreatment among HIV positive patients.
Social support and internalized shame:
Another subject which was found in few surveies was internalized shame and societal support. Li, Lee, Thammawijaya, Jiraphongsa, and Rotheram-Borus, ( 2009 ) carried out a research in Thailand to analyze relationship among HIV related stigma, internalized shame and societal support and its impact on quality of life of life of HIV positive persons. The consequences revealed a important negative association among societal support, internalized shame ( p= 0.001 ) and stigma ( p= & lt ; 0.05 ) . Furthermore important correlativity was found between depression and internalized shame ( p & lt ; 0.001 ) . Similar survey was sought in Ghana by Asante ( 2012 ) to look into the association between psychological well-being of HIV positives and societal support. Consequences revealed a negative association of depression, emphasis and anxiousness with societal support. This indicates that societal support is reciprocally relative to stigma, depression and internalized shame and some alterations in the societal environment may take to successful psychological version towards HIV.
Mental wellness services for HIV patients ; Global and regional positions
The critical demand to turn to mental wellness issues among HIV population is recognized globally. However, Reif, Whetten & A ; Raper ( 2006 ) believes that important dearth in entree to mental wellness persists for this susceptible population. The WHO ( 2008 ) study on HIV/ AIDS and mental wellness proposed a series of faculties and developing stuff for integrating of mental wellness intercessions into antiretroviral therapy plans. However, the application and effectivity of these faculties have yet to be studied. Apart from WHO initiatives, Baingana, Thomas and Comblain ( 2005 ) affirms that The World Bank is presently “ the largest long-run investor in the bar and extenuation of HIV/AIDS in developing states ” ( p.2 ) . Despite holding identified mental wellness issues as “ an of import emerging wellness job for developing market economic systems ” ( p.2 ) , it has yet non significantly addressed the function of mental wellness in the HIV/AIDS pandemic. On the other manus, Khan and Hyder ( 2001 ) in their article reference that private academic centres in Pakistan have played their function in carry oning surveies related to HIV prevalence and cognition consciousness and besides supplying appropriate medical installations and reding the HIV patients and households but these installations are limited and general populace has less entree to them. The nature of reding nevertheless, is non explicitly defined by the writers.
The analysis from the literature exhibits deficient informations in Pakistani cultural context sing mental wellness challenges of people populating with HIV, which could be used to supply the necessary services to run into the turning demands of HIV positive population. Hence, significant relevant information demands be collected in order to propose specific mental wellness services for these persons entirely.
Critical assessment and Gaps
After an in-depth critical reappraisal on the literature, it was found that up till now there has been a famine of research on the prevalence of HIV and its associated factors. However, limited researches have been done on the selected job of mental wellness issues among this population globally. Global Initiative on Psychiatry GIP ( 2008 ) clearly regards the deductions of untreated mental morbidity as both mental wellness and human rights issue. It farther emphasizes that the strong nexus between mental wellness and HIV is a fact but really small attending has been paid to this association.
There seems a deficiency of grounds sing mental wellness issues in developing states like Pakistan. The grounds for this could be unequal informations, societal stigma attached to HIV in the state and under reported HIV instances ( Khan & A ; Hyder, 2001 ) .The groundss above ascertain the significance of the inquiry under survey. Furthermore, no grounds of such survey which could research the mental wellness issues of HIV positive persons in Pakistan was found during the literature hunt.
Restatement of Research Question
As portion of my thesis, my research inquiry after this reappraisal would be: “ What mental wellness issues are prevailing among HIV positive patients in Pakistan, and what is the impact of these mental wellness issues in their perceptual experience, over disease patterned advance and quality of life? ”
This could be a assorted methodological analysis, i.e. a combination of qualitative and quantitative attack. Appropriate tools would be selected for measuring specific parts of the research inquiry after proof. Focus group treatments and interviews may be used where relevant to acquire the responses.
The analysis of the literature reveals that mental wellness jobs are widespread among the known HIV-positive patient population. These jobs include but are non limited to stigma, and societal isolation, anxiousness, major depression, substance maltreatment, station traumatic emphasis upsets, societal isolation and many more. The findings indicate that important attending to these issues in context of HIV intervention and bar must be warranted ( Whetten, Reif, Whetten, & A ; Murphy-McMillan, 2008 ) . The high prevalence of these upsets suggests the demand for more mental wellness attention installations for HIV-positive patients particularly in less developed and developing states like Pakistan. There is unequal guidance and psychiatric services available for this population particularly in low income states. The mental wellness intercession must non be undermined for these HIV positive persons. Healthcare bureaus must understand the psychosocial and socio cultural context of HIV, guarantee intervention attachment and bar and work at their best to relieve mental wellness jobs among HIV positive patients. This vulnerable population calls for a suited place in the society and ensured optimal quality of life.