Psychosocial Profile of HIV Patients on HAART in Southern India

doi:10.4236/wja.2011.14028

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World Journal of AIDS, 2011, 1, 192-197

doi:10.4236/wja.2011.14028 Published Online December 2011 (http://www.SciRP.org/journal/wja)

Psychosocial Profile of HIV Patients on HAART

in Southern India

Jayakumar Palanisamy1, Karthikeyan Murugesan2, Senthilkumar Subramanian3, Uma Devi4,

Pitchai Chinnapidaran4, Rajam ahendrav arm an Vellandi 4, Inigo Beula4

1Primary Health Center, Poll achi, India; 2Department of Psychiatry, Govt Rajaji Hospital, Madurai, India; 3Department of Public

Health and Preventive Medicine, Coimbatore, India; 4AntiRetroviral Therapy (ART) Center, Govt Rajaji Hospital, Madurai, India.

E-mail: [email protected]

Received October 16th, 2011; revised November 24th, 2011; accepted December 1st, 2011.

ABSTRACT

Background: Mortality of HIV/AIDS patients comes down in India after the National Aids Control Organization started

providing free Antiretroviral Therapy (ART) since 2004. Madurai ART Center started providing free ART since 2004.

Psychosocial profile of this population explored in this study. Methods: A cross sectional interview conducted during

the year 2008 with semi structured questionnaire on HIV positive clients who are on Highly Active Anti-Retroviral

Therapy (HAART) for more than 6 months. Convenience sampling done and totally 433 clients were interviewed with

informed consent. Results : Three fourth (73.4 %) of the clients know about ART centre through Government Hospitals

or Primary Health Centre. Most of the Clients (98.6%) on ART feel back to normal life or back to near normal life. Pill

burden/Pill fatigue perceived by clients is 4.8%. Discrimination perceived was 8.8% and mostly in their own house or

by neighbors, but most of their children (99.2%) were not discriminated as per the clients. Spouse positive rate for the

married clients was 61.5% and unmarried in this pop ulation was 4.6%. Major or minor psychological problems in this

group were 39.7 % and attempted suicide was 8.8%. Drug abuse (alcohol and smoking) while started on ART was

40.4% and the current abusers are 7.6%. Co n c lu s io n : This study supports effectiveness of free ART program and effec-

tive case referral from government institutions. High percentage of major or minor psychological problem warrants

further exploratory study and may need psycholog ical interventions in this po pulation.

Keywords: HI V , AIDS, Antiretroviral Therapy, P syc h osocial

1. Background

In India since 2004 with the availability of free HAART

in government program [1] through National AIDS Con-

trol Organization (NACO), people living with HIV/AIDS

keep on increasing. In south India, Madurai ART centre

which is having around 2500 clients on ART and regular

follow-up, out of these 433 clients on ART are inter-

viewed to find out their demographics, psychological

disturbances, and adherence to HAART, etc during the

year 2008.

2. Methodology

With convenience sampling a cross sectional survey was

conducted with semi structured questionnaires on

HIV/AIDS patients who are all on ART more than 6

months. Clients interviewed are more than 21 years of

age. Questionnaire administered includes questions re-

garding psychological, social, personal and family issues

of the clients. Participants should not have any major

clinical illness which might discomfort during the inter-

view and their quality of life.

3. Results

Among the interviewed clients (51.3% males, 48.7%

females) 95.8% of them are in 21 to 50 years of age

group. Positive clients from rural population is 44.8%

and urban/semi urban population is 55.2%.

Totally 75.8% of the clients were education wise illit-

erate or with in primary school. 58.4% of the clients are

daily wage laborers (Cooley’s) and 19.6% of the clients

are unemployed. 58.4% of the clients are living with their

spouses and 33.7% of them are separated or widowed.

Unmarried and divorced are 4.6% & 3.2% respectively.

Most (94.7%) of them are getting their economical sup-

port by their own, spouses or by their relatives.

Spouses of these clients 61.5% of them are positive. In

the positive spouses 35.4% of male spouses and 64.6% of

Psychosocial Profile of HIV Patients on HAART in Southern India193

the female spouses are positive. In spouse negative cli-

ents 83% of male spouses are negative and 17% of the

female spouses are negative (Figure 1).

In the study population 73.4% of the clients were

known about ART centre through Government Hospitals

(GH) or Primar y H ealth Cen tre ( PHC), 14 % th r ough Non

Governmental Organization (NGO) and 11% by their

own (Figure 2). This shows how they registered into

ART program ..

Among the clients 15.9% of them are traveling more

than 100 kilometers to collect their monthly drugs.

22.2% of the clients were missed some doses of drug

during their regular follow up period, among the total

clients 4.6% of them were missed more than 3 days (Fig-

ure 3).

As per their own perception 8.8% of these clients were

discriminated mainly in their own house or by neighbors

(Figure 4). But the children of these positive clients were

rarely (0.8%) discriminated.

Major (Suicidal thought) or minor psychological (Sleep

disturbances, sad mood, lack of concentration in their

work) problems were seen in 39.7% of the clients (Fig-

ure 5).

Pill burden/Pill fatigue perceived in this population is

4.8%. Drug abusers (smoking, alcohol, sleeping pills) in

this population were 40.4% and the current abusers are

7.6%. In this population 8.8% of them were having the

history of attempted suicide. Clients having children

were 86%, among them 7.8% of the clients are having

positive children and 30.4% of them were not yet tested.

Among these clients having children 40% worried about

future of their children and 36.6% of them want to send

their children to some care takers.99.2% of their children

were not discriminated as per the clients. Qualitatively,

98.6% of clients on ART are perceived that they are

“back to normal life” or “back to near normal life” (Fig-

ure 6).

4. Discussion

The active, productive and reproductive age group (21 to

50 years) is the majority on HAART, which is the target

group (15 to 49) in prevention strategies [2]. Transmis-

sion of HIV in this population is mainly through males,

which can be substantiated by male dominated society

[3]. High rate widowed/separated population urges to

promote remarriage and supporting strategies [4]. Around

16% of the clients were traveling more than 100 kms to

col lect their drugs which may be due to lack of ART cen-

ters nearby or avoidance of nearby ART centers due to sel f

stigma [5]. Three fourth of the clients were illiterate

Figure 1. HIV status of the spouses, as per the interviewed clients.

Psychosocial Profile of HIV Patients on HAART in Southern India

194

Figure 2. Client’s knowledge about ART centre.

Figure 3. Missed doses of ART dr ugs as per the clients and records.

Psychosocial Profile of HIV Patients on HAART in Southern India195

Figure 4. Showing where these clients perceived discrimination.

Figure 5. Psychological problems perceived by the clients.

Psychosocial Profile of HIV Patients on HAART in Southern India

196

Figure 6. Qualitative wellbeing after ART.

or less than primary schooling. Three fourth of the clients

know about ART centre through the government health-

care system which proves the impact of HIV related

government programs. Clients who missed their doses

need to be addressed to prevent the emergence of resis-

tance and treatment failure [6-12]. One third of th e study

population is w idowed or sep arated which mig ht have an

impact in treatment and prevention strategies due to lack

of socio-economic support to them [13]. Sleep distur-

bances noted in this population is high compared to other

psychological problems. Psychological problems, Pill

burden/pill fatigue and missed doses in this population

which may affect immunity and adherence needs focused

counseling which includes coping strategies on these

issues [14-28].

5. Conclusion

This study supports effectiveness of free ART program

and effective case referral from government institutions

through Integrated Counseling and Testing Centers

(ICTC). High percentage of major or minor psychologi-

cal problem warrants further exploratory study and may

need psychological interventions including targeted coun-

seling in this population.

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