CHAPTER – I
INTRODUCTION
In no discussion is the confrontation with personal finitude more direct, less compromising, or more insistent them in HIV infection. From the moment when a “positive test” is first announced, the person is caught in a maelstrom of suffering, the end of which at least a present is in all likelihood death. Yet, in the months or years before that end is reached, the individual must go on living. During the interval, family, friends, and the health. Professionals who attend the afflicted person also live unavoidably in community of suffering. Whose ethical challenges are among the most difficult humour are likely to confront.
For the person with HIV infection suffering often begins long before the pain, the debility, and the dementia. On that account, it is all the more anguished, because for an extended time life seems the same and yet is not, nor can it ever be the same again, with a confirmed diagnosis of HIV infection, an existential barrier is crossed. If the caregivers are to help they must somehow cross this barrier, too, to “enter into” suffering as Nouwen suggests. If they do not, or cannot, they may “do” many things for the person. But they cannot really help, because suffering engages the human spirit beyond the microcircuitry of the brain or the microphysiology of the body. The pain and symptoms of the troubled body must be mitigated, but this is not enough. To do this is only to stand on the threshold, but not to “enter” the individuals experience.
To “enter” the experience is exquisitely difficult. Each persons experience of suffering is unique. It is shaped by all those particularities of individual existence that give humans their personal identity. We can never completely enter into another’s experience of illness. Paradoxically, however, compassion literally means “co-suffering”. Compassion cannot exist unless we do enter to some discernable degree. In this research, now to elaborate a little about the concept of SES, life stress, locus of control and adjustment.
The influence of socio-psychological factors on HIV/AIDS
Man is just as truly a social as a biological creature and the socialization and development of the personality of an individual is a highly complex process. But the research undertaken all over the world indicate the fact that, the development of a personality of an individual is entirely influenced by his socio-economic cultural atmosphere to which he is exposed in his primitive years. Because, the social dimensions of the individuals personality are largely determined by his perception of social objects. His interactions and adjustments mainly depend on the interpersonal relations as well as the social, cultural, educational economic and psychological factors.
However, there is a evidence to suggest that environmental factors are of great significance in facilitating or inhibiting given needs, in conceiving the goals as well as in determining the extent to which ones needs are gratified support for this assumption comes from the studies on different aspects of socio-cultural disadvantage/deprivation, carried out in different parts of the world. When these conditions create force of isolation from society, social problems of personality development arise and a person may lose not only advantageous personality traits but suffer from the risk of stagnating in the development process that would lend to deprivation.
Likewise, the HIV affected person also the products of socioeconomic and cultural milieu in which they are born and brought up. And certainly these conditions and atmosphere would have a big impact on their psychological and personality traits, in his /her daily life in society. When the HIV affected people from well in economically, they are maintaining healthy life. In India, Rath (1974) has analyzed the relationship between social conditions and personality dimensions. He argues that the biosocial needs of the people are integrated with the external social demands. The latter are graduailised by internalized and the former are steadily socialized in course of socio cultural adjustment.
There is a clear moral and humanitarian obligation to provide appropriate care and support to each person infected with and affected by HIV/AIDS. The benefits of investing on care are manifold suffering is reduced and improvement is seen in the quality of life; economic and socially productive activity is likely to be prolonged.
Life stress
In recent years the role and status of HIV positive patient have been tremendously changed with the advent of AIDS educations and awareness programme and other training and more liberty for their rights and privileges, AIDS patients attitude their stereotyped role changing and their participation in social programmes and work place is increasing day by day. It has made then in cambent of increased socio familiar roles than they were having in past.
The AIDS patients who work outside the home are required to make many socio familiar adjustments that even contribute to stress and anxiety. Specially the AIDS patients adjustments and social support consists of support in several forms family, community and other institutions, like religion and the state. The growing body of literature documents the importance of social support network in maintaining good morale.
Many continue to perceive HIV in India’s is slight of the way is began; as an epidemic limited to urban areas, “only affecting”. High risk groups such as female sex workers trust drivers, men who have sex with men and injecting drugs users. But much has changed since the beginning of the epidemic. With an approximately 1% prevalence among adults in India (age 17-45) HIV is now a disease of the general population. Moreover, with 59% of cases currently in the country side, HIV is now more of a rural than an urban diseases. Perhaps the most counter intuitive fact regarding HIV today. However, is that the majority of women infected today are married and monogamous, having never had a sexual partner other than their husbands. Mortality at YRG care dropped from 25 deaths per 100 patients year to just 5 deaths per 100 patients years in under six years. This provides hope that Indian HIV patents can take ARV medications. Just as efficiently at their western counterparts, in a manner that saves lives. While access to ART may not be the solution to HIV in Indian, it is definitely one critical component of dealing with this epidemic and an ethical imperative in today’s world.
Stress in major source of hurting human being over ambition and search for identity has given rise to overall stress. In common prevalence stress is expressed when an individual becomes incapable to cope with the demands of environment, which results in pressure and strain, brings the person to feel tense and uncomfortable. In a stressful situation the individual is threatened beyond his capacity to endure men he adopts coping strategies to manage his behavouir as the situation demands.
No doubt, that stress is a common cold of modern living which is a prominent feature of each and every work field. Stressful event lead to disruptive and pathological states that invariably impair performance (Levin and Sctoch, 1970) according to Burke and Weir (1980) stress exists as a real problem in work in work world with serious implications for the health and well being.
According to Mason (1975) the term stress has been approached in at least four different ways:
a) As stimulus or external force acting on the organism
b) As the response or changes in the physiological functions,
c) As the interaction between an external force and the resistance opposed to it, as in biology
d) As a comprehensive phenomenon encompassing all the three.
The assumption behind the above definition, life changes require adaptation on the part of the individual and are stressful and persons experiencing marked life changes in the recent part are susceptible to physical and psychiatric problems. Studies of artificial stressors in the laboratory have many advantages, but they do not readily allow us to study how people are affected by events in their daily lives.
Locus of control
The concept of locus of control originates from Rotter’s social learning theory which assumes that the effect of a reward depends on the extent to which a person infers and causal relationship between his own behaviour and the reward. Internal versus external locus of control refers to the extent to which a person thinks he is able to exercise control over the events in his environment.
Rotter Seemer and Liverant (1962) defined the concept of internal and external locus of control as follows, basically locus of control has two parts, internal and external locus of control . If external locus of control lers extreme optimism an bubbling self confidence, external locus of control is belief in elements like star, luck, fortunate, etc. internal behavoiur brings relationship between their action and results on the other hand external open that there is direct nexus between their action and outside factors. Locus of control is an important aspect of the behavoiur. For the practicing school and health psychologists. This concept is apt to bring to mind a variety of ideas. A foundation for the conceptualization of locus of control and extensive and elaborate theoretical views of its development are found in the works of Aranfreed (1968), Rotter, Seeman and Liverant (1962) etc.
Actually the concept of Locus of control is formulated within the framework of the social learning theory (Rotter, 1954). It is related to the measurement of the extent to which an individual is self motivated, directed or controlled (internal frame of reference) and the extent to which the environment (luck chance etc.) influence his behaviour, simply stated, locus of control has to do with the placement of responsibility for the outcome of events or behaviours. The outcome of events or behavoiurs. The outcome of events are sometimes pleasant or unpleasant, encouraging or discouraging, gratifying or distressing can generally be referred to as reinforces and different people perceive them differently which is characterized a either internal or external control. External control refers to the belief that the individual does not control rewards or outcomes. Fate, luck and significant others are viewed as responsible for the outcome of events. In contrast and individual who believes that his own ability and efforts control vents are to be characterized as internally controlled.
Adjustment in a fast changing society is an important socio psychological aspect to be constantly studied. The problem of adjustment especially during the most crucial phase of HIV positive people. It should be given a through probing. Today given the globalization process the value structures etc., which traditionally gave a mooring to adjustment are being fast eroded and in their place the new ones are developing through their structure is not clear. Hence, the process of adjustment is becoming more and more complex and stressful in HIV affected people.
Further, the low SES conditions are preventing the individual from developing skills to cope with the adjustmetnal demands through restricted experience would expose the individual to differential problems. In other words HIV affected people limits the behavioural efficiency of an individual. This socio psychological variables, life stress, locus of control and adjustment. Therefore, assumes all the more importance vis-à-vis the changing social order. In view of the above it is very important to study the impact of SES on LS, LOC and adjustment of HIV positive people.
Now to elaborate a little about he concept of adjustment. The concept of adjustment is used to denote the personality of the individual. It is also used to refer to ones behavoiur, psychological conditions (normal or abnormal), sociability etc. This epithet is also used to describe the quality and success of life. However, the concept of adjustment as a research variable needs to be explored.
The concept of ‘adaptation’ which is the key term of Darwin’s theory of evolution was borrowed and renamed as ‘adjustment’ by psychologists. Though the concept of adjustment was in usage for a long time to explain certain process referring to the human behaviour, the scientific study of adjustment started only in the twenty first century.
Adjustment is a process in which the needs of the individual on one hand and the claims of the environment on the other are fully satisfied. A plethora of definition is given to the term adjustment by several scholars. These definitions relate mainly to the two aspects of adjustment 1) Individuals efforts to meet his needs and 2) adapting himself to the environment.
William Coe (1972) states that, adjustment is a “process by which an individual applies his resources to fulfill his personal need while at the same time maintaining harmony with his environment”.
According to Fredenberg (1971) adjustment involves transactions with the environment which may result in a change in ones behavoiur, or a change in environment or both. Each one o f us experience both external as well as external needs.
Thus, different definitions of adjustment speak of the satisfaction of ones needs, in relations to the environment and establishment of harmonious relationship with his environment. Needs are satisfied within the framework of the society to which he belongs, physical psychological and socio-cultural environments are of greater significance in the adjsutmetnal process at a given moment. For the satisfaction of a persons needs and successful survival, he has to modify his behaviour or modify the environment or both.
The need satisfaction and adjustment to environment are interdependent. If the environmental conditions are not conductive to satisfactions of ones biogenic and sociogenic needs. Adjustment to the surrounding becomes difficult. The individual faces adjustmetnal problems in the areas like home, health, social and emotional adjustment.
HIV/AIDS
Acquired immune deficiency syndrome (AIDS) is a life threatening syndrome of illness attributed to the human immunodeficiency virus (HIV). HIV infection ranges from asymptomatic infection to severe forms of the disease. Although clinical presentation varies, HIV typically infects human ‘T’ cells that are essential to normal functioning of the immune system with immune deficiency, the HIV infected person becomes susceptible to opportunistic organisms that normally would be harmless (Centres for Disease control (CDC), 1987).
According to the 1987 definition of the CDC, AIDS is characterized by HIV encephalopathy, HIV wasting syndrome, or certain diseases due to immunodeficiency in a person with laboratory evidence for HIV infection and without certain other causes of immunodeficiency (CDC, 1987). The later 1992 CDC, AIDS definition includes people who meet the 1987 definition and adds. HIV infected adults and adolescents with CD4 lymphocyte counts under 200 (CDC, 1991b). This definition moves the AIDS diagnostic label earlier onto the disease continuous, which is intended to be more inclusive of women and injecting drugs users (Chang, Katz and Hernandez, 1992, Murphy, 1991d).
HIV disease is transmitted by sexual, parental and prenatal routes involving exchange of body fluids with an infected person. Common routes include engaging in sexual intercourse with an infected person, using an infected needle to inject adding and receiving an infected blood product (CDC, 1992a). Lifestyle environmental conditions, other viruses, drug abuse, and other cofactors can affect the progression of HIV infection. A person may be HIV infected for many years before developing AIDS. Medications can inhibit HIV and help to treat opportunistic diseases (National center for Nursing Research, 1990).
Indeed, AIDS is a leading cause of death for some inner city children and for women and men who are 25 to 44 years of age, surpassing heart disease, cancer, suicide and homocide (CDC, 1992a). HIV disease rates are increasing among women, people of colour and persons who inject drugs. These increasing rates and higher death rates from AIDS for Indians are associated with poverty, drug abuse, teen pregnancy, prostitution, child abuse, spouse battering, and inadequate education, health care and social support.
HIV infection is spreading throughout the world, particularly in developing countries, which have the fewest available resources for preventing and care. The complex needs of HIV infected persons are adding additional strain to already overloaded health care systems. In the absence of a vaccine or cure, effective educational programs appear to be the most useful tools for preventing HIV transmission. The impact of HIV disease will depend on present efforts to prevent HIV transmission and treat HIV infected persons.
CHAPTER – 2
CONCEPTUAL FRAMEWORK
1) SOCIO ECONOMIC STATUS
Socio economic status refers to the hierarchical distractions between individuals or groups in societies or cultures. Anthropologists, historians and sociologist identify class as universal, although what determines class varies widely from one society to another. Even within a society, different people or groups may have very different ideas about what makes one “high” or “low” is the hierarchy (David, 1978).
The most basic class distinction between the groups is between the ‘powerful’ and the ‘powerless’. Social classes with more power usually subordinate classes with less power, while attempting to comment their own power positions in society. Social classes with a great deal of power are usually viewed as elites, at least within their own societies.
In the simplest societies, power is closely linked to the ability to assert ones status through physical strength; thus age, gender and physical health are often common delineators of class in rudimentary tribes. However, spiritual chorisma and religious vision can be at least as important. Also, because different livelihoods are so closely intertwined in simple societies, morality often ensures that the old, the young, the weak and the sick maintain a relatively equal standard of living despite low class status.
As societies expand and became more complex, economic power replaces physical power as the defender of the class status, so that ones class is determined to largely by:
Occupation
Education and qualifications
Income, personal, household and per capita.
Wealth or net worth including the ownership of land, property, means of production, etc.
Those who can attain a position of power in a society will often adopt distinctive life style to emphasize their prestige and further rank. Themselves within the powerful class. Often the adoption of these stylistic traits are as important as one’s wealth in determining class status, at least at the higher levels:
Costume and grooming
Manners and cultural refinement
Finally, fluid motions such as race can have widely varying degrees of influence an class standing. Having characteristics of the majority ethnic group and engaging in marriage to produce off spring improve one’s class status in many societies. But is still often the single most overreaching issue of class status in same societies, lower class, middle class, upper class.
For most of human history, societies have been agricultural and have existed with essentially two classes those who owned productive agricultural land, and those who worked for them, with the land wowing class, arranging itself into a sometimes elaborate ‘hierarchy based’ on the criteria listed in the previous section, but without over changing the essential power relationship of power and worker. About the 1770s, to know, when the term “social class” first entered the ‘Braharminism’ the concept of lower class, middle class, upper class, within that structure was also becoming very important (Simpson, 1992).
Today, most talk of social class assumes three general categories: an upper class of powerful owners, a middle class people who may not exert power over others but do control their own destiny to a certain extent though commerce or land ownership, and lower class of people who own neither property nor stock in the corporate systems and who rely on wages from above for their livelihood. Since, the age of revolution, eurocentric governments, have generally upheld the middle class as the ideal, and have at least claimed to be working toward expanding it. Especially in the India, the ideal of a middle class reached their dreams (Weiss, 1982).
Socio-economics is the study of the relationship between economic activity and social life. The field is often considered multidisciplinary, using theories and methods from sociology, economics, history, psychology and many others (Leonard Broom, 1977). It is a relatively new social science that has emerged as a separate field of study in the late twentieth century. Most colleges and universities do not have a separate department or degree for socio economic studies (Robyn Parker, Dept. Psychology, Monash University, 2007).
Socio economics typically analyses both the social impacts of economics activity and economic impacts of social activity. In many cases, however, socio-economists focus on the social impact of some sort of economic change. According to Burchill (1995). The socio economic status is characterized by the economic, social and physical environments in which individuals live and work, as well as demographic and genetic factors. Measures for SES may include income or income adequacy, education, occupation or employment.
Bill Clinton (2001) was explained that the “SES an assessment of an individual or family’s relative economic and social ranking”.
Totally social status is the ‘standing’, the honor or prestige attached to one’s position in society. Social status is influenced by social position. As a historical models class can be discerned in any society, some cultures have published specific guidelines to rank. In some cases, the ideologies presented in these rankings may not concur with the mainstream power dialectic of social class as it is understood in modern days.
The Indian caste system is one of the oldest and most important systems of social class with peculiar rigidity (Tiwari, 1996). In the sense that it lacks upward or downward nobility between castes. It differs from Varnashrama Dharma found in Hinduism, which allowed people born into a certain Varna to move upward or downwards deepening on their qualification. It divided society based on skill and qualification. Briefly, the Brahmin Varna was idealized as a leisurely priest class devoted to religious ceremonies, while the Kshatriya defended them as military princes.
The modern concept of the middle class was represented by the Vaishya Varna artisans, farmers, and merchants and the lower verna were the Shudra laborers. Within this basic framework were arranged a huge number of jatis, or subcastes (Swamy, 2004). Despite being notorious for its rigidity, is should be recognized not as a religious system as Varnashram Dharma prescribed in Hinduism, but a social system, which evolved from Varnasharma Dharma.
In modern societies, occupation is usually thought of as the main determinant of status, but even in modern societies other memberships or affiliations (such as ethnic group, religion, gender, voluntary associations, fandom, hobby) can have an influence. A doctor will have higher status than factory workers, for instance, but in some societies a white higher status doctor will have higher status than a non-white, immigrant doctor of minority religions. In pre-modern societies, status differentiation is widely varied. In some cases it can be quite rigid and class based, such as with the Indian caste system. In other cases, status exists without class and informally, is true with now some high educated society like capital cities, and some Buddhist societies. In these cases, status is limited to specific personal relationships. But now the people agree with cast is mainly, they are coming under humanity.
Status is an important idea in social stratification. Maxweber (1862) distinguishes status from social class though some contemporary empirical sociologists add the two ideas to create socio-economic status or SES, usually operatinalised as a simple index of income, education and occupational prestige. Status inconsistency is a situation when an individuals social positions have both positive and negative influences on his social status. For example, a teacher has a positive societal image (respect, prestige) which increases his status but may earn little money, which simultaneously decrease his status. In contrast, a drug dealer, smuggler may have low social position though have a high income.
Status based on inborn characteristics, such as gender, are called ascribed statuses, while statuses that individuals gained through their own efforts are called achieved status. Specific behaviors are associated with social stigmas which can affect status.
2) LIFE STRESS
The modern world, which is said to be a world of achievements, as also a world of a stress, one finds stress everywhere. Whether it be within the family, business organization, enterprise or any other social or economic activity, right from the time of birth tell the last breath drawn, an individual is invariably exposed to various stressful situations. Thus, it is not surprising that interest is the issue has been rising with the advancement of the present century which has been called the “Age of Anxiety and stress”. Stress is a subject which is hard to avoid. The terms is discussed not only in our every day conversations but has become enough of a public issue to attract widespread media attention whether it be radio, television, newspapers of magazines, the issues of stress figures everywhere.
Different people have different views about it, as stress can be experienced from a variety of sources. Ask the opinions of the different people and you are likely to get different definitions.
The air traffic controller sees it as a problem of alertness and concentrations.
The biochemist thinks of it as purely chemical events.
The commonly stress is force, pressure, strain or strong effort with references to an object or person.
Spancer, A. Rathus (1967) explain that stress is the demand that is made on an organism to adopt.
Selye’s (1936) defined as the nonspecific response of the body to any demand.
Mason (1975) explain that, stress us the stimulus or external force acting on the organism;
As the response or change in physiological functions.
As the interactions between an external force and the resistance opposed to it, as in biology.
As a comprehensive phenomenon encompassing all the above.
According to encyclopedia of human behaviour
The stress consisted of the ‘sum of all non-specific changes (within an organism) caused by function or damage’ or more simply. ‘The rate of wear and tear in the body’.
Here stress will be used to describe events that are threatening to an individual and which elicit physiological and beahavioral responses as part of allostaris.
APPROACHES OF STRESS:
The terms stress is used to connote a variety of meaning both by the common men and psychologists of different persuasions.
a) Stimulus oriented approach:
Stress is regarded as an external force which is perceived as threatening. Some view threat itself as stress. According to Selye (1956) any external event or any interval drive which threatens to upset the organism equilibrium is tress.
b) Response oriented approach:
The response oriented approaches described low stress is reacted to and how people functions under stress.
The way it is presumably experienced is inferred from the response made to it. The biologically oriented approach to stress is also response oriented.
c) The psychodynamic approach:
This approach considers events (Both external and internal) which pose a threat to the integrity of the organism reading to the disorganizations of personality as stress.
Stress presages loss of ego strength and loss of ego support, stress may be induced by interpersonal (external) or intrapsychic (between own impulses and ego) factors resulting in anxiety.
The socially oriented psychologists believe that the interaphsychic needs call into play mechanisms of perceptual selections, deference and vigilance. These are wide variations is reactions to stress and the capacity to tolerate it between persons in the same individual on different occasions.
The most basic fact about stress is that, like feelings stress is experienced. The feeling of stress is an act in which there is a reference, not a casual reaction to which there is a reference, not a causal relations, to an object that intended or internationally present.
BRIEF HISTORY ABOUT STRESS
The concept of stress was first introduced in life sciences by Hans Selye in 1936. It is a concept borrowed from the natural sciences.
Derived from the Latin word “Slringere” stress was popularly used in the seventeenth century to mean hardship, strain adversity or affiliation. It was used in the eighteenth and nineteenth centuries to denote force, pressure, strain or strong effort with reference to an object or person.
Ancient Indian concepts:
The concept of stress in the modern sense is not easily found in the traditional tests of Indian culture and tradition such as ‘Charak Samhika’ ‘Patanjali’s’ ‘Yogasutra’ and Bhagardgita. However a number of concepts developed similar to the phenomenon of stress. Some of these, for example or dukh (pain, misery or suffering) Klesa (affiliations).
Kaina or Trisna (Desires) atman and ahankara (self ego) adhi (mental aberrations) and prajnpardha (pailure or laps of consciousness) it is interesting to note that the body mind relationship, characteristics of modern stress studies, is emphasized in the Ayurvedic (Indian) system of medicine.
Stress and physiology:
Stress is unique in the category of diseases. It has no biological carrier such as a germ or virus. Rather, it is the result of how our mind and body function and interact. It is psychosomatic in the true sense of the ‘word psycho’ meaning ‘mind’ and same meaning ‘body’ it is the consequence of how we regulate or to put it more appropriately how we do not regulate, the metal and physical functioning of our being.
It is the ‘dis-ease’ created by the abuse of our mind and bodies and can lead totally different symptoms in different people. These may be as innocuous as temper tantrums or as destructive as a heart attack. Stress may express itself through alcoholism or depression. Though its symptoms are many its causes often go unrecognized and untreated.
Psychosomatic disease:
There is general agreement that high percentage of disease afflicting mankind are psychosomatic and that their primary causes are our though and beliefs. When we speak of psychosomatic nature of disease we basically means that the major source of the disease lies in ones emotional, mental or perceptual and behavioural react to our environment has resulted is internal physiological changes which either evolve into disease or allow disease status to exist.
According to Udupa (1977) reported that psychosomatic disease to progress through four distinct phases.
1. Psychic phase:
The phase is marked by mild but persistent psychological and behavioral symptoms of stress such as irritability sleep, loss of appetite etc.
2. Psychosomatic phase:
If the stress conditions continues, these symptoms become more pronounced, along with the beginnings of generalized physiological symptoms such as occasional hypertension and tremors.
3. Somatic phase:
This phase is marked by increased functions of the organs, particularly the target or involved organs. At this stage one begins to identify the beginning of a disease state.
4. Organic phase:
This phase is marked by the fall involvement of so called disease, with physiological changes such as an ulcerated stomach or chronic hypertension becoming manifest. There are many examples of psychosomatic disease which are directly related to stress they include, ulcers, cancer, bronchial, asthma, common colds, headaches, chest pains, spastic colons, constipation etc.
The list of almost endless, it is still not known why one organism system is affected by stress and another. Certainly genetic factors, diet and conditioned learning are all involved but the key lies in ones mental structures. In other word it can be said that stress is at the root of all psychosomatic disease regardless of the organ system involved. Studies of life stressors and their effects on health and health indicators can give us useful in sights in to the effects of stress. On health, the role of stressfully life events in the etiology research for the stressfully life events in the etiology research for the last 30 years.
THE CONCEPT OF LIFE STRESS
Life events stress are concerned with situational encounters the meaning that a person may attach to such events. It refers to our feelings that something of important to us is being jeopardized by events in our daily liver. In other words, the stressful life events are casually implicated in a variety of undesirable effects on our performance and health.
Dolirenwend and Duhrenwend (1977) the assumptions behind the idea are:
a) Life changes require adaptation on the part of the individual and are stressful.
b) Persons experiencing marked life changes in the recent part are susceptible to physical and psychiatric problems.
Studies of artificial stressors in the laboratory have many advantages but they do not readily allow us to study how people are affected by events in their daily lives. This is similar to Perstonjee observation (1987) while that the responses of human subjects are always mediated through several layers of cultural and social filters.
Anxiety
Anxiety is also a core concept in many other conceptions of maladjustment. Almost everyone experience some anxiety. Behavioral psychologists try to describe anxiety in a way that allows its effects on people to be measured. Anxiety is no longer regarded as a specific symptom. For most psychologists, anxiety refers to a wide range of symptoms, the most significant of which are fear apprehension, in attention, palpitation, respiratory distress and fear of death.
Meaning
A generalized feting a fear and apprehension that may or may not be related to a particular event or object and often accompanied by increased physiological arousal.
Busowitz (1928) explained that, the anxiety as the conscious experience of intense dread conceptualized as internally derived and unrelated to external threat.
Wolpe (1963) defined that the anxiety as an emotional habit consists of all the maladaptive emotional responses that constitute neurosis.
Ross (1973) explained that anxiety a series of symptoms which arise from family adaptations to the stress and strain of life. It is caused to over in an attempt to meet these difficulties.
Nearly all people suffering from anxiety disorders are anxious and have irrational fears coping with life’s rather than cope with their fears, they worse their conditions by avoiding confronting their problems.
Anxiety and Stress
A major task for a trait state theory of anxiety is to describe and specify the characteristics of stressor, stimuli that evoke different ional levels of a state of anxiety in persons who different in a state trait.
Atkinson (1964) suggests that a fear of failure motive is reflected in measure of A –traits experimental investigations, of anxiety phenomena have produced findings that are generally consistent with Atkinson, suggestions that fear of failure is major characteristics of high A –trait people and with seasons conclusion.
That ego – involving instructions are more detrimental to the performance of high –A –trait and than low A-trait subjects. Apparently failure ego-involving instructions evoke higher levels of A –state intensity in high. A trait subjects than in low A-trait subjects levels of A-trait would not necessarily to influence the intensity of A-state responses to all stressors. But only to those that persons with high A-trait perceive as more threatening.
Since high A-trait A-state anxiety individuals have been described as more self-depcatory it might be expected that they will manifest higher leads of A-state in situations that involve psychological threats to self-esteem rather than physical dangers. There is some evidence that persons with high A-trait do not perceive physical dangers as any more threatening than. A-trait individuals.
3) LOCUS OF CONTROL
Locus of control is a personality construct referring to an individuals perception of the locus of events as determined internally by his/her own behaviour versus fate, luck or external circumstances.
Some researcher (McCambs, 1991) suggests that what underlies the internal locus of control is the concept of “Self as agent”. This means that our thoughts control our actions and that when we realize this executive function of thinking we can positively affect our beliefs, motivation and academic performance. “The self as agent consciously or unconsciously direct, select and regulate the use of all knowledge structures and intellectual process in support of personal goals, intentions and choices” McCombs asserts that “the degree to which one choose to be self-determining is a function of ones realization of the source of agency end personal control”. In other words, we can say to ourselves, “I choose to direct my thoughts and energies toward accomplishment. I choose not to be daunted by my anxieties or feelings of inadequacy”.
Locus of control refers to an individuals generalized expectations concerning where control over subsequent events resides. In other words, who or what is responsible for what happens. It is analogous to, but distinct from, attributions.
According to Weiner (1962) the “attribution theory assumes that people try to determine why people do what they do, i.e., attribute causes to behaviour”. There is a three stage process which underlies an attribution. Step one: The person must perceive or possible observe the behaviour.
Step two: is to try and figure out if the behaviour was intentional,
Step three: is to determine if the person was forced to perform that behaviour.
The latter occur after the fact, that is, they are explanations for events that have already happened. Expectancy, which concerns future events, is a critical aspect of locus of control . Locus of control is grounded in expectancy – value theory, which describes human behaviour as determined by the perceived likelihood of an event or outcome occurring contingent upon the behaviour in question and the value placed on that event or outcome more specially, expectancy value theory states that if,
a) Someone values a particular outcome.
b) That person believes that taking a particular action will produce that outcome.
c) They are more likely to take that particular action.
Julian Rotter’s original (1966) locus of control formulation classified generalized beliefs concerning who or what influences things along a bipolar dimension from internal to external control: “Internal control” is the term used to describe the belief that control of future outcomes resides primarily in oneself while “External control” refers to the expectancy that control is outside of oneself, either in the hands of powerful other people or due to fate/chance.
Hannah Levenson (1973) offered an alternative model whereas Rotter’s conceptualization viewed locus of control as unidimensional (internal to external) Levensons’ model asserts that there are three independent dimensions:
Internality
Chance
Powerful others
According to Levenson’s model, one can endorse each of these dimensions of locus of control independently and at a same time. For example, a person might simultaneously believe that both oneself and powerful others influence outcomes, but that chance does not.
Since its introduction, the locus of control construct has undergone considerable elaboration and several context – specific instruments have been developed. Health researchers in particular have embarrassed locus of control as a concept for explaining behaviour. Among the most widely used health specific measures is the multidimensional health locus of control scales Waltston and Devillis, (1978). This instrument retains Lenson’s three dimensions but concerns outcomes that are specifically related to health and illness such as to staying well or becoming ill.
Locus of control , according to Rotter’s approach, can be divided into two separate source of control: internal and external. People with an internal locus of control believe that they control their own destiny. They also believe that their own experience are controlled by their own skill or efforts. An example would be “The more I study, the better grades I get” (Gershaw, 1989). On the other hand, people who tend to have an external locus of control tend to attribute their experience to face, chance, or luck. Examples: External locus of control : If a student attributes either their successes or failure to having a bad day, unfair grading procedures on their teachers part or even gods will, they can be said to have a more external locus of control .
These students might say, “It doesn’t matter how hard I study the teacher just doesn’t like me, so I know I wont get a good grade”. These students generally don’t learn from previous experiences. Since they attribute both their success and failure to luck or chance, they tend to lack persistence and not have very high levels of expectations.
Development of locus of control :
Generally, the development of locus of control stems from family, culture and past experiences leading to rewards. Most internals have been shown to come from families that focused on effort, education and responsibility. On the other hand, most externals come from families of a low socioeconomic status where there is a lack of life control.
The history of locus of control
This concept was developed by Julain Rotter in the 1960s. He originally named this concept locus of control of reinforcement. Rotter actually bridged the gap between behavioural and cognitive psychology. He believed that behaviour was greatly guided by the use of reinforcements. These punishments and rewards in turn shaped the way people interpreted the results of their own actions.
As everyone knows, generally in an educational setting knowledge flows from the teacher to the student. This type of environment could cause students to with draw. It is suggested that students take more of an active control in the learning process. It is also important to take into consideration whether each students has an external or internal locus of control . Knowing the location of control of your students will aid in planning the type or amount of reinforcements used in the class. Weiner’s (1982) theory applies to every teacher. If we take a look at self concept, there is a correlation between internal locus of control , and experiencing pride if a student were to do well in a class that normally is considered to be tough. On the other hand, a student does not view it as a success if they receive a good grade from a teacher who always gives high grades at the end of the quarter.
The attention theory has explained the difference in highly motivated students versus low achievers. High achievers will take the risk in order to succeed on an assignment. Low achievers avoid success because they feel that their success was based upon luck and that it would not happens again.
Internal locus of control can also be referred to as “self agency” “personal control”, “self determination”, etc. Research has found the following trends:
Males tend to be more internal than females
As people get older they tend to became more internal
People higher up in organizational structures tend to be more internal (Mamin, Harris, and Case, 2001).
However, its important to worn people against lapsing in the overly simplistic view notion that internal is good and external is bad (two legs good, four legs bad?). There are important subtleties and complexities to be considered. For example.
Internals can be psychologically unhealthy and unstable. An internal orientation usually needs to be matched by competence, self – efficacy and opportunity so that the person is able to successfully experience the sense of personal control and responsibility. Overly internal people who lack competence, efficacy and opportunity can became neurotic, anxious and depressed. In other words, internals need to have a realistic sense of their circle of influence in order to experience ‘success’.
Externals can lead easy going, released, happy lives (Harlow, 1978).
4) ADJUSTMENT
Adjusting to AIDS is an ongoing process in which the patient learns to cope with emotional and HIV related problems, and gain control over related life events. Patients are facing challenges that change as the disease and its treatment change. Common periods of crisis of challenge include hearing the diagnosis, receiving treatment, (for example, ART, surgery) completing treatment hearing that the HIV is in remission, hearing that to come back and becoming a HIV/AIDS survivor. Each of these events involves specific coping the questions about life and death, and common emotional problems.
Patients are better able to adjust to a HIV/AIDS diagnosis if they are able to continue fulfilling the responsibilities, cope with emotional distress, and stay actively involved in activities that are the important to them. Coping is the use of thoughts and behaviours to adjust to life situations. A persons coping stress related to his or her personality (for example, always expecting the best, always expecting the shy or reserved, or being outgoing).
Adjustment (from late Latin ad-juxtare, derived from Juxta, near, but early confounded with a supposed derivation from Justus, right), regulating, adapting or settling, in commercial law, the settlement of a loss incurred at sea insured goods. All human behaviour is purposeful. These are directed towards the attainment of some goals or satisfaction of some need. An individuals is said to be adjusted in environment if there is harmony among his/her needs are attainable. The other thing is that these goals should be socially desirable. So it is the harmony of the internal with the external.
“Life is presents a continuous chain of struggle for existence and survivals” says Darwin. Life is a continuous process of overcoming difficulties or of making adjustments.
General meaning of adjustment is the process of living itself or dynamic equilibrium of the total personality. It is a life long process in which one enters into a relationship of harmony with ones environment. Psychologically, adjustment means ‘a person interacts with his/her environment. Fortunate is the individual who is adjusted and considers it go. Every individual, great or small, old or young is confronted with the problem of adjustment. The problem of adjustment starts right from the birth of the child and continues till his/her death. The problem of adjustment is both internal as well as external.
The problem of adjustment is related to arriving at a balanced state between he needs of the individual and their satisfaction. Needs of the individual are multidimensional. Adjustment is a relative term. Opposite of adjustment is maladjustment. Life presents a continuous chain of struggle for adjustment.
According to James Drever (1952): Adjustment means the modification to compensate for or meet special conditions.
Carter V. Good (1959): Adjustment is the process of finding and adopting modes of behaviour suitable to the environment or the changes in the environment.
Gates and Jersild (1948): Adjustment is a continual process in which a person varies his behaviour to produce a more harmonious relationship between himself and his environment.
According to Crow and Crow (1956): As individual adjustment is adequate wholesome or healthful to the extent that he has established harmonious relationship between himself and conditions, situations and persons who comprise his physical and social environment.
According to Coleman, James, C., ‘Adjustment is the outcome of the individuals attempts to deal it with stress and meet his needs: also, his efforts to maintain harmonious relationship with the environment.
A perusal of the above definitions of adjustment leads us to the following characteristics of adjustment:
It helps us to keep balance between our needs and the capacity to meet these needs.
It implies changes in our thinking and way of life to the demands of the situations.
It gives us the ability and strength to bring desirable changes in the state of our environment.
It is physiological as well as psychological.
It is multidimensional
It brings us happiness and contentment
Therefore, a comprehensive definition of adjustment would be like this: “Adjustment is a conditions or state in which one feels that ones needs have been (or will be) fulfilled and ones behaviour conforms to the needs of a given environment or the environment is changed (or will be changed) in a manner as is conforms to the needs of the individual.
Concept of adjustment
The concept of adjustment means adaptation to physical enjoinment as well as to social demands. No human being can live apart from his physical environment. There is action and reaction chain going on between the individual and his environment. The there are social pressure and demands of socialization.
To these may be added the individuals personal demand such as the satisfaction psychological needs. All this complex functioning of the persons demands adjustment. The process of adjustment becomes still complicated when his interactions with one situations comes into conflict with the requirements of the other situation. One situation may give rise to pleasure while the other may give rise to pain. The resulting tension may cause disturbance in his psyche, produce uncomfortable physical symptoms or may even lead to abnormal behaviour.
The concept of adjustment is as old as human race on earth. Systematic emergence of this concept starts from Darwin. In those days the concept was purely biological he used the term adaptation. The adaptability to environmental hazards goes on increasing as we proceed on the phologenetic scale from the lower extreme to the higher extreme of life. Insects and germs, in comparisons to human beings, cannot withstand the hazards of chaining conditions in the environment and as the season changes, they die. Hundreds of species of insects and germs perish as soon as the winter begins. Man, among the living beings, has the highest capacities to adapt to new situations. Man as a social animal not only adapts to physical demands but he also adjusts to social pressure in the society.
Nature of adjustment
The concept of adjustment was originally biological one and was concerned with adaptation to physical environment for survival. Adaptation to physical environment is, of course, a persons important concern, but he has also to adjust to social pressures and demands of socialization that are inherent in living interdependently with other persons. There are also the demands from a persons internal nature, his physiological needs like hunger, thirst, sleep, sex, elimination, etc and psychological needs like needs to belong to get esteem, to self actualize, to get in combination and is interactive fashion that influence the psychological functioning and adjustment of person.
Process of adjustment
The process of adjustment is complicated because a person interaction with one demand may come in conflict with the requirement of another conflict can arise either because two internal needs are in opposition, or because two external demands are incompatible with each other, or because an internal need opposed to other needs may not provide full satisfaction. On the other hand, failure to gratify a strong need or to respond to a strong external demand may result in painful tension. These tensions can distribute psychological comfort, produce physical symptoms, or result in abnormal behaviour.
a) Adjustment as an achievement and a process
Adjustment may be viewed from two angles, from one angle, adjustment may be viewed as achievement or how well a person handles his conflicts and overcomes the resulting tension. From another angle, adjustment may be looked upon as a process or how a person adjust to his conflicts. In the first case we ask whether a person adjustment is adequate and efficient? In the second case we ask how does he adjust or what are the mode of adjustment to various demands.
b) Adjustment as a psychological process
Adjustment as a process is of major interest to psychologists who want to understand a person and his behaviour. The way one tried to adjust himself and to his external environment at any point of time depends upon interaction between the biological factors in growth and his social experiences.
In general, there are three broad types of adjsutive process in the event of a conflict between a persons internal need states and environment demands.
a) The person may modify or inhibit the internal impulse.
b) The person may try to alter the environmental demand in same manner so that he resolves the conflict.
c) The person may escape through unconscious resources to mental mechanisms like phantary, compensation, projection, rationalization, sublimation, etc.
We cannot call any of these modes of adjustments as the most superior. One of them used in isolation, to the exclusion of others is helpful in adjustment. Excessive use of any one of them is likely to be maladaptive. The human beings in order to reconcile their needs or the environmental demands must modify or inhibit their own impulses sometimes alter or modify the environmental demands must modify or inhibit their own impulses sometimes, alter or modify the environmental demands must modify or inhibit their own impulses sometimes, alter or modify the environment at other times, and use some mental mechanism at other times and at times a combination of all the three.
Principles of adjustment:
The principle of adjustment are being explained here:
a) Principles of knowing the self
To be adjusted, one should be aware of his strengths and weakness so that he may mould himself according to the required life style.
b) Principle of accepting ones self
An individual should accept himself as he is if he is not satisfy with himself and does not respect himself, he cannot adjust in the environment. He always complains of bad luck and does not have confidence in his capabilities.
c) Principle of integrating the self
The personality of an individual should be integrated. Those who have dis-integrating personality and are not able to take decision and not stick to a particular decision, they cannot adjust easily.
d) Principle of self drive and shaping:
Sometimes the decisions are imposed on individual. They not opt for a particular career or a business. These decision are imposed by some influential person. They feel disturbed and maladjusted.
e) Principal of self-control
The aggressive control and imposed discipline is the reason of maladjustment is an individual. So we should advocate self-discipline.
f) Principle of balance and harmonious development
An individual should aim at physical, mental, social, emotional and moral development. The he may be able to adjust himself.
g) Principle of understanding others
An individual should not only try to understand himself but also the others. He should respect their ideas and emotions.
General factors influencing adjustment
Many individual differences affect how a patient adjust to AIDS. It is difficult to predict cope how with AIDS. The following factors how a patient adjusts to AIDS.
The type of HIV stage and chance of recovery.
The phase of AIDS such as newly diagnosed, being treated, in remission, or recurred.
Individual coping abilities
Friends and family available to support the patient.
The patients age
The availability of treatment
Beliefs about the cause of AIDS
Specific influence an adjustment
Hearing the diagnosis
The process of adjusting to AIDS can begin even before hearing the diagnosis. Patients may normal levels of fear, worry, and concern when they have unexplained symptoms or are unveil to determine if they have cancer. When a patient hears the diagnosis of HIV/AIDS, many patient “could I die from this?”.
Receiving a diagnosis of AIDS can cause expected and normal emotional distress. But whatever result patient gradually accepts the reality of diagnosis, he/she may begin to experience depression, anxiety, lack of appetite, inability concentration, and varying degrees of inability to function in daily activities. When the patient understands information about treatment options, he/she may gradually feel more hopeful, eventually, patients developments to cope and be able to adjust to the AIDS diagnosis.
AIDS treatment
‘AIDS is controllable, but not curable’ when AIDS treatment begins, patients may experience fears about painful procedures, under effect (for example hair loss, nausea and vomiting; fatigue, pain) and interruptions to normal responsibilities (for example being unable to work). Patients who can weigh the discomforts loose against the benefits of long term gain (for example living longer) and decide, “its worth adjust well. Questions that patients may ask during treatment include “will survive this?” “what side effects will experience?” As these questions arise, patients will learn to them. Developing ways to cope with specific problems (for example fatigue, transportation to work schedule changes) is helpful.
Post treatment
AIDS treatment can cause mixed feelings. It may be time of celebration and increased anxiety with awareness that the AIDS could return once the treatment is stop who can balance their positive expectation with the realities of ongoing feats adjust well. Most experience increased anxiety and fear of the AIDS returning as they have less frequent co-physical. Other adjustment concerns include living with uncertainty, resuming previous resist and being overly concerned about health. During remission, patients often experience normally worry as the dates of regular follow up appointments with their oncologist approach with the AIDS has returned.
Normal adjustment to post treatment and remission may involve using the following coping help control normal emotional distress.
Being honest with ones emotions
Being aware of ones feelings and able to express them to others.
Having a non-judgmental acceptance of ones feelings and willingness to work through emotions.
Having support from others who are willing to listen and accept.
Patients who can express a wide range of both positive and negative emotions usually adjustment.
The return of HIV to AIDS
Changing from a treatment plan that focuses on curing the AIDS to one that provides complete symptoms can cause extreme anxiety. Patients may experience shock, disbelief and denial period of significant distress (for example, depressed moods, difficulty concentrating, and from of death). Normal adjustment may include periods of sadness and crying, feelings of anger, higher power, periods of withdrawal and isolation, and thoughts of giving up patients gradually return of AIDS over a period of weeks by changing expectations from curing to healing. How process of ‘becoming whole again’ by transforming ones life in many ways in the face of death important that the patient maintain hope through out this process patients who believe that suffering can be controlled will have hope for future quality of life. Those who believe they are cared for will have hope in future relationships. Religion and spiritually are very important in patients maintain hope.
Survivorship
The adjustment form completing AIDS treatment to a long term survivorship is a gradual patient extends over many years. Some common problems reported by AIDS survivors as they face include fear of the AIDS coming back, lasting physical effects such as tiredness, problems concerns about sexual functions. Most patients adjust well and some even report benefits of such as a greater appreciation of life, changes in life values and stronger spiritual or religion patients how do not adjust well usually have more medical problems, fewer friends and family support, fewer financial resources and problems with psychological adjustment.
The important areas of adjustment that are likely to affected by deprivation are home, health, social and emotional adjustment.
Home adjustment involves how much the individuals satisfaction or dissatisfaction with the home life, relationship with the parents, discipline etc. deprivation of basic needs, or partial satisfaction of needs, lack of warmth, and unsatisfactory relationship with in the family lead to adjsutmental problems. Deprivations has strong relationships with the home adjustment of the adolescents.
Health adjustment relates to the illness, ailments, diseases and health status of the individual. Health of individual depends upon the nourishment and medical care provided to him. Early malnutrition’s and illness cause everlasting effect on the health of an individual.
Economic insufficiency, inadequate housing facilities, in sanitary surroundings and lack of awareness about health and nutrition lead to health problems. These conditions are the result of deprivation. House health adjustment is associated with deprivation.
Social adjustment includes the individuals participation in social activities, seeking and enjoying company of others desirable and favourable attitudes and establishment of spontaneous and harmonious inter personal relationships. Poverty and socio cultural deprivation limit the social participation. Hence, he avoids meeting people feels uneasy, awkward, embarrassed, remains in the background and does not take initiative to meet other people. Deprivation has direct impact on the social adjustment.
Emotional adjustment is concerned with the emotional instability of the individual. Nervousness, depression, excitement, shyness are the characteristics of maladjustment deprivation frustrates the individuals satisfaction of needs, which leads to emotional disturbances. Socio cultural deprivation leads to feelings of being rejected inferiority, inadequacy and lack of self control mechanism and hostile rejection of adult values. As a result of deprivation, emotional adjustment gets affected adversely.
5) HIV/AIDS
The acquired immuno deficiency syndrome was first recognized in the United State of America in 1981 with an extraordinary out break of pneumocystis carini pneumonia and Kaposis Sarcoma in previously healthy young men. Since then the disease has been spreading alarmingly and has assumed the proportions of a global pandemic. It is now estimated that there are 22 million HIV cases world wide with one million children being already infected with HIV. It is predicted that by AD 2000 there will be 30 to 40 million HIV cases world wide and 12 to 18 million cases of full blown AIDS with the majority of them being in the Asian continent.
The Indian scenario is equally grim. Since the reporting of the first HIV seropositive case in 1986 form Chennai and the first AIDS case in 1987 from Mumbai, cases have been reported from all over the country in increasing numbers. From being in phase III, India has entered phase II.
Immunology:
Immunological investigations of AIDS cases reveal a defect in cell mediated immunity. The ‘T’ helper hypocyte which has been described as the conductor of the immuniological orchestra and carriers CD4 receptors on its surface is the main target of the HIV virus.
AIDS virus was isolated by two independent groups of workers in France (1983) and the USA (1984) and was named the Human Immuno deficiency virus I. Recently a second AIDS virus was discovered in West Africa which differs in its genome from HIV I and requires a separate ELISA test to detect its presence in the blood. It has been termed HIV II.
HIV is an RNA containing retrovirus, so termed because the RNA transcriptions proceeds in a reverse direction (RNA to DNA) before the viral genome can be incorporated into the host genome and viral replications can commence. This essential retrograde step is dependent on the presence of a viral enzyme called Reverse Transcriptase. Inhibition of this enzyme by drugs such as a Zidovadine prevents replications of HIV. After infections, antibodies to HIV usually appear in the blood after 6 to 12 weeks. Any patient sero-positive for HIV antibodies remains infected and infections for life.
Clinical spectrum:
AIDS is a disease indicative of a defect in cell mediated immunity in a person with non known cause for immuno deficiency other than the presence of HIV. The clinical case definitions of AIDS in adults as given by NACO is a positive test for HIV antibody detected by two separate tests using two different antigens and any one of the following criteria:
1. a) Weight loss of more than 10% body weight.
b) Chronic diarrhoea of more than one month duration
c) Chronic cough of more than one month duration
2. Disseminated military or extra pulmonary tuberculosis
3. Neurological impairment restricting daily activities
4. Candidiasis of the oesophagus
5. Kaposis sarcoma
For the first few years, most patients with HIV infections remain well. After acquiring the infections the majority of individuals remain a symptomatic. However, some cases experience an acute seroconversion illness in the form of fever, rash, sore throat headache and tender lymphadenopathy. Usually the patient recovers within a week and it is after a period of 6 to 10 years (asymptomatic phase) that infected individuals. Show the first clinical manifestations of AIDS. Often the earliest symptom is in the form of minor infections such as herpes or oral thrush.
In a small proportion of patients generalized lympha denophthly which persists for over 3 months at more than two sister occurs.
This is known as progressive glandular lymphadenopathy. The lymph nodes usually feel rubbery and are mobile and non-tender. This lymphadenopathy often regresses with time and progression of the disease. The onset of AIDS is heralded by the occurrence of major infections such as PCP, a serious weight loss may set in and the final cause of death is either a wasting syndrome or progressive HIV encephalopathy. The time from infection to death may vary from 1 to 20 years. Thus AIDS is more a state of risk rather than a single continued illness.
At any given time, full blown cases of AIDS represent only the tip of the iceberg with a larger proportion of asymptomatic HIV carriers, who may be a source of infection to others. Opportunistic infections can be categorized as protozoal, bacterial, fungal and viral infections.
Laboratory diagnosis:
The available laboratory tests can be categorized as follows:
1) Screening test:
a) ELISA
b) Latex agglutinations
c) Partial agglutinations test
2) Supplemental tests
a) Western blot
b) Immonofluorescence assay (IFA)
c) Radio immuno precipitations assay (RIPA)
3) Confirmatory tests:
a) Detection of viral RNA by PCR
b) Detection of HIV specific circulating antigen (P24)
c) Virus isolation
Treatment
1) Treatment and prophylaxis of opportunistic infections
a) Pneumocystics carini infection – cotrimexazole
b) Mycobacteria TB – 9 months course of 4 drugs
c) Candidial infection – clotrimazole / keloconaxole
d) Cryptococcal meningitis – Amphoterecin / Flucytosine
e) Cytomegalvirus infection – Ganciclovir /Foscurnet
f) Herps simplex and Herpes Zoster – Acyclovis
2) Anti-retroviral agents
a) Reverse transcriptase inhibitors include zidovudine (AZT), Lamivudine, Zalcilabine
b) Protease inhibitors such as saquinavir, Rilonavir, indinavir.
c) Immuno modulators to restore the defective immune system: Interlukine 2, Gamma Interferon, Bone narrow transplantation, gene therapy
Prevention
Since there exists neither any care nor any vaccine for AIDS prevention is the only existing means of checking the rampant spread of this disease. As there are three prime modes of transmission, the preventive measures should be directed at slopping the sexual, perinatal and blood related transmission of infection by way of education, concuselling and behaviour modification.
Prevention in a health care setting involves following the universal precautions.
Commonly used disinfectants to kill HIV include 70% alcohol, 35% isopropyl alcohol, 0.5% paraformaldhyde, 0.5% Lysol, 2% gluteraldehyde, household bleach.
Vaccine will be an important tool in the prevention of the HIV epidemic. Several candidate vaccine are undergoing phase I trials.
Major hurdles faced are: high viral mutations, transmission of infection by cell free and cell associated virus, and the need for development of effective mucosal immunity, chimpanzees have been found to be useful models for research. Recombinant envelope proteins and recombinant viruses expressing a number of HIV proteins have been found to be safe and immanogenic. However, it will take several years of clinical trails to establish the efficacy of a candidate vaccine against HIV.
CHAPTER – III
REVIEW OF LITERATURE
Acquired immune deficiency syndrome (AIDS) is a life threatening syndrome of illness attributed to the human immunodeficiency virus (HIV). HIV infection ranges from asymptomatic infection to severe forms of the diseases. Although clinical presentation varies, HIV typically infects human ‘T’ cells that are essentials to normal functioning of the immune system. With immune deficiency, the HIV infected person becomes susceptible to opportunistic organism that normally would be harmless (Centers for disease control (CDC), 1987).
For persons suffering HIV a there is a say to be no social acceptance and social support from any part of the society. HIV infected are targeted as social taboos with very little support from the society. Many research work pertaining to the physical and mental situation of HIV infected reveals the point where in the people are neglected in almost all walks of life.
Many prevention programmes has been started to defend the HIV infected. One such programme has need for effective targeted HIV prevention programme was done by Lorenzo Williams, Health watch, New York, NY (2001). Seniors at risk: the need for effective, targeted HIV prevention programs.
Data from 10 focus groups of African seniors over 50 population as defined by the centers for CDC and prevention conducted in the Northeast and Midwest urban areas. Emphasis on the delivery of HIV prevention services to this valuable and often misdiagnosed population, identifying available resources and addressing services gaps. Social marketing and media HIV prevention education programmes should be developed and implemented and HIV prevention programmes targeting seniors should utilize senior peer educators.
In 1999 studied Sandra K. Plach, The purpose of this report is to describe the diverse ways midlife women with HIV/AIDS practice ‘self care’. This qualitative analysis examines transcripts of interviews conducted with a midlife and middle class women age 50 years and old living HIV/AIDS. Data came from a sub sample of a large longitude qualitative study of 55 HIV infected women residing in Wisconsin. In depth understanding of the meaning and impact of HIV/AIDS on corners everyday lives. Four of the women in this sub sample are concession, and are African, American and ‘1’ is latina. They range in age from 50 to 56 (M = 52) and report yearly incomes of < $ 10,000 (n-4) < $ 20000 (n=4) and > $ 30000 (n=1) most (80%) contracted HIV through heterosexual contact. All reside within a major metropolitan area of the state.
Marcia M. Neundorfer (1995) examined the SES of social support plays an important role in the well being of individuals regardless of age. While the need for social support may increase as we age, or ‘convey’ of support, however, may in fact decrease with age. If we are to understand how age impacts individuals living with HIV diseases, it will require an increased knowledge of how social status and social support network differ among old and younger persons as well as what sociodemographic factors are associated with those changes.
Practitioners working with HIV infected older adults need to carefully examine social status and social support networks as part of the assessment process and consider more formal mechanisms to provide assistance and social support when necessary.
In 1998 Kalhlenn M. Nokes was using telephone support group for HIV positive persons aged 50 to increase social support and health related knowledge. Kathleen was studied middle aged and older persons living with HIV/AIDS have unique needs arising from the physical, mental and social changes associated not only with normal aging but also related to living with a chronic illness.
Tiwari et al. (1999) examined the family member who were getting education or had completed education. Similarly, summation of weighted scores achieved by family members on occupational profile was divided by the some numbers of individuals to arrive at the final score on the occupational profile.
Bosentan, A. (2006) Switzerland, having conducted studies in only oral approval medication for PAH. According to their social status Canada has approved medicine for patients wise pulmonary arterial hypertension (PAH) secondary to HIV, who did not adequately respond to conventional therapy. PAH is a life threatening long disease, characterized by elevated blood pressure inside the pulmonary artery. Victims of PAH have unexplained symptoms.
Dutch firm Octoplus has cleared phase I trials for Locteron, which is using a new polymer drug delivery. Scientists have developed a mouse model of ‘X’ linked severe combined immuno deficiency (XSCID) which offer real hope that gene therapy for X-linked SCID can be made both safe as well as effective.
The study was conducted in 2000 by Brenda Lee Curry. The copasetic; peer run support group for older women with HIV/AIDS. The lack of social, support for middle aged and older women living with stress. Description of a peer run support group for women 50 living with HIV/AIDS. The copasetic group has been meeting weekly since August, 2000. Current membership consists of 16 women whose ages range from 47 to 73 years.
Issues discussed are health related issues associated with living with HIV/AIDS and other chronic illness such as hepatitis’s and diabetes; in this regard grand and great grand children; dating and companionship issues and coping with social isolation.
Scott Hawlharnwaite, CBSW (2001) having conducted studies in 2001 the areas agency on going, region one implemented the National Family caregiver support programme change the ‘locus of control ’. Two of the mandated services are to provide educational and support programme for family caregivers. In partnership with the foundation for senior living and the community group AGES. The first caregivers educational forum for GLBT seniors was held in November, 2001.
In 1989 studied Haley and Pardo, however believe that longitudinal studies are important to account for the changing nature of stresses. According to them, longitudinal decrease in care gives depression in case of AIDS may represent successful adaptation, but may also be related to decrease in such patient problems as wondering or dangerous behaviours. Caregivers is poor health may be especially vulnerable during later phases of dementia that require direct AIDS care is new, two contradictory hypothesis are often poised to explain the long term consequences of the care giving role. The ware and tear hypothesis suggest that the repetitive nature of care giving will take its all and deplete an individuals physical and emotional resources. The adoptational hypothesis suggests that with experiences, care giving may get easier or became bearable (Haley and Pardo, 1989) which of the two is a better explanations remains to be resolved.
In 1999 Campbel given reports that despite the stress, strain, mothers derive a sense of purpose from caring or their HIV positive child, though the death becomes very painful us it despites the natural life process in which parents are supposed to die before their offspring.
Rotter (1966) has been noted “Individuals with external locus of control orientation tend to perceive enforcement as controlled by forces or people outside of themselves. They tend to believe that fake chance or powerful others exert more control over their lives than do they.
In a study Wolfe (1970) concluded, “The superiority of internals over externals in predictive accuracy indicates that the internals either acquired more information bearing on their own academic outcomes or used available feed back more effectively or both”. This reveals that internals have always an edge over externals on certain selected variables.
Sharon D. Lee, MD, Medical Director (1991) has been noted “Is it HIV or Aging: A dialogue between physician and patient. In 1991, when the 56 year old HIV infected woman first enusualted with the family practice physician who would become her healthcare provider, she was told; “I expect that some time in the future you will schedule an appointment with me, fearful that some symptom is a sign of HIV progression when, in fact, it will only be an indicator of the aging process”. Indeed, for the past 12 years, Jane P. Fowler has frequently talked over medical worries with her doctor, Sharon D. Lee, inquiring if her skin is dry because of HIV or because she is growing older, if her hearing impairment is a result of the virus, or her years.
Inquiries such as these are of great importance to offer women aging with HIV and should also be of interest to care and social service providers who need to understand; especially the concerns and sensitive of their elder female patients and clients.
Dr. Lee, founder and medical director of southwest Boulevard Family Health Care in Kanasas city, KS, will review current literature and data as it relates to older women, and Flower, director of the National HIV wisdom for older women program, will describe how she lives her life as an older woman with HIV and the treatment and care she receives for her physical, emotional health and her adjustment with family.
It is imperative the older infected women have a forum in which to discus their specific concerns about aging with HIV, be it in the privacy of a providers office, in the shared environment of a support group, or in a session at a health conference.
The study by Frances Jackson, Ph.D., R. N. Henry Ford Health System, Detroit, MI (2003). Community addressing adjustment and needs of Hidden communities. The purpose of this was to measure the knowledge of HIV, perception of seriousness and HIV/AIDS susceptibility, and risky behaviours in older African Americans. It was conducted in two phases. Phase one consisted of a mailed survey. In phase two, a focus groups were held, four female and five male. In phase one, 500 participants who met the criteria (African American, age 50 years older, no diagnosis of HIV or dementia) were randomly selected from Henry Ford Health system to participate is a nail survey.
HIV knowledge was measured using the HIV questionnaire (Rose, 1995), which is based on the Health Belief model and is composed susceptibility (7 questions) and risky behaviour (8 questions), adjustment (5 questions) Locus of control (7 questions). 155 (31%) useable questionnaires were returned. The majority of participants were female (69%, n=106) and participants were almost evenly divided among those who had less than a high school education.
This study has implications for future research and planning interventions for older adults. While knowledgeable about HIV, older adults lack understanding about how the virus is transmitted. Inclusion of older African American in studies of HIV/AIDS may e critical to impacting this disease.
In 1999 Samuel Lurie studied Adjusting, “Understand and Addressing needs of Transgender older Adults”. The term ‘transgender’ is now common in HIV prevention and treatment work, but what exactly is the “T” in GLBT? How is transphobia different than homophobia, and why is it important to work against both? This workshop will address issues for members of the Transgender community specific barriers to health care, risks for HIV and sources of pride and how they differ (and overlap) with issue of the Gay, Lesbian and Bisexual communities. Through examining these issues is an interactive format, participants will gain tools to serve and advocate for transgendered people in their communities. The presenter is a transgendered activities and health trainer, committed to addressing these issues these issues in a safe, engaging format. All levels of experience or understanding of transgender issues welcome.
Christopher L. Caleman, Ph.D., ACRN, Richmond, VA (2002) His research on “Determinants of sexual behaviour in HIV infected Black Men Forty and Older”. For more than a decade, AIDS investigators have focused on understanding the epidemiology of HIV transmission among adult and adolescent populations. While the incidence and prevalence of HIV infection among these populations give rise for concern, very little research has addressed transmission of HIV infection in adults 40 and older among whom the number of AIDS cases is steadily rising. Data taken from a national survey reveal that middle aged/elderly individuals admit to high risk behavoiur. The greatest increases in HIV infection in this older age group is occurring highest among minority populations. Because there is a pacikity of research examining the linkage of cognitive process and age for minority populations, the purpose of this on going study is to examine behavioral 10 factors using a modified version of the Health Belief model to determine the relationships between perceived susceptibility, perceived severity, perceived barriers, self efficacy, AIDS knowledge, social support, spirituality, adjustment, locus of control , sexual orientation, relationship status HIV symptoms and sexual behavoiurs, and to determine which factors are associated with unprotected sexual behavoiurs and protected sexual behavoiurs in African American men who are HIV seropositive or have AIDS and are forty and older. This research is being funded by a (K-Award Kozn R08095-01) National Institute of Health/National Institute of Nursing Research. Research methods used are quantitative and model testing.
After reviewing a number of studies pertaining to the preventive measures taken for HIV patients. The present study is designed to study ‘The impact of socio-economic status, locus of control and adjsutmetnal problems of HIV positive patients.
CHAPTER – IV
METHODOLOGY
HIV is currently spreading in the world at the rate of one new infection every fifty seconds. The HIV/AIDS is not confined to any one class, community, religion, age-group, sex or profession, according to the Indian Health Organization (IHO), women and children are believed to be more prone to AIDS (The Hindustan Times, April 7, 2007). The HIV infection is spread over all regions and all groups.
The enormity of the problem, and the concern generated by it globally, can be ganged by the fact that in the last week of January 1988 a historic and unprecedeucted meeting took place in London. It was the world summit of minister of Health from 148 countries along with health experts, the first occasion when a single disease syndrome was discussed at that level. Enough to show the panic situation set in motion by AIDS. The historic London declaration, emerging from the meeting stated “In the absence at present of a vaccine or cure for AIDS, the single most important component of National AIDS programme is information and education.
Above the review of literature it has been showed the history of AIDS. In this reference almost all researcher done research an medicine not the psychological aspect. But this studies conducted so far have focused attention on either socio-economic status or personality traits of HIV +ve patient but the integrative study of “socio-economic status and its relationship with life stress, locus of control and adjustmental problems on HIV +ve patient” has been relatively ignored. Are the personality traits of the HIV +ve patient of low socio-economic status different from those of the HIV +ve patient of high socio economic status?
Given the same opportunity and relatively equal physical endowments why is it that only a few people having the good health, while the majority of HIV +ve patient are suffering from the illness? Is there a difference in their life stress, locus of control , adjustment of people due to varied socio economic status?
Given the same opportunity and relatively equal physical endowments why is it that only a few people having the good health, while the majority of HIV +ve patient are suffering from the illness? Is there a difference in their life stress, locus of control , adjustment of people due to varied socio economic status?
Many research studies in HIV field are from the medicine. But very few psychological field. This studies purely lay stress on HIV +ve patient’s, psychological aspects like socio-economic status, locus of control and adjustmental problems. Each aspects of this study is related to each other.
1) Statement of problem:
Certain environmental and social factors also may put people with serious and persistent mental illness at risk for HIV. For example, the recurrent instutionalisation that is part of living with a mental illness may interrupt long term relationships and reinforce the tendency to have unknown sexual postness. Spending extended periods of time in same sex units in hospital shelters, or prisons may foster same sex activity, which is particularly risky for men, while institutional policies that limit access to condoms may affect patients ability to practice safer sex.
Other social/environmental factors such as homelessness, transient living arrangements, and alienations from supportive social relationships can also increase the risk of acquiring HIV.
Urban or rural HIV patients are often concentrated in inner city, neighbourhoods with high rates of drug abuse, alcoholism, sexuality transmitted diseases, and HIV. In treatment settings of targeted areas, all sexual opportunities are high risk. High rates of unemployment also may contribute to greater risk taking, possibly by increasing the pressure to engage in survival sex or commercial sex work. any support services that help people with severe mental illness maintain stable housing and employment may reduce their risk of acquiring or transmitting HIV.
The main important factors is the socio economic status when the positive HIV people will have high SES then the people will be in good health conditions.
Therefore, if the individual is devised the basic necessities. They cannot cope effectively with the demands of the social environment. Because of socio economic inequality, social interaction, negatives, lack of motivation will definitely have high impact on the positive people live the healthy life. And it is more evident and visible in the Indian context, where in sizeable part of the population is suffering from lot of socio economic and cultural handicaps and the HIV people in India are not exceptions to this phenomenon. Therefore, an attempt is made to study the impact of socio-economic status on the life stress, locus of control , adjustment problems on HIV +ve patient.
2) The objectives of the study
1. To know the significant difference between male and female HIV +ve patients in life stress, locus of control and adjustment.
a. To know whether male HIV +ve patients have low life stress, compare to female HIV +ve patients.
b. To known whether male HIV +ve patients have better adjustment then female HIV +ve patients.
2. To know the significant impact of SES on life stress locus of control and adjustment.
a. To know whether high SES have low life stress than the low SES HIV +ve patients.
b. To know whether high SES have external locus of control compare to low SES.
c. To know whether high SES have better adjustment than the low SES HIV +ve patients.
3. To know the significant difference between rural and urban HIV +ve patients in life stress, locus of control and adjustment.
a. To know whether rural HIV +ve patients have low life stress than the urban HIV +ve patients.
b. To know whether rural HIV +ve patients have external locus of control where as urban have internal locus of control .
c. To know whether rural HIV +ve patients have better adjustment compare to the urban HIV +ve patients.
3) The variables:
1. The socio economic status and sex are independent variables.
2. The dependent variable are
a. Life stress
b. Locus of control
c. Adjustment problems
4) The hypothesis of the study
1. There is significant difference between male and female HIV +ve patients in life stress, locus of control and adjustment.
a. Male HIV/AIDS patients have low life stress, compare to female HIV/AIDS patients.
b. Male HIV +ve patients have external locus of control and female HIV/AIDS patients have internal locus of control .
c. Female HIV/AIDS patients have better adjustment than female HIV/AIDS patients.
2. There is significant impact of SES on life stress, locus of control and adjustment of HIV/AIDS patients.
a. High SES have more life stress than the low SES HIV/AIDS patients.
b. High SES have external locus of control compare to low SES HIV/AIDS patients.
c. Low SES have better adjustment than the low SES HIV/AIDS patients.
3. There is significant difference between rural and urban HIV/AIDS patients in life stress, locus of control and adjustment.
a. Rural HIV/AIDS patients have low life stress than the urban HIV/AIDS patients.
b. Rural HIV/AIDS patients have external locus of control where as urban have internal locus of control .
c. Rural HIV/AIDS patients have better adjustment compare to the urban HIV/AIDS patients.
Methodology
The present investigations pertaining to “The impact of socio economic status on life stress, locus of control , adjustmental problems of HIV +ve patient” is in the frame work of ex-post-facto research. The particulars of samples, tools, collection of data and statistical techniques are given as under:
5) Sample:
The total sample consist of 400 HIV +ve patient belonging to high socio economic status and low socio economic status from Gulbarga, Bidar, Raichur and Belgum District. The age level ranging from 18-45 were selected randomly. The sample design is given below:
Sample design
Sex High socio economic status Low socio economic status Total
Rural Urban Rural Urban
Male 50 50 50 50 200
Female 50 50 50 50 200
Total 100 100 100 100 400
6) Tools:
a) Personal data schedule:
This is framed to collect information regarding the personal and socio demographic status of the sample.
b) Socio economic status scale:
The socio economic status scale developed by Bhardwaj and Chavan (1984) has been used in the present study to measure social, educational, professional and economic perspective of the perspectives of the participants scoring was done according to scoring key given in the manual.
Scoring:
Scoring of the test is very easy and of a quantitative type. Scoring key provides the weight age score for each item. Every alternative of any of the item has only one weighted score which will serve to provide the score if any of the item has only one weighted score which will serve to provide the score if any ticked mark () is present in the horizontal plane for father, mother and case (i.e., the tested). The scoring key is to be placed vertically between the two assigned points on the test. The separate scores for each area then to be totaled vertically. These totals of the scores for each separate area are there after to be put in big boxes provided at the vertical end of each area for father, mother and case.
The same process of scoring has to be followed in respect of each page of the scale. It has to be borne in mind very clearly that there are separate scoring keys for each page of the test and the keys have been numbered accordingly.
Interpretation:
Interpretation of any status or all the nine types of status can be made with the help of t-scores. Categories of any status can be ascertained with the help of manual.
c) Distressful life events scale
Distressful life events scale (DLES) developed by Dr. Kiran Bala Verma and Dr. Madhu Asthana’s has been used in the this study. It measures the positive relationship between successful events and illness onset.
It has been generally assumed that life events influences the onset of disease by means of their emotionally arousal influence of the individual.
This questionnaire consists of form A (Hindi) for male with 50 items.
Form B (Hindi) for female with 54 items.
This subject is asked to mark the events which he/she fell in his/her life and is effected by them on a three point scale. Each items is related on 4 three point scale, 2 marks are given to extremely effected 1 marks to less effected and ‘0’ (Zero) is given to not effected.
The locus of control scale developed by Rampal has been used in the present study. The scoring procedure of the present scale is very simple. One has to give 2 marks to all those items, which are related to external (i.e., to all B statements of items No. 1, 4, 5, 6, 7, 8, 10, 13, 14, 15, 17, 18, 19, 20, 22, 23, 24, 25, 27, 30, 31, 32, 33 and all the A statements of item no. 1, 4, 5, 6, 7, 8, 10, 13, 14, 15, 17, 18, 19, 20, 22, 23, 24, 25, 27, 30, 31, 32, 33 and to all the B statements of items No. 2, 3, 9, 11, 12, 16, 21, 28, 29, 32, 34 and 35). Later one has to add all the scores and makes interpretation of the total obtained scores of the subjects according to interpretation procedure.
d) Adjustment inventory:
The original Bell’s adjustment inventory was in English and for the purpose of standardization in India conditions it was translated in Hindi and English by Dr. (Mrs.) Lalita Sharma. The present inventory consists of 80 items. High score on the inventory indicate low adjustment where as low scores indicate high adjustment in different area of adjustment as well adjustment taken as a whole. Number of items related to each area of adjustment like, home, health, social, and emotional.
Two category of response ‘Yes’ or ‘No.’ been provided for answer to each items.
Collection of data:
To meet the objective of the present study the data was collected at Gulbarga, Bidar, Raichur and Belgum District ICTC and NGOs centers, by personally interviewed the each clients by help of inventory, SES scale, distressful life events scale, locus of control scale and adjustment inventory.
The testing was done in two stages. At the first stage SES scale was administrated to the total 600 respondents to categorize them into the low socio economic groups (200) and high socio economic groups (200), taking the first and third quartile as cut off points respectively.
At the second stage the distressful life events scale, locus of control , adjustment inventory, were administered on the groups of high socio economic status, and low socio economic status. The responses were scored and terminated.
7) Statistical analysis:
Keeping the objectives of the study in view, the following statistical techniques were applied. Mean, SD were calculated the t-test was used to assess the significant differences between SES, Rural/Urban and Gender with dependent variables.
CHAPTER – V
DISCUSSION
Right from the time of birth till the last breath drawn, an individual is invariably exposed to various stressful situations. Thus, it is not surprising that interest in the issue has been rising with advancement of the present century which has been called “Age of Anxiety and Stress”. Stress is a subject which is hard to avoid. The term is discussed not only in our everyday conversations but has become enough of a public issue to attract widespread media attention whether it be radio, television, news papers of magazines, the issue of stress figures everywhere. Different people have different views about it, as stress can be experienced from a variety of sources.
Certain environmental in social factor may lead to stress full experience. Stress is set to be one of the many factors which makes the individual ill both physical and mental. Many acute and chronic disease are the outcome of stressful life situations. Same disease like HIV/AIDS lead the individual to stressful situations. HIV/AIDS is one of the source of life stress experienced by the individual. Life stress is also influenced by SES, gender male, female and area of residing urban/rural. In the present study an attempt has been made to study the life stress of HIV/AIDS patient belonging to different SES different gender and different area of residing. Accordingly data were collected, tabulated of presented in the following tables.
AIDS patients are socially discriminated in every field of life. They are looked down upon with negative attitude and disliked by the society. They are not offend any social status or importance in any situations. They are isolated from all important occasion in the society and left alone without any support from friends and relatives. Even the family members do not accept this infected, person in the family circle. The present and future is fogged with darkness once the patient is diagnosed as HIV/AIDS rest of his /her life is effected. He/she is unable to take any decision due to the stress he/she is facing due to social rejection. The stressful situation effect his health also. The immune which effected by HIV is still more effected by stress. Hence, formulated hypothesis is that HSES HIV/AIDS patients have more life stress than the LSES HIV/AIDS patients.
Table No. 1: Showing mean, SD and t-value of life stress of HSES and
LSES HIV/AIDS patients.
HSES LSES
Mean 8.85 7.94
SD 2.35 2.44
t-value 3.95**
** Significant at 0.01 level
Table No. 1: The mean score of HSES and LSES in life stress is 8.85 and 7.94 and the SD is 2.35 and 2.44 respectively. The calculated t-value is 3.95 which is significant at 0.01 level. It shows that there is significant difference in the life stress of HIV/AIDS patients belonging to HSES and LSES. The hypothesis that there is significant difference between life stress of HSES and LSES is accepted.
HIV/AIDS is one of the dangerous disease. Without any discrimination, whether the infected person is male/female, Rich/poor living in city or village. There are many reasons by which person are infected. The general view about HIV/AIDS infection is by only illegal sexual contact. Due to this they are neglected and socially rejected. There are different views about male and female HIV/AIDS infected. Women is perceived by as a mother of the India. Which has respect and dignity in the some way. If she infected by HIV/AIDS disease, she is refused and rejected. In the sick conditions she is not treated as she supposed to be treated. Due to this condition, she will be forced to live in stressful condition, which leads to anxiety, depression and carelessness.
Hence the hypothesis is formulated that male HIV/AIDS patients have more life stress compare to female HIV/AIDS patients.
Table No. 2: Showing mean, SD and t-value of stress of male/female
HIV/AIDS patients (N=400)
Male Female
Mean 19 17.86
SD 3.37 4.17
t-value 3.00 **
** Significant at 0.01 level
Table No. 2 reflects the difference between the life stress of male and female HIV/AIDS patients. The mean score of life stress of male and female is 19 and 17.86 respectively. Where as the SD is 3.37 and 4.17 respectively. The calculated t-value is 3. Which is significant at 0.01 level. It shows that there is significant difference in the life stress of male and female HIV/AIDS patients. Therefore, the hypothesis that there is significant difference between life stress of male and female is accepted.
People who are living in urban area they are aware of daily way of life. They are socially, culturally, educationally better than the Rural people. Urban people are usually expose to mass media and modern life due to this they lead less stressful life. Comparatively rural people. They are aware of HIV/AIDS and its consequences. Hence, the hypothesis is formulated that rural HIV/AIDS patients have a low life stress than urban HIV/AIDS patient.
Table No. 3: Showing mean, SD and t-value of stress of urban and rural
HIV/AIDS patients (N=400)
Urban Rural
Mean 32.1 33.3
SD 1.18 4.36
t-value 0.45
Table No. 3 shows the mean SD and t-value obtained from the sample. The mean value is 32.1 and 33.3, and SD is 1.18 and 4.36 respectively. The mean score of rural HIV/AIDS patients is more than the urban, which indicates that the rural have more stress than the urban. The t-value is 0.45 is not significant.
People suffering from HIV/AIDS either coming from rural/urban area are aware of different problems. Different problematic situation they may face in their life. Due to this there is no difference between rural/urban HIV/AIDS patients the level of stress.
Graph – 1: Shows, the mean score of the total samples on stress
Locus of control
Locus of control refers to an individuals generalized expectations concerning where control over subsequent events resides. In other words, who or what is responsible for what happens. It is analogous to, but distinct from, attributions.
Some research (Mc, Combs, 1991) suggests that what underlies the internal locus of control is the concept of “self as agent”. This means that our thoughts control our actions and that when we realize this executive functions of thinking we can positively affect our beliefs, motivations and academic performance.
There is no human being without committing a mistake but many of us don’t accept the mistakes but try to give reasons ourselves by holding others as responsible for the mistakes done by us. Economic status of a man makes him to feel or express goodness of ourselves they solder the responsibility of their conditions. Where as people belonging to LSES solder the responsibility on god or other person responsible for their sufferings. Hence, the formulated hypothesis is that high SES have external locus of control compare to low SES HIV/AIDS patients.
Table No. 4: Showing mean, SD and t-value of Locus of control of high
and low SES HIV/AIDS patients (N=400)
HSES LSES
Mean 48.18 54.58
SD 4.87 3.36
t-value 1.04
Table No. 4 shows the mean, SD and t-value obtained form the sample. The mean value and SD of HSES and LSES on locus of control and 48.18 and 54.58 and SD is 4.87 and 3.36 is respectively. The mean score of LSES is greater than the high SES. But t-value 1.04 is not significant. Hence, there is no significant difference between the high and low SES HIV/AIDS patient in locus of control .
Socio-economic status do not influence the locus of control of HIV/AIDS patients. Both high and low SES patients have external locus of control because they never accept there mistake which is responsible for HIV/AIDS infected.
Neither male nor female HIV/AIDS patients take upt the responsibility that it was the mistake. Due to which they are suffering from HIV/AIDS. Accordingly, they feel that other people are responsible for infection.
Hence, the formulated hypothesis is that male HIV/AIDS patients have external locus of control and female HIV/AIDS patients have internal locus of control.
Table No. 5: Showing mean SD and t-value of locus of control of male and
female HIV/AIDS patients (N=400)
Male Female
Mean 33.66 31.3
SD 4.36 5.96
t-value 4.50**
** Significant at 0.01 level
Table No. 5 shows the mean, SD and t-value obtained from the sample. The mean value of locus of control of male is 33.66 and that of female is 31.3 and SD is 4.36 and 5.96 respectively. The t-value is 4.50 it is significant at 0.01 level. This shows, there is significant difference between the male and female HIV/AIDS patient in locus of control.
Therefore, the hypothesis that there is significant difference between locus of control of male and female.
Awareness of HIV/AIDS in urban/rural areas make people to protect themselves from this life killing disease. Irresponsibility and unfaithful towards ones spouse may rest in the attack of unavoidable HIV/AIDS disease. Many people aware of causes of AIDS they never agree or accept that they are responsible for the acquired HIV/AIDS. No person accept the reality and truth that it is their mistake for the suffering.
Hence, the formulated hypothesis is rural HIV/AIDS patients have external locus of control were as urban have internal locus of control.
Table No. 6: Showing mean, SD and t-value of locus of control of urban
and rural HIV/AIDS patient (N=400)
Urban Rural
Mean 27 26.7
SD 3.50 3.80
t-value 0.87
Table No. 6 shows, mean scores, of urban and rural is 27 and 26.7 and SD is 3.50 and 3.80. The calculated t-value is 0.87 which is not significant. This indicate that there is no significant difference in the locus of control of urban and rural HIV/AIDS patients.
People residing in urban/rural area do not differ in the reasons. They accept the cause and affect of HIV/AIDS is from external agent only.
Graph 2: The mean score to total samples on LOC
Adjustment
Adjusting with a AIDS patient is an on going process in which the patient learns to cope with emotional and HIV related problems and gain control over related life events. AIDS patients are facing many challenges its treatments. Common challenges includes hearing the diagnosis, receiving treatment (For example, ART). Completing treatment, hearing that the concerns is in remission, hearing that to come back and becoming a HIV/AIDS survivor. Each of these events involves specific coping the questions about life and death and common emotional problems.
Patients are better able to adjust to a HIV/AIDS diagnosis if they are able to continue fulfilling the responsibility, cope with emotional distress and stay actively involved in activities that are the important to them.
Coping is the use of thoughts and behaviour to adjust to life situations. A persons coping with stress related to his or her personality (for example, always expecting the best, always expecting the shy or reserved or being outgoing).
The man is social animal, without society cannot survive. We are bounded with so many rules and regulation of the society. He/She should follow the norms of the society. All our liking and disliking wants and needs are to be satisfied under social conditions. It is very difficult to survive with breaking the rules of the society. In one or the other way HIV/AIDS patients violated the social norms and invited suffering for long live life.
Socioeconomic status influence on the adjustment and leads to live in different way. Hence, the formulated hypothesis is that low SES have better adjustment than the high SES HIV/AIDS patients.
Table No. 7: Showing mean , SD and t-value of adjustment of high and low
SES HIV/AIDS patients (N=400)
HSES LSES
Mean 82.57 70.57
SD 65.97 10.29
t-value 2.53*
* Significant at 0.05 level
Table No. 7. The mean score is 82.57 and 70.57 and SD is 65.97 and 10.29 respectively. The t-value is 2.53 indicates significant difference at 0.05 level of significant. The above scores explain the facts that there is significant difference between the adjustment level of HSES and LSES HIV/AIDS patients.
Therefore, the hypothesis is accepted.
Men dominated society has restricted the women within the four walls. She has been not allowed to interact with others easily. She has been deprived by her rights of education, socialization due to this conduces environment. She is not aware of her own way of life. She has been appreciated, respected in the place of mother India. But natural facilities not extended to her naturally. Therefore, she is made ignorant and not brought on the main strains. She has been not made awarded of HIV/AIDS replication on her life and family. Hence, she is facing so many problems. Simply compromising with system.
Hence, formulated hypothesis is female HIV/AIDS patients have better adjustment than the male HIV/AIDS patients.
Table No. 8: Showing mean, SD and t-value of adjustment of male and
female HIV/AIDS patients.
Male Female
Mean 32.64 29.63
SD 4.49 5.67
t-value 11.53**
** Significant at 0.01 level
The table reveals the mean score of male and female patient is 32.64 and 29.63 and SD is 4.49 and 5.67 respectively. The high mean score of male patient indicates the fact that, the male patients are having better adjustment than the female, patient. The obtained t-value is 11.53 it is significant at 0.01 level. Therefore, the hypothesis that there is significant difference between adjustment of male and female is accepted.
Awareness of HIV/AIDS either in Rural/Urban area makes the individuals to cope with this problem successfully. HIV infected has to make many adjustment in their social life.
Hence, formulated hypothesis is Urban HIV/AIDS patients have better adjustment compare to the Rural HIV/AIDS patients.
Table No. 9: Showing mean, SD and t-value of adjustment of urban and
rural HIV/AIDS patients (N=400).
Urban Rural
Mean 35.63 39.56
SD 7.43 5.70
t-value 8.93 **
** Significant at 0.01 level
The table No. 9 shows, mean SD and t-value of adjustment of urban and rural HIV/AIDS patients. It can be seen from the above table that, the mean scores urban and rural patients is 35.66 and 39.56 respectively. The high mean score of rural patients indicates that, the rural patients are adjustable than the urban patients. The obtained t-value is 8.93 which is significant at 0.01 level. Therefore, the hypothesis that, the rural HIV positive patients have better adjustment compare to the urban HIV/AIDS patients, accepted.
HIV/AIDS urban patients are comparatively better adjusted to the social situation in their life. The urban dwellers are not worried about others and won’t interfare in the personal life of other’s. Due to which the urban HIV/AIDS patients do not worry about the social status and adjust properly were as the rural atmosphere makes people to take keen interest in the personal matters of each and every person.
Graph 3: Shows the mean score of total samples of on adjustment
CHAPTER – VI
SUMMARY AND CONCLUSION
1. There is significant difference in the life stress of High Socio Economic Status and Low Socio Economic Status HIV/AIDS patients. High Socio Economic Status HIV/AIDS patients have high life stress compare to Low Socio Economic Status HIV/AIDS patients.
2. There is significant difference in the life stress of male and female HIV/AIDS patients. Male HIV/AIDS patients have high life stress compare to female HIV/AIDS patients.
3. There is no significant difference in the life stress of urban and rural HIV/AIDS patients.
4. There is no significant difference in the Locus of Control of High Socio Economic Status and Low Socio Economic Status HIV/AIDS patients.
5. There is significant difference between the male and female HIV/AIDS patients in Locus of Control.
6. There is no significant difference in the Locus of Control of urban and rural HIV/AIDS patients.
7. There is significant difference in the adjustment of High Socio Economic Status and Low Socio Economic Status HIV/AIDS patients. Low Socio Economic Status HIV/AIDS patients have better adjustment than High Socio Economic Status HIV/AIDS patients.
8. There is significant difference between adjustment of male and female HIV/AIDS patients. Female HIV/AIDS patient have better adjustment than female HIV/AIDS patients.
9. There is significant difference between adjustment of urban and rural HIV/AIDS patients. Rural HIV/AIDS patients have better adjustment compare to the urban HIV/AIDS patients.
CHAPTER – VII
BIBLIOGRAPHY
1. Alan E. Kazden (1998). Encyclopedia of psychology, Oxford University Press, Volume 7, 247-251, 373-375.
2. Allers, C. T. (1990). AIDS and the older adult. The Gerontologist, 30, 405-407.
3. Bandra Griffin (1998). Sober Sex: New York Publications 32-48.
4. Bell, N. K. (1989). Women and AIDS: Too little; too late? Hypatia, 4(3), 3-22.
5. Benjamin, B. Lahey (1998). Psychology an introduction. Tata McGraw Hill Publication, New Delhi, 210.
6. Benson, H. (1975). The relaxation response, Morrow, New York, 128.
7. Berestord, L. (2006). Alternative, out patient settings of care for people with AIDS. Quarterly Review Bulletin, 15, 9-16.
8. Cohen, S., Wills, T. A. (1985). Stress, Social support and the buffering hypothesis, psychoball publications 310-357.
9. Ehrenreich, Barbara (1989). Fear of falling, the inner life of the middle class, New York, NY: Harper Collins: 19-22.
10. Eileen, E. (2003). Approaches for Health professionals carrying for HIV infected older adults. Mount pleasant Press, 92-95.
11. Fletcher and J. Fitness (1996). Knowledge structures in close relationships. A social psychological approach. Lawrence Erlbaum Press, 183-192.
12. Government of Karnataka, Department of Health and Family Welfare, Participants Manual June 2004, 47-56.
13. Hans, T. (2000). A meta analysis of the effect of adventure programming on locus of control . Journal of contemporary psychotherapy, 30(1), 33-60.
14. Hattie, J. A., Marsh, H. W., Neil, J. J. and Richards, G. E. (1997). Adventure education and outward bound: Put of class experiences that have a lasting effect. Review of Educational Research 67, 43-87.
15. Heagurty, M. C. and Abrams, E. J. (1992). Caring for HIV infected women and children. The New England Journal of Medicine, 326, 887-888.
16. Indian Journal of Psychology 2005(1): 101-105.
17. Karl Goodkin, M. D. (2000). Aging and Neuro – AIDS conditions. Coral Gables Press. 22-25.
18. Kuppaswamy, B. I. (1962). SES (urban) Delhi Mansayan, 3-4.
19. Lazarus, R. S. and Folkman’s (1984). Stress, appraisal and coping, New York, Springer Publications, 138.
20. Leveson, H. (1973). Multidimensional locus of control in psychiatric patients. Journal of consulting and clinical psychology, 41, 397-404.
21. Lynch, Shirley, Hurford, David, P. and Cole Amykay (2002). Parental enabling attitudes and locus of control of at risk and honors students. Adolescence, 37 (147): 527-549.
22. MacWilliam, L. (2005), A population based Health information system, med care publication 313-318.
23. Mamlin, N., Harris, K. R., Case, L. P. (2001). A methodological analysis of Research on Locus of control and Learning Disabilities; Rethinking a common assumption. Journal of special education, Winter, 48-89.
24. Marsh, H. W. and Richards, G. E. (1986). The Rotter locus of control scale: The comparison of alternative responses formats and implications for reliability, validity and dimensionality journal.
25. Mayer, Richard E. (2002). The promise of emotional psychology, Pearson educations, New Jersey, 28-30.
26. Mearns, Jack (2004). The social learning, theory of Julian Rotter, New York, Plenum Press.
27. Michael Marmot (2004). Status Anxiety, Hamish Hamilton Press, 245-269.
28. Neill, J. T. (2005). Locus of control a class tutorial.
29. Nelkin, D. (2006). AIDS and the new media. The Milbank Quarterly, 69, 293-307.
30. Peslonji, D. M. (1999). Stress and coping, SAGE publication New Delhi, Second Edition, 15-17, 35-42.
31. Pradeepkumar Joshi, (2004). Social development and social welfare. Anmol publication Pvt. Ltd., New Delhi, 284-293.
32. Project Report, Freedom Foundation Bellary (2005) 14-15.
33. Rahadkar, W. B. (1960). A scale for measuring SES of Indian form families. Agril. Coll. Mag. Publication, 34-37.
34. Reamer, F. G. (1991). AIDS and ethics. New York: Columbia University Press, 128-130.
35. Roller, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological monographs, 80.
36. Roos, N. P., Black, C. (1995). A study on high SES people in mumbaicity. Shiva Sena Publications 82-109.
37. Rotter, J. (1966). Generalized expectancies for internal versus external control of reinforcements. Psychological monographs, 80, whole No. 609.
38. Shaver, P. R., Collins, N. and Clark, C. L. (1996). Attachment styles and internal working models of self and relationship partners Harward Press. 122-125.
39. Shirpurkar, G. R. I. (1967). Construction and Standardization of a scale for measuring status for form families. Indian J. Extn. Edu. 16-24.
40. Simpson, J., Rholes, W. R. and Nelligan, J. S. (1992). Support seeking and support giving within couples in an anxiety provoking situation. The role of attachment styles, Journal of personality and social psychology, Vol. 62 No. 3, 434-446.
41. Singh, Y. (1984). Image of man: Theory and ideology in Indian Sociology, Delhi: Chanukya Publication 132-141.
42. Srinivas, M. N. (2006). The development of Sociology and social anthropology in India, sociological bulletin Vol. 73, No. 8, (Sept.) 170-89.
43. Swamys hand book: Chennai, Swamy Publishers (P) Ltd., (2004).
44. Theielker, V. et al. (2004). The relationship between positive reinforcement and locus of control .
45. Thompson, William, Joseph Hickey (2005). Society in Focus, Boston, M. A., Pearson, 205-313.
46. Tiwari, S. C., Aditya Kumar (2004). Development and standardization of a scale to measure SES in urban and rural communities in India. King George publications, 309-311.
47. Vanneman, Reeve, Lynn Weber Canon (1988). The American perception class. New York, NY: Temple University Press, 92-103.
48. Verma, Pelto, Sehensul and Joshi (2004). Sexuality in the time of AIDS. SAGE publications, New Delhi, 20-22.
49. Wallston, K. A. Wallston, B. Sc. And Devellis, R. (1978). Development of the multidimensional Health Locus of control (MHLC) Health Education Monographs, 6: 160-170.
50. Weiner, B. (1974). Achievement of motivation and attribution theory, Morristown, N. J. General Learning Press.
51. Weiner, B. (1980). Human motivation. N. Y: Holt, Rinchart and Winston.
52. Weiss, R. (1982). Attachment in adult life, Tavistock publications, London, 133-145.
No comments:
Post a Comment