Marital
Adjustment, Depression, Anxiety and Stress among HIV working and non-working
married women.
(ii) Introduction :HIV/AIDS affects
the economic well-being of families, businesses, and societies in many ways.
When people become ill and die, society loses not only those people but also
their productive potential. They no longer hold jobs, manufacture goods,
provide services, or support their families. Families lose their breadwinners;
the nation loses people who contribute to the well-being of society.
As families use their time and money
to care for ill members, their energies and diverted from working to provide
income or farming to provide food. Not only the present but also the future is
affected, as family members discontinue education because of the financial
needs of the family. Even burying the dead makes life more difficult for
families and society. Funerals are costly, and people miss days from work to
attend the rituals. The epidemic’s high death toll is producing cultural
changes. In some communities with high rates of HIV infection, cemeteries have
become overcrowded, creating pressure to accept practices not previously
sanctioned by religious and cultural authorities, such as cremation. Funerals
are a visible, potentially numbing reminder to all that a deadly disease threatens
their survival.
HIV threatens workplace productivity
because of deaths, absenteeism due to illness and funeral attendance, and lower
productivity of sick or newly hired replacement workers. Other increased costs
to the business sector include expenses for insurance and medical care for sick
employees, which must be weighed against the cost of having to train new
employees if more experienced employees become sick because of inadequate
health care.
At the societal level, economic
growth in many nations is lagging because so many skilled and experienced
workers have dies of AIDS. High unemployment and high rates of infection to
keep social supports intact. Studies of teachers and health care workers, for
example, indicate that many in those professions have been infected with HIV.
Society faces the challenges of having many of its productive members sick or
dying, leaving few people to care for children and the elderly. In many
countries, the number of people affected by HIV/AIDS is overburdening health
care and social support resources.
The effect of HIV /AIDS on broader
indicators for development, such as life expectancy, has been profound. In the
1950s, a child born in southern Africa had a life expectancy of 44 years. By the early 1990s, that figure
has risen to almost 60 years. But life expectancy is expected to drop to 45
years between 2005 and 2010 because of the toll that AIDS has taken. Poor
households are being pushed deeper into poverty. The effects of the AIDs
epidemic will be felt for generations, because so many children are being
deprived of adequate nurturing, nutrition, education, and good role
models.
Psychological
Effects of HIV on the Family
HIV affects the whole family, not
only the infected individual. When one member of a family has HIV, often there
are others who are as yet undiagnosed. When HIV infects one partner in a
relationship, both partners are affected. The infection may indicate that sex
or other risk behavior has occurred outside the relationship, but even if the
infection predated the relationship, both partners will be involved in the
emotional trauma of the discovery. Ideally, the couple should openly discuss
sensitive matters such as condom use, sexual fidelity, and childbearing. This
step does not always happen. Regardless of his or her own risk behavior, the
undiagnosed partner may express anger and violence toward the person who has
been diagnosed. The diagnosis of HIV infection in a child usually indicates the
presence of the virus in the mother. The father and other siblings may carry
the infection as well.
Cultural, social, biological, and
economic pressures make women more vulnerable to HIV infection than men. In
some areas, the high prevalence of rape puts some women at risk of acquiring
HIV. In others, older men who may be infected with HIV pressure teenagers into
sexual relationships. Women are often economically dependent on men and unable
to negotiate safer-sex practices, including condom use. Women are usually the
primary caregivers for their families and may have little support from others
when they are ill themselves. As more people receive care for HIV/AIDS in their
own homes or the homes of others, health care workers must keep in mind that
HIV-infected women are likely to care for everyone else in the family, often to
the detriment of the women’s own health. Households led by women also face
greater economic difficulties and have fewer supports.
Strengthening the family structure is
especially important because of the tremendous stress that HIV puts on family
systems. Besides caring for ill relatives and for orphans, families are often
beset by economic and social problems as well as the grief that accompanies the
loss of family and friends. They may benefit from group or family counseling, including
counseling about their desire to have a family, perhaps the need to prevent
unwanted pregnancies, and negotiation or risk = reduction practices such as
condom use. Individuals may need training in assertiveness and how to
communicate their needs. Remember also the more basic needs that the family is
facing food, shelter, and dwindling finances.
One of the most important
relationship between a man and women is marriage. It involves emotional and
legal commitment that is quite important in any adult life. Moreover, selecting
a partner and entering into a marital contact is considered both maturational
milestone and personal achievement. There is no doubt that the choice of
marital partner is one of the most important decisions one makes in his/her life
time. People marry for many reasons, like; love, happiness, companionship and
the desire to have children, physical attraction, or desire to escape from an
unhappy situation. Marriage is a commitment with love and responsibility for
peace, happiness and development of strong family relationships. Marriage as
socially legitimate sexual union, begun with a public announcement and
undertaken with some ideas of permanence; it is assumed with more a less
explicit marriage contract, which spells out the reciprocal rights and
obligations between the spouses and future children.
Marital adjustment is the state in
which there is an overall feeling in husband and wife of happiness and
satisfaction with their marriage and with each other. All the marriages are aimed
at happiness. In one or another way most
couples marry filled up with expectations. Some of the expectations will be
realistic while others unrealistic. This is due to the complex as a universe.
Therefore, is marriage two universes close together. Marital adjustment calls
for maturity that accepts and understands growth and development in the spouse.
If this growth is not experienced and realized fully, death of marital
relationship is inevitable. A relationship between couples is not instantaneous
rather a slow progress. It is like the undetected cancer that kills silently
and softly.
Husbands and wives have indicated
some of the factors that contributed to marital satisfaction. Some of their
findings revealed existing social, cultural, educational level as related with
greater satisfaction. Occupation and income, which are often thought to be
associated with levels of satisfaction, have no relationship with it. The
number of children too affects marital satisfaction. There is evidence that the
pressure of managing multiple roles in women are the greatest, and the
psychological benefits of employment are the least, under conditions of heavy
family responsibilities that is, when young children are at home. But beyond
specific factors such as these, what is important to martial satisfaction over
the course of marriage is the ability of partner to adjust to a variety of
changes and to cope with a number of stresses.
HIV infected spouses suffering from
severe stress blame the deteriorating relationships on their spouses. Looking at the growing rate of divorces,
court cases for alimony, physical abuses and single parents; it does seem as if
handling a relationship can be a tricky and often taxing issue. The possible
causes can be endless. More often than not, stress arising from marital
relationships is manifested in chronic disorders such as depression, anxiety,
insomnia and hypertension. Since a relationship depends on the nature of the
persons involved, it helps to seek the middle path when the inherent individual
differences surface. It often helps to change one’s attitude go for counseling
or talk openly with your spouse’s about problems facing your relationship.
Depression in a spouse is an issue
that most HIV couples will face at some point in their marriage. Depression is
a normal & natural response to loss or grief, whether a death, separation
from a loved one, job loss, loss of physical health or relocation. Marital
distress and relationship conflict also contribute to depression.
Symptoms of depression include
feelings of sadness, hopelessness, helplessness, anxiety, irritability,
agitation, fatigue, low energy, and reduced activity level are common and there
is also withdrawal from social contact and loss of interest in previously
enjoyed activities, including sex. There may be changes in appetite, weight or
sleep patterns, memory problems or difficulty concentrating often there are
feelings of worthlessness or inadequacy and a lowered sense of self-esteem. In
more serious cases there may be suicidal thoughts or a feeling that life is not
worth living (comer, 1996). Married women have higher rates of depression than
unmarried women, but the reverse is true for men. Marriage seems to confer a
greater protective advantage on men than women.
• Origin of the research problem:
Psychosocial aspects of HIV patients
have been studied extensively throughout the fast few years. Many researches
have contributed to increase psychological and social adjustments of HIV
patients. Current investigation is based on these researches and the increasing
need of methods of psychosocial adjustments of HIV patients.
• Interdisciplinary relevance:
Better psychosocial adjustments of
HIV patients will further help Medical Science, Anthropology, Sociology and
Biology.
• Review of Research and
Development in the Subject :
Happily married people have been
found to be healthier than unmarried people or unhappily married people, consistently over a number of separate
researches (Kiecolt-Glaser and Newton, 2001). Marital functioning is central to
mental as well as physical health, including autonomic, endocrine and immune
systems (Whisman, 1999). Periodontal disease, rheumatoid arthritis, cardiovascular function, blood pressure,
behavioural symptoms of neurological disorders are examples of biological
diseases that are affected by marital relationship. Better sleep, fewer
depressive symptoms also characterize satisfied married couples (Prigerson et
al.,1999).
However, these benefits are stronger
for men and not so for women. In satisfied marital relationships, men and women
are equally benefitting in health measures but in dissatisfied marriages the
women manifested more physical and mental health problems, including depression
(Sullivan et al.,1994). The underlying mechanism contributing to women’s
greater responsivity to marital distress may be explained by relational
self-representations, communion trait and role differences (Cross and Madson,
1997a). Bird (1999) reports that the role inequalities and family
responsibilities faced by working women at home contributes to depression, high
blood pressure, higher levels of cortisol and norepinephrine.
Women who are living with HIV are particularly vulnerable since
they are faced with specific problems. They often feel lonely and experience
shame, stigma, anxiety, depression and feelings of uncertainty and, in
addition, are challenged in their roles as caregivers, mothers and wives (Chung
and Magraw 1992). Lack of emotional, financial and social support, poverty, low
level of education also compounds the problem (Mello et al., 2010). Leserman
(2008)found substantial and
consistent evidence that chronic depression, stressful events, and trauma may
negatively affect HIV disease progression. Jones et al. indicated that family
stressors predicted deterioration in health of women with HIV.
Significance of the study:
To improve the quality of life of women living with HIV it is
important to understand the depression, anxiety, stress, marital adjustment,
and working/non-working status and plan suitable interventions in the light of
the findings.
·
(iii) Objectives
- To study
the level of marital adjustment among working and non-working married
women with HIV.
- To study
the level of depression anxiety and stress among working and non working
married women with HIV.
·
(iv) Methodology & Plan of Work:
Sample
: The sample of 150 HIV infected married women (75 working and 75
non-working) will be taken for this study from Karnataka and Punjab. Working
women would be counselors, peer educators and Nurses. Convenient random
sampling will used for this study.
Tools
:
Marital adjustment Inventory (MAI) (1987) by Dr. Harmohan Singh
(1987) self-reported inventory of marital adjustment is consisting A-10 &
B-10 Items.
The coefficient of reliability for
each of the six professions of the inventory and for general population are 94.
There were determined for correcting the odd-even terms and applying the
spearman Brown-prophecy formula.
Depression
Anxiety stress scale by Lovibond (DASS) (1995)
Internal consistency reliability
coefficients for DASS-42 items, depression, anxiety stress subscales and full
scale were found to be high with cronbach’s alphas of .89, .85, .81
and .95 respectively. For DASS-21, these values were .79, .71, .76 and .89.
Statistical analyses
Appropriate statistical analyses will be done to explain the
relationship between the variables under study.
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