Protective factors after hiv diagnosis by Mi Echanis Melgar

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  • 1. ProtectiveFactors after HIVDiagnosisMaria Isabel E. Melgar, PhDAteneo de Manila University Psychology Dept.Quezon City, Philippines
  • 2. • Brief background and introduction• Problem statements• Methods• Results• Analysis• RecommendationsOverview
  • 3. • What are the protective factors that prevent Filipino people living with HIV from committing suicide?• What are the coping mechanisms utilized by PLHIV respondents to deal with this disease and the percieved efficacy to use various coping strategies?• What are the implications of these findings on the psychological counseling of PLHIV?Problem Statements
  • 4. • Completed or successful suicides• Suicidal ideation (thoughts)• Attempted suicide (non-fatal suicidal behaviour)Risk of Suicidality(Cooperman & Simon, 2005)
  • 5. • Philippines has one of the lowest rates of suicide in the world compared to Asian neighbors.• 2.5 per 100,000 men; 1.7 per 100,000 women (WHO, 2003)• Over 7,200 PLHIV (July stat 56% higher than last year). Unrecorded: 4 suicidesBackground
  • 6. (Komiti et.al.; Roy, 2003) • Persons with HIV have much higher suicide rates than the general population & those with other life threatening illnesses • Women with HIV are more likely to commit suicideReview of RelatedLiterature
  • 7. • ( Komit, et al, 2001) Found no consensus about association between suicidalideation and being HIV seropositive. Psychologicalvariables such as current stressors, unemployement, pooradaptation, hopelessness, neuroticism and low socialsupport are important drivers.
  • 8. • HIV status may not be the most relevant factor related to suicide but other suicide risk factors play a role • Previous psychiatric history
  • 9. • Substance abuse • Physical and sexual abuse • Unemployment • Financial difficulties • Social isolationPredictors
  • 10. HIV positive individuals are most vulnerable during the first 12 months after diagnosisMy observation
  • 11. Over time, HIV-positive people are able to find more adaptive ways of coping than suicidal thoughts or behaviour. - Those with AIDS have less suicide ideation.
  • 12. • RITM (1984-2000): no successful suicide but moderately high prevalence of suicide ideation• Overall, prevalence of depression is high. However, formal screening for depression and suicide ideation is not part of the protocol.
  • 13. • PLHIV’s Reasons for living• PLHIV’s coping efficacy and actual strategiesFocus of the Study
  • 14. • Survey (96 PLHIV respondents)• Interviews with key informants (6 interviewees)• FGDs (3 groups)Mixed Methods
  • 15. Protective beliefs are concerned with the meanings an individual assigns one’s self, one’s environment and one’s future (Beck, 1976; Ellis, 1962)Definition
  • 16. Protective Beliefs• Survival and coping• Responsibility to family• Responsibility to friends• Child- related concerns• Moral obligation• Fear of social disapproval• Fear of suicideLinehan et.al. 1983
  • 17. Respondents: 96 HIV- Positive RespondentsResidence: Six Provincial sitesAge Range: 18- 60 Years old Mean: 33.15 years (SD = 8.55)Duration of diagnosis: 1 month to 21.7 years Mean duration: 44. 84 months The Survey
  • 18. Gender: 67 males (69.8%) 29 females (42%)Sexual Orientation: 21 % - homosexual 29 % - bisexualChildren: 31 % - with childrenProfile
  • 19. Religion: 74 % were Roman CatholicEducation: 46 % earned a Bachelor’s degreeProfile
  • 20. • Instruments: • Self-esteem (Rosenberg) • Coping Self Efficacy (Chesney, Folkman & Taylor) • Filipino Reasons for Living (Lorenzo)Demographic Profile FormHealth QuestionnaireConsent FormInstruments
  • 21. Table 6. PLHIV Psychological Characteristics N Minimum Maximum Mean SDSelf Esteem 96 13.00 30.00 20.34 3.99Coping Self-Efficacy 95 125.00 260.00 200.21 32.71Reason For Living 95 89.00 162.00 149.54 13.52 Results
  • 22. Factor 1 Strong relationship with GodFactor 2 Support from Family Dimensions of Reasons for Living (Factor Analysis of 27 items)
  • 23. 1. Praying to God2. Making new friends3. Standing firm and fighting for what they want.4. Engaging in positive talk5. Doing something positive when discouraged6. Getting support from the familyTop Coping Efficacy Items
  • 24. Positive correlation between Coping Efficacy and Reasons for Living
  • 25. Interviews and FGDs
  • 26. “The peer support group.”“Pinoy Plus is my family.”“Persistence of my support group.”“Peer counseling.”“Religion can be destructive too whenpeople start to tell that you were punishedby God.”What helped you copewhen first diagnosed?
  • 27. “Outreach, helping fellow PLHIV.”“A job.”“Support of family.”“My advocacy.”“www.pinoylifeguide.org”What is helping now?
  • 28. Faith in God Peer Support Group Family Active Support CopingSummary: ProtectiveFactors
  • 29. The Context
  • 30. Parents 60.4 %Friends 52.1 %Health Care 52.1 %ProvidersChildren 40 %Partners 43.8 %Siblings 41.7 %Who knows about yourstatus?
  • 31. Access to health and social services among PLHIVrespondents n %ARV 74 77.1Peer counseling 73 76.0Information and education 62 64.6 Results
  • 32. Technology access among PLHIV respondents n %Cellphone 91 94.8Internet 71 74.0Computer 43 44.8 Results
  • 33. Table 3. Social networking sites used by PLHIVrespondents n %Facebook 78 81.2Twitter 30 31.2Myspace 7 7.3Multiply 5 5.2 Results
  • 34. a. High technology accessb. Moderately high access to peer counselingc. Moderately high access to ARVd. Adequately educated on HIVContext: Profile
  • 35. PLHIV Adaptive Beliefs Rational ConstructiveAssessment of Copingone’s resources
  • 36. GodFace to face and Peer Support Hi- Tech GroupCommunication Family
  • 37. Supportive Relationships Stigma of HIVLife after HIV
  • 38. • Relationships and Connectedness• Being loved• Purpose and meaningWhy live?
  • 39. • This is an exploratory study. More research on: -prevalence of suicide ideation; suicide attempts;successful suicide across stages of HIV - psychological autopsy and case studies - relationship between stigma and suicide - risk factors for suicide - in-depth study of coping mechanisms - spirituality and suicide behavior - psychological preventive interventions.Recommendations
  • 40. Maraming Salamat Po!