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HIV/AIDS
and the human psyche
Science
in Africa
January 2005
http://www.scienceinafrica.co.za/2005/january/hivpsyche.htm
Do men and women
react differently when they are diagnosed with HIV/ AIDS? The answers
to these questions raise important implications for health care workers.
While much research
focuses on the psychological implications of being diagnosed with HIV/
AIDS, very little research has been done on the role of gender. Do men
and women differ in their response to the diagnosis? And if they differ,
what does that tell us?
This question was
investigated by Dr Ben Olley, who was the recipient of last year's prestigious
Africa Research Fellowship. He performed his work in Prof. Dan Stein's
Anxiety and Stress Disorders Research Unit at the Medical School of the
University of Stellenbosch and has since then returned to his home country,
Nigeria.
Dr Soraya Seedat,
a co-investigator on the project, says HIV/ AIDS is usually associated
with high rates of psychiatric and emotional problems, in addition to
its negative social impact. Research has found that these problems contribute
to people not sticking to their drug regimens. It can even speed up the
progression of the disease and hasten the death of a patient.
"Most of the existing
research has been conducted in the developed world and very little or
no gender differences have been reported. However, women in the developing
world generally face more stigmatization and suffer more negative life
events than men, leading us to suspect that being diagnosed HIV-positive
could lead to more psychological problems among women," she explains.
Gender divide
The study team
assessed 149 newly diagnosed HIV/ AIDS patients (44 male and 105 female)
attending an infectious diseases clinic at the Tygerberg Hospital. The team
used well-known psychiatric questionnaires to assess the patients. The most
frequent diagnosis was depression (34,9%) followed by dysthymic disorder
(21,5%) (see box for an explanation of this disorder).
Interestingly, there
was no difference between the rates of depression in the two genders.
"This differs from our studies done in HIVnegative populations, where
women are at least twice more likely to develop depression," says Dr Seedat.
This is where the similarity between the men and women ended. The researchers
found that the women were more likely to suffer from post-traumatic stress
disorder (PTSD), while the male patients were significantly more likely
to abuse alcohol and have risky sex.
"We're not sure why
women more frequently develop PTSD. Hormonal and neurodevelopmental factors
may play a role but there isn't enough evidence to allow us to draw any
conclusions," she explains.
Why are men more likely
to abuse alcohol and have risky sex? "In our experience, men are more
likely to 'externalise' their distress. An interesting possibility is
that they could have been infected with HIV as a result of their alcohol
abuse.
Another possibility
is that they could use alcohol as a coping mechanism after becoming HIV-positive
- almost 'self-medicating', says Dr Seedat.
Implications for health
Dr Seedat says
HIV-positive women are a high-risk population for developing depression.
Studies by other researchers concluded that HIV-positive women are four
times as likely as HIV-negative women to develop depression.
"So much focus is
given to the physical aspects of the disease, but I really believe that
a mental health evaluation should form part of the general health assessment
of the HIV-positive patient.
"Although more careful
evaluation is needed, our results suggest that maybe our approach to treatment
needs to be different for men than for women.
"Women have a hormonal
cycle that may influence their response to medication - this includes
medication for physical and mental health problems," Dr Seedat says. -
[MRC News]
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