1. Lecture 8 Chronic Illness and AIDS
Health Psychology
Lecture 8
Chronic Illness and AIDS

2. Lecture 8 - Outline Part 1 Part 2 Part 3 Living with chronic illness
AIDS
Part 3
Male Circumcision

3. What is the difference between acute and chronic illness?
Acute Chronic
Onset abrupt usually graduated
Duration limited lengthy, indefinite
Cause single multiple, changes
Diagnosis usually accurate often uncertain
Prognosis usually accurate often uncertain
Intervention usually effective often indecisive
Outcome cure no cure
Uncertainty minimal pervasive
Knowledge professionals complementary

4. The context of chronic illness
With chronic disease, the patient’s life is irreversibly changed. Neither disease nor its consequences are static.
They interact to created illness patterns requiring continuous and complex management. Furthermore, variations in patterns of illness ands treatments with uncertain outcomes creates uncertainty about prognosis. The key to effective management is understanding the different trends in the illness patterns and their pace. The goal is not cure but maintenance of pleasurable and independent living
(Holman & Lorig, 2000)

5. Chronic Illness as a Crisis
Serious chronic illness is a crisis
Disruption and change (identity, location, role, social support, future goals)
Increased demands (ongoing response to illness)
Uncertain outcomes
No cure, requires ongoing management

6. Initial reactions to chronic illness
Shock
Denial
Loss and grief
Anxiety and depression
20-25% experience psychological symptoms
If these reactions last too long, they can have an unhelpful effect on the illness

7. Chronic Illness as a “Crisis”
Illness can be considered a crisis because it represents a turning point in an individual’s life.
Disruption to established patterns of personal and social functioning produces a state of psychological, social, and physical disequilibrium
Adaptation = finding new ways of coping with drastically altered circumstances.

8. Crisis Theory (Moos, 1982)
A model describing the factors that affect people’s adjustment to having serious illness.
Coping process (3 stages) is influenced by 3 factors
Illness-Related Factors
Background and personal Factors
Physical and Social Environment Factors
Coping process influences outcome of crisis

9. “The Coping Process”

10. Contributing Factors Illness-Related Factors
Degree to which an illness is hidden
Degree to which illness intrudes on lifestyle
Background and Personal Factors
Age, gender, social class, philosophical or religious commitments, self-esteem
Physical and Social Environment Factors
Social support

11. The Coping Process Cognitive appraisal Adaptive tasks Coping skills
Meaning or significance of the illness
Meaning of Illness Questionnaire
Adaptive tasks
Formulation of tasks to help cope with illness
Illness-related
General psychosocial functioning
Coping skills
Denial, information seeking, goal setting, recruiting support

12. Major Adaptive Tasks with Chronic Illness

13. Outcome of Crisis Adaptation and Adjustment Quality of Life
Physical, vocational, self-concept, social, emotional, compliance
Quality of Life
Degree of excellence people appraise their lives to contain
Excellence usually = fulfillment or purpose
Health-related quality of life (physical status and functioning, psychological status, social functioning, disease or treatment-related symptomatology)

14. Psychosocial Interventions
Education and support services
Most common intervention to help people adjust
Majority choose not to attend such groups
Current trend to examine other ways of offering support (workbooks, telephone linkups, websites)
Psychotherapy, CBT, family therapy, etc
Costly, not always necessary

15. AIDS Example - living with a chronic illness What is AIDS?
Epidemiology
Causes of HIV/AIDS
Treatment of HIV/AIDS
Role of psychology in the HIV epidemic
Living with HIV/AIDS
Palliative care
Bereavement

16. What is AIDS? Acquired Immune Deficiency Syndrome
Infectious disease (unlike cancer, CVD)
Immune system destroyed by HIV
Characteristic set of illnesses as a result

17. Epidemiology “deadliest plague in history”
Now one of 10 leading cause of death in US
Primary cause of premature death
12-18 million have died of AIDS
40 million HIV+ people in the world (2001)

18.   Epidemiology Patterns of infection around the world
Pattern I (USA, Canada, Western Europe, Australia)
Women account for < 20% of AIDS cases
Education campaigns reduced rate of infection
Pattern II (Africa, India, some SE Asia)
Women account for ~50% of AIDS cases
80% of AIDS cases are in developing countries
Pattern III (Russia, Sth America, Asia)
Characteristics of epidemic not yet clear

19. What causes AIDS? Human Immunodeficiency Virus (HIV)
HIV causes AIDS by attacking helper T cells
Course of the HIV infection
Stage 1 - brief flu like illness (1 week after infection)
Stage 2 - latent period (asymptomatic)
Stage 3 - AIDS-related complex (cluster of symptoms)
Stage 4 - AIDS (T-lymphocyte count below 200)

20. How is the virus transmitted?
3 bodily fluids (rich in white blood cells)
Blood (needle sharing, blood transfusion, mother to fetus)
Semen (unprotected sex)
Vaginal fluids (unprotected sex)

21. How is the virus transmitted?
5 factors increase the likelihood of infection
Infection dose
Concentration of virus in infectious fluids
Semen more dangerous than vaginal fluids
Co-factors (e.g., genital ulcers)
Immune status of the recipient
Clinical status of the carrier
most infectious at early stages

22. Treatment of HIV/AIDS … there is still no cure! Antiretroviral agents
Inhibit HIV replication
Increased helper T cell count
Many opportunistic diseases can be treated with medication (antibiotics)

23. Role of Psychology Primary Prevention Condom Use Needle sharing
Health Belief Model
Theory of Reasoned Action/Planned Behavior
Needle sharing
Drug laws (Glascow vs. Edinburgh)
CBT (relapse prevention)

24. Role of Psychology Secondary Prevention Testing
Test positive (own reaction, others’ reaction)
Test negative
Not tested
Atoni et al (1990) … see Sarafino, p. 453

25. Role of Psychology Helping people with HIV
Psychological impact of HIV unclear
Compliance with medical regimes
Palliative care

26. Role of Psychology
Kubler-Ross - Stages of Adjusting to Dying

27. Role of Psychology Bereavement
Grief (feeling) and mourning (expression of feeling)
AIDS unique
Gay men receive less social support when partner dies
Numerous AIDS deaths (demoralization)
Urging to “get on with life” unproductive

28. Male Circumcision = HIV Prevention?
Press Release
Male Circumcision = HIV Prevention?

29. Press Release
In a paper to be published soon, an Australian obstetrician has suggested that the foreskin accounts for 80 per cent of infections from males.
The evidence? Comparisons of infection rates between those countries that practice circumcision - Thailand, India and Cambodia - and those that don’t - The Philippines, Bangladesh and Indonesia.
The rates are 10 to 50 times higher in the latter than the former! Too simple to be true? And the answer: a worldwide circumcision drive? Too painful to contemplate?

30. Press Release
Why do you think it is that people don't want to hear about it? “Well, I mean it's so laughably simple, I think. That's probably one of the things against it. One would have thought that, you know, years ago people ought to be asking, if I can use the pun, the seminal question of how is it that HIV virus actually gets into the male reproductive tract? How does it get into the female reproductive tract? And we've been so obsessed with developing vaccines and developing drugs that might combat the infection that we've forgotten the simple first principle of how does the virus enter the body?”
ABC radio, March 2000

31. Evidence? H1: Male circumcision lowers HIV risk
How could you test this hypothesis?
Design at least 2 studies to test this hypothesis.

32. The “Disinhibition Effect”
An increase in unsafe behaviors in response to the introduction of a preventive or therapeutic intervention
Applies to any field of public health, not just HIV
- seat belts/reckless driving
- chest x-ray/tobacco use
- anesthesia for childbirth/sexual activity