**9. Conclusion**

The main determinants of HIV/AIDS that have a great impact on the psycho-social life of HIV positive people could be divided in four main groups: biology, behaviour, microenvironment and macro environment determinants. From the biology determinants the most affecting ones are: virus subtypes, stage of the infection, other health complications, circumstances, and so on. From the behavioural determinants the most

The following outlines the *most problematic social issues* of people living with HIV/AIDS in

• Lack of support and understanding from close relatives and community members, • Follow up of adherence and compliance of drug usage in public, during working

• The issue of having a child / children. ("Will the new-born child be HIV negative?")

• The challenges of getting a job despite HIV positivity, (Will they be accepted as any

• In situations where the spouse is negative (the discordant couples) the positive spouse is worried if she/ he will be accepted in that relationship or will be chased away. • Another question is, if the partner accepts him/her? Will family members of the

• Relatives start to handle the property of the HIV positive person as if the was already

• Recognition, HIV positive people are human beings and they should be treated with

The clients of VCT mentioned also some other issues, which they face, for example poor supplies of ARVs; how the available treatment is not available for all; corruption, which allows receiving treatment only in the case of some acquaintances and contacts with higher positioned staff in rural clinics. Clients have also financial problems. Some of them have a

The service providers, who always seem to have "permanent issues" with anybody who has HIV/AIDS constantly breach confidentiality. Some clients start to drink alcohol and turn

On the side of counsellors in VCT the challenging issues are often linked with the poor level of education of the clients and strong traditional beliefs. There is usually a high level of conflict that some clients find themselves in, for example conflict between religious beliefs

Another issue is the high expectation referring to the dependency syndrome, depending too much on guidance and not being able to be self-dependant or self-sufficient. There is an increase of the threshold for starting ARVs by the government from CD4 counts of below 250 to CD4 counts of below 350. This is very important and positive for a third-world country; it is not only practical but also realistic. It easily caused a shift of half a million people to be immediately put on ARVs yet the stock, stores, staff, infrastructure, expertise

The main determinants of HIV/AIDS that have a great impact on the psycho-social life of HIV positive people could be divided in four main groups: biology, behaviour, microenvironment and macro environment determinants. From the biology determinants the most affecting ones are: virus subtypes, stage of the infection, other health complications, circumstances, and so on. From the behavioural determinants the most

Mukuru slums, Kenya want to discuss with counsellors in VCT:

• The big challenge of disclosure and the subsequent steps,

• Will there be some partner of the same status to marry?

hours/in church/while travelling, and so on.

negative partner bless that marriage?

• They should be offered quality health care services.

long way to travel from home to the treatment centres.

into heavy drinkers / drug users in order to avoid stress.

and counselling staff were not present and available.

• Financial instability,

other person?)

dead.

respect,

and traditional African beliefs.

**9. Conclusion** 

influential belong to issue pertaining to sexual practices, rate of partner change, prevalence of partners, condom usage and so on.

On the micro environmental level there are determinants as urbanization, mobility, access to health-care services, and status of women, violence issues, stigmatization and discrimination and so on.

The macro environment determinants influencing the daily life of people living with HIV are culture, religion, governance, income distribution as well as wealth.

All these aspects should be taken into account by analysing the psychological and social living of HIV positive people. Psychological mechanisms such as denial, avoidance, grief, discrimination, etc. are encouraged by practices and gender-dominant relationships in the African culture, which increases women's and children vulnerability to HIV infection. It is very important to create a positive environment and positive mind-set for people living with HIV/AIDS.

The stigma can be minimized through campaigning, so that people can continue to lead a life, which is productive and full-valued. For a wider outreach of actions, programs cannot be restricted to massive information diffusion but the psycho-educational strategies need to be applied on a small number of target groups. There is the need, not only to increase the medical knowledge but also to enhance the awareness about HIV/AIDS in general.

Culture, values, traditional norms and taboos are lost as a consequence of too many HIV/AIDS deaths. The support groups seem to be a very positive way in supporting people how to cope with the situation. The services provided to the families are needed very much and also the wider family should be well–informed and educated in order to provide basic emotional and psycho-social support.

A great amount of special care must be given to HIV positive children and children, who became orphaned due to HIV/AIDS. Education and support is the most effective tool that helps people living with HIV/AIDS to live a psychologically well-balanced life. Proper support will also help people with HIV/AIDS to move through the appropriate stages and to reach the acceptance of their status and to cope with all the psycho-social issues in their lives.

HIV positive people can use the educational activities to learn the way of how in order to be in charge of their own medical care, and how to protect themselves as well as those around them. They can also disseminate this education to others and help to reduce the stigma within their communities. Through the many changes and challenges, it the support of family, friends, communities, and health care professionals which are essential to overall well-being.

### **10. References**

Bar R. et.al. (2000). *Counselling in Health Care Settings,* Casell, ISBN 0-304-33986-5, London, England

Bastecky, J. et al. (1993). *Psychosomatic medicine,* Grada Avicenum, Praha, Czech Republic


**Part 3** 

**The Impact of Social and Psychological** 

**Factors on HIV/AIDS and Related Behaviours** 

of Intervention for vulnerable children and their families, Fondazione Emanuela Zancan, ISBN 88-88843-24-8. - S. 424-425, Padova, Italy

Brabec, L. (2001). *Christian thanatology*, Gemma, Praha, Czech Republic

