**3. Spiritual aspects**

178 Social and Psychological Aspects of HIV/AIDS and Their Ramifications

*Anxiety disorders* are often accompanied by characteristic somatic, physiological, and autonomic, biochemical, endocrinal and behavioural changes. The fact is that so far there is no possibility to cure HIV infection, leading to the feeling of helplessness, loss of personal

*Depression* can have many causes. An affected person may get the feeling that the virus takes control over his body. Just the fact that a close person died of AIDS, together with not existing the possibility of planning one owns long-term future has a negative impact on

In connection with the depressive syndrome there are several types of depression, i.e. exogenous, endogenous or neurotic depression. By the *exogenous depression* there have been reported such problems as the experience a sudden loss caused by the death of a loved one. There is expected an internal biological ability, which causes depressive psychopathology regardless of external circumstances by the so-called *endogenous depression*. By the *neurotic*  depression there is an expected effect of long-term stress and frustration. This form is present in the condition of most HIV/AIDS positive orphans. The symptoms of depression are present in neurotic and anxiety disorders such as mixed anxiety depressive disorder and the disorder of adaptation. Depressive behavioural disorder is often diagnosed especially, in the childhood, within a mixed behavioural and emotional disorder. (Koutek & Kocourkova,

The prevalence of depressive disorders rates up to 40 to 55% by orphans with HIV up to the age of 10, up to 50 to 75% of adolescents who were given professional help. (Rubinstein,

Depressive syndrome in these children is associated with an extremely sad mood, slowing of psychomotor speed, sleep disturbance and suicidal thoughts. A typical symptom is presented by increased irritability, behavioural problems with elements of aggression.

Some people react to news about their HIV/AIDS status by denying it. For some of them, such refusal may present a constructive way to handle the shock of the diagnosis. However, if this condition persists, the denial can become unproductive, because these people refuse also the social responsibility associated with HIV positivity. This reaction is typical for

*Anger and aggression* are typical aspects which accompany people in situations of bereavement. Some individuals become angry and aggressive. They are often very upset about their fate. They continuously have the feeling, that they are not treated decently and

• inability to change the circumstances and consequences of HIV infection

• separation, isolation and physical pain,

• future social and sexual rejection • sequential failure of vital functions,

• fear of undignified dying and dying in pain,

• the inability to ensure optimal health condition,

• failure of the one´s close relatives to deal with the situation, • unavailability of appropriate therapeutic procedures, • loss of privacy and fear of disclosure of information,

• loss of physical and financial independence. (Satir, 2006)

control, which may be associated with a resulting depression.

**2.5 Denial, anger, aggression and suicide attempts** 

children, in the case of the death on a parent.

• fear from degradation,

one´s psychic condition.

2003)

2001)

A situation in which one must face loneliness, loss of control and death, can lead to *spiritual questions* and seeking assistance in the faith. Concepts such as sin, guilt, forgiveness, reconciliation and tackle, may become subjects of spiritual and religious discussions. Similar moments become topical for many HIV positive patients. The cause of many emotional and psychic problems is presented by various infections, difficult situations and difficult periods of exhaustion. Even greater impact on the HIV positive person, however, presents the rejection of one´s own family or friends and one is separated from the society and pushed aside.

Many people believe that only religious people have spiritual needs. But non-believers begin to deal with questions about the meaning of one´s own life exactly during their illness and when they suffer. Everybody needs to find out, that the life has had had and still have some meaning. Everybody needs to deal with things, which are hard for him and which are unchangeable.

Sometimes the suffering radically changes the actual life and it often affects moral values of people. (Dobrikova, 2005)

When talking about the spirituality of children, many may argue that children´s ability of abstract thinking needed for understanding of religion is not developed and that they cannot understand the concept of God Despite the developmental perspective that generally criticizes the view of children's spirituality, we must acknowledge the fact that children are the pilgrims, who are trying to the meaning of world and the meaning of their own life.

Of course, the initial views of spiritual values and experiences children may experience in different ways, depending on whether they are raised in religious families, if they regularly experience religious rituals and to what extend are they raised in a religious way. Every child explains these events introspectively to oneself. It is perhaps not so important, at what age, the child begins to understand and express spirituality, but it is important to create room for a child´s questions and to supply her or him with the answers. (Dane & Levine, 2002)

Any death, especially death of a parent brings many spiritual issues. The child asks: "Why did he / she die?" "Why is this happening to me?" "Who will take care of me?" All these

Psychosocial Aspects of People Living with HIV/AIDS 181

In the current phase of the unstoppable progress of HIV/AIDS pandemic and development of the fight against HIV/AIDS, is a systematic effort needed more than ever. Effort, which could counteract with the spreading of infection from the position of respecting human

• Wide access to modern medicines and clarifying of their correct application. Treatment success depends on a motivated and diligent cooperation with the physician. As a broad and comprehensive approach a wide-spread, not-discriminating use of drug prophylaxis is understood and is indicated in cooperation with health insurance, • Extension of expert advising, testing and other activities related to prevention,

• Informational and educational campaigns which lead to increased tolerance of the society towards the affected population and to elimination of the constant re-occurring

• Improvement of legislation protecting privacy and preventing discrimination. (Mayer,

HIV/AIDS positive individuals have the same right to protect their rights as other members of the society. They have the right to work, have a job, right to obtain education, the right to attend a school, right for the social security and assistance, right for the protection against inhuman or degrading treatment or punishment. The most important and recognized principle is, that people or groups of people, who are at a higher risk of getting infected, in particular those, who are already infected or those who develop AIDS will not be

Probably the most common reason for the discrimination is an irrational fear of and fear from contact with people infected by HIV/AIDS, fear from infection and from, the possible consequences of the disease, suffering and death. Based on ignorance, all of these factors cause discrimination tendency. It is also subconscious, but irrational. A significant percentage of discriminatory attitudes of the population are related to the fundamental ignorance, about HIV transmission routes. That is another reason for the necessary

Another reason for discrimination is usually called *pre-existing discrimination,* i.e. disagreement or disapproval with the existence of certain opposition groups. Only few common people are aware that in this case, the discrimination itself presents a risk of further spreading infection. It is necessary to combat the discrimination as such, in all its forms and manifestations. Frequently, the reasons for this are certain social manifestations originating from certain professional attitudes. They usually manifest themselves in condemning people with certain lifestyle or still uncertain attitudes of some churches, based on intolerance. Daily preventive practice is therefore necessary, so that new social and other moments can be steadily implemented into plans of prevention to weaken the mentioned attitudes.

One group which has experienced overriding forms of discrimination is that of women. All over the world there is evidence that women have been coerced or pressured to have abortions or be sterilized because they are HIV-positive. Doctors have even exaggerated the rate of perinatal transmission of HIV to infants in order to convince women to terminate a pregnancy. Others have refused outright to offer reproductive health services to such women. In health care, there are reports of a refusal to treat HIV-positive patients and of discrimination against health workers who are HIV-positive. Health workers are also compromised because of their physical closeness to AIDS patients. Discrimination has occurred in the provision of funeral services. This includes the refusal to handle bodies of

repetition of targeted informational and educational campaigns.

rights, in particular in these areas:

social stigma,

1999)

discriminated.

(Mayer, 1999)

questions imply the spiritual dimension. These questions are very real for children whose parents died of AIDS but they are suppressed from fear and because of the stigma associated with HIV positivity.

The child can have trouble finding help and support from peers and adults because there is a mysterious silence about everything, no one wants to talk about the death of his close relative or what so more, to talk about HIV / AIDS. The child feels fear and shame to share his feelings with others, or it makes the situation deteriorate. If somebody belongs to the Christian faith, who perceives AIDS as a consequence of the moral bankruptcy of the individual, it does not make the situation easier. While the church preaches to love sinners, at the same time it condemns the sin. From this perspective, PLHWA are responsible for their conditions, but they deserve compassion and assistance. The child could eventually find their harbour in the church, even if it offers a very mixed or negative image of people with HIV / AIDS. This point of view complicates the child´s spiritual interpretation. All life situations the child had already had to go through, such as the death of a parent, poverty, deprivation, sniffing the glue, violence, make the spiritual survival complicated and they burden his purity. HIV positivity present chaos, uncertainty, unpredictability to the child, it causes lot of problems and on-going struggle. (Shorter & Onyancha, 1998)

The spirituality and religion can present a complicated issue. It is necessary to have the child explained his own responsibility for loss, death, disease, so that the child does not perceive these as his own sins. It is necessary to give them room, time and assistance in this direction. Religious rituals, in which the child can take part, can help and be one of the most significant is at the funeral. The child itself has to make the decision, whether he wants to be part of it or nor. Memorial mass, private rituals, lightning the candles, prayer, all of that can be a part of the therapy for the child.
