**6. Discussion**

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

Findings about the participants' alcohol consumption, both before and after having established their HIV infection status, are presented in Table 4. The variables selected for analysis were about the consumption of alcoholic beverages and frequency and number of alcoholic beverages consumed before sex. A statistically significant difference (p = .001) was observed in the variable "drinking alcoholic beverages before sex" among the participants before and after establishing their HIV infection status (Table 4). The analysis of the question "Did you drink any alcoholic beverage such as beer, wine, wine coolers, or liquor before you had sexual intercourse the last time?" shows that before establishing their HIV infection status, 35% of the participants had consumed an alcoholic beverage before sex. In comparison, 28% of the participants indicated that they had consumed an alcoholic beverage before sex after establishing their HIV infection status. The difference between drinking alcohol before sexual intercourse – both before and after the knowledge of HIV infection status – among PLWHA is 18.50% with a 95% confidence interval (CI) from 8.07% to 27.07%; this is statistically significant (p = .0001). No significant differences were observed in other measures of HIV/AIDS-risky behaviors. These include frequency and quantity of alcohol consumed before sex, IDU, and sharing the same syringe or needle with another

Variable Before the knowledge After the knowledge A 95% CI and p value of HIV infection status of HIV infection for the difference status between proportions

Yes 80 (35 %) 65 (28 %) (CI, 8.07 -27.87%; p = 0.001)

 A few times 101 (58 %) 83 (53 %) (CI, -6.1 -16 %; p = 0.42) Half of the time 32 (18 %) 32 (20 %) ( CI, -6.8 -10.9 %; p = 0.75) Most of the time 20 (11 %) 15 (9 %) (CI, -5 -8.9 %; p = 0.67) Every time 22 (13 %) 28 (18 %) ( CI, -3.2 -13.3 %; p = 0.27)

1-2 drinks 99 (57 %) 83 (51%) ( CI, -5.1 -16 %; p = 0.32) 2-4 drinks 39 (23 %) 42 (26 %) (CI, -6.6 -12.6 %; p = 0.61) 5 or more drinks 35 (20 %) 37 (23 %) (CI, -6.2 -12.2 %; p = 0.59) Injecting drug use 13% (n =225) 12% (n =225) (CI, -6.6 -6.7 %; p = 0.89)

needle with another person 74% (n =235) 79% (n =235) (CI, -18.7-27.8%;p = 0.87)

Table 4. The difference between drinking alcohol before and after establishing HIV infection

person (Table 4).

Drink any alcoholic

Frequency of alcohol

Number of drinks

status

Sharing the same syringe or

beverage before sex n = 229 n = 229

No 149 (65 %) 164 (72 %)

consumed before sex n = 175 n = 158

before sex n = 173 n = 162

The association between low SES and risk of HIV infection has been well documented in the scientific literature (Hargreaves, 2002; Solorio et al., 2002). The HIV/AIDS pandemic is most severe in the poorest countries, worldwide, and among people of color (UNAIDS, 1999). Similarly, HIV/AIDS prevalence in the U.S. is disproportionately high in poor communities and runs rampant among African Americans. Although HIV/AIDS affects all races in the U.S. there is no single explanation for why HIV/AIDS affects African Americans disproportionately. A combination of biomedical, behavioral, and SES factors, often working together conjointly, seems to be responsible for this health disparity. Poverty, income inequality, and lack of or limited access to appropriate and high-quality health care programs are some of the social determinants that influence the health of PLWHA.

Studies have shown the prevalence of psychosocial problems not only to be common in PLWHA but related to increased high-risk behaviors. These include drug use before sex, sharing the same syringe/needle with another person to inject themselves, and having had multiple sexual partners. The findings suggest that psychosocial problems influence HIV/AIDS-risky behaviors and may contribute to the high probability of HIV infection within high-risk populations. The most plausible explanation for this finding is that psychosocial problems, such as depression, impair both physical and cognitive functioning and can interfere with the decision to practice safe sexual behaviors. Moreover, depression is a barrier to behavior change. Currently, treating depression is the most successful strategy to effectively reduce the risk of acquiring and spreading HIV/AIDS (Paterson et al., 2000).

In this study, results confirmed that psychosocial variables related to HIV/AIDS-risky behaviors are complex. Thus, a detailed understanding of how psychosocial factors impact on HIV/AIDS risk-taking behaviors among PLWHA might be important for prevention and control purposes. Study results demonstrate substance abuse, especially alcohol, is linked to the tendency to have multiple partners and sexual intercourse without condoms. The findings demonstrated the prevalence of depression in PLWHA which occurs concurrently with substance abuse in this population. Participants significantly reduced alcohol intake post-diagnosis – a research finding that highlights the effectiveness of incorporating alcoholreduction strategies to reduce HIV/AIDS-risky behaviors - however, PLWHA should be advised not to drink excessive amounts of alcohol, which is associated with high-risk sexual and drug injection-related behaviors that increase the likelihood of HIV transmission (Dag, 2008).

The findings of this study also indicate that PLWHA continue to engage in HIV/AIDS risky behaviors after the knowledge of their HIV status. There are several possible explanations for this finding. First, with the advent of HAART in 1996 mortality among PLWHA decreased dramatically (Bouhnik et al., 2007). Most of the PLWHA who get therapeutic benefits from HAART may attain an improved quality of life and functional status with the alleviation of the physiological, social, and psychological consequences of HIV/AIDS. These gains may be accompanied by increases in HIV/AIDS-risky behaviors that include sharing the same syringe/needle with another person. Secondly, PLWHA may have unrealistic beliefs about the impact of HAART on disease transmission rates and therefore may perceive the consequences of transmitting HIV/AIDS as being less serious than in the past. The proven efficacy of HAART in reducing mother-to-child transmission of HIV/AIDS may reinforce these beliefs. PLWHA who have such beliefs may be less likely to use condoms consistently or may have a higher number of sexual partners than those who do not.

Triple Challenges of Psychosocial Factors, Substance Abuse,

**8. Acknowledgment** 

**9. References** 

and HIV/AIDS Risky Behaviors in People Living with HIV/AIDS 153

are required to explore the epidemiology of HIV/AIDS; 2) Use epidemiologic models to address the social determinants of health as these factors are critical to reduce and eliminate HIV/AIDS and other health disparities; 3) Advance research to examine the resistance to behavior change as well as the motivation for behavior change as these factors also are central to the design of effective HIV/AIDS prevention and intervention strategies; 4) Develop cross-disciplinary research that includes advanced knowledge of basic and applied psychological and social research and the ways in which they interact together; and 5) Encourage strong collaborations among researchers, policy-makers, and communities to identify and address biomedical, behavioral, and psychosocial factors that are responsible for the risky sexual behaviors that ultimately result in further transmission of HIV/AIDS.

This work was supported by a Research Centers in Minority Institutions (RCMI) Award, 2G12RR03059-16, from the National Center for Research Resources and Project EXPORT Award from the National Center on Minority Health and Disparities (NCMHD), National

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Similarly, PLWHA who are using HAART therapy may be less inclined to insist on safer behaviors if they perceive the consequences of HIV infection to be somewhat less terrible because of the availability and efficacy of this antiretroviral therapy. In this era of HAART, addressing the psychosocial health burdens of PLWHA will be an essential component to the development of effective strategies to combat HIV/AIDS.

While the need for effective psychosocial health services for PLWHA is clear, the challenges are equally evident. At least three areas are suggested as high priorities for future research. First, interventions for depression should be developed for PLWHA. Evidence should be gathered on the effectiveness of such interventions not only for improving mental health but also for reducing substance abuse and HIV/AIDS-risky behaviors so as to reduce transmission of HIV/AIDS. Particular attention is warranted for methods or ways to identify PLWHA who are experiencing depression and to understand and address the mechanisms through which these experiences pose barriers to healthy behaviors.
