INTRODUCTION:

Infection with the human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS), which affects the cells of the immune system, and destroys or impairs their function. The virus is transmitted through direct contact with an infected mucosal membrane or bodily fluids such as blood, semen, and breast milk. After an initial frequently asymptomatic phase, skin problems and upper respiratory tract infections develop, and patients begin to lose weight. Chronic diarrhea, persistent fever, fungal or bacterial infections, and tuberculosis may follow. As the disease progresses, the immune system deteriorates, slowly losing its ability to fight other infections and diseases, and ultimately leading to “immune deficiency”. The study was carried out with the objective of, to assess the bio psychosocial problems and lived experiences of AIDS patient receiving A.R.T therapy.

Nurses have an important role to play in facing AIDS related care aspect. The nurse should deliver the care in a holistic way, nursing care should include emotional support and nurse should provide informational support and practical support. The assessment of bio psychosocial problems of AIDS patients has significant role for identification of problems and to develop and implement the plan of care.

Statement of the problem:

Assess bio psychosocial problems and lived experiences of Acquired Immunodeficiency Syndrome patient receiving Anti-Retroviral Therapy at Pravara Rural Hospital Loni (Bk)

Objectives:

1. To assess the bio psychosocial problems of AIDS patient receiving A.R.T therapy.

2. To correlate the bio psychosocial problems and selected demographic variables of AIDS patient receiving A.R.T therapy.

3. To assess the relationship between anxiety, depression, emotional distress, social stigma and social isolation.

4. To assess the lived experiences of AIDS patient receiving A.R.T therapy.

MATERIAL AND METHODS:

Research design and approach: Sequential research quantitative and qualitative evaluatory survey approach.

Research variables: Bio-psychosocial problems and lived of HIV/AIDS patients

Confounding variables Socio demographic variables like Age, Gender, Source of infection.

Setting of the study: PIMS Loni (BK), Ahmednagar.

Population: HIV/AIDS patients who are above 18 years

Sample Size: 60

Sampling Technique: Purposive sampling

Inclusion criteria:

The HIV/AIDS patients who were:

1. Visiting to A.R.T center in Pravara Rural Hospital

2. Available at the time of study

3. Giving written informed consent.

Exclusion criteria:

The HIV/AIDS patients who were:

1. Having associated psychiatric disorders.

2. Having cognitive impairment, hearing impairment

3. Unable to respond tool.

Methods of data collection:

Structured interview schedule

Reliability:

The tool was found to be reliable with the r value for the anxiety (r = 0.80), depression (r = 0.90) and emotional distress (r = 0.80) social stigma (r = 0.80), social isolation (r = 0.90).

ANALYSIS AND INTERPRETATION OF STUDY FINDINGS:

This section deals with the analysis and interpretation of the data collected from 60 samples, through a descriptive study by simple random sample method. To assess the bio-psychosocial problems and lived experiences of AIDS patient receiving anti retro viral therapy Pravara rural hospital. The collected data are tabulated in the master sheet and analyzed by using descriptive and inferential statistics.

The analyzed data is under the following headings:

Session I:

Table No: 1 Description of socio demographic profile of patient with AIDS

Sr. No.	Socio demographic	Percentage (%)
1.	Age
	18-29	23
	30-39	20
	40-49	34
	50-59	23
2.	Gender
	Male	57
	Female	43
3.	Marital Status
	Married	50
	Unmarried	16
	Divorced	4
	Widow	30
4.	Educational Status
	Not Formal Education	50
	Primary Education	27
	Secondary Education	17
	Graduate	6
5.	Income
	<5000	63
	5001-10,000	37
6.	Religion
	Hindu	50
	Muslim	23
	Christian	27
7.	Occupation
	Daily Wages	37
	Home Maker	23
	Farmer	40
8.	Residence
	Rural	90
	Urban	10

Table No: 2 Description of clinical characteristics of patient with AIDS

Sr. No.	Clinical characteristics	Percentage (%)
1.	Clinical Transmission
	Unknown Sources	77
	Sexual Intercourse	13
	Mother to child	10
2.	Duration of Illness
	>12 Months	63
	>6 months	27
	6-12 Months	10
3.	Level of CD₄ count
	100-149	57
	150-199	30
	200-299	13
4.	Co-Morbid Illness
	Tuberculosis	63
	Heart attack	7
	Other	30
5.	Duration of treatment
	Regular	37
	< 3 months	63

Section II:

Table No. 3: Assessment of bio psychosocial problems of patient with AIDS

Sr. No.	Psychosocial Problems	Frequency (n)	Percentage (%)
I	Visual
	Dry eyes	8	13
	Blurred vision	4	7
	Photophobia	2	3
	Short sightedness	6	10
	Long sightedness	14	23
II	Auditory
II	Impacted wax	44	73
	Cardiovascular
	Heart rate increased	10	17
	Congestive cardiac failure	4	7
	Heart sound	6	10
III	Pulmonary
	Chronic cough with sputum	40	67
	Respiration rate (increased)	42	70
IV	Aspect
	Respiration sound (abnormal)	38	63
	Dyspnea	40	67
V	Gastrointestinal
	Indigestion	60	100
	Loss of appetite	58	97
	Gastritis/peptic ulcer	14	23
	Jaundice	34	57

Table No. 4: Area wise comparison of mean, SD and mean percentage of anxiety, depression, emotional distress, social stigma and social isolation of patients with AIDS.

Sr. No.	Areas	Max score	Mean score
Sr. No.	Areas	Max score	Mean	SD
1	Anxiety	21	13.70	2.58
2	Depression	21	10.73	3.47
3	Emotional distress	50	32.37	4.62
4	Social stigma	24	15.00	2.31
5	Social isolation	18	9.90	1.31

Section III: Assessment of lived experiences HIV/AIDS patients:

Content Analysis:

Based on the findings of the study following themes were evolved:

· Diagnosis of disease

· Feelings after diagnosis

· Health problem because of AIDS

· Family support

· Social stigma

Section IV: C. Item wise assessment bio psychological problems HIV/AIDS:

· Item wise assessment of anxiety of AIDS patient: Item wise comparison of anxiety score of life responses of AIDS patient shows that majority (57%) always, “Getting a sort of frightened feeling as if something awful is about to happen”, (53%) feeling tense or ‘wound up’ (50%) sometimes they, “Have worrying thoughts go through their mind”, and (33%) getting sudden feelings of panic.

· Item wise assessment of depression of AIDS patient: Item wise comparison of depression score of responses of AIDS patient shows that majority (53%) have lost interest in my appearance, (53%) feels cheerful, and (40%) feel as if I am slowed down, (47%) can enjoy a good book or radio/TV program (37%) look forward with enjoyment to things”.

· Item wise comparison of emotional distress of AIDS patient: Item wise comparison of emotional distress score of responses of AIDS patients shows that majority (37%) have low self- esteem or self- confidence and no longer enjoy activities I previously found pleasurable often feels quite anxious, (33%) often feel quite depressed and often feel agitated or restless. The (30%) patients often feel quite irritable or angry often feel quite anxious.

· Item wise comparison of social stigma of AIDS patients: Item wise comparison of social stigma score of AIDS patient shows that majority (50%) because of my illness, I felt left out of things and (27%) felt embarrassed about their illness. The (23%) of patients feels Some people acted as though it was my fault, I have this illness the above-mentioned table interpret that AIDS patient have least social stigma.

· Item wise comparison of social isolation of AIDS patient: Item wise comparison of social isolation score of AIDS patient shows that majority (67%) were “agree there are plenty of people I can rely on when I have problems”, (63%) were “There are many people I can trust completely, “(57%) were there are enough people I feel close to. The above mention table interpret that the AIDS patient don’t have feeling of loneliness.

DISCUSSION:

Findings related to relationship between anxiety, depression, emotional distress, social stigma, and social isolation of the AIDS patients:

· It was found that the anxiety had moderate positive co- relation with the depression r value is (0.59), emotional distress r value is (0.40) and social stigma r value is (0.35).

· It was found that the depression had moderate positive co- relation with the anxiety r value is (0.11), emotional distress r value is (0.41) and social stigma r value is (0.15).

· It was found that the emotional distress had moderate positive co- relation with the anxiety r value is (0.40), depression r value is (0.41).

· It was found that the social stigma had moderate positive co- relation with the anxiety r value is (0.35), depression r value is (0.15).

· It interprets that the study variables such as anxiety, depression, emotional distress, and social stigma had positive correlation among them.

CONCLUSION:

AIDS patients has a so many problems such as biological, psychological and social and physical problem and psychological problem. Study reveals that AIDS patients had physical problems related to vision, cardiovascular, respiratory, gastrointestinal, and neurological. And moderate degree of psychiatric problems such as anxiety, depression and emotional distress and social problems like social stigma and social isolation.

IMPLICATION FOR NURSING:

The implication of this study could be discussed under nursing education, nursing administration and nursing research.

NURSING EDUCATION:

· Nurse educator should educate to student nurses and other health care worker to improve the knowledge and crate awareness regarding AIDS.

· The findings may improve a critical analysis of nursing professional caring the patients with AIDS.

NURSING RESEARCH:

· This study finding providing information on bio psychosocial problems and lived experiences of AIDS.

· Findings of the study will help the nursing professional working in anti-retroviral therapy center, hospitals and community for the reinforcing their knowledge.

RECOMMENDATION:

Based on the study finding the following recommendations have made for

The further study

· Similar study may be replicated on large samples to generalize the findings.

· Similar study can be conducted in different settings like institutional homes, community etc. which will help in comparison.

· A study can be conducted to find the effectiveness of nursing intervention of specific symptoms to improve the quality of life.

· A study can be conducted to assess the role of family and social support on problems faced by AIDS patients.

· Longitudinal study can be conducted on quality of life of HIV/AIDS patients

ACKNOWLEDGEMENT:

The authors are grateful to the authorities of Pravara Medical Trust’s, College of Nursing Loni, Bk. District: Ahmednagar (MH) India .413736

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

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Received on 15.04.2020 Modified on 04.06.2020

Int. J. of Advances in Nur. Management. 2020; 8(4):279-283.

DOI: 10.5958/2454-2652.2020.00062.1

Age in year	Number of samples	Anxiety		Depression		Emotional distress		Social stigma		Social isolation
Age in year	Number of samples	Mean	SD	Mean	SD	Mean	SD	Mean	SD	Mean	SD
18-29 years	14	13.28	2.25	7.71	3.25	31.00	4.96	15.57	1.34	9.71	1.32
30-39 years	12	14.00	2.40	12.67	1.96	32.67	5.83	13.33	2.93	10.08	1.37
40-49 years	20	14.00	1.76	11.30	3.24	33.10	4.34	15.00	2.67	9.80	1.28
50-59 years	14	13.42	3.86	11.29	2.97	32.43	3.63	15.86	1.02	10.07	1.38