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The Development of a Counselling Intervention for People Living with Hivand Aids Experiencing Stress-Related Psychological Conditions in the Eastern Cape Province

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The Development of a Counselling Intervention for People Living with Hivand Aids Experiencing Stress-Related Psychological Conditions in the Eastern Cape Province THE DEVELOPMENT OF A COUNSELLING INTERVENTION FOR PEOPLE LIVING WITH HIVAND AIDS EXPERIENCING STRESS-RELATED PSYCHOLOGICAL CONDITIONS IN THE EASTERN CAPE PROVINCE N.V. TWAISE 2016 THE DEVELOPMENT OF A COUNSELLING INTERVENTION FOR PEOPLE LIVING WITH HIVAND AIDS EXPERIENCING STRESS -RELATED PSYCHOLOGICAL CONDITIONS IN THE EASTERN CAPE PROVINCE NOMVULA VIRGINIA TWAISE Submitted in fulfilment of the requirements for the Doctor of Philosophy Degree (Psychology) in the Faculty of Health Sciences at the Nelson Mandela Metropolitan University DECEMBER 2016 SUPERVISOR: PROF T.V. MAYEKISO CO-SUPERVISOR: PROF D.S. ELKONIN ii DECLARATION I, NOMVULA VIRGINIA TWAISE, Student No. 21129181, hereby declare that the thesis for PhD (Psychology) to be awarded is my own work and that it has not previously been submitted for assessment or completion of any postgraduate qualification to another university or another qualification. …………………………….. Nomvula V. Twaise iii Acknowledgements I would like to express my sincere appreciation to the following people for making this research project possible; First and foremost, I give thanks to God Almighty for giving me strength, favour, courage and determination to complete this project. My ancestors for watching over me throughout this project. My Supervisors: Prof Thoko Mayekiso – for believing that I can do this and accommodate me in her hectic schedule and Prof Diane Elkonin – for her time, prompt responses, encouragement, guidance, patience, valuable advice and critical comments throughout this project. May you both continue to produce more academic leaders and help people like me to realize their potential. Colleagues- Prof G. Ekosse who saw potential in me when I could not see any and continued to check up on me even through my supervisors. My partner who encouraged me to study PhD eighteen years ago, at the time I was still starting to enjoy my hard earned money and I did not listen. I guess it was not time yet. My son – Owethu (popularly known as ‘Wawa’) who did not even pay attention to his mother’s studies until recently. I also give special thanks to my family members, relatives and friends who supported my endeavours. I am grateful to People living with HIV and AIDS who agreed to participate in this study. Staff and home-based carers of Sophumelela Centre, nurses and lay counsellors of Nontyatyambo clinic who enthusiastically participated in this study. I will forever be grateful to them. My dear friend – Dr Pelisa Dana for helping me with quantitative analysis of data and encouragement. iv Dedication This thesis is dedicated to people living with HIV and AIDS in South Africa. v Abstract People living with HIV and AIDS (PLHIV) suffer from a number of stress-related psychological disorders. The aim of this study was to develop an integrative intervention, which combined Cognitive Behaviour Therapy (CBT), Body-Mind Therapy and Multicultural perspectives to assist health care workers in identifying and treating stress- related psychological disorders among people living with HIV and AIDS. The study employed an intervention research design using both qualitative and quantitative methods. The quantitative data was collected from PLHIV attending HIV Counselling and Testing (HCT) and Anti-retroviral therapy clinics in the Buffalo City Municipality (BCM) of the Eastern Cape Province. The qualitative data was collected from the health care workers of the selected study sites. Purposive sampling was used to select the study sample. Instruments used included a biographical questionnaire, the Beck Depression Inventory-II (BDI-II), Medical Outcome Study- HIV (MOS-HIV) and focus group interviews to gather data for the development of an intervention model that would address reported stress-related psychological disorders. Findings showed that people living with HIV and AIDS endure stress in their lives on daily basis rather than episodes of severe or clinical depression. Many of the PLHIV are dealing with a number of psychosocial problems that compromise their quality of life and health status. In conclusion, the study illustratively interpreted and discussed the results in relation to the objectives of the study. The study recommends that PLHIV should be exposed to stress management programmes, and health care workers (HCWs) should be offered training in basic counselling skills, stress management and/or debriefing. Key words: HIV and AIDS; stress-related psychological conditions; African worldview vi Abbreviations: AIDS -Acquired Immune Deficiency Syndrome ART -Antiretroviral Therapy ARVs -Anti-retrovirals BDI-II - Beck Depression Inventory -II CBT - Cognitive Behavioural Therapy HBC -Home-based carers HCT -HIV Counselling and Testing HCW - Health Care Workers HIV - Human immunodeficiency Virus MOS-HIV - Medical Outcome Survey - HIV NMMU - Nelson Mandela Metropolitan University PLHIV - People living with HIV and AIDS PMTCT - Prevention of Mother to child Transmission REC-H - Research Ethics Committee - Human THP - Traditional healing practitioner TRE - Trauma releasing exercises Interchangeable terms ‘Clients’ interchangeable with ‘Patients’ ‘Health care workers’ inclusive of ‘Home-based carers’, Professional nurses, ‘Lay counsellors’ and ‘Social workers’ ‘Participants’ inclusive of ‘HCW participants and ‘PLHIV participants’ or ‘client participants’ ‘PLHIV clients’ interchangeable with ‘Client participants’ ‘Counselling intervention’ interchangeable with ‘Intervention’ vii TABLE OF CONTENTS DECLARATION III ACKNOWLEDGEMENT IV DEDICATION V ABSTRACT VI KEY WORDS VI ABBREVIATIONS VIII LIST OF TABLES XIII LIST OF FIGURES XIV CHAPTER 1: BACKGROUND TO THE STUDY 1.1. Introduction 1 1.2. Problem Statement 9 1.3. Rationale for the study 11 1.4. Research questions 12 1.5. Aims and Objectives of the study 12 1.6. An overview of the Research Methodology 13 1.6.1. Research setting 13 1.6.2. Research design- Intervention research design 13 1.6.3. Population and Sampling 15 1.6.4. Data Collection 15 1.6.4.1. Cross-sectional survey: Questionnaire 16 1.6.4.2. Psychological tests 16 1.6.5. Research Procedure 18 1.6.6. Delimitations 19 1.6.7. Data Analysis 19 1.6.8. Ethical Considerations 19 1.6.9. Layout of the study 20 CHAPTER 2: LITERATURE REVIEW 21 2.1. Introduction 21 2.2. An overview of psychological stressors 21 2.3. Fundamental facts about HIV and AIDS 24 2.3.1. Human Immune-deficiency Virus (HIV) 24 2.3.2. Acquired Immune deficiency Syndrome 24 2.4 Theories of the origin of HIV and AIDS 25 viii 2.5. The epidemiology of HIV 26 2.5.1. Global epidemic 26 2.5.2. Sub-saharan Africa epidemic 27 2.5.3. South African epidemic 28 2.6. Types and sub-types of HIV 29 2.7. HIV transmission 30 2.7.1. Sexual transmission 30 2.7.2. Blood transmission 32 2.7.3. Mother-to-child transmission 33 2.8. Myths about HIV and AIDS 34 2.9. HIV and AIDS and Immune System 35 2.9.1. HIV infection Cycle 36 2.10. Managing HIV Infection and Antiretroviral therapy (ART) 37 2.11. HIV and AIDS Phases and Opportunistic Infections (OIs) 41 2.12. Psychosocial and emotional experiences among PLHIV 43 2.13. Stress-related psychological disorders and HIV and AIDS 43 2.13.1. Anxiety disorder and HIV and AIDS 45 2.13.2. Anxiety disorder 46 2.13.3. Acute stress disorder 47 2.13.4. Posttraumatic stress disorder (PTSD) 47 2.13.5. Depressive disorders 48 2.13.5.1. Depressive disorder and HIV and AIDS 50 2.13.5.2. Barriers to diagnosing depression in PLHIV 51 2.13.5.3. Depressive disorder treatment in PLHIV 51 2.13.6. Adjustment disorder and HIV and AIDS 53 2.13.7. Alcohol use disorder and HIV and AIDS 54 2.13.8. Stigma and Discrimination (S&D) 56 2.14. Rationale for psychological services for PLHIV 58 2.15. Conclusion 59 CHAPTER 3: THEORETICAL FRAMEWORK 60 3.1. Introduction 60 3.2. Integrative psychotherapy 60 3.2.1. Technical eclecticism approach 62 3.3. Body-mind therapy 63 ix 3.4. Cognitive Behavioural Therapy (CBT) 69 3.4.1. The use and limitations of CBT 73 3.5. Multicultural Approach 74 3.5.1. African worldview on mental illness 75 3.5.1.1. God and ancestors as causal agents of illness 76 3.5.1.2. Implications of external causation of illness for HIV and AIDS 77 3.5.2. Multicultural competencies and standards 78 3.6. Conclusion 79 CHAPTER 4: RESEARCH METHODOLOGY 80 4.1. Introduction 80 4.2. Research aim and objectives 80 4.3. Research design 80 4.3.1. Quantitative research method 81 4.3.2. Qualitative research method 82 4.4. Research setting 83 4.5. Population and Sample 86 4.5.1. The sample for phase one 87 4.5.2. The sample for phase two 88 4.5.3. The sample for phase three 90 4.6. Research Instruments 90 4.6.1. Biographical questionnaire (Bio) 90 4.6.2. Medical Outcomes Study- HIV (MOS-HIV) 90 4.6.3. Beck Depression Inventory (BDI) 91 4.6.4. Focus Group Discussions (FGD) 92 4.7. Research procedure 92 4.8. Data collection 97 4.8.1. The development of the counselling intervention model 97 4.8.1.1. A review of literature 97 4.8.1.2. An integration of the theoretical framework guiding the research 98 4.8.1.3. Biographical questionnaire and psychological assessments 98 4.8.1.4. Focus group interviews with health care workers 98 4.8.1.5. Pilot Study 99 4.8.2. The implementation of the intervention model 100 4.8.2.1. Training of health care workers 100 x 4.8.2.2. The implementation of the intervention by HCW 101 4.8.3. Preliminary evaluation on the implementation of the intervention model 102 4.9. Ethical considerations 102 4.10. Data Analysis 103 4.11. Conclusion 104 CHAPTER 5: RESEARCH FINDINGS 105 5.1.
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