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Abstract

The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic is in its third decade and has reached to alarming proportions worldwide. According to the Centers for Disease Control and Prevention, more than one million people are living with HIV with an estimated 56,300 infections happening each year in the United States. Diagnosis of HIV/AIDS via early testing along with pretest and post-test counseling is important for psychosocial stabilization and destigmatization. Risk reduction counseling as a preventive counseling method is equally important in high-risk individuals such as adolescents, substance abusers and in gay and bisexual population. The purpose of this review is to address a number of counseling strategies used for education and counseling of individuals at risk of getting HIV/AIDS and also among those who are HIV-infected.

CHAPTER ONE

INTRODUCTION

1.1      Background of the study

HIV/AIDS has become a threat to public health in Nigeria as a result of its devastating consequences, which are manifested in forms of prolonged sickness, deaths and increase in number of orphans and widows/widowers. Nigeria has an estimated population of about 150 million of which about 3.5 million are infected by HIV/AIDS (FMINO, 2007). HIV/AIDS was first identified in Nigeria in 1985 and reported at an International Conference in 1986 (Adeyi et al, 2006). The HIV/AIDS pandemic led to the death of 170,000 Nigerians in 2007 (UNAIDS, 2008).

According to Edewor (2010), Nigeria has already surpassed the 5 percent explosive prevalence phase and the disease has killed more than 1.3 million people and orphaned more than 1 million children (FMINO, 2007). The infection rates of HIV/AIDS vary across the six geopolitical zones of Nigeria. According to Edewor (2010), the mode of HIV transmission in Nigeria is mainly through unprotected sex, and other factors which contribute to the spread of the virus include poverty, Sexually Transmitted Infection (STI), social and religious norms and political and social changes (National AIDS/STD Control Programme, 1999). Parke and Aggleton (2007) noted that negative social attitudes toward marginalised populations, policies mandating the testing of high risk groups and limited legal protections based on HIV status may exacerbate stigma.

They stressed further that increase vulnerability to discrimination complicates the social and psychological adjustment of Persons Living With HIV/AIDS (PLWHA). The victims require necessary assistance to be able to live happily and contribute meaningfully to the development of the society. Thus, they need psychosocial supports to be able to cope with their challenges. Psychosocial needs can be described as social, mental and spiritual requirements of PLWHA in order to live quality life and contribute to development of the society. The needs can be viewed from a psychological theory propounded by Abraham Maslow in 1943. According to Maslow (1954), the hierarchy of needs is often portrayed in the shape of a pyramid, with the largest and most fundamental levels of needs at the bottom, and the need for selfactualization at the top.

The most fundamental and basic four layers of the pyramid contain what Maslow called "deficiency needs" or "d-needs", esteem, friendship and love, security, and physical needs. With the exception of the most fundamental (physiological) needs, if these "deficiency needs" are not met, an individual’s body gives no physical indication but the individual feels anxious and tense. Maslow's theory suggests that the most basic level of needs must be met before an individual strongly desires (or focuses motivation upon) the secondary or higher level needs. Maslow also coined the term “Meta-motivation” to describe the motivation of people who go beyond the scope of the basic needs and strive for constant betterment. “Meta-motivated” people are driven by B-needs (Being Needs), instead of deficiency needs (D-Needs)(Wikipedia, 2011). For the purpose of this study, the psychosocial needs adopted comprise physiological needs, safety needs, belongingness needs, esteem needs, aesthetic needs and self-actualization as propounded by Maslow.

Physiological needs include food, air and water; safety needs involve housing and security; belongingness implies social interaction and group affiliation; esteem needs involve high regard for self and others; aesthetic needs deal with love of beauty while self-actualization involves becoming what one desires to be in life. Since the discovery of HIV/AIDs in the 1980s, more than 20 million people have died from the disease. The disease killed three million people in 2003 and is now the leading cause of death and lost years of productive life for people aged ranging from 15 to 59 worldwide (WHO Report, 2004). HIV/AIDS epidemic has become a worrisome phenomenon and individual carrier of the infection suffers from several mental health consequences. The infection is associated with enormous trauma of which stigma and discrimination against people living with HIV/AIDS remain the major psychological stresses.

It is perhaps no news that HIV/AIDS patients suffer from psychosocial and neuropsychiatric problems even their health care workers sometimes develop burn-out syndrome that is characterized by emotional distress, lowered job productivity and spread of work problems to family and conjugal relationships. The potential impact of stigma and discrimination has been of ongoing concern to counselors and agencies involved in addressing the HIV/AIDS epidemic. Discrimination at individual, community and national levels have major implications for the epidemic, as divides or separation is created between those who are vulnerable to infection and those who are not. Stigmatization in any magnitude has multiple effects on the lives of people living with HIV/AIDS and more broadly on members of society, creating disruptions in social functioning, and increasing people's vulnerability to infection and reducing the overall caring capacity of communities.

Stigma is perhaps a pervasive problem that affects health globally, threatening an individual's psychological and physical well-being. HIV/AIDS epidemic has significant effect on the economic and sociological wellbeing of victims. The psychological aftermaths of HIV test mostly if positive prevent majority of the people in Nigeria and Yakurr Local Government area in particular to be tested. As such, counseling of people living with HIV and how to deal with the psychological as well as the social effects of the infection in the area remains a challenge to counselors and corporate bodies alike. However, the problem of how best to counsel infected people is perturbing especially with the rate at which HIV and AIDS are spreading in the state.

1.2      STATEMENT OF THE PROBLEM

HIV/AIDS has become a threat to public health in Nigeria as a result of its devastating consequences, which are manifested in forms of prolonged sickness, deaths and increase in number of orphans and widows/widowers. Nigeria has an estimated population of about 150 million of which about 3.5 million are infected by HIV/AIDS (FMINO, 2007). HIV/AIDS was first identified in Nigeria in 1985 and reported at an International Conference in 1986 (Adeyi et al, 2006). The HIV/AIDS pandemic led to the death of 170,000 Nigerians in 2007 (UNAIDS, 2008).
According to Edewor (2010), Nigeria has already surpassed the 5 percent explosive prevalence phase and the disease has killed more than 1.3 million people and orphaned more than 1 million children (FMINO, 2007). The infection rates of HIV/AIDS vary across the six geopolitical zones of Nigeria. It is in this respect that the researcher intend to investigate the effect of counseling on the psychological adjustment of people living with  HIV/AIDS.
1.3      OBJECTIVE OF THE STUDY
The main objective of this study is to ascertain the effect of counseling on the psychological adjustment of people living with HIV/AIDS in Nigeria. But for the successful completion of the study the researcher intend to achieve the following objective;
 i)             To ascertain the effect of counseling on the psychological adjustment of HIV/AIDS patient
ii)           To investigate the relationship between counseling and psychological adjustment of HIV/AIDS patient in Nigeria
iii)          To ascertain the impact of counseling on the psychological well-being of HIV/AIDS patient.
iv)         To investigate the role of counseling on the life span of people living with HIV/AIDS 
1.4      RESEARCH HYPOTHESES
For the success completion of the study, the following the research hypotheses are formulated by the researcher;
H0: there is no significant relationship between counseling and psychological adjustment of people living with HIV/AIDs in Nigeria
H1: there is a significant relationship between counseling and the psychological adjustment of people living with HIV/AIDs in Nigeria
H0: counseling does not have any significant effect on the psychological adjustment of people living with HIV/AIDs in Nigeria
H2: counseling does have a significant effect on the psychological adjustment of people living with HIV/AIDs in Nigeria.
1.5      SIGNIFICANCE OF THE STUDY
It is believed that at the completion of the study, the findings will be of great importance to HIV/ AIDs patient in the country as the study seek to enumerate the benefit of counseling to the general well-being of thePatients, the study will also be of benefit the medical practitioners and the employees of Centers for Disease Control and Prevention, as the study laid emphasis on the benefit of counseling and guidance on the life span of HIV/AIDs patient in the country. The study will also be useful to researchers who intend to embark on research in similar topic, Finally the findings of this study will also be immense benefit to government, academia, scholars, researchers and the general public.
1.6       LIMITATION OF THE STUDY SCOPE
 ANDThe scope of this study covers the effect of counseling on the psychological adjustment of people living with HIV/AIDs in Nigeria. However, in the cause of the study the researcher encounters some constrain which limited the scope of the study;
a)     AVAILABILITY OF RESEARCH MATERIAL: The research material      available to the researcher is insufficient, thereby limiting the study.
b)     TIME: The time frame allocated to the study does not enhance wider         coverage as the researcher has to combine other academic activities        and examinations with the study.
c)     FINANCE: The finance available for the research work does not     allow for wider coverage as resources are very limited as the        researcher has other academic bills to cover
1.7 DEFINITION OF TERMS
HIV/AIDs: Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV). Following initial infection, a person may not notice any symptoms or may experience a brief period of influenza-like illness. Typically, this is followed by a prolonged period with no symptoms. 
Counseling: Counseling is the activity of the counselor, or a professional who counsels people especially on personal problems and difficulties. In order to become a licensed mental health counselor in the United States, one must hold at least a master's or doctoral degree.
Psychological adjustment: In psychology, adjustment refers to the behavioral process of balancing conflicting needs, or needs against obstacles in the environment. varied activity, or exploratory behavior accompanied by problem solving.
Infection: Infection is the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to these organisms and the toxins they produce. Infectious disease, also known as transmissible disease or communicable disease, is illness resulting from an infection.
1.8 ORGANIZATION OF THE STUDY       
This research work is organized in five chapters, for easy understanding, as follows. Chapter one is concern with the introduction, which consist of the (background of the study), statement of the problem, objectives of the study, research questions, research hypotheses, significance of the study, scope of the study etc. Chapter two being the review of the related literature presents the theoretical framework, conceptual framework and other areas concerning the subject matter.     Chapter three is a research methodology covers deals on the research design and methods adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding.  Chapter five gives summary, conclusion, and recommendations made of the study.

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