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Міжнародний неврологічний журнал 6 (60) 2013

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Features of psychoneurological and sexual health of hiv-infected persons and their partners in the context of their psychosexual orientation and life affiliate steam

Автори: R. T. Gabrel, M. V. Markova - Kharkiv Medical Academy of Postgraduate Education; Center for Prevention and Control of AIDS Kyiv City Clinical Hospital № 5

Рубрики: Неврологія

Розділи: Клінічні дослідження

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Analysis of the literature shows the fragmentation of research aimed at the resolution of the problem of extending and improving the quality of life of people living with HIV. This is due to the complexity and polymodality investigated phenomena, including the top spot should cover issues of emotional and psychological resources to HIV-infected sources consisting of individual personality characteristics of the individual and interpersonal primarily partnership, support and interaction. Develop a strategy and tactics of medical and psychological support for HIV-infected partner pairs so far not found a solution and introduction into clinical practice, which greatly reduces the effectiveness of medical and psychological assistance to this category of patients and their families. Meanwhile, the successful solution of this problem it is necessary to study the characteristics of mental status and sex of HIV-infected persons and their partners, which is indispensable to the development of comprehensive measures to improve the quality of life of HIV-infected persons and their families.

So, to achieve this goal during 2010 - 2013 biennium on the basis of the Kiev Center for Prevention and Control of AIDS Kyiv City Clinical Hospital № 5, we have examined 105 emergency, in which one partner was HIV-positive, namely 70 heterosexual PE , 35 pairs of which was infected persons (group 1) and 35 couples where the woman appeared to be infected (group 2), and 35 homosexual PP, where one partner is HIV-positive (group 3). The criteria for inclusion in the study were: 1) confirmed infection in AIDS Centre (Kyiv) one of the partners, prescription infection within 1 year, and 2) record partnership at least a year (living together with the prevailing familial roles), and 3) no children; 4) lack of mental and behavioral disorders due to psychoactive substance use.

Comprehensive survey included structured clinical-anamnestic interview with the analysis of socio-demographic characteristics and psychodiagnostic study. The study of depressive and anxiety responses of HIV-infected patients was carried out using the Hospital Anxiety and Depression Scale HADS and clinical questionnaire to identify and assess neurotic states K. K. Jachin, D. M. Mendelevich. Assessment of sexual implement performed using the criteria of system-structural analysis of sexual health and sexuality displays developed by V. V. Krystal. The success of private life and the level of violations determined by marital satisfaction questionnaire A. Lazarus, the analysis of quantitative and qualitative indicators which (total score and the degree of congruence in each partner), concluded on the existence and level of severity of a violation of private life.

In all infected individuals, regardless of gender or psycho-sexual preference, mental disorders were areas of clinical level of severity. Found that the general trends of HIV-infected persons can determine the presence of clinically significant anxiety and depressive symptoms, with a predominance of severity of anxiety symptoms compared with depressive, p <0.05. Among infected persons greatest severity of pathological anxiety for all symptoms found in homosexual men among heterosexual individuals in women set higher severity of anxiety symptoms, compared with heterosexual men (p <0,05). Also found a significant (p <0.01) the prevalence of depression in gay men compared to heterosexual men and women, between which significant differences were found. Thus, as a general indicator of the average assessment of severity of anxiety and depressive symptoms, and by analyzing the structure of these symptomatic psychopathological phenomena, all the patients infected with HIV, dominated by male homosexual group (p <0,05).

Other clinical picture observed in the study of mental health of partners of infected persons. Thus, the overall average anxiety and depression in wives group 1 (5.1 / 4.08) and men group 2 (7.06 / 5.33) were almost within the normal, indicating a lack of reliably marked clinical symptoms of anxiety and depression in this contingent. However, detailed analysis of individual symptom severity allowed to select among these groups examined two subgroups of patients with different states of mental disturbances. In 48.6% of women infected men group 1 and 40% of men infected women in group 2 installed absence of any, even subclinical, anxiety and depressive symptoms. However, in the latter (51.4% of women of group 1 and 60% of men 2) diagnosed with anxiety and depressive manifestations, which, however, had less severity than their infected partners (p <0,01). Intergroup analysis revealed gender differences mental health of partners of infected individuals, the opposite was found in patients with HIV: the severity and anxiety and depressive symptoms was higher in men infected women than in wives of infected men (p <0,01). In contrast to heterosexual partners of infected people, infected homosexual men diagnosed with clinically defined anxiety and depressive symptoms: overall average severity of anxiety in them was 17.78, and Depression - 14.02 points. In addition, it was found that the average severity of individual symptoms of anxiety in them was higher than their infected partners (p <0,01).

In-depth analysis of mental health and clinical content of psychopathological symptoms, diagnosed in the patients allowed to classify existing symptoms and there are two major clinical and pathogenetic symptoms, all of which were represented the major psychopathological syndromes: nozogenic and asthenic somatogenic. Nozogenic symptoms include anxiety and depression (45.7% men and 14.3% women group 1, 31.4% of men and 54.3% of women in Group 2, 42.9% positive and 57.1% of uninfected men 3) and the anxiety-phobic (25.7% men and 34.3% women group 1, 20% men and 28.6% of women in Group 2, 60% positive and 68.6% of uninfected men 3) syndrome, asthenic syndrome somatogenic - asthenic-depressive (48.6% male group 1, 54.3% of women in Group 2, 51.4% of infected men group 3), asthenic-hypochondriac (31.4% male group 1, 8.6% of men and 34 3% of women in Group 2, 37.1% positive and 17.1% of uninfected men group 3) and asthenic-neurotic (17.1% male and 2.9% female group 1, 28.6% of women in Group 2, 45 7% of infected and uninfected males 17.1% Group 3) syndromes.

In the study of the sex of the patients found that heterosexual PP, regardless of whether husband or wife is infected in the genesis of deformation destructive sexual behavior leading role belongs to the distortion of partnerships and somatic consequences of HIV infection. In PP genesis of homosexual sexual problems is more complex, their basis is intrapersonal conflict due stigmatized sexual identity ambivalence of identity, enhanced interpretation of the fact of infection as a consequence of features psychosexual orientation, socio-cultural  discrepancy own ideas, as well as a full range of somatic problems arising the presence of HIV. In addition, 44.3% of heterosexual PP, in which one partner is infected with HIV, the lack of established violations of sexual, indicating the presence of interpersonal resources for the conservation of partnership and support, which is important in terms of their use of rehabilitation potential in the complex treatment and rehabilitation programs for this contingent.

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