Transcript Gender effect of HIV on Neuropsychological functioning

Mental Health
Consequences of HIVA Gender Perspective
Ravi Paul 1, J.Anitha Menon1, Mary S Ngoma1 Knut A. Hestad2,
1 University of Zambia
2 Norwegian University of Science and Technology
Introduction
HIV and AIDS scenario in Zambia
• In 2009, an estimated 14.3 per cent of Zambia’s
12.9 million population was infected with HIV,
and Zambia is seventh among the countries
worst affected by this epidemic (National AIDS
Council, 2010).
• The country’s first reported AIDS diagnosis was
in 1984, and this was followed by a rapid rise in
estimates of HIV prevalence (Zambian Ministry of
Health and Central Board of Health, 2005).
Women and HIV
• HIV prevalence among Zambian women is
three times as high as in males :
– enforcement of laws regarding property
ownership,
– inheritance
– marriage and sexual negotiations with their
husband.
• Cultural practices:
e.g. sexual cleansing (kusalazya) and wife
inheritance (kunjilila mung’anda)
make women more vulnerable to HIV
Psychosocial consequences of
HIV in Women
• Stigmatization,
divorce
or
abandonment
• Psychosocial Stressors: guilt of
not
sharing
their
status,
depression and the trauma of
knowing they are positive
• Antiretroviral drugs
• Gender violence, physical and
sexual abuse
Effect of HIV on CNS
• HIV enters the central nervous system
(CNS) early after infection and eventually
results in both structural and functional
brain changes in about 30-50% of cases
(Shaw et al. 1985).
• These changes may have significant
effects on day-to-day functioning (Antinori et
al., 2007).
HIV and Cognitive Impairment
• Prevalence of milder cognitive impairment
may be increasing as HIV+ people are
living longer due to modern antiretroviral
therapy (Heaton et al., 2011).
• Individuals infected with clade C may be at
risk of developing HIV Associated
Neurocognitive Disorders (HAND) (Joska et
al., 2010; Yepthomi et al., 2006).
Research evidence from Zambia
• Examined
neuropsychological
differences,
especially
gender
difference,
between
HIV
seropostive (HIV+) patients being followed in a
University of Zambia clinic and demographically
comparable seronegative (HIV-) controls recruited in
the same setting.
• Sample: 38 individuals who tested HIV+ and 42 who
were tested HIV- Recruited from the University of
Zambia anti- retroviral therapy (ART) clinic in
consultation with the medical officer
• Inclusion criteria: a minimum of 8 years of
education, in the age range of 20 years to 40 years,
have no known risk for neurological impairment
other than HIV infection, and no history of alcohol or
drug abuse
Results
• Difference between HIV+ and HIV- in areas of:
– speed of information processing
– verbal fluency
– executive functioning and
– visual episodic memory
• Difference seen between HIV+ and HIV –cohorts was
primarily due to the HIV
seropositive females
Ref: Hestad, Menon et al. (2012) Sex Differences in
Neuropsychological Performance as an Effect of Human
Immunodeficiency Virus Infection- A Pilot Study in
Zambia, Africa. Journal of Nervous and Mental Disease
TTHANK YOU
from the land of
VICTORIA FALLS