Pain in people living with HIV/AIDS in the Western Cape
The increased life expectancy of people living with HIV/AIDS (PLWHA) has meant that the disease has changed status from a terminal to a chronic condition. Along with this shift, increased attention has been given to maximising the quality of the prolonged life. A common, long standing problem impacting quality of life in PLWHA is that of pain. Investigating pain in PLWHA was therefore the core subject under study in the current thesis. The thesis consists of four main components. Firstly, a theoretical framework for pain as a biopsychosocial phenomenon from which current literature on the aetiology and management of pain in this population was reviewed. Secondly, to gain an understanding of whether pain was a problem in the English and/or Afrikaans speaking urban and rural population of PLWHA, a prevalence study was conducted. Thirdly, an investigation assessing the efficacy of the use of a biopsychosocialy informed intervention for the management of pain in this population was conducted. And finally a qualitative study exploring the experiences of adult women living with pain and/or HIV was studied. The findings of the prevalence study showed that urban participants (with a prevalence rate of 42% (CI:34-50%) n=151) were 8.1 (CI:3.7-17.9) times more likely to experience pain than their rural counterparts (with a prevalence rate of 8% ((CI:4-15%) n=96). From this it was concluded that pain is indeed a problem in the urban community, whereas it was not as big a problem in the rural community. This prompted the researchers to conduct the intervention study in the urban population. The intervention study however suffered from a small sample size (N=32 having given consent, but only n=17 attending baseline data collection) which limited analysis. Upon reflection, the small sample was a result in and of itself, and could be considered as an indication that interventions need to be strongly informed by what is deemed (un-)acceptable by the community in which they are run and tested. As such, a conclusion was made that the ‘one-size-fits-all’ approach to the management of pain in HIV/AIDS may not be the solution. With this result from the intervention study, as well as the vastly different pain prevalence rates seen in the prevalence study, a qualitative study was added. Using a purposive sampling technique, seven participants (three from the urban site, and four from the rural site) who were HIV positive, with (n=4) and without (n=3) pain, were interviewed and their responses analysed and compared. With the use of the Morse model, the qualitative study gave insight into how pain and/or HIV influenced the experiences of Afrikaans and/or English speaking women, and also highlighted the role that stigma/support plays in their experiences with pain and HIV. From all three studies it is clear that pain in HIV/AIDS is complex and requires specific community tailored approaches.
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