Expereinces Of Forgiveness, Psychological Healthrelated Quality Of Life And Immunological Markers: A Study Among People Living With Hiv/Aids In Ghana.

ABSTRACT

The role of forgiveness of perceived offenses in health has gained empirical attention for about three decades now in various areas including the area of Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS). This study aimed at investigating the relationship between forgiveness of offenses directly related to one’s HIV/AIDS-positive status and two health outcomes – psychological health-related quality of life (PHRQOL) and immune functioning, measured by change in cluster of differentiation 4 (CD4) cells. Employing an explanatory mixed method design, crosssectional survey data was first collected on a total of 325 people living with HIV/AIDS (PLWHA) receiving antiretroviral therapy (ART) across HIV outpatient clinics at the Korle-Bu, Komfo Anokye, and Tamale Teaching Hospitals in Ghana. Participants completed validated forgiveness measures across three contexts – intrapersonal, interpersonal, and spiritual. Multivariate regression analyses revealed that forgiveness, particularly positive attitudes toward God and decisional forgiveness of self, uniquely predicted PHRQOL and change in CD4 cell count respectively in adjusted analyses. However, health behaviours did not moderate the forgiveness-health relationship in all contexts. To expound on the survey findings, a follow-up phenomenological study on the lived experiences of forgiveness of HIV-related offenses among 15 of the survey participants using a semi-structured interview schedule was conducted. Using interpretative phenomenological analysis, six themes emerged indicating that forgiveness was experienced as internal and external actions confirmed by the experience of positive psychological changes within the offended. These changes held meaning for participants’ psychological health, their physical and socioeconomic wellbeing, as well as for adhering to ART, engaging in protective sexual behaviours, and living a new, focused, and purposeful life. Overall, the findings complementarily lend support to the Stress and Coping Model of Forgiveness, the Biopsychosocial Contexts of Framework of Forgiveness in HIV/AIDS, and the Afrocultural Social Ethos Framework. Namely, among PLWHA in Ghana, forgiveness as an adaptive coping strategy for perceived HIV-related offenses may hold benefits for psychological and immune health possibly through the stress response system and also positive health behaviours, and that among other factors, values for communalism and spirituality may facilitate forgiveness experiences via social support and religious beliefs and practices. These findings hold important implications for theory building, clinical practice, policy development, and for public health and health psychology practice. There is the need for health psychologists through collaborations with clinicians, public health professionals, and policy makers to develop and implement culturally-relevant forgiveness assessments and interventions suitable for use in clinical settings. These, together with existing ART-adherence counselling protocols, may support PLWHA to appropriately cope with any perceived offenses and emotional pain, and to feel motivated to engage in adherent and protective behaviours, both of which behaviours are necessary for curbing secondary transmission of HIV/AIDS.