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ANALYSIS OF PSYCHO-SOCIAL AND ECONOMIC ADAPTATION AMONG INDIVIDUALS LIVING WITH HIV/AIDS IN KADUNA STATE NIGERIA
ABSTRACT
The purpose of the study wasto assess psycho-social and economic adaptation among people living with HIV/AIDS(PLWHA) in Kaduna State. The research design that was used for this study was an ex-post facto research design. The population for this study was 268,903. A stratified random sampling procedure was used to divide Kaduna State into three (3) existing senatorial districts (3 Strata). Random sampling procedure was used to sample2/3 of the Local Government Areas (LGAs), 5 LGAs from each senatorial district (stratum). Purposive sampling procedure was used to select a Health Care Facility (HCF)from each selected Local Government Area (LGA). A total of 384 copiesof the questionnaire were purposively administered and retrieved from the respondents. Proportionate sampling procedure was used in sampling the respondent, the sample size for Kaduna North was 116 respondents, while for Kaduna Central was 173respondents and for South Senatorial Districts was 95 respondents. Frequency countsand percentages were used to describe demographic characteristics of the respondents. Mean and Standard Deviation wereusedtoanswer the research questions.Inferential statistics of one sample t-test was used to test Hypotheses 1-3, while inferential statistics of two sample t- tests was used to test Hypotheses 4-6.The findings of the study revealed that psychological adaptation was significant (P= 0.00) among people living with HIV/AIDS in Kaduna State, sociological adaptation was significant (P=0.00) among people living with HIV/AIDS in Kaduna State. While male and female living with HIV/AIDS do not significantly differ (P=0.105) and (tcal= 0.943) in their economic adaptation in Kaduna State.On the basis of the findings of the study the following conclusion were drawn: that people living with HIV/AIDS adapted to both their psychological and sociological conditions in Kaduna State, male and female living with HIV/AIDS do not differ in their economic adaptation and gender difference in Kaduna State. The following recommendations were made;PLWHA adapt to their psychological variablessuch as emotional distress (anger, anxiety, depression) and sociological variables such as trust, acceptance, disclosure, interaction among others, therefore HIV/AIDS counselingby health care providers, counselors and psychologistsshould be sustained and there is need for civil society organizations (CBOs) to come to the door step of PLWHIV/AIDS to organize them to form a support groups, so as to ensure their involvement in planning and development of behavioural change activity relating to stigma and discrimination, as this wouldimproved their life. Male and Female living with HIV/AIDS do not differ in their economic adaptation. Therefore, there is the need for government to strengthen the policy environment that empower cPLWHA support group in order to close the gap in access to treatment and social support to infected male and female living with HIV/AIDS in Kaduna State.
LIST OF ABBREVIATIONS
| ABC | – Abstinence Be Faithful Condom use | |
| AIDS | – Acquired Immune Deficiency Syndrome | |
| ANC | – Antenatal Care | |
| ART | – Antiretroviral Therapy | |
| ARV | – Antiretroviral | |
| BBFSW | – Brothel and non Brothel Female Sex Workers. | |
| FMOH | – Federal Ministry of Health | |
| FSW | – Female Sex Works | |
| HAART | – Highly Active Antiretroviral therapy | |
| H C F | – Health Care Facility | |
| HIV | – Human Immunodeficiency Virus | |
| IDU | – Intravenous Drugs Users | |
| KADSACA | – Kaduna State Agency for the control of AIDS | |
| MSM | -Male Sex with Male | |
| NEWPLWHA | – Network of People Living With HIV/AIDS | |
| PABA | – People Affected by HIV/AIDS | |
| PLWHA | – People Living With HIV/AIDS | |
| SDS | – Social Determinant of Stigma | |
SMT – Stigma Mental Illness
STD – Sexually Transmitted Disease
STI – Sexually Transmitted Infection
OPERATIONAL DEFINITION OF TERMS
- Adaption; Is the adjustment of people living with HIV/AIDS to improve
psychological, cultural, sociological or economical challenge.
- Economic adaptation: Refers to financial aids, social support, assessing to household with People Living with HIV/AIDS and medical service to infected person. Psychological adaptation: Adjustment from negative behavior such as anger, anxiety, depression and moodiness of people living with HIV/AIDS to positive Psychosocial: Is the psychological and social aspect of management of people living
with HIV/AIDS
- Sociologicaladaptation: The adjustment to the demands, restrictions and morals of Society where people living with HIV/AIDS will live in harmony. Social adaptation sees us having satisfying social interactions and relationships.
- Socialsupport: Is the assistance, care for people living with HIV/AIDS mostly supportive social network, which can be emotional, tangible or compassion. Stigma and discrimination: This is the prejudice negative attitude, abuse and maltreatment directed at people living with HIV/AIDS
TABLE OF CONTENT
CHAPTER ONE Page (s)
1.1 Introduction. 1
1.1 Background of the study 1
1.2 Statement of Problem 5
1.3 Purpose of the Study 6
1.4 Research Questions 7
1.5 Hypotheses 8
1.5.1 Major Hypothesis 8
1.5.2 Sub-Hypothesis 8
1.6 Basic Assumptions 9
1.7 Significance of the study 9
1.7.1 Delimitation of the Study 11
CHAPTER TWO
2.0 Review of Related Literature 12
2.1 Introduction 12
2.2 Concept of HIV/AIDS 12
2.2.1 Mode of Transmission of HIV/AIDS 13
2.2.2 Treatment of HIV/AIDS 14
2.2.3 Symptoms 17
2.3 Conceptual framework 18
2.4 Empirical Review 19
2.4.1 Psychological Impact of HIV/AIDS 20
2.41.1 Self Stigma Among People Living With HIV/AIDS (PLWHA) 21
2..4.2 Sociological Impact of HIV/AIDS 21
2.4.2.1Culture, sexual Religious and Legal Issues and poverty of PLWHA 22
2.4.2.2Proper Counseling and Social Support for People Living With HIV/AIDS 23
2.4.2.3 Prevention 25
- 4Economical Impact of HIV/AIDS 27
2.5Psychological Adaptation of adaption people living with HIV/AIDS 28
2.5.1 Removing Stigma and Resistance to Change 29
- Sociological Adaptation of adaption people living with HIV/AIDS 30
- Silent among PLWHIV/AIDS 31
- Economic Adaptation of people living with HIV/AIDS 31
- Family Socio – Economic Statues as a Determinant of Economic Adaptation 32
- Nutrition and HIV/AIDS 32
- Psychological Adaptation and Gender Deference among people living
with HIV/AIDS 31
- Sociological Adaptation and Gender Deference among people living
withHIV/AIDS 36
- Feature of Culture and Sexuality in HIV/AIDS era 37
- Economic Adaptation and Gender Deference among people living
withHIV/AIDS 41
- The Care for people living with HIV/AIDS 42
- Health Education and Promotion 44
- Right of People Living With HIV/AIDS (PLWHA) 45
- General Recommendation for Taking Care of Your Self 48
- Trend in Management 49
- Implication to Public Heath 50
- Loss to Man Power and Economic Growth 51
- Psychosocial support for people living with HIV/AIDS 51
- Physiological and Psychological Effects of Exercise Intervention in HIV Disease 53
- Summary 54 CHAPTER THREE 58
3.0 Methodology 58
- Research Design 58
- Population of the Study 58
- Sample and Sampling Procedure 58
- Instrumentation 62
- Validity of Instrument 63
- Procedure for Data Collection 63
- Procedure for Data Analysis 64
CHAPTER FOUR 65
4.1 Introduction 65
4.2 Result 66
4.3 Discussion 74 CHAPTER FIVE 75
5.1 Summary 78
5.1.2 Summary of Major Findings 78
5.2 Conclusion 79
5.3 Recommendation 79
REFERENCES 81
LIST OF TABLE
Table 3.1 Summary of sampled Local Government Areas (LGAs) and Health Care
Facilities (HCF) From the Three Senatorial District of Kaduna State 62
Table 4.1 Demographic Characteristics of the Respondents 66
Table 4.2 Mean Score and Standard Deviation of Responses of People Living
With HIV/AIDSon Psychological Adaptation 68
Table 4.3 Mean Score and Standard Deviation of Responses of People Living With
HIV/AIDS on Sociological Adaptation 69
Table 4.4 Mean Score and Standard Deviation of Responses of People
Living With HIV/AIDS on Economical Adaptation 70
Table 4.5 Summary of one Sample t-test Analysis on Psychological Adaptation of
PeopleLiving With HIV/AIDS 70
Table 4.6 Summary of one Sample t-test Analysis on Sociological Adaptation of
People Living With HIV/AIDS 71
Table 4.7 Summary of one Sample t-test Analysis on economical Adaptation of
People Living With HIV/AIDS 71
Table 4.8 Summary of two Sample t- test Analysis on psychological Adaptation
Between Male and Female Living With HIV/AIDS 72
Table 4.9 Summary of two sample t-test Analysis on Sociological Adaptation
Between Male and Female Living With HIV/AIDS 72
Table 4.10 Summary of two Sample t-test Analysis on Economical Adaptation
BetweenMale and Females Living With HIV/AIDS 73
CHAPTER ONE
INTRODUCTION
Background of the study
Globally, the pandemic of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) has continued to pose serious health and socio – economic challenges. (Afolabi, Afolabi, Odewale&Olowookers, 2013).There were 23 million new HIV infection globally, showing a (33%) decline in the number of new infections from 3.4 million in 2001. HIV/AIDS in Africa was one of the most important global public health issues of our time, and perhaps, in the history of mankind. In Africa, AIDS was one of the top causes of death.While only comprising slightly fewer than (15%) of the total population of the world, Africans account for nearly (70%) of those who live with HIV and were dying of AIDS (AIDS in Africa, 2014). However, Southern Africa exhibits pandemic-level HIV infection rates, with extreme levels in the countries of Botswana, Lesotho, South Africa, Namibia, Zimbabwe, Swaziland, and Zambia. By contrast, some countries in North Africa have HIV prevalence rates lower than most cities in the United State of America. Countries in Western Africa include Senegal, the Gambia, Cape Verde, Guinea-Bissau, Guinea, Sierra
Leone, Liberia, Côte d‟Ivoire, Ghana, Togo, Benin, Cameroon, Nigeria, and the landlocked states of Mali, Burkina Faso and Niger ( AIDS in Africa,2014).
Similarly, United Nation (2015) reported that, Nigeriawas the second highest HIV/AIDS burden in the world with 3.4 million living with the virus in 2014. The figure represents
(4.1%) national prevalence rates as found from the United Nation Programmeon
AIDS(UNAIDS).According to United Nation Programme on AIDS (2016), at November 2015 in every region of the world there were three or four countries that were devastated with the epidemic. For example in sub-Saharan Africa just three countries – Nigeria, South Africa and Uganda account for 48% of all new HIV infections. World Health organization (2016), documented that 37 million people were living with HIV in 2016 globally. However,HIV prevalence by United Nation Programmed on AIDS (UNIADS) in Nigeria was3.2% among the adult population, giving a total of 3.4 million Nigerians living with HIV (Nigerian Health Watch, 2016).In Nigeria, Kaduna state rank among the worst hit by HIV/AIDS with approximately 400,000 people living with the virus (Adeoti& Dung, 2012).Kaduna State has a prevalence of 9.2% and only 24% of children has access to antiretroviral drugs (Abubakar, 2015).
Peter, kamath, Adrews, and Monappa, (2014), found that HIV infection has been viewed as chronic disease which was manageable with lifelong highly active anti-retroviral therapy (HAART). However, the long term toxicities of currently available antiretroviral drugs combine with HIV/AIDS profound impact on individuals, psychological, social, physical and economical well – being associated with poor adherence to active anti-retroviral therapy
(ART) and higher rate of discontinuation of treatment among people living with HIV/AIDS (PLWHA). This may act as significant barriers to National AIDS control program goals. HIV/AIDS were one of the most destructive diseases mankind has ever faced. It brings with profound psychological, social, economic and public health consequences and has become one of the world most serious health and development challenges (Internet HIV and AIDS Stigma and Discrimination, 2014). Some of these challenges include AIDS related stigma and discrimination which refers to prejudice, negative attitudes, abuse and maltreatment directed at people living with HIV/AIDS (PLWHA). The consequences of this stigma and discrimination were wide – ranging for example, being shunned by family, peers and the wider communities, poor treatment in health care facilities and education settings, psychological damage, and a negative effect on the success of HIV testing and treatment (Internet HIV and AIDS Stigma and Discrimination, 2014). This informed the need for research in psychological, sociological and economic adaptations.
The poor psychological adaption was often as a result of stigma that leads to depression, anxiety, stress and felling of hopelessness of people living with HIV/AIDS (Hult, wrubel, Bransrom, Accree&Tedlie, 2012). Sometimes, HIV infection and related opportunistic infections can also directly impact the brain and nervous system. This may lead to problems in memory, thinking, and behavior and can be a challenge to a person‟s mental health. In addition, some medicines used to treat HIV may have side effects that affect a person‟s
mental health (United State Department of Health and Human Services, 2017). However, many factors influence the way people living with HIV/AIDS (PLWHA) experience and communicate their pain. These factors can be categorize as both psychological and emotional (Mikan, 2011). As well chronic pain in people living with
HIV/AIDS was often associated with psychiatric illness and substance abuse (Melin, 2013 &Mikan, 2011). Drugs abuse also enhances the spread of HIV/AIDS by depressing judgment and making addict engage in high risk sexual behavior (National Reproductive Health, HIV/AIDS Prevention Care Project, 2009). So the need to stop stigma is the responsibility for all, so that the tomorrow of PLWHA would be looking better.
Within the past decade, tremendous advances in the fight against HIV have resulted in declining mortality rate and improved life expectancy of those infected. Despite these advances, there continue to be strong social barriers such as HIV – related stigma that negatively affect HIV testing, disclosure, access to care, and health status of populations that may be at risk of infection (Emmanuel, 2010). Despite increased HIV/AIDS awareness and the limited ways it was contracted, social isolation remains a reality for many with HIV. Fear of social stigmas makes disclosing one’s HIV status to friends and family a concern for many with the infection. Determining when to share one’s HIV status and whom to share it with can be a stressful decision due to fear of others’ reactions (Brown, 2017)).Additionally fear – base HIV campaigns have been known to intensify discriminations, as HIV remains a highly stigmatized condition. One in three people diagnose with the virus would have experienced HIV – discrimination at certain point in their lives. However, regrettably people living with HIV/AIDS (PLWHA)were often discriminate against because of (often unfounded) fear of infection which was negatively associated with promiscuity and drugs addiction (Musawa, 2013).
Sexes for survival greatly reduce women‟s ability to freely choose when sex should take place or to negotiate safe sex. There was evidence from all regions globally that the major driving force behind sex work, whether commercial or occasional, was economic opportunity. Sex work that was poverty driving was likely to encourage greater risk taking behavior, such as man – use of condom with client (Elhadji, 2001). Poverty and limited availability of health care facilities were major barriers to health care service in resources poor countries. For people living with HIV/AIDS (PLWHA), economic and geographic factors were compounded by social stigma and decrease mobility making delivery of public health service an even greater challenges (Ogojo, Stuar, Kidana& Wube,2013). With subsistence agriculture as predominant occupation of the indigenes of Kaduna State, the poverty level in the state was higher than the average for the country. Most of the people living with HIV/AIDS were very poor and find it difficult to feed or even transport themselves to the hospital. This makes it quit difficult for them to access extra care service (ante-retroviral and some laboratory support) provided free of charge, courtesy of donor and government support. Quite a number of clients have had to be discharged without receiving special treatment and care and most were treated without paying their hospital bills (Adeoti& Dung, 2012).
Despite higher response to antiretroviral therapy (ART) among people living with HIV/AIDS (PLWHA), HIV continues to disproportionally affect people in Nigeria and other developing countries. If any, there were few pertinent studies that explore both psychos – social and economic adaptation among people living with HIV/AIDS in Nigeria. Monjok, Smesry, and James (2010), documented that relevant research studies were needed to thoroughly understand the consequences of stigma and discrimination at the levels and its effect on HIV prevention, treatment and care as it was directly related in the different socio – cultural setting in Nigeria. Therefore, this study was design to address and analyze four gabs: first psychological related factors, second – sociological related factors, third economic related factors and fourth the setting in Kaduna State and there after suggest to legislatives and planners to develop appropriate and timely intervention program that would encourage prompt accessibility to treatment and supporting Network of people living with HIV/AIDS (PLWHA) by reviewing the right of PLWHA to action.
1.2 Statement of Problem
The researcher was a peer educator trainer (a National Youth Service Corps (NYSC) member who was trained to train school children by forming anti-HIV/AIDS club on prevention of HIH/AIDS). On an outreach visits, the researcher interact with the members of network of people living with HIV/AIDS support group and observed that people living with HIV/AIDS (PLWHA) have been psychologically affected and predispose to stigma and discrimination, denied respect and acceptance by the community, family, friends and love ones. These lead to poor adaptive rate, pain, trauma and increase unequal income opportunities, food insecurity, and inaccessibility to health care services and to link with support groups. This scourge has been inflicting pain and grief, causing fear and uncertainty, encouraging the spread of the epidemic and threatening the economy. So far, there was no single document that investigates the psychological, sociological and economic adaptations of people living with HIV/AIDS (PLWHA) in Kaduna State. These issues raises above motivated the researcher to conduct a research on psycho-social and economical adaptation among people living with HIV/AIDS (PLWHA) in Kaduna State.
People living with HIV/AIDS (PLWHA) were known to have great emotional need and require enormous support for coming to term with dire afflicting status. Some of the feeling that PLHWA experience include, shock or anger at being positively diagnose with HIV, fear of isolation by family and friends and worries about infecting other. By bearing such a heavy emotional burden was surprised that depression was twice as common in PLWHA compare to the general population (Oppong, 2012). Kaduna state was yet to legislate on the stigmatisation and discrimination of people living with HIV/AIDS and people affected by AIDS (PABA) (Ejembi, 2010). This was a driving force that had an implication on the psychological, sociological and economic adaptation of people living with HIV/AIDS in
Kaduna State.
1.3 Purpose of the study
The purpose of this study was to investigate the psycho-social and economic adaptation of people living with HIV/AIDS in Kaduna State. The specific purposes were to assess:
- Psychological adaptation of people living with HIV/AIDS in Kaduna State
- Sociological adaptation of people living with HIV/AIDS in Kaduna State
- Economic adaptation of people living with HIV/AIDS in Kaduna State
- Whether psychological adaptation would differ among gender of people living with
HIV/AIDS in Kaduna State.
- Whether sociological adaptation would differ among gender people living with
HIV/AIDS in Kaduna State.
- Whether economic adaption would differ among gender of people living with
HIV/AIDS in Kaduna State.
1.4 Research Questions
The study wasconducted to answer the following questions;
- What is the psychological adaptation of people living with HIV/AIDS in
Kaduna State?
- What is the sociological adaptation of people living with HIV/AIDS in Kaduna
State?
- What is the economic adaptation of people living with HIV/AIDS in Kaduna
State?
- Would psychological adaptation differ among gender of people living with HIV/AIDSadaptation in Kaduna State?
- Would sociological adaptation differ among gender of people living with HIV/AIDS adaptation Kaduna State?
- Would economic adaptation differ among gender of people living with HIV/AIDS condition in Kaduna State
1.5 Hypotheses
On the basis of the research questions, one major and six sub-hypotheses were formulated for the purpose of this study
1.5.1 Major Hypothesis:
People living with HIV/AIDS do not significantly adapt to psychological, sociological and economic adaptations in Kaduna State.
1.5.2 Sub-Hypotheses
- The psychological adaptation of people living with HIV/AIDS is not significant in
Kaduna State.
- The sociological adaptation of people living with HIV/AIDS is not significant
in Kaduna State.
- The economic adaptation of people living with HIV/AIDS is not significant in Kaduna State.
- There is no significant difference between males and female living with HIV/AIDS in their psychological adaptation in Kaduna State.
- There is no significant difference between males and female living with HIV/AIDS in their sociological adaptation in Kaduna State.
- There is no significant difference between males and female living with HIV/AIDS in their economic adaptation in Kaduna State.
1.6 Basic Assumptions
The basic assumptions of the study were as follows;
- If psychological adaptation of People living with HIV/AIDS (PLWHIV/AIDS) is Positive, they would effectively cope with their condition.
- If sociological adaptation of People living with HIV/AIDS (PLWHIV/AIDS) is
positive, this would create better understanding of themselves in Kaduna State.
- If economic adaptation of People living with HIV/AIDS (PLWHIV/AIDS) is positive, they would cope with their medication.
- If psychological adaptation betweengenders of people living with HIV/AIDS is positive, they would enjoy doing things with others.
- If sociological adaptation between genders of people living with HIV/AIDS is positive, they would share time with people.
- If economical adaptation between gender of people living with HIV/AIDS is positive, theywouldnot default to treatment.
1.7 Significance of the study
It is expected that the result of the research work be useful to:
- Researchers; May add to the existing literature that could be useful to other researchers.
- Government; May help Government to understand how people living with HIV/AIDS were treated in the health care setting by medical practitioners. As well it may help government to see the blue print of the recommendation made that were specific and relevant intervention programmers‟ that would alleviate the problem of people living with HIV in Kaduna state. It would help Government to implement issues that were read and pass into law by policy makers.
- Medical practitioners; May help medical practitioners to understand how people living with HIV/AIDS were neglected and often stigmatize by the general public, So that they would counsel them to developed positive emotions and self esteem. May help them to understand the dangers associated with defaulting to treatment and advocate for follow up, tracking and monitoring services.
- Heath Educators; May help health educators to advocate on behavioural change to the general public on dangers associated with stigmatizing people living with HIV/AIDS, so that they would accept, love and take care of them. It would help health educators to advocate on proactive intervention programmed that would promote the better understanding of people living with HIV/AIDS.
- Nongovernmental Organisation; May encourage Nongovernmental organizations to give more psycho-social support to person infected with HIV/AIDS. It would help them to understand that psychosocial and palliative support services were poorly developed in Kaduna state, so that they would advocate for better support services in term of Nutrition, access to health care facilities, incentive and encourage people living with HIV/AIDS to join support group.
- International Organisation; it would help international organizations such as (World Health Organisation, United Nation International Children Emergency Fund, United Nation Development Programme and United Nation Programme on AIDS) to understand how devastating HIV/AIDS was in Kaduna state and provide more
technical and financial assistance to the state. .
1.8 Delimitation of the Study
The study was delimited to assessment of psychosocial and economical adaptations among adaption people living with HIV/AIDS in Kaduna State.
ABSTRACT
The purpose of the study wasto assess psycho-social and economic adaptation among people living with HIV/AIDS(PLWHA) in Kaduna State. The research design that was used for this study was an ex-post facto research design. The population for this study was 268,903. A stratified random sampling procedure was used to divide Kaduna State into three (3) existing senatorial districts (3 Strata). Random sampling procedure was used to sample2/3 of the Local Government Areas (LGAs), 5 LGAs from each senatorial district (stratum). Purposive sampling procedure was used to select a Health Care Facility (HCF)from each selected Local Government Area (LGA). A total of 384 copiesof the questionnaire were purposively administered and retrieved from the respondents. Proportionate sampling procedure was used in sampling the respondent, the sample size for Kaduna North was 116 respondents, while for Kaduna Central was 173respondents and for South Senatorial Districts was 95 respondents. Frequency countsand percentages were used to describe demographic characteristics of the respondents. Mean and Standard Deviation wereusedtoanswer the research questions.Inferential statistics of one sample t-test was used to test Hypotheses 1-3, while inferential statistics of two sample t- tests was used to test Hypotheses 4-6.The findings of the study revealed that psychological adaptation was significant (P= 0.00) among people living with HIV/AIDS in Kaduna State, sociological adaptation was significant (P=0.00) among people living with HIV/AIDS in Kaduna State. While male and female living with HIV/AIDS do not significantly differ (P=0.105) and (tcal= 0.943) in their economic adaptation in Kaduna State.On the basis of the findings of the study the following conclusion were drawn: that people living with HIV/AIDS adapted to both their psychological and sociological conditions in Kaduna State, male and female living with HIV/AIDS do not differ in their economic adaptation and gender difference in Kaduna State. The following recommendations were made;PLWHA adapt to their psychological variablessuch as emotional distress (anger, anxiety, depression) and sociological variables such as trust, acceptance, disclosure, interaction among others, therefore HIV/AIDS counselingby health care providers, counselors and psychologistsshould be sustained and there is need for civil society organizations (CBOs) to come to the door step of PLWHIV/AIDS to organize them to form a support groups, so as to ensure their involvement in planning and development of behavioural change activity relating to stigma and discrimination, as this wouldimproved their life. Male and Female living with HIV/AIDS do not differ in their economic adaptation. Therefore, there is the need for government to strengthen the policy environment that empower cPLWHA support group in order to close the gap in access to treatment and social support to infected male and female living with HIV/AIDS in Kaduna State.
LIST OF ABBREVIATIONS
| ABC | – Abstinence Be Faithful Condom use | |
| AIDS | – Acquired Immune Deficiency Syndrome | |
| ANC | – Antenatal Care | |
| ART | – Antiretroviral Therapy | |
| ARV | – Antiretroviral | |
| BBFSW | – Brothel and non Brothel Female Sex Workers. | |
| FMOH | – Federal Ministry of Health | |
| FSW | – Female Sex Works | |
| HAART | – Highly Active Antiretroviral therapy | |
| H C F | – Health Care Facility | |
| HIV | – Human Immunodeficiency Virus | |
| IDU | – Intravenous Drugs Users | |
| KADSACA | – Kaduna State Agency for the control of AIDS | |
| MSM | -Male Sex with Male | |
| NEWPLWHA | – Network of People Living With HIV/AIDS | |
| PABA | – People Affected by HIV/AIDS | |
| PLWHA | – People Living With HIV/AIDS | |
| SDS | – Social Determinant of Stigma | |
SMT – Stigma Mental Illness
STD – Sexually Transmitted Disease
STI – Sexually Transmitted Infection
OPERATIONAL DEFINITION OF TERMS
- Adaption; Is the adjustment of people living with HIV/AIDS to improve
psychological, cultural, sociological or economical challenge.
- Economic adaptation: Refers to financial aids, social support, assessing to household with People Living with HIV/AIDS and medical service to infected person. Psychological adaptation: Adjustment from negative behavior such as anger, anxiety, depression and moodiness of people living with HIV/AIDS to positive Psychosocial: Is the psychological and social aspect of management of people living
with HIV/AIDS
- Sociologicaladaptation: The adjustment to the demands, restrictions and morals of Society where people living with HIV/AIDS will live in harmony. Social adaptation sees us having satisfying social interactions and relationships.
- Socialsupport: Is the assistance, care for people living with HIV/AIDS mostly supportive social network, which can be emotional, tangible or compassion. Stigma and discrimination: This is the prejudice negative attitude, abuse and maltreatment directed at people living with HIV/AIDS
TABLE OF CONTENT
CHAPTER ONE Page (s)
1.1 Introduction. 1
1.1 Background of the study 1
1.2 Statement of Problem 5
1.3 Purpose of the Study 6
1.4 Research Questions 7
1.5 Hypotheses 8
1.5.1 Major Hypothesis 8
1.5.2 Sub-Hypothesis 8
1.6 Basic Assumptions 9
1.7 Significance of the study 9
1.7.1 Delimitation of the Study 11
CHAPTER TWO
2.0 Review of Related Literature 12
2.1 Introduction 12
2.2 Concept of HIV/AIDS 12
2.2.1 Mode of Transmission of HIV/AIDS 13
2.2.2 Treatment of HIV/AIDS 14
2.2.3 Symptoms 17
2.3 Conceptual framework 18
2.4 Empirical Review 19
2.4.1 Psychological Impact of HIV/AIDS 20
2.41.1 Self Stigma Among People Living With HIV/AIDS (PLWHA) 21
2..4.2 Sociological Impact of HIV/AIDS 21
2.4.2.1Culture, sexual Religious and Legal Issues and poverty of PLWHA 22
2.4.2.2Proper Counseling and Social Support for People Living With HIV/AIDS 23
2.4.2.3 Prevention 25
- 4Economical Impact of HIV/AIDS 27
2.5Psychological Adaptation of adaption people living with HIV/AIDS 28
2.5.1 Removing Stigma and Resistance to Change 29
- Sociological Adaptation of adaption people living with HIV/AIDS 30
- Silent among PLWHIV/AIDS 31
- Economic Adaptation of people living with HIV/AIDS 31
- Family Socio – Economic Statues as a Determinant of Economic Adaptation 32
- Nutrition and HIV/AIDS 32
- Psychological Adaptation and Gender Deference among people living
with HIV/AIDS 31
- Sociological Adaptation and Gender Deference among people living
withHIV/AIDS 36
- Feature of Culture and Sexuality in HIV/AIDS era 37
- Economic Adaptation and Gender Deference among people living
withHIV/AIDS 41
- The Care for people living with HIV/AIDS 42
- Health Education and Promotion 44
- Right of People Living With HIV/AIDS (PLWHA) 45
- General Recommendation for Taking Care of Your Self 48
- Trend in Management 49
- Implication to Public Heath 50
- Loss to Man Power and Economic Growth 51
- Psychosocial support for people living with HIV/AIDS 51
- Physiological and Psychological Effects of Exercise Intervention in HIV Disease 53
- Summary 54 CHAPTER THREE 58
3.0 Methodology 58
- Research Design 58
- Population of the Study 58
- Sample and Sampling Procedure 58
- Instrumentation 62
- Validity of Instrument 63
- Procedure for Data Collection 63
- Procedure for Data Analysis 64
CHAPTER FOUR 65
4.1 Introduction 65
4.2 Result 66
4.3 Discussion 74 CHAPTER FIVE 75
5.1 Summary 78
5.1.2 Summary of Major Findings 78
5.2 Conclusion 79
5.3 Recommendation 79
REFERENCES 81
LIST OF TABLE
Table 3.1 Summary of sampled Local Government Areas (LGAs) and Health Care
Facilities (HCF) From the Three Senatorial District of Kaduna State 62
Table 4.1 Demographic Characteristics of the Respondents 66
Table 4.2 Mean Score and Standard Deviation of Responses of People Living
With HIV/AIDSon Psychological Adaptation 68
Table 4.3 Mean Score and Standard Deviation of Responses of People Living With
HIV/AIDS on Sociological Adaptation 69
Table 4.4 Mean Score and Standard Deviation of Responses of People
Living With HIV/AIDS on Economical Adaptation 70
Table 4.5 Summary of one Sample t-test Analysis on Psychological Adaptation of
PeopleLiving With HIV/AIDS 70
Table 4.6 Summary of one Sample t-test Analysis on Sociological Adaptation of
People Living With HIV/AIDS 71
Table 4.7 Summary of one Sample t-test Analysis on economical Adaptation of
People Living With HIV/AIDS 71
Table 4.8 Summary of two Sample t- test Analysis on psychological Adaptation
Between Male and Female Living With HIV/AIDS 72
Table 4.9 Summary of two sample t-test Analysis on Sociological Adaptation
Between Male and Female Living With HIV/AIDS 72
Table 4.10 Summary of two Sample t-test Analysis on Economical Adaptation
BetweenMale and Females Living With HIV/AIDS 73
CHAPTER ONE
INTRODUCTION
Background of the study
Globally, the pandemic of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) has continued to pose serious health and socio – economic challenges. (Afolabi, Afolabi, Odewale&Olowookers, 2013).There were 23 million new HIV infection globally, showing a (33%) decline in the number of new infections from 3.4 million in 2001. HIV/AIDS in Africa was one of the most important global public health issues of our time, and perhaps, in the history of mankind. In Africa, AIDS was one of the top causes of death.While only comprising slightly fewer than (15%) of the total population of the world, Africans account for nearly (70%) of those who live with HIV and were dying of AIDS (AIDS in Africa, 2014). However, Southern Africa exhibits pandemic-level HIV infection rates, with extreme levels in the countries of Botswana, Lesotho, South Africa, Namibia, Zimbabwe, Swaziland, and Zambia. By contrast, some countries in North Africa have HIV prevalence rates lower than most cities in the United State of America. Countries in Western Africa include Senegal, the Gambia, Cape Verde, Guinea-Bissau, Guinea, Sierra
Leone, Liberia, Côte d‟Ivoire, Ghana, Togo, Benin, Cameroon, Nigeria, and the landlocked states of Mali, Burkina Faso and Niger ( AIDS in Africa,2014).
Similarly, United Nation (2015) reported that, Nigeriawas the second highest HIV/AIDS burden in the world with 3.4 million living with the virus in 2014. The figure represents
(4.1%) national prevalence rates as found from the United Nation Programmeon
AIDS(UNAIDS).According to United Nation Programme on AIDS (2016), at November 2015 in every region of the world there were three or four countries that were devastated with the epidemic. For example in sub-Saharan Africa just three countries – Nigeria, South Africa and Uganda account for 48% of all new HIV infections. World Health organization (2016), documented that 37 million people were living with HIV in 2016 globally. However,HIV prevalence by United Nation Programmed on AIDS (UNIADS) in Nigeria was3.2% among the adult population, giving a total of 3.4 million Nigerians living with HIV (Nigerian Health Watch, 2016).In Nigeria, Kaduna state rank among the worst hit by HIV/AIDS with approximately 400,000 people living with the virus (Adeoti& Dung, 2012).Kaduna State has a prevalence of 9.2% and only 24% of children has access to antiretroviral drugs (Abubakar, 2015).
Peter, kamath, Adrews, and Monappa, (2014), found that HIV infection has been viewed as chronic disease which was manageable with lifelong highly active anti-retroviral therapy (HAART). However, the long term toxicities of currently available antiretroviral drugs combine with HIV/AIDS profound impact on individuals, psychological, social, physical and economical well – being associated with poor adherence to active anti-retroviral therapy
(ART) and higher rate of discontinuation of treatment among people living with HIV/AIDS (PLWHA). This may act as significant barriers to National AIDS control program goals. HIV/AIDS were one of the most destructive diseases mankind has ever faced. It brings with profound psychological, social, economic and public health consequences and has become one of the world most serious health and development challenges (Internet HIV and AIDS Stigma and Discrimination, 2014). Some of these challenges include AIDS related stigma and discrimination which refers to prejudice, negative attitudes, abuse and maltreatment directed at people living with HIV/AIDS (PLWHA). The consequences of this stigma and discrimination were wide – ranging for example, being shunned by family, peers and the wider communities, poor treatment in health care facilities and education settings, psychological damage, and a negative effect on the success of HIV testing and treatment (Internet HIV and AIDS Stigma and Discrimination, 2014). This informed the need for research in psychological, sociological and economic adaptations.
The poor psychological adaption was often as a result of stigma that leads to depression, anxiety, stress and felling of hopelessness of people living with HIV/AIDS (Hult, wrubel, Bransrom, Accree&Tedlie, 2012). Sometimes, HIV infection and related opportunistic infections can also directly impact the brain and nervous system. This may lead to problems in memory, thinking, and behavior and can be a challenge to a person‟s mental health. In addition, some medicines used to treat HIV may have side effects that affect a person‟s
mental health (United State Department of Health and Human Services, 2017). However, many factors influence the way people living with HIV/AIDS (PLWHA) experience and communicate their pain. These factors can be categorize as both psychological and emotional (Mikan, 2011). As well chronic pain in people living with
HIV/AIDS was often associated with psychiatric illness and substance abuse (Melin, 2013 &Mikan, 2011). Drugs abuse also enhances the spread of HIV/AIDS by depressing judgment and making addict engage in high risk sexual behavior (National Reproductive Health, HIV/AIDS Prevention Care Project, 2009). So the need to stop stigma is the responsibility for all, so that the tomorrow of PLWHA would be looking better.
Within the past decade, tremendous advances in the fight against HIV have resulted in declining mortality rate and improved life expectancy of those infected. Despite these advances, there continue to be strong social barriers such as HIV – related stigma that negatively affect HIV testing, disclosure, access to care, and health status of populations that may be at risk of infection (Emmanuel, 2010). Despite increased HIV/AIDS awareness and the limited ways it was contracted, social isolation remains a reality for many with HIV. Fear of social stigmas makes disclosing one’s HIV status to friends and family a concern for many with the infection. Determining when to share one’s HIV status and whom to share it with can be a stressful decision due to fear of others’ reactions (Brown, 2017)).Additionally fear – base HIV campaigns have been known to intensify discriminations, as HIV remains a highly stigmatized condition. One in three people diagnose with the virus would have experienced HIV – discrimination at certain point in their lives. However, regrettably people living with HIV/AIDS (PLWHA)were often discriminate against because of (often unfounded) fear of infection which was negatively associated with promiscuity and drugs addiction (Musawa, 2013).
Sexes for survival greatly reduce women‟s ability to freely choose when sex should take place or to negotiate safe sex. There was evidence from all regions globally that the major driving force behind sex work, whether commercial or occasional, was economic opportunity. Sex work that was poverty driving was likely to encourage greater risk taking behavior, such as man – use of condom with client (Elhadji, 2001). Poverty and limited availability of health care facilities were major barriers to health care service in resources poor countries. For people living with HIV/AIDS (PLWHA), economic and geographic factors were compounded by social stigma and decrease mobility making delivery of public health service an even greater challenges (Ogojo, Stuar, Kidana& Wube,2013). With subsistence agriculture as predominant occupation of the indigenes of Kaduna State, the poverty level in the state was higher than the average for the country. Most of the people living with HIV/AIDS were very poor and find it difficult to feed or even transport themselves to the hospital. This makes it quit difficult for them to access extra care service (ante-retroviral and some laboratory support) provided free of charge, courtesy of donor and government support. Quite a number of clients have had to be discharged without receiving special treatment and care and most were treated without paying their hospital bills (Adeoti& Dung, 2012).
Despite higher response to antiretroviral therapy (ART) among people living with HIV/AIDS (PLWHA), HIV continues to disproportionally affect people in Nigeria and other developing countries. If any, there were few pertinent studies that explore both psychos – social and economic adaptation among people living with HIV/AIDS in Nigeria. Monjok, Smesry, and James (2010), documented that relevant research studies were needed to thoroughly understand the consequences of stigma and discrimination at the levels and its effect on HIV prevention, treatment and care as it was directly related in the different socio – cultural setting in Nigeria. Therefore, this study was design to address and analyze four gabs: first psychological related factors, second – sociological related factors, third economic related factors and fourth the setting in Kaduna State and there after suggest to legislatives and planners to develop appropriate and timely intervention program that would encourage prompt accessibility to treatment and supporting Network of people living with HIV/AIDS (PLWHA) by reviewing the right of PLWHA to action.
1.2 Statement of Problem
The researcher was a peer educator trainer (a National Youth Service Corps (NYSC) member who was trained to train school children by forming anti-HIV/AIDS club on prevention of HIH/AIDS). On an outreach visits, the researcher interact with the members of network of people living with HIV/AIDS support group and observed that people living with HIV/AIDS (PLWHA) have been psychologically affected and predispose to stigma and discrimination, denied respect and acceptance by the community, family, friends and love ones. These lead to poor adaptive rate, pain, trauma and increase unequal income opportunities, food insecurity, and inaccessibility to health care services and to link with support groups. This scourge has been inflicting pain and grief, causing fear and uncertainty, encouraging the spread of the epidemic and threatening the economy. So far, there was no single document that investigates the psychological, sociological and economic adaptations of people living with HIV/AIDS (PLWHA) in Kaduna State. These issues raises above motivated the researcher to conduct a research on psycho-social and economical adaptation among people living with HIV/AIDS (PLWHA) in Kaduna State.
People living with HIV/AIDS (PLWHA) were known to have great emotional need and require enormous support for coming to term with dire afflicting status. Some of the feeling that PLHWA experience include, shock or anger at being positively diagnose with HIV, fear of isolation by family and friends and worries about infecting other. By bearing such a heavy emotional burden was surprised that depression was twice as common in PLWHA compare to the general population (Oppong, 2012). Kaduna state was yet to legislate on the stigmatisation and discrimination of people living with HIV/AIDS and people affected by AIDS (PABA) (Ejembi, 2010). This was a driving force that had an implication on the psychological, sociological and economic adaptation of people living with HIV/AIDS in
Kaduna State.
1.3 Purpose of the study
The purpose of this study was to investigate the psycho-social and economic adaptation of people living with HIV/AIDS in Kaduna State. The specific purposes were to assess:
- Psychological adaptation of people living with HIV/AIDS in Kaduna State
- Sociological adaptation of people living with HIV/AIDS in Kaduna State
- Economic adaptation of people living with HIV/AIDS in Kaduna State
- Whether psychological adaptation would differ among gender of people living with
HIV/AIDS in Kaduna State.
- Whether sociological adaptation would differ among gender people living with
HIV/AIDS in Kaduna State.
- Whether economic adaption would differ among gender of people living with
HIV/AIDS in Kaduna State.
1.4 Research Questions
The study wasconducted to answer the following questions;
- What is the psychological adaptation of people living with HIV/AIDS in
Kaduna State?
- What is the sociological adaptation of people living with HIV/AIDS in Kaduna
State?
- What is the economic adaptation of people living with HIV/AIDS in Kaduna
State?
- Would psychological adaptation differ among gender of people living with HIV/AIDSadaptation in Kaduna State?
- Would sociological adaptation differ among gender of people living with HIV/AIDS adaptation Kaduna State?
- Would economic adaptation differ among gender of people living with HIV/AIDS condition in Kaduna State
1.5 Hypotheses
On the basis of the research questions, one major and six sub-hypotheses were formulated for the purpose of this study
1.5.1 Major Hypothesis:
People living with HIV/AIDS do not significantly adapt to psychological, sociological and economic adaptations in Kaduna State.
1.5.2 Sub-Hypotheses
- The psychological adaptation of people living with HIV/AIDS is not significant in
Kaduna State.
- The sociological adaptation of people living with HIV/AIDS is not significant
in Kaduna State.
- The economic adaptation of people living with HIV/AIDS is not significant in Kaduna State.
- There is no significant difference between males and female living with HIV/AIDS in their psychological adaptation in Kaduna State.
- There is no significant difference between males and female living with HIV/AIDS in their sociological adaptation in Kaduna State.
- There is no significant difference between males and female living with HIV/AIDS in their economic adaptation in Kaduna State.
1.6 Basic Assumptions
The basic assumptions of the study were as follows;
- If psychological adaptation of People living with HIV/AIDS (PLWHIV/AIDS) is Positive, they would effectively cope with their condition.
- If sociological adaptation of People living with HIV/AIDS (PLWHIV/AIDS) is
positive, this would create better understanding of themselves in Kaduna State.
- If economic adaptation of People living with HIV/AIDS (PLWHIV/AIDS) is positive, they would cope with their medication.
- If psychological adaptation betweengenders of people living with HIV/AIDS is positive, they would enjoy doing things with others.
- If sociological adaptation between genders of people living with HIV/AIDS is positive, they would share time with people.
- If economical adaptation between gender of people living with HIV/AIDS is positive, theywouldnot default to treatment.
1.7 Significance of the study
It is expected that the result of the research work be useful to:
- Researchers; May add to the existing literature that could be useful to other researchers.
- Government; May help Government to understand how people living with HIV/AIDS were treated in the health care setting by medical practitioners. As well it may help government to see the blue print of the recommendation made that were specific and relevant intervention programmers‟ that would alleviate the problem of people living with HIV in Kaduna state. It would help Government to implement issues that were read and pass into law by policy makers.
- Medical practitioners; May help medical practitioners to understand how people living with HIV/AIDS were neglected and often stigmatize by the general public, So that they would counsel them to developed positive emotions and self esteem. May help them to understand the dangers associated with defaulting to treatment and advocate for follow up, tracking and monitoring services.
- Heath Educators; May help health educators to advocate on behavioural change to the general public on dangers associated with stigmatizing people living with HIV/AIDS, so that they would accept, love and take care of them. It would help health educators to advocate on proactive intervention programmed that would promote the better understanding of people living with HIV/AIDS.
- Nongovernmental Organisation; May encourage Nongovernmental organizations to give more psycho-social support to person infected with HIV/AIDS. It would help them to understand that psychosocial and palliative support services were poorly developed in Kaduna state, so that they would advocate for better support services in term of Nutrition, access to health care facilities, incentive and encourage people living with HIV/AIDS to join support group.
- International Organisation; it would help international organizations such as (World Health Organisation, United Nation International Children Emergency Fund, United Nation Development Programme and United Nation Programme on AIDS) to understand how devastating HIV/AIDS was in Kaduna state and provide more
technical and financial assistance to the state. .
1.8 Delimitation of the Study
The study was delimited to assessment of psychosocial and economical adaptations among adaption people living with HIV/AIDS in Kaduna State.
ANALYSIS OF PSYCHO-SOCIAL AND ECONOMIC ADAPTATION AMONG INDIVIDUALS LIVING WITH HIV/AIDS IN KADUNA STATE NIGERIA
