Assessment Of Psychosocial And Economic Adaptation Among People Living With HIV/AIDS In Nigeria

Project and Seminar Material for Nursing (Science)

Abstract

The purpose of the study was to assess psycho-social and economic adaptation among people living with HIV/AIDS(PLWHA) in Nigeria, Akwa-Ibom State as case study. The research design that was used for this study was an ex-post facto research design. A stratified random sampling procedure was used to divide Akwa-Ibom State into three (3) existing senatorial districts (3 Strata). Random sampling procedure was used to sample 2/3 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 copies of the questionnaire were purposively administered and retrieved from the respondents. Frequency counts and percentages were used to describe demographic characteristics of the respondents. Mean and Standard Deviation were used to answer the research questions. The findings of the study revealed that psychological adaptation was significant (P= 0.00) among people living with HIV/AIDS in Akwa-Ibom State, sociological adaptation was significant (P=0.00) among people living with HIV/AIDS in Akwa-Ibom 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 Akwa-Ibom 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 Akwa-Ibom State. The following recommendations were made; PLWHA adapt to their psychological variables such as emotional distress (anger, anxiety, depression) and sociological variables such as trust, acceptance, disclosure, interaction among others. 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 Akwa-Ibom State.

Table of Content

Title Page
Certification
Dedication
Acknowledgement
Table of Content
List of Tables
Abstract

Chapter One:

Introduction

1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objective of the Study
1.4 Research Questions
1.6 Significance of the Study
1.7 Scope of the Study
1.8 Limitation of the Study
1.9 Definition of Terms
1.10 Organisations of the Study

Chapter Two:

Review of Literature

2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review

Chapter Three:

Research Methodology

3.1 Research Design
3.2 Population of the Study
3.3 Sample Size Determination
3.4 Sample Size Selection Technique and Procedure
3.5 Research Instrument and Administration
3.6 Method of Data Collection
3.7 Method of Data Analysis
3.8 Validity of the Study
3.9 Reliability of the Study
3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

4.1 Data Presentation
4.2 Analysis of Data
4.3 Answering Research Questions
4.4 Test of Hypotheses
4.5 Interpretation of Result

Chapter Five:

Summary, Conclusion and Recommendation

5.1 Summary
5.2 Conclusion
5.3 Recommendation
References
APPENDIX
QUESTIONNAIRE

Chapter One

Introduction

1.1 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, Nigeria was 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, Akwa-Ibom state rank among the worst hit by HIV/AIDS with approximately 400,000 people living with the virus (Adeoti& Dung, 2012).Akwa-Ibom 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 Akwa-Ibom 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 Akwa-Ibom 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 Akwa-Ibom 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 Akwa-Ibom 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). Akwa-Ibom 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 Akwa-Ibom 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 Akwa-Ibom State.

The specific purposes were to assess:

Psychological adaptation of people living with HIV/AIDS in Akwa-Ibom State
Sociological adaptation of people living with HIV/AIDS in Akwa-Ibom State
Economic adaptation of people living with HIV/AIDS in Akwa-Ibom State

1.4 Research Questions

The study was conducted to answer the following questions;

What is the psychological adaptation of people living with HIV/AIDS in Akwa-Ibom State?
What is the sociological adaptation of people living with HIV/AIDS in Akwa-Ibom State?
What is the economic adaptation of people living with HIV/AIDS in Akwa-Ibom State?

1.5 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 Akwa-Ibom 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 Akwa-Ibom 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 Akwa-Ibom state and provide more technical and financial assistance to the state.

1.6 Scope of the Study

The study was delimited to assessment of psychosocial and economical adaptations among adaption people living with HIV/AIDS in Akwa-Ibom State.

1.7 Limitation of Study

Finance, inadequate materials and time constraint were the challenges the researchers encountered during the course of the study.

1.8 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

Sociological Adaptation:

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.

Social Support:

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

1.9 Organizations of the Study

The chapter one consist of the introductory part of the study which includes the study background, the statement of the research problem, the study objective and scope of the study.

The second chapter is a critical review of other literatures relevant to the study and its objectives including the theoretical framework for the study. While the third chapter is methods of data collection, sampling and data analysis used in conducting the study. The fourth chapter centres around the research findings including an analysis of how it relates to previous findings. The fifth chapter consists of the summary of findings, conclusion and recommendations base on the study objectives.

Chapter Five

Summary, Conclusion and Recommendations

5.1 Summary

The main purpose of the study was to assess the psycho-social and economic adaptation among people living with HIV/AIDS in Akwa-Ibom State. To achieve this purpose three (3) research question were formulated for the study.

The questionnaire which was employed as instrument used to gather information for the study contains four 4 major sections: Demographic characteristic of respondents, Psychological, sociological and economical adaptations of people living with HIV/AID respectively.

5.2 Conclusion

On the basis of the finding in of the study, the following conclusions were drawn:

People living with HIV/AIDS have psychological adaptation in Akwa-Ibom State.
People living with HIV/AIDS have sociological adaptation in Akwa-Ibom State
People living with HIV/AIDS have economic adaptation in Akwa-Ibom State
Male and female living with HIV/AIDS differs in their psychological adaptation in Akwa-Ibom State.
Male and female living with HIV/AIDS differs in their sociological adaptation in Akwa-Ibom State.
Male and female livings with HIV/AIDS do not differ in their economical adaptation in Akwa-Ibom State.

5.3 Recommendations

On the basis of conclusion drawn, the following recommendations were made:

Concerning the psychological adaptation of people living with HIV/AIDS (PLWHA) in Akwa-Ibom State it was concluded PLWHA adapt to their psychological adaptation variables. Therefore, it was recommended that HIV/AIDS counseling should be sustaining to archive great impact on overcoming emotional distress, such as anger, anxiety and depression. And continuity in educating community members to stop stigmatization of HIV infected person be sustain.
Civil society organization should continue to put more effort in order to reach out to the door step of people living with HIV/AIDS (PLWHA) to organized them to form a support groups, so as to ensure their involvement in planning and development behavioural change activities relating to stigma and discrimination as well as in assisting them to get more packages that would improved their life‟s at the grass root level.
Government should continue to strength the policy environment that empowers people living with HIV/AIDS support groups in order to close the gap in treatment by ensuring all HIV/AIDS infected person enable everywhere access treatment services.
There were the need for more advocacies on the danger of drugs and alcohol especially during social event to HIV infected persons so that should practice safe sex if they cannot abstained as well as on how to promote gender equalities as a basis for human rights advancement.
Also mass media need to intensify effort to ensure the dissemination of the correct and appropriate information on dangers associated with defaulting or non adherence to treatment / antiretroviral therapy of persons infected with HIV/AIDS. This was in order to avoid transmission of resistance strength a major problem among males and females living with HIV/AIDS.
Government should empower people living with HIV/AIDS as poverty and wealth inequalities between men and women can fuel the transmission, as some infected men and women engaged in unsafe sex practices in exchange of money as a result of sugar daddy and sugar mommies syndrome which need to be stopped.

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