STRESS FACTORS AND COPING STRATEGIES OF WOMEN CAREGIVERS OF HIV POSITIVE CHILDREN IN MASSEY STREET CHILDREN’S HOSPITAL, LAGOS

Abstract

Globally Human Immunodeficiency Virus (HIV) infection constitutes a threat to human health. Caregivers, especially women face challenges in performing the multitude of tasks caring for HIV positive children. This burden may result in emotional, physical, psychological, social and financial stress. In Nigeria, the stress experienced by women caring for these children and associated factors has not been adequately studied. This study was designed to assess the stress experienced and coping strategies adopted by women caregivers of HIV positive children at Massey Street Children Hospital Lagos Island, Nigeria. A cross-sectional study was carried out. in-depth interviews using an in-depth interview guide were used to obtain information from seven consenting purposively selected women at two Anti retroviral Therapy (ART) clinics in Lagos. Information gathered was used to develop the study questionnaire. This questionnaire was subsequently used to interview 200 consenting purposively selected women caring for HIV-positive children in the Antiretroviral Therapy (ART) clinic. The questionnaire contained questions on socio-demographic characteristics and 22-item 5-point Likert-type scale ranging from 4 (very stressful) and 0 (Not applicable). Maximum total stress score for the scale was 88.0. Caregivers with stress scores ≥40 were categorized as very stressed, caregivers with stress scores 24 – 39 were moderately stressed and those with stress scores ≤ 23 were mildly stressed. Types of coping strategies utilized on the stress inducing factors were identified. The in-depth interview data were analyzed using a thematic approach while descriptive statistics and ANOVA were used for quantitative data. The In-depth interview revealed that caregivers experienced stress if they are widows, unemployed, lack strong social support network and were not informed on how to access treatment and formal support. Age of the respondents was 32.9±10.6 years, 78.5% were married. Fifty-three per cent had at least a secondary school education. Seventy-three per cent had high stress on discovery of the HIV-positive status of their children, 12.0% had moderate stress and 13.0% reported no stress at all. The women were of low socio-economic status, mostly traders (53.5%). Other high stress inducing factors included admission of child to hospital (38.0%) and waiting to know baby’s HIV status (50.5%). Married women had total stress score 31.2±10.3, widowed women 32.6±13.3, and single women 43.0±10.6. Women caregivers with stress scores ≥ 40(71.0%) were very stressed and ≤ 23(26.0%) were mildly stressed respectively. Acceptance of the child’s HIV diagnosis (80.0%) and other stress inducing factors was the main coping strategy. Specific coping strategies employed included non disclosure of child’s HIV status to friends (81.5%) and family (53.5%). Analysis of variance showed that marital status of women, educational level and occupation were significantly associated with mean stress scores. The caregivers of the HIV positive children were very stressed. Acceptance of the child’s HIV positive diagnosis was the main coping strategy. Caregivers utilized specific coping strategies which included non disclosure of child’s HIV status to family and friends. Linkages to support services offering specific physical, emotional, psychological, social and financial interventions that will help them cope better with the stress of their caregiving role are recommended.