STRESSORS, COPING MECHANISM AND SOCIAL SUPPORT AMONG HIV POSITIVE FEMALES ATTENDING ANTIRETROVIRAL TREATMENT CLINIC IN A TERTIARY INSTITUTION IN IBADAN.

Abstract

Human Immunodeficiency Virus (HIV) is one of the infections which induce a lot of stress. In Nigeria, stressors and coping mechanism among women living with HIV have not been fully investigated. The study therefore assessed the stressors, ways of coping, with HIV and sources of social support among the women attending the President's Emergency Programme For AIDS Relief, (PEPFAR) Anti Retroviral treatment clinic. The study was a cross-sectional survey involving 396 consenting HIV positive women who attended PEPFAR clinic, College of Medicine,. University of Ibadan, for their routine for their care and treatment July and August 2008.They were selected by multistage sampling technique. Focus Group Discussion (FGD) sessions and validated questionnaire were used for data collection. The questionnaire was the adaptation of the HIV stress scale developed by Packenham and Rinaldand and Ways of Coping Checklist as revised by Vitaliano. Descriptive and inferential statistics were used to analyze the data. The FGD data were analyzed using the thematic approach. The mean age of the respondents was 34.8±9.0 years. Majority (89.4%) had formal education. Seventy six percent were employed and 62.6% were married. Sixty six percent had disclosed their HIV status to their partners. Forty six percent respondents reported that their partners were very supportive while 17.4% stated that their partners were partially supportive. Only 19.5% reported that their partners were not supportive. The major sources of support mentioned included family (43.9%), partner (31.6%) and God (12.6%). Signs of stress reported included headache (63.9%), decreased sex drive (55.3%), worry (52.3%), muscle tension and pain (51.5%) and irrational fear (40.4%). The mean stress scores by marital status were: married (21.4±14.4), widowed (24.8±12.3), separated (27.4±13.6), divorced (32.3±11.0) and single (22.9±16.2) with no significant difference (p>O.05). The proportion of respondents who received pre-test counseling was 82.8% while 92.4% received the post-test counseling. Few (9.6%) respondents received only post test counseling while 7.6% received neither pre-test nor post-test counseling. Main stressors identified included difficulty in coming to terms with HIV status (83.8%), difficulty in telling others about their HIV status (76.8%) and financial difficulty (53.5%). The coping strategies employed included acceptance (88.4%), confrontation (88.4%). avoidance (79.0), crying (60.1%), wishful thinking (48.0%), anger (34.3%) and blaming self and others (14.4%). The FGD discussants disclosed that decisions related to infant feeding and reduction of mother to child transmission of HIV were found to be stressful. It was disclosed that though the anti-retroviral therapy was active, psychological burden of the condition persisted. The HIV positive women were affected by different stressors which are mainly psycho-social and economic in nature. Counseling, advocacy and increased support are needed to addressing the HIV-related stress burden.