Environmental Characteristics of HIV/AIDS Affected Households in a Nigerian Rural Community.

A study of environmental attributes of HIV/AIDS affected households in Ijesa region, Nigeria (N = 297). Data from both primary and secondary sources were used to establish the relationship between socio-economic and environmental characteristics at different rural community zones; namely traditional core, post traditional and contemporary. There were more female HIV/AIDS patients, located in traditional core zones (78.1%) with high house density, living in shared apartments where residents shared sleeping and bath/toilet rooms. Thus, rape was significantly associated with the design and habitation density of households. In addition, widowhood, young age, informal education, menial jobs and unemployment of patients did not correlate with most environmental variables related to HIV/AIDS in contemporary zone compared with traditional zone. However, wealth status and quality education in relation to good housing environment and decent house density were significant in contemporary zone respectively. The study concluded that policies on HIV/AIDS prevalence at rural community level should focus more on high density areas having poor socio-economic and environmental characteristics.

Pattern of Utilisation of Dental Health Care Among HIV-positive Adult Nigerians.

PURPOSE: To determine the pattern of dental care utilisation of people living with HIV (PLHIV). MATERIALS AND METHODS: A cross-sectional questionnaire survey of 239 PLHIV patients in three care centres was done. Information on sociodemographics, dental visit, risk groups, living arrangement, medical insurance and need of dental care was recorded. The EC Clearinghouse and WHO clinical staging was used to determine the stage of HIV/AIDS infection following routine oral examinations under natural daylight. Multivariate logistic regression models were created after adjusting for all the covariates that were statistically significant at univariate/bivariate levels. RESULTS: The majority of subjects were younger than 50 years, about 93% had not seen a dentist before being diagnosed HIV positive and 92% reported no dental visit after contracting HIV. Among nonusers of dental care, 14.3% reported that they wanted care but were afraid to seek it. Other reasons included poor awareness, lack of money and stigmatisation. Multivariate analysis showed that lack of dental care was associated with employment status, living arrangements, educational status, income per annum and presenting with oral symptoms. The area under the receiver operating curve was 84% for multivariate logistic regression model 1, 70% for model 2, 67% for model 3 and 71% for model 4, which means that the predictive power of the models were good. CONCLUSION: Contrary to our expectations, dental utilisation among PLHIV was generally poor among this group of patients. There is serious and immediate need to improve the awareness of PLHIVs in African settings and barriers to dental care utilisation should also be removed or reduced.

The effect of psychological distress on medication adherence in persons with HIV infection in Nigeria.

BACKGROUND: A high level of adherence to prescribed antiretroviral (ARV) regimens is required to achieve and maintain suppression of human immunodeficiency virus (HIV) replication and prevent drug resistance. OBJECTIVE: This study aimed to determine the possible relationship between psychopathology and ARV medication adherence in Nigeria. METHOD: Persons with HIV infection (N=182) completed various questionnaires on sociodemographic and clinical details, general psychopathology, self-esteem, and medication adherence. RESULTS: Low medication adherence was reported in 26.9% of the participants; significant correlates included presence of psychopathology and perceived poor social support. CONCLUSION: The success of any intervention policy for HIV-infected persons in sub-Saharan Africa must consider both low level of medication adherence and its associated factors.

Social, psychological and health concerns among people living with HIV/AIDS in Nigeria.

PURPOSE: The aim of the present study was to identify the concerns and the influence of demographic factors on the social, psychological and health concerns of people living with HIV/AIDS (PLWHA) in a Nigerian population. MATERIALS AND METHODS: A questionnaire survey was conducted among 141 consenting PLWHA in the Ife-Ijesa zone, Osun State, Nigeria. A 22-item questionnaire elicited information on PLWHA's concerns about social, psychological and health issues. RESULTS: The main social concern was that of 'Feeling very lonely', whereas the major psychological concern was that of 'Lack of interest in things'. The most common health concern reported was 'Gradually getting thinner', whereas 'No cure for AIDS' was the least. 'Getting tired easily' was also a highly rated concern. Males had statistically significant fewer social concerns than females. Unemployed PLWHA had fewer social, health and psychological concerns when compared with the employed. There was a statistically significant relationship between age and health concerns (P < 0.05). CONCLUSIONS: PLWHA in the present study reported that they were concerned about social, psychological and health issues, despite the fact that they were attending support group meetings. Efforts on care should not only focus on health and medical issues but also on social and psychological issues.

Post-traumatic stress disorder (PTSD) after stigma related events in HIV infected individuals in Nigeria.

BACKGROUND: One of the most distressing concerns of many people living with HIV in sub-Saharan Africa is the stigma. Intense stigma may be traumatic. This study aimed to investigate the probability and correlates of Posttraumatic stress disorder (PTSD) following intense stigmatizing events and situations in HIV infected individuals in Nigeria. METHODS: Adult sero-positive attendees of an HIV care centre (N = 190) completed questionnaires regarding sociodemographic and clinical details; the 12-item General Health Questionnaire (GHQ-12) and the Rosenberg's Self-Esteem Scale. The clients were then interviewed for the presence of stigma related PTSD with a modified version of the mini international neuropsychiatry interview (MINI). RESULTS: About 2/3 of the participants had experienced at least an intense HIV-related stigmatizing event or situation. The rate of HIV-stigma related PTSD was 27.4%. Independent predictors of HIV stigma-related PTSD included past history of traumatic events (Single event, OR 2.28, 95% CI 1.08-4.73; Multiple events, OR 9.47, 95% CI 2.97-32.20), low self esteem (OR 6.52, 95% CI 2.59-16.55), poor level of social support (OR 3.33, 95% CI 1.24-9.79) and presence of general psychopathology (OR 2.18, 95% CI 1.07-4.44). CONCLUSION: PTSD may not be specific to traumatic events alone. There is a possibility of PTSD after an intense stigmatizing event or situation. While the validity for the validity of HIV-stigma related PTSD warrants further investigation, stigma needs to be considered when planning rehabilitation strategies for HIV infected individuals in sub-Saharan Africa. A closer attention to self esteem, level of social support and presence of psychopathology is needed in these individuals.

The economic burden of HIV and AIDS on households in Nigeria.

The study estimates the economic burden of HIV and AIDS on households in a Nigerian population. The data derive from a cross-sectional survey of households affected by HIV or AIDS in Ife-Ijesa Zone, Osun State, Nigeria. The sample consisted of 117 purposively selected, consenting adult HIV patients attending a general and teaching hospital. Participants were asked to self-report monetary expenses for HIV-related care, loss of savings, and funeral costs. The data show a significantly sharp drop in the participants' household income as a result of care for HIV-related illnesses, from the time of knowing one's HIV status to the time of illness, among three occupational categories (artisans, civil servants and unemployed; p = 0.02). Mean income among those in the unemployed category fell by 84.1%, income among artisans dropped by 72.6%, and income among civil servants decreased by 44.4%. The monetary loss during the course of HIV-related illnesses was heaviest for the artisan group, followed by the unemployed and the civil servants. Those who had lost a substantial part of their savings to HIV-related care were most numerous among the unemployed, followed by artisans and civil servants. Out of 16 households, 11 (42.3%) had received support from relatives during a funeral ceremony. There was a significant association between the occupational group and working for more hours after illness (χ(2) = 9.28, df = 4; p = 0.05). Nearly all orphaned children were distributed to the extended family following the AIDS death of a parent. Among all the occupational groups, borrowing from a cooperative society during the course of HIV-related sickness was the commonest form. The findings add to data showing that despite the extended family support system, adult deaths due to AIDS continue to undermine the viability of sub-Saharan African households.

Relationship between depression and quality of life in persons with HIV infection in Nigeria.

OBJECTIVE: Despite the fact that two-thirds of all the people with HIV live in sub-Saharan Africa, little is known about the emotional state and quality of life (QOL) of subjects with HIV in this region. The objective of this study was to evaluate the association between clinical depression and quality of life in a group of HIV sero-positive subjects in Nigeria. METHODS: Subjects with HIV infection (n = 87) completed a questionnaire detailing sociodemographic and HIV related variables. The subjects were assessed for the diagnosis of depression using the Mini International Neuropsychiatric Interview (MINI) and their subjective health related quality of life (QOL) was assessed using the short version of the WHO quality of life scale (WHOQOL-BREF). RESULTS: There were 25 (28.7%) subjects with diagnosis of depression. Lower educational level correlated with poorer QOL in all the domains of WHOQOL-BREF except the "social relationship" domain. Also, poor social support correlated with poorer QOL scores on domains of "physical health" and "social relationship" and presence of medical problems was significantly associated with poorer scores on domains of "physical health" and "psychological health." Diagnosis of depression was significantly correlated with poorer QOL in all domains except the "social relationship" domain. CONCLUSION: Poorer health related QOL in Nigerian subjects with HIV was associated with depression, lower educational and socioeconomic levels, and poor social support. Early identification and referral of patients with depression needs to be incorporated into intervention programs designed for HIV infected individuals in this region.