International Journal of Medicine and Biomedical Research

Volume 2 Issue 3 September – December 2013

www.ijmbr.com
© Michael Joanna Publications

Original Article

Quality of life of people living with HIV/AIDS in Cross

River, Nigeria
Samson-Akpan PE*, Ojong IN, Ella R, Edet OB

Department of Nursing Sciences, College of Medical Sciences, University of Calabar, Cross-

River, Nigeria.

*Corresponding author: [email protected]

Received: 10.04.13; Accepted: 29.10.13

ABSTRACT
Background: People living with HIV/AIDS (PLWHA) now enjoy appreciable
longevity and there is need to enhance their quality of life. Unfortunately,
limited studies in Nigeria have used the World Health Organization Quality Of
Life BREF (WHOQOL-BREF) to determine the quality of life of PLWHA. Aim:
This study was to assess the quality of life of PLWHA participating in five
support groups in Southern Cross River Senatorial District. Methods: The
study was a descriptive survey. It was delimited to PLWHA who belonged to
support groups and were available to complete the questionnaire. A total of
123 PLWHA were recruited into the study. WHOQOL BREF was used for
data collection. Results: The mean (SD) age of the PLWHA was 36.4 +/-
10.9. Most 83(67.5%) were females while 40 (32.5%) were males (Figure 1).
With regards to education, most of the respondents 60(48.8%) attended
secondary school, followed by 48(39%) who attended tertiary institutions
while only 15(12.2%) had primary education (Figure 2).The highest mean
(SD) quality of life score emanated from physical health, 14.04+2.66.The
mean (SD) scores in the three domains were similar among the PLWHA:
psychological health, 13.55+ 2.45; social relation, 13.60+3.01; environment,
13.25+2.58. Conclusion: The study suggests that the lower mean score for
environment may be an indication of poverty and poor living conditions while
higher mean score for physical health may suggest accessibility to anti
retroviral drugs. Therefore it was suggested that loan should made
accessible to PLWHA in Cross River State. This should empower them to
establish means of livelihood.

Key words: Quality of life, people living with HIV/AIDS, physical health,
psychological health, WHOQOL-BREF, Nigeria

[3]
INTRODUCTION a prevalence rate of over 15%. Nigeria
had 2.98 million infected people with adult
Joint United Nations Programme on prevalence rate of 3.6 and orphans were
[1,4]
HIV/AIDS (UNAIDS) estimated that at least 2,175,760 as at 2009. Although, there is
33.3 million people lived with HIV/AIDS in a slight decrease in adult prevalence rate
2009, with 1.8 million HIV/AIDS related from 4.4% in 2005 to 3.6% in 2009;
deaths, and 2.6 new infections.
[1,2] O‟ConnelSkevinton and Saxena posit that
Furthermore, many African countries have the rate of HIV/AIDS pandemic in

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 Samson-Akpan et al.: Quality of life of people living with HIV/AIDS

developing countries is scary or but worse QoL in the social relationship

[14]
frightening; with little access and domain.
inadequate highly active retro viral therapy
(HAART), an increased number of people Regarding the relationship between gender
living with HIV/AIDS (PLWHA) are left with and QoL, Fatiregun et al. also observed
no option than to suffer with the disease that women showed a higher QoL score
which impact negatively on their quality of compared to men in virtually all domains
[5]
life (QoL). and significantly higher level on the
[13]
independent domain. Nevertheless other
Actually, countries with high prevalence studies have reported lower QoL scores in
have overstretched health systems, lack psychological and environment domains
[12,15,16]
resources and have the lowest level of among women.
hospital bed and health worker per person
which overburdens the health care delivery Previously, some of the groups which had
[6,7]
system. Consequently, many strategies been highly vulnerable to HIV infection
are used to give medical support to were commercial sex workers (CSW),
PLWHA. These approaches include adolescents, youths, prisoners, and people
organizing them into groups to access with multiple sex partners, presently
support from government and non- literature suggest that this infection has
governmental organization on their health penetrated all levels or segments of
[8,9] [13,17]
care needs. The president had also Nigerian population. HIV/AIDS is a
directed Federal Ministry of Health (FMoH) chronic progressive disease which
and National Committee on AIDS(NACA) threatens the quality of life of the infected
[9]
to place 2500,000 PLWHA on anti- and the affected. Therefore, it is
[8]
retroviral therapy by 2006. With major important to determine the QoL of PLWHA
advances in medical treatments PLWHA in order to estimate the burden of disease
are living longer and their quality of life has since the prevalence of HIV infection is
become an important focus to researchers estimated to have accounted for about
[11] [13]
and health care providers. 20% of the disease burden. There are
many instruments developed and
[1,13,19]
Qol is defined as individual‟s perceptions described to measure the QoL. There
of their positions in the life context of the are also studies that have documented the
culture and value system where they live, validity of WHOQOL-HIV BREF instrument
[20]
and in relation to their goals, expectations, used among HIV patient. However, there
standards and concerns. It is a broad are limited studies in our environment
[12,13]
ranging concept, incorporating in a using WHOQOL-HIV bref instrument.
complex way a person‟s physical health, This study assessed the quality of life of
psychological health, level of PLWHA participating in support groups in
independence, social relationships, Southern Cross River Senatorial District.
personal beliefs and relationship to salient Cross River State has a prevalence of
[11,12]
features of the environment. 6.1% which is believed to be one of the
highest in the South-South Geopolitical
[21]
Fatiregun et al. using a descriptive cross Zone. This study will add to the existing
sectional study design with WHOQOL-HIV body of knowledge on the quality of life of
BREF instrument on 252 PLWHA in Kogi PLWHA. It will also help the government
State, Nigeria observed that the overall and other non- governmental organizations
mean scores in the three domains were to develop interventions that will help to
similar: psychological health 15.0+2.8; improve the quality of life of PLWHA if the
physical health 15.2+2.5; and mean scores for different aspect of the
spiritual/religion/personal beliefs QoL are low. It will also help PLWHA to be
[13]
15.7+2.5. The study also highlighted aware of their QoL and they may try to
lower mean scores in social relationship readjust if the mean scores are low in
[13]
13.2+2.5 and environment 13.1+1.9. comparison with other studies.
Similar results were also observed in Soa
Paulo, Brazil that the mean scores for METHODOLOGY
social relationships and environment
[12]
domains fell in the intermediate level. The study is a descriptive survey which
These results were also affirmed by Fleck took place in Southern Senatorial District
et al. that PLWHA had a better QoL related of Cross River State, Nigeria. Southern
to their physical and psychological health Senatorial District of Cross River State is

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 Samson-Akpan et al.: Quality of life of people living with HIV/AIDS

made up of seven Local Government measures personal relationships, social

[23]
Areas (LGAs). Three LGAs consisting of support, and sexual activity.
Akamkpa, Calabar Municipality and Environment domain measures financial
Calabar South LGAs were randomly resources, freedom, physical safety and
selected for the study. There are 20 security, health and social care:
HIV/AIDS support groups for PLWHA in accessibility and quality, home
[22]
the selected LGAs. environment, opportunity for acquiring new
information and skills, participation in and
The total numbers of clients in the opportunities for recreation/leisure
HIV/AIDS support groups were 218. There activities, physical environment
[23]
were five support groups covered by the (pollution/noise/traffic/climate), transport.
NGO which were purposefully selected for
the study because of the regularity and Statistical analysis
consistency of holding meetings with Data were analyzed using SPSS version
PLWHAs. The participants were 15. Data were analysed using descriptive
purposefully selected on the basis of and inferential statistics. The WHOQOL
regular participation at group meetings. BREF was rated on Likert scale of 1-5.
The total number of PLWHAs in these Five denoted the highest score. Negative
groups was 123, this constituted 56% of worded items were corrected and scored
the target population. The distribution of positively. Mean and standard deviation
the participants was as follows: Akamkpa used highlighted the summary of scores on
LGA had three communities (Uyanga =22 the quality of life. All scores were multiplied
PLWHA; Mbarakom=21 PLWHA; Akamkpa by 4 in order to be directly comparable with
urban =15 PLWHA). Calabar municipality the scores obtained from the WHOQOL
had 25 PLWHA while Calabar South LGA BREF-100. In order to determine the
had 40 PLWHA from their support groups. difference between male and female
(dichotomous variables) quality of life in
WHOQOL-HIV BREF (1997) US version relation to the different domain,
was used for data collection. WHOQOL- independent t test was used. The level of
HIV BREF consists of 31 items, with each significance was at p<0.05
[23]
item using a 5-point Likert Scale. These
items are distributed in four domains as RESULTS
follows: physical health domain measures
activities of daily living, dependent on The mean (SD) age of the PLWHA was
medicinal substance and medical aid, 36.4 +/- 10.9. Most 83 (67.5%) were
energy and fatigue, mobility, pain and females while 40 (32.5%) were males. With
discomfort, sleep and rest, work regards to education, most of the
[23]
capacity. Psychological health domain respondents 60 (48.8%) attended
measures body image and appearance, secondary school, followed by 48 (39%)
negative feelings positive feelings self who attended tertiary institutions while only
esteem, spirituality/religion/personal 15 (12.2%) had primary education
[23]
beliefs. Social relationship domain

Table 1: Socio-demographic pattern of the respondents (n = 123)

Variables Categories N %
Gender (n Male 40 32.5
123) Female 83 67.0

Educational
status Non formal
Primary 6 4.9
Secondary 9 7.3
Tertiary 60 48.8
48 39.0

Marital Single 48 39.0

status Married 53 43.1
Separated 11 8.9
Divorced 5 4.1
Widowed 6 4.9

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 Samson-Akpan et al.: Quality of life of people living with HIV/AIDS

Table 2: Quality of life score from WHOQOL-HIV bref by domain

S/n Domain Mean (SD) Minimum- Maximum

1 Physical health 14.04(2.66) 4.00-20.00
2 13.55(2.45) 4.00-20.00
3 Psychological health 13.60(3.01) 4.00-20.00
4 Social relations 13.25(2.58) 4.00-20.00

Environment

The highest mean (SD) quality of life score PLWHA: psychological health, 13.55+
emanated from physical health, 2.45; social relation, 13.60+3.01;
14.04+2.66. The mean (SD) scores in the environment, 13.25+2.58 (Figure 1).
three domains were similar among the

Table 3: Relationship between gender and quality of life scores of PLWHA

Domain Male Female T-

Mean (SD) Mean (SD) Value
Physical 14.3 (2.6) 13.9 (2.6) .72

Psychological 13.3 ( 2.5) 13.6 (2.4) -.57

Social relation 13.8 (2.7) 13.5 (3.1) .49

Environment 13.7 (2.8) 13.0(2.4) 1.30

P<0.05;df 121; crit. t 1.97

The result of gender status in Table 3 that the overall mean scores in the two
showed no significant difference in all the domains (physical and psychological
[13]
domains of QoL. The calculated t-value in health domains) were similar. It was also
all the domains of QoL were less than the noted that the scores in Fatiregun et al.
critical t-value of 1.97 at 0.05 level of study were higher than what were obtained
[13]
significance with 121 degree of freedom. in this study. Regarding physical health
Further results also showed that majority of having the highest score this may be
the respondents rated their QoL scores as attributed to the availability of anti retro-
good 57 (46.3%), very good 21 (17.1%) viral therapy which is highly subsidized by
[8]
while 21 (17.1%) said their QoL scores the government.
were neither poor nor good. Regarding
being satisfied with health, majority of the It was also observed that environment had
respondents 59 (48%) said they were the lowest mean score followed by
„satisfied‟ with their health; 13 (10.6%) psychological health. These results are
[13]
were „very satisfied‟ with their health while also in consonance with Fatiregun et al.
27 (22%) were neither „satisfied nor study which also highlighted lower mean
dissatisfied‟. scores in environment. Similar results were
also observed in Soa Paulo, Brazil that the
DISCUSSION mean scores for social relationships and
environment domains fell in the
[12]
In this study, the overall QoL mean scores intermediate level. Environment domain
in the three domains (psychological health, measures financial resources, freedom,
social relation and environment) were physical safety and security, health and
similar and they fell within the intermediate social care: accessibility and quality, home
level. It was also noted that physical health environment, opportunity for acquiring new
had the highest score. These results are information and skills, participation in and
affirmed by Fatiregun et al. which observed opportunities for recreation/leisure

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 Samson-Akpan et al.: Quality of life of people living with HIV/AIDS

activities, physical environment suggested that a revolving loan should

(pollution/noise/traffic/climate), made accessible to PLWHA through the
[22,23]
transport. The results indicating low support groups which can also double as
scores for environment in this study may Cooperative Society for PLWHA. This is
imply lack of money and poor living hoped would empower them to establish
conditions since most the respondents means of livelihood. Secondly,
were of secondary school level whose Government should continue to make
earnings may not be adequate for personal antiretroviral drugs accessible to PLWHA
and social needs. at a subsidized price to enhance higher
quality of life. There is still need to carry
The results for social relations and out a large scale study in the whole state
psychological health domains may also to ascertain the quality of life of PLWHA.
indicate stigmatization and discrimination
faced by the PLWHA. In addition, personal Previous Publication: This study has been
relationships, sexual activities and social published in part as an abstract in the
support of PLWHA can have negative proceedings of the 6th International AIDS
effect in the social relation domain if the Society (IAS) Conference on HIV Pathogenesis,
Treatment and Prevention, that held on 17th-
individual experiences difficulty in these 20th July 2011, in Rome, Italy.
[13]
situations.
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