A study to assess the problems and coping strategies among people living with HIV/AIDS at ART centre, Capital Hospital, Bhubaneswar, Odisha

INTRODUCTION

It is the immune system that normally fights off these microorganisms and keeps the body healthy. But over the last fifteen years a new disease spread by a family of viruses called HIV which has spread globally. It has been given this name because of its long-term effect to attack the immune system of the human body, making it weak and deficient. The virus has weakened the immune system of the body so much that they develop a number of different illnesses such as tuberculosis, pneumonia, persistent diarrhea and fever and skin infections.¹ In 1981, the first case of new syndrome was recognized and reported by the Center for Disease Control (CDC), Atlanta, USA, a rare form of pneumonia caused by Pneumocystis Carinii and Kaposi’s sarcoma in an apparent by healthy person, who was a homosexual man and who died due to loss of immunity. AIDS is not a health problem, economic problem, cultural problem and also a political problem.² The first case of HIV in India was diagnosed among commercial sex workers in Chennai in 1986. HIV/AIDS progressively reduces the effectiveness of immune system and leave individuals susceptible to various opportunistic infections and tumors. HIV is transmitted through the direct contact of mucous membrane with a body fluid containing HIV such as blood, semen, vaginal fluid and breast milk. The mode of transmission is anal, vaginal and oral sex, blood transfusion, contaminated needles and exposure to any of the body fluids.³ Reduction of sexual transmission is achievable through sexual abstinence, monogamy, condoms, treatment of concurrent sexually transmitted infections (STI) and HIV counseling and testing.⁴

An objective of the study was to assess the problems among HIV/AIDS patients, to identify the coping strategies among HIV/AIDS patients, to determine the relationship between problems and coping strategies among people living with HIV/AIDS patients and to find out the association between problems and coping strategies among HIV/AIDS patients with selected demographic variables.

METHODS

The descriptive survey research design was selected for the present study. The study was conducted between March 2020 to September 2020 at ART Centre, Capital Hospital, Bhubaneswar, Odisha. People living with HIV/AIDS patients who were receiving anti-retroviral therapy were selected by using purposive sampling technique from ART centre, Capital Hospital, Bhubaneswar, Odisha. The sample size (N=100) was calculated by taking 15% proportion of 5% margin error and 95% confidence level.

Inclusion criteria

HIV/AIDS patients more than six months of duration attending ART clinics. Those who were give their consent to participate in the study.

Exclusion criteria

HIV/AIDS patients who were not present at the time of data collection.

Data collection tool

Section A

It includes demographic variables of HIV/AIDS such as age, gender, education, occupation, marital status, total family income.

Section B

Checklist for assessing the problems of HIV/AIDS patients like physical, psychological and financial problems.

Section C

Brief cope to assess the coping strategies of people living with HIV/AIDS. In this study “brief COPE” was used which was developed by Eisenberg et al, in 2012.¹² The brief COPE comprised of 28 items, which measures 14 conceptually differentiable coping reactions (avoidant coping and approach coping). They are active coping, planning, positive reframing, acceptance, humour, religion, using emotional support, using instrumental support, self-distraction, denial, venting, substance use, and behavioural disengagement and self-blame.

Data collection

Data was collected by the investigator after obtaining permission from the concerned authorities of selected hospital. The investigator explains about the objectives of the study. The method of data collection was interviewing technique.

Statistical analysis

After the data collection, responses were entered to the statistical package for Social Sciences (SPSS) software version 27.0.1. The level of significance were set at (p value <0.05). Through Pearson’s correlation the relationship was finding and the association between the selected demographic variables with problems and coping strategies was done by using chi square test.

Ethical clearance and informed consent

The study was carried out after getting the approval from Institutional Ethical Committee of Kalinga Institute of Medical Sciences (KIMS), KIIT deemed to be University, Bhubaneswar. The participants were informed about the purpose of the study and the consent was taken from the participants and the investigator did not face any kind of problem

RESULTS

Characteristics of HIV and AIDS patients

The Most of the HIV and AIDS patients 39 (39%) belongs to the age group 18-30 year, 60 (60%) were male, had higher secondary education, 33 (33%), 50 (50%) were self-employed, 72 (72%) were married and 49 (49%) were range 29,199 to 39,032 (Table 1).

Table 2 reveal the physical problems in terms of mean and SD (5.41±1.28) and 45.08 as a mean percentage, psychological problems in terms of mean and SD (4.20±1.17) and 52.50 as a mean percentage and financial problems in terms of mean and SD (2.97±0.95) and 37.12 as a mean percentage.

Mean and SD of the coping strategies of HIV and AIDS patients

It summaries of the 14 coping strategies studied, the mean and SD of the HIV/AIDS patients were self-distraction (5.41±1.50), followed by using positive reframing (5.26±1.42), active coping (5.16±1.35), substance use (4.98±1.70), venting (4.88±1.40), using emotional support (4.86±1.44), use of informational support (4.83±1.62), planning (4.77±1.50), acceptance (4.76±1.45), humor (4.43±1.57), denial (4.40±1.55), self-blame (4.35±1.44), behavioural disengagement (4.25±1.70) and religion (2.93±1.65) being used least frequently (Table 3).

Scoring key

In the physical problems total score was 12. Each yes responded were awarded with one score while no responded were given zero score. In the psychological problems and financial problems total score was 8. Each yes responded were awarded with one score while no responded were given zero score (Table 4).

Brief COPE

The brief COPE comprised of 28 items, which measures 14 conceptually differentiable coping reactions (avoidant coping and approach coping). They are active coping, planning, positive reframing, acceptance, humour, religion, using emotional support, using instrumental support, self-distraction, denial, venting, substance use, and behavioural disengagement and self-blame.

Level of problems of HIV and AIDS patients

In the level of physical problems of study population, 76 (76%) had moderate problems, 19 (19%) had severe problems, 5 (5%) had mild problems. In psychological problems 60 (60%) had moderate problems, 32 (32%) had severe problems, 4 (4%) had mild problems and 4 (4%) had very severe problems and financial problems 57 (57%) had moderate problems, 36 (36%) had mild problems, 7 (7%) had severe problems (Table 5).

Findings related to relationship between problems and coping strategies of HIV and AIDS patients

The relationship between physical problems and coping strategies among HIV/AIDS patients which was analysed by using Karl Pearson co-efficient correlation. The results reveals that “r” value =0.017, and p value =0.206 which indicates the there was no significant correlation between physical problems and coping strategies of HIV/AIDS patients. The psychological problems and coping strategies “r” value =0.011, and p value 0.916 which indicates the there was no statistical significant correlation between psychological problems and coping strategies of HIV/AIDS patients and financial problems and coping strategies “r” value =0.028, and p value 0.785 which indicates the there was no statistical significant correlation between financial problems and coping strategies of HIV/AIDS patients (Table 6).

Association between the selected demographic variables with problems and coping strategies

It reveals the association between the marital status and physical problems with χ² value =35.54 and p value = 0.008 which was highly significant, marital status and psychological problems with χ² value =28.47 and p value =0.019 which was highly significant, total family income and financial problems with χ² value =23.56 and p value =0.009 which was highly significant and marital status and financial problems with χ² value =61.16 and p value =0.329 which does not had statistical significant (Table 7).

DISCUSSION

Demographic variables relevant that most of the HIV and AIDS patients 39 (39%) belongs to the age group 18-30 year, 60 (60%) were male, had higher secondary education, 33 (33%), 50 (50%) were self-employed, 72 (72%) were married and 49 (49%) were range 29,199-39,032. The 76 (76%) HIV and AIDS patients were physical problems, 60 (60%) had moderate psychological problems and 57 (57%) had moderate financial problems and most coping strategies used by HIV and AIDS patients were self-distraction (5.41±1.50). There was no statistically significant correlation between problems and coping strategies of HIV/AIDS patients. The association between the marital status and physical problems χ² value =35.54 and p value = 0.008 which is highly significant, association between the marital status and psychological problems χ² value =28.47 and p value =0.0019 which was highly significant and association between the total family income and financial problems χ² value =23.56 and p value = 0.009 which was highly significant.

A study was conducted by Amin et al on 100 HIV/AIDS patients. The HIV/AIDS patients were having psychological problems, anxiety (14% patients had moderate level, 59% had severe problems), stress (2% patients had mild, 35% had moderate problems and 63% had severe problems) and depression (26% had moderate problems, 74% had severe problems). The marital status was negatively significant correlated with psychological problems (anxiety, stress and depression). The correlation of marital status with psychological problems anxiety, stress and depression was 0.578, -0.237 and -0.284.⁹

A study was conducted by Kaur et al on 150 HIV/AIDS patients at ART centre Jalandhar, Punjab. The coping strategies mean and SD (138.97, 21.04). The relationship between quality of life and coping strategies ‘r’ value =0.275 and p value =0.0001, which indicate weak positive correlation.¹⁰

A cross-sectional study was conducted by Kanthan et al at ART clinic LLRM Medial College, Meerut among 200 HIV/AIDS patients. The coping strategies were used by the HIV/AIDS patients’ self-distraction mean and SD (6.56±1.54).¹¹

CONCLUSION

In this present study the most of the HIV and AIDS patients were having the moderate problems of physical problems 76 (76%) and self-distraction (5.41±1.50) coping strategies were used.

ACKNOWLEDGEMENTS

The authors would like to thank all the HIV and AIDS patients who participated in this study and also would like to thank the staff of the Capital hospital Bhubaneswar for their co-operation.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee of Kalinga Institute of Medical Sciences

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