1.1 Background to the study
Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) is a pandemic disease in which the body’s defense mechanism is weak and this makes the body unable to get rid of infection (NACA, 2001). HIV/AIDS is an incurable diseases that makes the casualty susceptible (Rajeev, 2012), and is associated with significant morbidity and mortality despite the availability of treatment and care. (Smeltzer, Bare, Hinkle & Cheever, 2010).
As at the end of 2015 – 36.7 million people probably were living with the virus, 2.1 million people were nearly infected; 1.1 million people died from the disease; and 18.2 million people were accessing ART as June 2016. Since the beginning of the epidemic, over 78 million people have become infected; and 3.5 million have died from AIDS related diseases thus challenging improvements to world health today (UNAIDS, 2016). In sub Saharan Africa about 21 million people are living with HIV/AIDS and 32% of this population are presently on ART as at 2012 (UNAIDS, 2013). Also, in Nigeria, estimated 3.1 % adults within the ages of 15 – 49 are living with HIV/AIDS which is equal to about 3.5 million people from about 141 million of the total population (UNAIDS, 2016).
Nigeria is Africa most populous country with 140,4311,790 population figure as at the last census, and is also rated as tenth largest country in the world with the approximate estimation of 55% literate and 70% poor in the population (UNAIDS, WHO & Nigerian Population Comission 2009). Also, in Nigeria, estimated 3.1 % adults within the ages of 15 – 49 are living with HIV/AIDS which is equal to about 2.6 million people from about 141 million of the total population (UNAIDS, 2008). Another report from NACA (2009) statistics shows average 4.6% prevalence HIV rate among Nigerians (NACA, 2009). HIV/AIDS in Nigeria remains a vital public/ community health issue since Nigeria is a base or environment with many people living with HIV with South Africa prevalence 19.2% as at the end of 2015 (UNAIDS, 2016). The widespread of this disease has negative effect on the psychosocial, cultural, and developmental aspects of life, which makes the diseases a critical public health issue (UNAIDS, 2008).
One of the variables to be measured in this study is social support which has been associated to better Quality of Life among PLWHA in different studies (Khumaseen, Aoup-por & Thammachak, 2012). Social support is defined as “the view or experience that one is loved and cared for by others, esteemed and valued, and part of a social network of mutual assistance and obligations” (Taylor, 2007, p. 145). Social support assistance, user fees friendly, good patient – health workers relationship can help to curb non-adherence. An in-depth knowledge of the multifaceted interrelationship of the biological sociological factors is required to understand non-adherence, and Quality of life thus creating avenue for more effective non-adherence intervention programs (Olowookere, et al, 2012). Also, Adedimeji & Odutolu (2007) in a quantitative research to determine the extent to which certain factors contribute to improvement in QoL of PLWHA reported that availability of care and social support from spouse friends and family members yielded good QoL with 93%. Social support services is limited and lacking in this country and this makes evaluation of the wellbeing and longetivity of PLWHA important as to how individual perceive their own health using different instrument such as WHOQOL HIV BREF version instrument. (Folasire, Irabor & Folasire 2013).
The incurable and pandemic nature of HIV/AIDS calls for mobilization of resources such as human, money & material resources to improve quality of life among PLWHA. HIVAIDS is a serious humanitarian problem that could affect the physical, psychological, social status of PLWHA. The Quality of Life (QoL) of HIV/AIDS patient is crucial as well as the disease progression because of their need for adaption to changes in their lives which include financial & societal changes. Therefore, consideration for improving their quality of life is paramount (Fan, Kuo, Kao, Morisky & Chen 2011). According to World Health Organization (2005) quality of life is described as individual’s perceptions of their position in the life in the context of culture and value systems in which they live and in relation to their goals, standards, expectations, and concerns.
The indicator of physical, mental, social, and spiritual, wellbeing is Health Related Quality of life and this could serve as means of measuring the total wellbeing of PLWHA which include their functions and perceptions based on life experiences (Malucclo, Palemo, Kadliyala, & Rawat, 2015). However, the HRQOL is regarded as non-medical aspect of living example psychosocial, socio economic aspect etc (Trana, Ohinmaaa, Nguyen, Nguyen & Nguyen, 2011). Advances in the management of HIV/AIDS makes it a chronic condition thereby causing reduction in morbidity and mortality thus improves QoL (Millard, Elliott, Slavin, McDonald, Rowell, & Girdler 2014). As HIV treatment and care worldwide is moving from emergency to longer term strategies management, there are structural and contextual factors that influence the outcome of this intervention. The factors include individual, facility based, environmental/cultural etc (Aidala, Wilson, Shubert, Gogolishvili, Globerman, Rueda, et al, 2016).
The changes that result from HIV care and Management conote that individual with the diseases should take responsibility for themselves since it is now a chronic condition. Thus this will help to prevent disability and improve QoL (Millard et al, 2014). In the care and management of HIV/AIDS wholistic approach is needed to promptly address issues since it remains a chronic diseases. The stress and fear that accompany the diseases has been reduced since it has been addressed in relation to other aspects of life. Focus should now be shifted or adjusted to how individual adjusts to symptoms (Buseh, Kelber, Stevens, & Park, 2008), and Health related QOL which is a determinant of overall personal health (Krause, Butler, & May, 2013).
According to United States Department of Health and Human Services (HHS) (2011), The two overarching goals of Healthy people 2020 include (1.) Improving the overall quality of life (2.) Improving the health of all groups. The QoL of PLWHA can be traced to the increase in life span of infected individuals due to availability and access to ART. Socio economic conditions of individuals with HI/AIDS can alter QoL thereby affecting health-seeking behaviours (Mawar, Katendra, Bagul,.Bembalker, Vedamurthachar, Tripathy, et al., 2015). Another variable of interest in this study is demographic factors which have been proven to improve quality of life and are seen as determinant of quality of life. Socio demographic charasteristics like income level, Marital status, educational level, occupation when investigated among PLWHA in China was found to influence quality of life which means people with higher income and are married tend to show positive quality of life.( Rajeev etal.., 2012). The explanation for this could be as a result of the knowledge gained from the exposure in the workplace which could impact quality of life. Also employment among other demographic factors like gender, higher income, and gender are associated with improved quality of life as seen among PLWHA in India (Basavaraj etal.., 2010). The reason for the employment may be a source of income, care and social support to the individual that are affected which means having a good job may directly or indirectly improve QoL.