ECONOMIC PROBLEMS OF YOUTH WITH HIV/AIDS IN IBADAN, NIGERIA

---

AO. Sangowawa¹ and E.T. Owoaje²

1. Institute of Child Health, University of Ibadan/ University College Hospital, Ibadan.
2. Department of Community Medicine, University of Ibadan/University College Hospital, Ibadan Nigeria.

Abstract

Background: HIV/AIDS has emerged as one of the major global public health problems and it also has substantial economic impact on individuals and their families.

Objectives: This paper describes the economic problems of youth with HIV in Ibadan, Nigeria.

Methods: A cross-sectional survey of PLWHA attending two HIV/AIDS support groups in Ibadan and the University College Hospital (UCH) antiretroviral (ARV) clinic was carried out. Information was obtained on socio-demographic characteristics and economic problems.

Results: One hundred and seventy youth aged 18-35 years were interviewed; 140 (82.4%) were female. One hundred and eight (63.5%) respondents were currently employed, 57 (52.8%) of whom were traders. Reasons for unemployment were that respondent’s business capital had been used up to pay for healthcare (38.3%) and ill health (23.4%); while 38.3% were currently schooling. Common economic problems experienced by the respondents were significant increase in healthcare expenses (38.8%) and loss of employment (22.0%). Coping strategies employed to mitigate these problems included depletion of savings 61.1%, borrowing (18.8%) and sale of property (9.4%). Loss of employment was significantly higher among respondents who were symptomatic prior to diagnosis and among those who had a health complaint at the time of the study. Female respondents were also more likely to have lost their jobs compared to male.

Conclusion: The study highlights the economic impact HIV as a chronic disease has on those infected. Care and support programs thus need to have a strong economic component in order to adequately meet the needs of PLWHA.

Keywords: Economic problems, HIV/AIDS, Youth

Introduction

HIV has remained a global public health problem. At the end of 2010, more than 40 million people were said to be living with HIV/AIDS globally, with most of them living in developing countries.¹ The 2008 National HIV Sentinel Survey in Nigeria showed that the national HIV prevalence for women attending antenatal clinics was 4.6% and the highest prevalence was recorded among youths aged 25-29 years.² The disease affects those in the most productive age group and once the diagnosis is made, they require antiretroviral therapy, treatment of other infections and nursing care. People Living with HIV/AIDS (PLWHA) often experience significant changes in all aspects of their lives. The health problems of HIV infection thus become financial problems first for the individual with HIV, then for his/her family and eventually for the larger society. Economic problems faced by PLWHA include loss of income as a result of job loss or inability to work because of the illness, and increased medical expenses from payments for drugs and other remedies.^3-7 Studies have further reported that PLWHA employ various strategies to cope with the economic problems associated with the disease.^{3, 8-11}

Some coping strategies employed by individuals and households with HIV include utilization of savings, reduction in consumption expenditure, sale of assets, borrowing, obtaining help from parents, extended family and other community actors and withdrawal of children from school.^{3, 8 – 11} Although some PLWHA are able to cope with their economic challenges, it has been reported that many more struggle rather than cope with the disease.¹² This has immense implications on their lives after diagnosis.

Many of the studies conducted among PLWHA focus on problems and challenges experienced by PLWHA in general although National data shows that the prevalence of HIV is higher among Nigerian youths. This paper thus reports the economic problems faced by youths with HIV as well as the coping strategies they adopt to mitigate the impact of the disease. The findings presented here are part of a larger study on the social and economic problems of adult PLWHA receiving care and support in Ibadan.

MATERIALS AND METHODS
This cross-sectional study was carried out in Ibadan, the capital of Oyo state between 2004 and 2005. The minimum sample size for the main study was calculated using the sample size formula for cross-sectional studies ([Z2pq]/d2)¹³. A standard normal deviate (Z) of 1.96 and degree of accuracy (d) of 0.05 were used. Unemployment rate was utilized as an indicator of socio-economic problems of PLWHA and a prevalence of 29% was used based on findings from a study of PLWHA in India¹⁴. This gave a minimum sample size of 161. This value was then multiplied by 2 to adjust for the design effect of using a cluster sampling technique¹⁵. About 372 respondents were approached, 322 of whom eventually consented to participate in the study (response rate 86.65). Data on the 170 respondents aged 18–35 years were then extracted from the main dataset and analyzed.

A cluster sampling technique was used to select respondents from the HIV/AIDS support groups. Two of the three registered HIV/AIDS support groups for adults with HIV in Ibadan at the time of the study were chosen by simple random sampling and all consenting members present at the time of data collection were selected. In addition, all consenting people with HIV referred to the Anti-Retroviral Treatment Clinic of the University College Hospital (UCH) Ibadan via the UCH General Out-patients clinic Ibadan, Oyo State, Nigeria were also included in the study. The working definition of youth used in this paper is as given by the National Youth Policy and strategic Plan of Action of the Federal Republic of Nigeria which defines youth as, ‘all males and females aged 18 to 35, who are citizens of the Federal Republic of Nigeria’ ^16.

A semi-structured inter viewer-administered questionnaire was used to obtain information on socio-demographic characteristics, medical and economic problems and strategies adopted by respondents to cope with the economic problems they faced (if any). Ethical Approval was obtained from the University of Ibadan/University College Hospital Ethical Review Board. The purpose of the study was explained to the respondents and, informed consent obtained from them. Trained research assistants then administered the questionnaire to respondents. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 16. Frequencies and proportions were generated and chi-square test used to determine associations between categorical variables (socio-demographic characteristics and loss of employment).