Stigma Consciousness, Coping Strategies And Cd4 Counts Of Persons With Hiv/aids

CHAPTER THREE

METHOD

This study tested the predictions of hypotheses one, two, three, four and five. In order to test the predictions successfully, method was adopted in which the participants drawn from population of PLWHA, the instruments used in data collection were described; the procedure followed in data collection and design/method of data analysis were also explained.

Participants

Four hundred and thirty (148= men; 282=women) people living with HIV/AIDS recruited from population of people living with HIV/AIDS in Anambra state, south eastern Nigeria served as participants. Their age ranged between 17 and 70 years with the mean age of 35.73 years and standard deviation of 8.4 years. The participants were recruited from the population of PLWHA that enrolled for Antiretroviral Therapy (ART) in Anambra state and whose HIV/AIDS seropositive status and CD4 counts were known. And who have lived with HIV/AIDS for at least six months as at the time of this study. Regular monitoring of CD4 counts is an integral part of healthcare programme for people living with HIV/AIDS. Thus, CD4 count is tested every six months to monitor their immune system functioning.

Estimated population of 31,931 (thirty-one thousand, nine hundred and thirty-one) people enrolled for ART in nine ART sites in Anambra state as at the time of this study (ANSACA, 2009). This population represents enrolments from the following ART sites, General Hospital Onitsha = 3,988 (three thousand, nine hundred and eighty-eight); Holy Rosary Maternity Hospital Onitsha = 987 (nine hundred and eighty- seven); St. Charles Borromeo Hospital Onitsha = 5,971 (five thousand, nine hundred and seventy-one); General Hospital Awka = 2,922 (two thousand, nine hundred and twenty-two); Our Lady of Lourdes hospital Ihiala = 1,949 (one thousand, nine hundred and forty- nine), and Nnamdi Azikiwe University Teaching Hospital Nnewi = 14,816 (fourteen thousand, eight hundred and sixteen). Others are Rushgreen Hospital, Onitsha = 214 (two hundred and fourteen); St. Joseph Hospital Adazi = 709 (seven hundred and nine); and General Hospital Enugwu-Ukwu = 375 (three hundred and seventy-five). These figures vary due to deaths of patients and steady transfer rates to other ART sites

In order to have a representative sample, three ART sites were selected from the three senatorial zones of Anambra state, Anambra Central, Anambra North and Anambra South each with seven local government areas. The senetorial zones were adopted as strata for this study. From each stratum, one ART site was randomly selected. Samples were selected from the three ART sites as follows; General Hospital Awka = 101 from the central; St. Charles Borromeo Hospital Onitsha=156 from the north; and Nnamdi Azikiwe University Teaching Hospital Nnewi= 173 from the south. The choice of the three hospitals for selection of participants was because the researcher considered them, the best-equipped and oldest ART sites with the largest enrolments from their strata, and easily accessible for the nature of these data collection. Most important, ART sites are located in urban areas of Anambra state. Therefore, it was meaningless to consider rural areas in sampling process. Actual selection of participants was based on the population that visited the sampled ART sites in the months of August and September 2009 for ART, since they were always on two months routine appointment.

Pregnant women were eliminated from the study since they were casually considered to, either suffer from some pregnancy conditions that are capable of affecting their immune system or receive medical attention capable of boosting up their immunocompetence levels. In addition, children under 15 years were excluded since they have not had enough exposure to account for experiences of stigma consciousness or engage in information coping. Moreover, PLWHA who also suffer from diabetes, tuberculoses or asthma were excluded from the study since they were considered to have comorbidity that could cause preexisting immune system damage.

Instrument

Instruments used in this study were stigma consciousness questionnaire (SCQ) Pinel (1999), social support scale Turner, Frankel and Levin (1983), Ways of Coping Inventory Folkman and Lazarus (1980), Information Coping scale (Kalichman & others, 2006), and patients’ folders. Folder refers to file containing personal information of patient in and out of hospital. Pilot studies were conducted to validate and establish the reliability of the instruments.

Stigma consciousness questionnaire was developed for use with women and was later modified for use with gay men and lesbians (Pinel, 1999). The instrument has ten (10) items that actually measure stigma consciousness. (Example: see appendix A.) The instrument was validated using principal – axis factor analysis with Varimax rotation. Single factor (stigma consciousness) was established for the 10 items accounting for 96.5% of the common variance and 24% of the total variance. The factor pattern revealed that all the 10 items loaded .32 and above. The 10 item scale was examined for internal consistency using Cronbach alpha. The result revealed reliability of .74 (Pinel, 1999). Therefore, the validity was well established. However, to the researcher’s awareness, the instrument has not been used on people living with HIV/AIDS in Nigerian culture. So, there was the need to modify and establish the use of the scale in this study. The 10-item questionnaire was modified for use with people living with HIV/AIDS. Thus, in a pilot study, the researcher administered the modified instrument to 46 people living with HIV/AIDS. Data collected were subjected to factor analysis using principal component factor analysis with Varimax rotation. The factor pattern revealed eigenvalue of .2 loadings and above for all the 10 items. Also, reliability was established using both Cronbach alpha and split – half methods. The result revealed internal consistency of .77 Cronbach alpha and .73 Split-half (Spearman – Brown equal length). Therefore, the instrument was found reliable for use in this study, (See Appendix B).

The second instrument was social support scale named Provision of Social Relations (PSR). The scale was developed to measure social support (Turner, Frankel & Levin, 1983). The instrument has 15 items with two dimensions, family support and friend support. (Examples: whatever happens, I know my family will always be there for me should I need them. And, when I am with my friends, I feel completely able to relax and be myself.) The authors reported concurrent validity correlating significantly with the Kaplan scale of social support and internal consistency, with alpha that range from .75 to .87.